Effect of ferroptosis mediated by glutathione peroxidase 4 in the occurrence and progression of synovitis in knee osteoarthritis / 中国组织工程研究

BACKGROUND:Synovitis plays a leading role in the early progression of knee osteoarthritis and is a potential early therapeutic target.However,the mechanism of synovitis remains unclear.In animal models,increased systemic iron and intracellular iron uptake can induce and exacerbate osteoarthritis,but the association with ferroptosis in synovitis remains unclear.Further studies are needed to investigate the role of ferroptosis in the development and progression of synovitis in osteoarthritis. OBJECTIVE:To investigate the role of ferroptosis mediated by glutathione peroxidase 4(GPX4)in the development of synovitis in knee osteoarthritis. METHODS:The synovial tissues of 43 patients with osteoarthritis who underwent arthroscopic or joint replacement surgery and 10 patients undergoing arthroscopic treatment of meniscal injury or ligament tear were collected and divided into three groups according to the Kellgren-Lawrence grading of X-ray images:normal control group(KLG 0,n=10),early knee osteoarthritis group(KLG 1,2,n=20)and late knee osteoarthritis group(KLG 3,4,n=23).Hematoxylin-eosin staining was used to observe the severity of synovitis in each group,and iron deposition in the synovium in each group was evaluated by Prussian blue staining.The expressions of Acyl-CoA Synthetase Long Chain Family Member 4(ACSL4),GPX4,cyclooxygenase 2 and tumor necrosis factor α in the synovium were detected by immunohistochemical staining.Western blot and immunofluorescence were used to detect the expression of ferroptosis-related proteins ACSL4 and GPX4. RESULTS AND CONCLUSION:Compared with the normal control group,iron content in synovial tissue was increased in the knee osteoarthritis groups,and iron deposition in the late knee osteoarthritis group was higher than that in the early osteoarthritis group.ACSL4 was highly expressed in the synovial tissue of knee osteoarthritis compared with the normal control group(P＜0.01),and GPX4 was lowly expressed in the synovial tissue of knee osteoarthritis(P＜0.01).The expression level of ACSL4 increased with the progression of osteoarthritis,while the expression level of GPX4 decreased with the progression of osteoarthritis.The expression of cyclooxygenase 2 in the synovium of osteoarthritis was significantly higher than that in the normal synovium,and the expression was the highest in the early stage of osteoarthritis,which was significantly different from that in the advanced stage of osteoarthritis(P＜0.01).The expression of tumor necrosis factor α in the synovium of osteoarthritis was significantly higher than that in the normal synovium,but there was no significant difference between early and late osteoarthritis groups(P＞0.05).To conclude,the deposition of iron exists in the synovial tissue of osteoarthritis and ferroptosis is involved in the occurrence and progression of synovitis in knee osteoarthritis.

The impact of multiple sclerosis on the size and morphology of corpus callosum: an MRI-based retrospective study / Impacto de la esclerosis múltiple en el tamaño y la morfología del cuerpo calloso: un estudio retrospectivo basado en resonancia magnética

SUMMARY: The corpus callosum (CC) includes the majority of fibers linking the two brain hemispheres. Several cross sectional studies showed an association between callosal atrophy and malfunction and neurodegenerative diseases, which may play a role in their pathological manifestations. As a result, the accurate quantification of the corpus callosum is important to have normative values according to sex, age and ethnicity. The purpose of this study is to determine the size of CC in patients suffering from multiple sclerosis, and compare it to CC size in healthyindividuals. Midsagittal size of CC were recorded prospectively from 404 routine MR brain examinations in normal individuals. The internal skull surface was measured to calculate CC/ internal skull surface ratio. Two groups of patients were studied: 200 (100 male /100 female) healthy individuals and 204 (101 males/103 females) with multiple sclerosis (MS). Mean surface area of CC in controls was 6.58±1.04 cm2 and there was no significant difference between males and females (P< 0.627). CC/ internal skull surface ratio was 4.44±0.77 %. MS patients showed a significant decrease in CC size compared to normal controls. Using MR imaging, we measured the mean sizes of the various portions of the CC in normal individuals, in addition to MS patients; these values may provide a useful basis to determine changes occurring in CC structures.

El cuerpo calloso (CC) incluye la mayoría de las fibras que unen los dos hemisferios cerebrales. Varios estudios transversales mostraron una asociación entre la atrofia y el mal funcionamiento calloso y las enfermedades neurodegenerativas, lo que puede desempeñar un papel en sus manifestaciones patológicas. En consecuencia, la cuantificación precisa del cuerpo calloso es importante para tener valores normativos según sexo, edad y etnia. El propósito de este estudio fue determinar el tamaño de CC en pacientes que padecen esclerosis múltiple y compararlo con el tamaño de CC en individuos sanos. El tamaño sagital medio del CC se registró prospectivamente a partir de 404 exámenes cerebrales de RM de rutina en individuos normales. Se midió la superficie interna del cráneo para calcular la relación CC/superficie interna del cráneo. Se estudiaron dos grupos de pacientes: 200 (100 hombres/100 mujeres) sanos y 204 (101 hombres/103 mujeres) con esclerosis múltiple (EM). El área superficial media de CC en los controles fue de 6,58±1,04 cm2 y no hubo diferencia significativa entre hombres y mujeres (P< 0,627). La relación CC/superficie interna del cráneo fue de 4,44±0,77 %. Los pacientes con EM mostraron una disminución significativa en el tamaño de CC en comparación con los controles normales. Usando imágenes de RM, medimos los tamaños medios de las diversas porciones del CC en individuos normales, además de pacientes con EM; estos valores pueden proporcionar una base útil para determinar los cambios que ocurren en las estructuras CC.

Multiresolution discrete optimization registration method of ultrasound and magnetic resonance images based on key points / 生物医学工程学杂志

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.

Functional Magnetic Resonance Imaging Study of Oxcarbazepine Effect on Auditory Cortex / 医学研究杂志

Objective Functional magnetic resonance imaging was used to explore the effects of oxcarbazepine on auditory cortex function in patients with epilepsy.Methods 21 patients with epilepsy treated with oxcarbazepine and twenty-one patients with epilepsy who matched age and gender but did not treat with oxcarbazepine were collected.Amplitude of low frequency fluctuation(ALFF)and re-gional homogeneity(ReHo)were used to compare the differences in the functional activity of the auditory cortex between the two groups.Results Compared with the patients without oxcarbazepine,the patients with oxcarbazepine had higher ALFF values in the right superior temporal gyrus,bilateral middle temporal gyrus and visual union cortex,and lower ALFF values in the bilateral orbitofrontal area and infe-rior temporal gyrus,the patients with oxcarbazepine had higher ReHo values in right superior temporal gyrus,bilateral middle temporal gy-rus,orbitofrontal area,and left visual union cortex,and lower ReHo values in bilateral superior temporal gyrus,inferior temporal gyrus and right middle temporal gyrus.In the same cross-sectional area,ALFF and ReHo values were enhanced in the right superior temporal gyrus,right cingulate gyrus,right somatosensory cortex and left visual union cortex,while ALFF and ReHo values were weakened in the bilateral inferior temporal gyrus.However,there was no significant difference in ALFF and ReHo values of bilateral transverse temporal gyrus and transverse temporal sulcus between the two groups.Conclusion Oxcarbazepine may affect auditory cortex function in patients with epilepsy,and it mainly acts on the secondary auditory cortex or regulates the excitatory balance of the auditory network.

Correlación entre aspectos clínicos, imagenológicos e histopatológicos en el diagnóstico de tumores y seudotumores raquídeos extramedulares / Correlation between clinical, imaging, histological and pathological aspects in the diagnosis of spinal extramedular tumors and pseudotumors i: en

Introducción: Los tumores intradurales extramedulares son causa de morbilidad y mortalidad. Para identificarlos y analizarlos, la resonancia magnética resulta el método diagnóstico imagenológico de elección. Objetivo: Caracterizar a pacientes con tumores y seudotumores raquídeos intradurales extramedulares según variables clínicas, imagenológicas (por resonancia magnética) e histopatológicas. Métodos: Se efectuó un estudio observacional, descriptivo, longitudinal y prospectivo en 20 pacientes con diagnóstico clínico de sospecha de tumor o seudotumor intradural extramedular o no, confirmado mediante resonancia magnética, quienes fueron atendidos en el Departamento de Imagenología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba de enero del 2014 a igual mes del 2017, procedentes de los hospitales generales de esta provincia y de Guantánamo. Resultados: Existió una mayor frecuencia del sexo masculino (70,0 %), principalmente en las edades de 60 y más años (30,0 %), así como del dolor vertebral (100,0 %) y las alteraciones de los reflejos osteotendinosos (65,0 %) como síntomas y signos de los procesos neoplásicos. Según la intensidad de las señales captadas en la resonancia magnética, primaron los tumores isointensos en la secuencia T1 (70,0 %) y los hiperintensos e isointensos en la secuencia T2 (35,0 % en cada uno), sobre todo de localización dorsal (60,0 %). Asimismo, el diagnóstico clínico de sospecha más usual fue el de mielopatía compresiva (25,0 %), en tanto, entre los diagnósticos imagenológicos e histopatológicos sobresalieron las metástasis y los meningiomas. Conclusiones: La resonancia magnética ofrece una aproximación al diagnóstico definitivo de estos tumores, el cual es corroborado con el estudio histopatológico.

Introduction: The intradural extraspinal tumors are morbidity and mortality cause. To identify and analyze them, the magnetic resonance is the imaging diagnostic means of election. Objective: To characterize patients with intradural extramedular spinal tumors and pseudotumors according to clinical, imaging (by magnetic resonance) histological and pathological variables. Methods: An observational, descriptive, longitudinal and prospective study was carried out in 20 patients with suspicious clinical diagnosis of intradural extraspinal tumor or pseudotumor or not, confirmed by means of magnetic resonance who were assisted in the Imaging Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from January, 2014 to the same month in 2017, coming from the general hospitals of this province and Guantánamo. Results: There was a higher frequency of the male sex (70.0 %), mainly 60 and more years (30.0 %), as well as of the vertebral pain (100.0 %) and disorders of the muscle stretch reflex (65.0 %) as symptoms and signs of the neoplasm processes. According to the intensity of the signs captured in the magnetic resonance, the isointense tumors prevailed in the sequence T1 (70,0 %) and the hyperintense and isointense in the sequence T2 (35.0 % in each one), mainly of dorsal localization (60.0 %). Also, the most common supicious clinical diagnosis was that of compressive myelopathy (25.0 %), as long as, among the imaging, histological and pathological diagnosis the metastasis and meningiomas were notable. Conclusions: The magnetic resonance offers an approach to the definitive diagnosis of these tumors, which is corroborated by means of the histological and pathological study.

Leucoencefalopatía posterior reversible en pacientes trasplantados. Presentación clínica, radiológica y evolución / Posterior reversible encephalopathy syndrome in transplanted patients. Clinical features and imaging follow up

Resumen El síndrome de leucoencefalopatía posterior reversible (PRES) es un desorden neurológico agudo caracterizado por cefalea, alteración de la conciencia, convulsiones y alteraciones visuales, con imágenes de edema vasogénico reversible en regiones cerebrales posteriores. Nos propusimos describir una serie de casos de pacientes trasplantados que desarrollaron PRES, caracterizando su presentación, evolución clínica, imágenes y terapéutica. Se analizaron historias clínicas informatizadas desde enero 2009 hasta enero 2019. Se recabaron datos demográficos, antecedentes clínicos, motivos y días de internación, tiempos desde el trasplante a la presentación clínica y diagnóstico. Se evaluó la mejoría/resolución en estudios por imágenes y la supervivencia anual. Se identificaron 27 pacientes con PRES; 22 trasplantados de órgano sólido de 1647 totales (1.3%) y 5 de médula ósea de 617 totales (0.8%). La media de edad fue de 38.2 años (DS 19.5), 62.9% de sexo femenino, 59.2% (16) antes del año del trasplante. Las comorbilidades más frecuentes enfermedad renal (14; 51%) e hipertensión arterial (11; 40%). Se realizó tomografía axial computarizada (TAC) a 23 pacientes (85.1%), siendo patológica en 11 (47.8%), y resonancia magnética nuclear (RMN) a 25 (92.6%), mostrando patrón característico en 17 (62.9%), con mejoría/resolución antes del año en 20 (74%). El tratamiento fue sintomático, modificando la inmunosupresión. Se registraron 5 óbitos durante la internación y otros 3 antes del año, con una supervivencia anual del 70.3% (19). La población de trasplantados, en crecimiento en nuestro medio, es particularmente susceptible al PRES. Tanto su presentación en estudios por imágenes, como su comorbilidad, difieren de otras poblaciones.

Abstract Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder characterized by headache, encephalopathy, seizures and visual disturbances, with reversible vasogenic edema in posterior brain areas. The aim of this research was to describe a case series of transplanted patients who developed PRES, characterize their presentation, treatment, clinical and imaging evolution. Electronic medi cal records were analyzed from January 2009 to January 2019. Demographic data, clinical backgrounds, causes of admission, hospital length of stay and time from transplantation to PRES were collected. Image improvement/ resolution and annual survival were assessed. We identified 27 patients with PRES; 22 of 1647 total solid-organ transplant (1.3%) and 5 of 617 total bone marrow transplant (0.8%). The mean age at presentation was 38.2 years (SD 19.5), 62.9% female, 59.2% (16) before the year of transplantation. The most common comorbidities were kidney disease (14; 51%) and high blood pressure (11; 40%). Computed axial tomography (CT) was per formed in 23 patients (85.1%), with pathological findings in 11 (47.8%). Magnetic resonance imaging (MRI) of 25 (92.6%), showed a characteristic pattern in 17 (62.9%) with improvement/resolution before the year in 20 (74%). Treatment was symptomatic, modifying immunosuppression. Five deaths were recorded during hospital stay and another 3 before the year of admission, with an annual survival of 70.3% (19 patients). Organ transplant trend is growing in our region. These patients are particularly susceptible to PRES, with a different imaging presentation and comorbidities from other populations.

Myotonic dystrophy type 1 with anterior temporal white matter changes mimicking cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

@#Myotonic dystrophy type 1 is the most common type of muscular dystrophy in adults characterized by progressive myopathy, myotonia, and occasional systemic involvement. This is a case of myotonic dystrophy type 1 with cognitive decline showing brain magnetic resonance image abnormality mimicking cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

A review on motion tracking methods for left myocardium based on cardiac cine magnetic resonance image / 生物医学工程学杂志

Due to the high spatiotemporal resolution , cardiac cine magnetic resonance imaging (CCMRI) has been widely used to evaluate the cardiac function of cardiovascular diseases such as myocardial ischemia and so on. Segmentation-based motion tracking of left myocardium is very important for comprehensive evaluation of cardiac function in the diagnosis and treatment of cardiovascular diseases. However, it is a challenge to track motion of left myocardium, which is homogeneous and cannot provide effective motion information. In this paper, CCMRI imaging techniques for myocardial motion tracking are introduced firstly. Then approaches for motion tracking of left myocardium based on CCMRI image are described in details and are summarized and prospected at the end, which not only helps beginners to have a quick and comprehensive understanding on this topic, but also provides theoretical reference to related researchers for further optimization of approaches for motion tracking of left myocardium. From the current study, motion tracking approaches for left myocardium based on CCMRI image make comprehensive use of the spatiotemporal motion characteristics of CCMRI image, the motion and structures of myocardium of left ventricle and so on, which can make up for the shortcomings of sparse motion information of CCMRI image. However, it still needs improved constraint framework, verification methods and so on.

Meningitis Criptocócica. Diferentes Contextos Clínicos Y Complicaciones. Serie De 7 Casos / Cryptococal Meningitis. Different Clinical Context And Complications. Seven Cases

Resumen Introducción: La meningitis Criptocócica (MC) es una infección grave del Sistema Nervioso Central. El diagnóstico y tratamiento de estos pacientes suele ser complejo, tanto por la severidad de las manifestaciones clínicas, como por sus complicaciones. El objetivo de este trabajo es describir los diferentes contextos clínicos, las características neuroradiológicas y las complicaciones en estos pacientes. Pacientes: Se realizó una revisión retrospectiva de los factores clínicos y radiológicos de 7 pacientes atendidos con MC durante el periodo octubre 2016 y septiembre del 2017, en el hospital Eugenio Espejo. Resultados: Predominó el sexo masculino (6/7), con una edad promedio 31,6 años (rango 19-44). El tiempo promedio que tardó el diagnóstico fue de 8,1 semanas. Se evidenciaron causas de inmunosupresión en 5 pacientes, dos VIH positivos, un caso de Leucemia Linfoblástica Aguda, linfopenia idiopática CD4 y Linfagectasia Intestinal Primaria respectivamente. La disminución de la agudeza visual, auditiva y la criptococosis diseminada se presentaron en 3 de los enfermos, con una mortalidad del 26,8%. La hipoglucorraquia fue una característica relevante de los enfermos, el promedio fue de 12,7mmg/dl. En la IRM la lesión más común fue la dilatación de los espacios de Virchow Robins (5/7), seguido de las lesiones isquémicas (2/7). Conclusiones: La MC presenta una elevada morbimortalidad, con síntomas iniciales que pueden ser inespecíficos lo que retarda el diagnóstico e inicio de los antifúngicos. Las condiciones inmunosupresoras predisponentes pueden ser múltiples y en ocasiones todo un reto diagnóstico.

Abstract Introduction: Cryptococcal meningitis (CM) is a serious infection of the Central Nervous System. The diagnosis and treatment of these patients is often complex, due to the severity of the clinical manifestations and their complications. The aim of this study is to describe the different clinical contexts, the neuroradiological characteristics and the complications of patients with CM. Patients: We performed a retrospective review of clinical and radiological factors of 7 patient's diagnosis and treated with CM during the period October 2016 and September 2017, at the Eugenio Espejo Hospital. Results: Male sex was predominant (6/7), with an average age of 31.6 years (Range 19-44). The average time for the diagnosis was 8.1 weeks. Immunosuppression causes were evidenced in 5 patients, two HIV positive, one case with Acute Lymphoblastic Leukemia, CD4 idiopathic lymphopenia and Primary Intestinal Linfagectasia respectively. Three patients developed complications as disseminated cryptococcosis, visual acuity and hearing loss, mortality rate reach 26.8% of patients. Hypoglycorrhachia was a relevant feature with average 12.7mmg / dl. In MRI, the most common lesion was dilatation of Virchow Robins spaces (5/7), followed by ischemic lesions. Conclusions: CM is characterized for high morbidity and mortality, initial symptoms may be nonspecific and delays the diagnosis as well as initiation of antifungal agents. Several predisposing immunosuppressive conditions can be found and sometimes a diagnostic challenge.

Bilateral Stress Fracture of Femur Neck, Fatigue Type of Non-Athlete Young Adult

Bilateral femoral neck stress fractures have been rarely reported. When diagnosed, they are usually limited to athletes or military personnel. A 35-year-old man, previously healthy, visited the emergency department for right inguinal pain. On physical examination, no external wound, tenderness or limitation of motion were found in either lower extremity. Plain radiography showed normal findings but an magnetic resonance image showed a linear fracture in the femoral neck. In this case, bilateral femoral neck stress fractures were found in a young non-athlete adult with no prior medical history of related injuries. Surgery is generally not performed for stress fractures but considering the patient's early mobilization and the need for quick reintegration into society, surgery was done in this case.

Comparison of image quality of brain between conventional MR sequence and compilation sequence / 中国医学影像技术

Objective: To compare the image quality of brain of magnetic resonance image compilation (MAGiC) sequence and conventional MR sequence. Methods Ninety-six subjects underwent conventional MR sequences and MAGiC sequence scanning. The quality scores and SNR were compared between conventional MR sequence T1 FSE, T2 FSE, T1 Flair and T2 Flair images as well as MAGiC sequence reformated MAGiC T1, MAGiC T2, MAGiC T1 Flair and MAGiC T2 Flair images. Results There was no statistical difference of image quality score, artifact score, detection of lesions score between conventional sequences images and MAGiC sequence images (all P>0.05). SNR of MAGiC T1, MAGiC T2, MAGiC T1 Flair, MAGiC T2 Flair images were higher than that of corresponding conventional sequence images (all P<0.01). Conclusion: The quality of brain images captured with MAGiC and conventional sequences are similar, and SNR of MAGiC sequence images are higher than conventional sequence images.

Quantitative analysis of hepatocellular carcinomas pathological grading in non-contrast magnetic resonance images / 生物医学工程学杂志

In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: = 125; validation dataset, = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.

A multi-label fusion based level set method for multiple sclerosis lesion segmentation / 生物医学工程学杂志

A multi-label based level set model for multiple sclerosis lesion segmentation is proposed based on the shape, position and other information of lesions from magnetic resonance image. First, fuzzy c-means model is applied to extract the initial lesion region. Second, an intensity prior information term and a label fusion term are constructed using intensity information of the initial lesion region, the above two terms are integrated into a region-based level set model. The final lesion segmentation is achieved by evolving the level set contour. The experimental results show that the proposed method can accurately and robustly extract brain lesions from magnetic resonance images. The proposed method helps to reduce the work of radiologists significantly, which is useful in clinical application.

Pancreatic Cystic Neoplasm: Radiologic Evaluation and Differential Diagnosis / 대한췌담도학회지

Pancreatic cystic neoplasm is a clinically challenging entity. Its incidence estimated up to 45% of the general population. The biological behavior ranges from benign to malignant disease. The strategy for pancreatic cystic neoplasm could be to prevent progression to pancreatic cancer while minimizing the costs. The first step for the correct management is correct diagnosis. In this paper, the radiological differential diagnosis of them will be described.

Comparative analysis of MR imaging findings of perianal fistulas in patients with and without Crohn disease / 中华放射学杂志

Objective To investigate the differences in magnetic resonance imaging characteristics between perianal?fistulas of Crohn disease (P?FCD) and perianal?fistulas of non?Crohn disease (P?FNCD). Methods A retrospective analysis was made of 109 patients with perianal fistula who were confirmed by clinical examinations and surgery and had complete preoperative pelvic MRI data from sir run run shaw hospital affiliated to Zhejiang University from June 2015 to March 2017. Patients were divided into P?FCD and P?FNCD groups according to whether the patient was clinically diagnosed with Crohn disease (CD). There were 59 cases in group P?FCD and 50 cases in group P?FNCD. All patients underwent pelvic MRI plain scan and enhanced scan. the classifications of perianal fistula (St. James University Hospital classification and improved Parks classification) were evaluated. The number of branches, the number of abscesses, the number of internal opening, the height of the internal opening were measured and recorded. The incidence of proctitis and anal inflammation were recorded. Van Assche score was evaluated. Measured data between patients in the P?FCD and P?FNCD groups were compared using independent sample t test (normal distribution) or non?parametric test (skewed distribution).The quantitative data were compared using cross?sectional Pearson χ2 test. Results There were significant differences in the number of branches, the number of abscesses, the number of internal opening, the height of the internal opening, the positive rate of proctitis, the positive rate of anal canalitis, and the Van Assche score between the P?FCD group and the P?FNCD group (all P<0.05). There was no significant difference in the modified Parks classification between the P?FCD group and the P?FNCD group (P>0.05).There was significant difference in the classification of St. James University Hospital between the P?FCD group and the P?FNCD group (P<0.05). Conclusions P?FCD is mainly composed of high complex anal fistula, which is significantly different from P?FNCD. We used St. James University Hospital classification and Van Assche score to diagnose perianal fistula in combination with clinical examinations, which was helpful for the diagnosis of P?FCD.

Lesiones degenerativas del menisco / Lésions méniscales dégénératives / Degenerative lesions of meniscus

Introducción: La enfermedad degenerativa articular afecta a todas las estructuras intrarticulares entre las que se encuentran el menisco y el cartílago. Las lesiones del menisco están asociadas a otras enfermedades que provocan dolor. Objetivo: Describir el comportamiento de las lesiones degenerativas del menisco en un grupo de pacientes. Métodos: Se realizó un estudio observacional analítico, con 230 pacientes que presentan diagnóstico clínico, imaginológico y artroscópico de lesiones degenerativas del menisco, atendidos en el Hospital Universitario Manuel Ascunce Domenech, del 9 octubre de 2012 al 22 de enero de 2018. Las variables del estudio fueron: edad, sexo, rodilla derecha e izquierda, menisco medial-lateral, las cinco variantes de la clasificación artroscópica de Boyer T, síntomas y signos, lesiones intrarticulares asociadas, lesión de cartílagos y procedimientos artroscópicos. Se empleó la distribución de frecuencias absoluta y relativa en el análisis de las variables cualitativas y la media aritmética para la variable cuantitativa edad. Para la relación entre variables cualitativas independientes se utilizó la prueba de chi-cuadrado. Resultados: El promedio de edades de los pacientes estudiados fue de 54,5 años. La proporción por sexo fue 2,5 mujeres por 1 hombre afectado. Según la clasificación artroscópica de Boyer T, hubo mayor incidencia del tipo I en los enfermos (47 por ciento). Predominó el dolor difuso de la articulación. La lesión asociada con mayor incidencia fue la de cartílagos grados III/IV. Los procedimientos artroscópicos más empleados fueron: el lavado articular, desbridamiento y la meniscectomía parcial. Conclusiones: Las lesiones degenerativas del menisco son frecuentes en pacientes con la enfermedad degenerativa articular. Se asocian a otras enfermedades articulares que provocan dolor, de ahí que sus síntomas y signos sean similares. El grado de afección del menisco no es simétrico al del cartílago. El tratamiento artroscópico es el de elección, por sus múltiples ventajas. Son necesarios varios procedimientos en un mismo enfermo(AU)

Introduction: The articular degenerative disease affects all intra-articular structures, including meniscus and cartilage. Meniscus injuries are associated with other diseases that cause pain. Objective: To describe the behavior of meniscal degenerative lesions in a group of patients. Methods: An analytical observational study was carried out in 230 patients presenting a clinical, imaging and arthroscopic diagnosis of meniscus degenerative lesions; they were treated at Manuel Ascunce Domenech University Hospital, from October 9, 2012 to January 22, 2018. The variables of the study were age, sex, right and left knee, medial-lateral meniscus, Boyer's T five variants of arthroscopic classification, symptoms and signs associated intra-articular injuries, cartilage injury and arthroscopic procedures. The distribution of absolute and relative frequencies was used in the analysis of the qualitative variables and the arithmetic mean for the quantitative age variable. The chi-square test was used to assess the relationship between independent qualitative variables. Results: The average age of the patients studied was 54.5 years. The proportion by sex was 2.5 women per one affected man. According to Boyer T arthroscopic classification, there was higher incidence of type I in these patients (47 percent). The joint diffuse pain predominated. The highest incidence lesion associated was cartilages grades III / IV. Joint washing, debridement and partial meniscectomy were the most arthroscopic procedures used. Conclusions: Degenerative lesions of the meniscus are frequent in patients with degenerative joint disease. They are associated with other joint diseases that cause pain; hence, their symptoms and signs are similar. The degree of affection of the meniscus is not symmetrical to that of the cartilage. The treatment of choice is arthroscopic, due to its multiple advantages. Several procedures are necessary in the same patient(AU)

Introduction: La maladie articulaire dégénérative touche toutes les structures intra-articulaires, telles que le ménisque et le cartilage. Les lésions méniscales sont associées à d'autres affections qui provoquent la douleur. Objectif: Le but de cet article est de décrire le comportement des lésions méniscales dégénératives dans un groupe de patients. Méthodes: Une étude observationnelle et analytique de 230 patients diagnostiqués de lésions méniscales dégénératives par examen clinique, IRM et arthroscopie, et traités à l'hôpital universitaire Manuel Ascunce Domenech, du 9 octobre 2012 au 22 janvier 2018, a été réalisée. Les variables utilisées dans cette étude ont compris l'âge, le sexe, le genou affecté (gauche et droit), le ménisque médial-latéral, les cinq variables de la classification arthroscopique de Boyer, les symptômes et signes, les lésions intra-articulaires associées, la lésion de cartilages, et les méthodes arthroscopiques. On a employé la distribution des fréquences absolues et relatives pour l'analyse des variables qualitatives, et la moyenne arithmétique pour la variable quantitative de l'âge. Pour la relation entre les variables qualitatives indépendantes, on a utilisé le test du chi carré (χ2). Résultats: L'âge moyen des patients dans cette étude a été 54.5 ans. Le sex-ratio a été de 2,5 femmes contre 1 homme. Selon la classification arthroscopique de Boyer, les lésions de type I ont été les plus fréquentes chez les malades (47 %). La douleur diffuse de l'articulation a été en prédominance. La lésion intra-articulaire associée de plus haute incidence a été celle de cartilages grades III/IV. Parmi les procédés arthroscopiques les plus souvent utilisés, on peut trouver le lavage articulaire, le débridement et la méniscectomie partielle. Conclusions: Les lésions méniscales dégénératives sont fréquentes chez les patients atteints de maladie articulaire dégénérative. Elles sont associées à d'autres affections articulaires provoquant la douleur, c'est pourquoi leurs symptômes et signes sont similaires. Le grade d'atteinte du ménisque est différent à celui du cartilage. Étant donné ses multiples bénéfices, le procédé arthroscopique est le traitement de choix. Il faut utiliser plusieurs procédés chez un même malade(AU)

A comparative study of target volumes based on deformation registration using preoperative prone magnetic resonance imaging and postoperative prone computed tomography imaging for patients undergoing breast-conserving surgery / 中华放射医学与防护杂志

Objective@#To explore the differences and correlation between the target volumes based on deformation registration (DIR) using preoperative prone diagnostic magnetic resonance (MR) imaging and postoperative prone computed tomography (CT) simulation imaging for patients undergoing breast-conserving surgery (BCS).@*Methods@#Eighteen breast cancer patients suitable for external-beam partial breast irradiation (EB-PBI) after BCS were enrolled. Preoperative prone diagnostic MR and postoperative prone CT scan sets were acquired during free breathing for all patients. The gross tumor volume (GTV) delineated on the preoperative diagnostic MR images was defined as GTVMRI, the clinical target volumes (CTVMRI+ 1 and CTVMRI+ 2)were defined as 10 and 20 mm margins around the GTVMRI, and the planning target volume (PTVMRI+ 1 and PTVMRI+ 2) were defined as 15 and 25 mm margins around the GTVMRI, respectively. Tumor bed (TB) delineated on the postoperative prone CT simulation images acquired during free breathing was defined as GTVTB, CTV and PTV were defined as 10 and 15 mm margins around the GTVTB, respectively. The target volume of the whole breast contoured on the MR and CT images were defined as CTVBreast-MRI and CTVBreast-CI, respectively. The MR and CT images were registered deformably in MIM software system.@*Results@#The GTVTB, CTVTB and PTVTB were significantly greater than GTVMRI, GTVMRI+ 1 and PTVMRI+ 1, respectively (Z=-3.593, -3.593, -2.983, P<0.05). Meanwhile, the CTVTB and PTVTB were significantly less than the CTVMRI+ 2 and PTVMRI+ 2, respectively(Z=-2.722, -2.853, P<0.05). The conformal index (CI) and degree of inclusion (DI) of GTVTB-GTVMRI, GTVTB-CTVMRI+ 1, CTVTB-GTVMRI and CTVTB-GTVMRI+ 1 based on center-coincidence of the compared targets were better than those based on DIR of the thorax(Z=-3.724、-3.724、-2.591、-3.593, P<0.05; Z=-3.724、-3.724、-3.201、-3.724, P<0.05).@*Conclusions@#For the patients enrolled for prone EB-PBI, target volumes delineated on the preoperative prone MR images were significantly smaller compared to that on the postoperative prone CT images, but a statistically significant positive correlation was found between the MR and CT target volumes. There were still relatively poor spatial overlap whether for the whole breast or the targets between the preoperative prone diagnostic MR images and the postoperative prone simulation CT images based on DIR. Therefore, it is infeasible to guide postoperative EB-PBI target delineation using the preoperative prone diagnostic MR images.

Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

PURPOSE: This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture. MATERIALS AND METHODS: Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed. RESULTS: The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0–20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4–12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2–15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4–9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear. CONCLUSION: LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

Interobserver variation in target volume for salvage radiotherapy in recurrent prostate cancer patients after radical prostatectomy using CT versus combined CT and MRI: a multicenter study (KROG 13-11)

PURPOSE: To investigate interobserver variation in target volume delineations for prostate cancer salvage radiotherapy using planning computed tomography (CT) versus combined planning CT and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten radiation oncologists independently delineated a target volume on the planning CT scans of five cases with different pathological status after radical prostatectomy. Two weeks later, this was repeated with the addition of planning MRI. The volumes obtained with CT only and combined CT and MRI were compared, and the effect of the addition of planning MRI on interobserver variability was assessed. RESULTS: There were large differences in clinical target volume (CTV) delineated by each observer, regardless of the addition of planning MRI (9.44–139.27 cm³ in CT only and 7.77–122.83 cm³ in CT plus MRI) and no significant differences in the mean and standard deviation of CTV. However, there were decreases in mean volume and standard deviation as a result of using the planning MRI. CONCLUSION: This study showed substantial interobserver variation in target volume delineation for salvage radiotherapy. The combination of planning MRI with CT tended to decrease the target volume and the variation.

Impact of a Geometric Correction for Proximal Flow Constraint on the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method

BACKGROUND: Overestimation of the severity of mitral regurgitation (MR) by the proximal isovelocity surface area (PISA) method has been reported. We sought to test whether angle correction (AC) of the constrained flow field is helpful to eliminate overestimation in patients with eccentric MR. METHODS: In a total of 33 patients with MR due to prolapse or flail mitral valve, both echocardiography and cardiac magnetic resonance image (CMR) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA (RV(PISA)), convergence angle (α) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying by α/180 (RV(AC)). RV measured by CMR (RV(CMR)) was used as a gold standard, which was calculated by the difference between total stroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. RESULTS: The correlation between RV(CMR) and RV by echocardiography was modest [RV(CMR) vs. RV(PISA) (r = 0.712, p < 0.001) and RV(CMR) vs. RV(AC) (r = 0.766, p < 0.001)]. However, RV(PISA) showed significant overestimation (RV(PISA) - RV(CMR) = 50.6 ± 40.6 mL vs. RV(AC) - RV(CMR) = 7.7 ± 23.4 mL, p < 0.001). The overall accuracy of RV(PISA) for diagnosis of severe MR, defined as RV ≥ 60 mL, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using RV(AC) (p = 0.028). CONCLUSION: Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometric AC of the proximal constraint flow largely eliminates overestimation.