Sub-differentiation of PI-RADS 3 lesions in TZ by advanced diffusion-weighted imaging to aid the biopsy decision process.

Background: Performing biopsy for intermediate lesions with PI-RADS 3 has always been controversial. Moreover, it is difficult to differentiate prostate cancer (PCa) and benign prostatic hyperplasia (BPH) nodules in PI-RADS 3 lesions by conventional scans, especially for transition zone (TZ) lesions. The purpose of this study is sub-differentiation of transition zone (TZ) PI-RADS 3 lesions using intravoxel incoherent motion (IVIM), stretched exponential model, and diffusion kurtosis imaging (DKI) to aid the biopsy decision process. Methods: A total of 198 TZ PI-RADS 3 lesions were included. 149 lesions were BPH, while 49 lesions were PCa, including 37 non-clinical significant PCa (non-csPCa) lesions and 12 clinical significant PCa (csPCa) lesions. Binary logistic regression analysis was used to examine which parameters could predict PCa in TZ PI-RADS 3 lesions. The ROC curve was used to test diagnostic efficiency in distinguishing PCa from TZ PI-RADS 3 lesions, while one-way ANOVA analysis was used to examine which parameters were statistically significant among BPH, non-csPCa and csPCa. Results: The logistic model was statistically significant (χ2 = 181.410, p<0.001) and could correctly classify 89.39% of the subjects. Parameters of fractional anisotropy (FA) (p=0.004), mean diffusion (MD) (p=0.005), mean kurtosis (MK) (p=0.015), diffusion coefficient (D) (p=0.001), and distribute diffusion coefficient (DDC) (p=0.038) were statistically significant in the model. ROC analysis showed that AUC was 0.9197 (CI 95%: 0.8736-0.9659). Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 80.4%, 93.9% and 75.5%, respectively. FA and MK of csPCa were higher than those of non-csPCa (all p<0.05), while MD, ADC, D, and DDC of csPCa were lower than those of non-csPCa (all p<0.05). Conclusion: FA, MD, MK, D, and DDC can predict PCa in TZ PI-RADS 3 lesions and inform the decision-making process of whether or not to perform a biopsy. Moreover, FA, MD, MK, D, DDC, and ADC may have ability to identify csPCa and non-csPCa in TZ PI-RADS 3 lesions.

Exposure-Response Analysis and Mechanism of Ginkgolide B's Neuroprotective Effect in Acute Cerebral Ischemia/Reperfusion Stage in Rat.

Ginkgolide B (GKB) is a well-established neuroprotectant for acute ischemia stroke. However, its cerebral exposure and real-time response remain elusive in acute ischemia/reperfusion stage, and it hinders its usage in therapeutic window of ischemia stroke. Therefore, we investigate the exposure-response relationship of GKB (10 mg/kg, intravenously (i.v.)) as well as its neuroprotective mechanism in acute ischemia/reperfusion rats. Cerebral and plasma exposure of GKB is comparatively explored in both of normal rats and acute ischemia/reperfusion rats. Correspondingly, neurological function and brain jury indexes were assessed at each time point, and superoxide dismutase (SOD), malondialdehyde (MDA), platelet activator factor (PAF) and thromboxane A2 (TXA2) are indexed as pharmacological response to GKB. Exposure-response relationships are analyzed by using linear regression. Additionally, cerebral expressions of proteins in PAF-regulated pathways are tested at each time point. Results show cerebral and plasma concentrations of GKB are much higher in acute ischemia/reperfusion rats than those in normal rats. Cerebral infarction, neurological function (NF) score, abnormal PAF and excessive MDA are significantly alleviated in 24 h after GKB injection, and PAF is reduced in exposure-response manner with significant concentration-response relationship (R2 = 0.9123). Regarding downstream proteins in intracellular PAF-regulated pathway, GKB progressively inhibits Bax, Caspase-3, p-p65 and p-IKK, while gradually restoring LC3B, p62 and p-mammalian target of rapamycin (mTOR) to the basic level within 24 h. Conclusively, GKB exhibits greater cerebral exposure in acute ischemia/reperfusion rats and neuroprotective effect through reducing PAF in exposure-response manner and mediating PAF-regulated intracellular signaling pathways. Our finding highlights clinical implications of GKB in therapeutic time window of ischemic stroke.

An epidemiological study of the prevalence rate of inflammatory back pain and axial spondyloarthritis in a university in the south of China.

Inflammatory back pain (IBP) is an important clinical feature for axial spondyloarthritis (SpA). Yet, little is known about their prevalences in China. We conducted an epidemiological study in a university to detect the prevalences of IBP and axial SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. We investigated 3770 participants from South China Agricultural University by face-to-face questionnaires and evaluated the prevalences of chronic low back pain (CLBP) and IBP. In addition, 333 students including all IBP patients volunteered to do HLA-B27 test, and we performed X-ray examination on students with suspect axial SpA. Axial SpA was confirmed by rheumatologists according to ASAS criteria. The mean (± SD) age of screened population was 19.48 (± 2.80) years, while female to male ratio was 1.45:1 (2229/1541). Seven hundred thirty-one (19.39%) of all participants had CLBP and 111 (2.94%) had IBP. Among the 333 students receiving HLA-B27 test, 13 (0.34%, 13/3770) fulfilled ASAS criteria for axial SpA. Nine students had sacroiliitis on imaging plus at least one SpA feature (IBP and positive HLA-B27 results). Four students had positive HLA-B27 plus at least two other SpA features (arthritis/enthesitis and good response to NSAIDs). For CLBP, female/male was 485/246. For axial SpA, female/male was 4/9(P = 0.014). In southern China, the prevalences of CLBP and IBP were respectively 19.39 and 2.94% in university, and the prevalence of axial SpA was 0.34%. Although more female students had CLBP, males were more likely to suffer from axial SpA.

In Vivo Assessment of Neurodegeneration in Type C Niemann-Pick Disease by IDEAL-IQ.

Objective: To noninvasively assess the neurodegenerative changes in the brain of patients with Niemann-Pick type C (NPC) disease by measuring the lesion tissue with the iterative decomposition of water and fat with echo asymmetry and least square estimation-iron quantification (IDEAL-IQ). Materials and Methods: Routine brain MRI, IDEAL-IQ and 1H-proton magnetic resonance spectroscopy (1H-MRS, served as control) were performed on 12 patients with type C Niemann-Pick disease (4 males and 8 females; age range, 15-61 years; mean age, 36 years) and 20 healthy subjects (10 males and 10 females; age range, 20-65 years; mean age, 38 years). The regions with lesion and the normal appearing regions (NARs) of patients were measured and analyzed based on the fat/water signal intensity on IDEAL-IQ and the lipid peak on 1H-MRS. Results: Niemann-Pick type C patients showed a higher fat/water signal intensity ratio with IDEAL-IQ on T2 hyperintensity lesions and NARs (3.7-4.9%, p < 0.05 and 1.8-3.0%, p < 0.05, respectively), as compared to healthy controls (HCs) (1.2-2.3%). After treatment, the fat/water signal intensity ratio decreased (2.2-3.4%), but remained higher than in the HCs (p < 0.05). The results of the 1H-MRS measurements showed increased lipid peaks in the same lesion regions, and the micro-lipid storage disorder of NARs in NPC patients was detectable by IDEAL-IQ instead of 1H-MRS. Conclusion: The findings of this study suggested that IDEAL-IQ may be useful as a noninvasive and objective method in the evaluation of patients with NPC; additionally, IDEAL-IQ can be used to quantitatively measure the brain parenchymal adipose content and monitor patient follow-up after treatment of NPC.

Possible predictors for relapse from etanercept discontinuation in ankylosing spondylitis patients in remission: a three years' following-up study.

The aim of this study is to assess the recurrence probability and the possible predictors in patients with ankylosing spondylitis from etanercept discontinuation in a 3-year observational cohort ( ClinicalTrials.gov : NCT02915354). A cohort of 35 patients who achieved an ASAS 20 response at the end of a randomized controlled trial underwent a 3-year follow-up evaluation. The primary end point was clinical relapse defined as the BASDAI score going back to 80% of its initial level at the beginning of the trial. Prognostic factors of relapse were analyzed using the Cox regression. Median duration of clinical remission was 15.0 months (interquartile range, 3.7-26.3 months). The cumulative probabilities of relapse at 1, 2, and 3 years were 45.7, 57.1, and 60.0%, respectively. The proportion of recurrence was not significantly different between placebo group and etanercept group by Kaplan-Meier analysis (placebo vs. etanercept: 61.11 vs. 58.82%, P = 0.890). Two independent factors associated with increasing risk of relapse were (1) age of patients (25 years or older with risk of 3.07, 95% confidence interval, 1.19-7.97, P = 0.021); (2) onset age (younger than 24 years with risk of 3.12, 95% confidence interval, 1.24-7.83, P = 0.016). No correlation was observed in the present study between the time of relapse and the duration of the treatment with etanercept in AS patients who achieved the ASAS 20 response after receiving the treatment. The older age and younger onset age of patients seems to be important factors associate with an increasing risk of relapse.

[Study of apparent diffusion coefficient value and histopathological differentiation of hepatocellular carcinoma].

OBJECTIVE: To determine the relationship between apparent diffusion coefficient (ADC) and histopathological differentiation of hepatocellular carcinoma (HCC). METHODS: Magnetic resonance examinations of magnetic resonance imaging (MRI) plain scan, LAVA dynamic enhanced scan and diffusion weighted imaging (DWI)(1.5 T, b values: 0 and 600 s/mm²) were retrospectively reviewed for 229 surgically resected HCCs. Histopathology revealed 34 well, 170 moderately and 25 poorly-differentiated HCCs. The incidence of each ADC value was measured. The relationship between ADC and histopathological differentiation was also evaluated. RESULTS: The ADC value of well-differentiated HCCs (1.68 ± 0.13 × 10⁻³ mm²/s) was significantly higher those of moderately HCCs (1.31 ± 0.16 × 10⁻³ mm²/s) (P < 0.05) and poorly-differentiated HCCs (1.08 ± 0.11 × 10⁻³ mm²/s) (P < 0.05). There was a significant positive correlation between ADC value and differentiation of HCCs (r = 0.693, P < 0.05). ROC analysis showed that the optimal cutoff point of ADC value was 1.500 × 10⁻³ mm²/s in diagnosing well-differentiated HCCs. A cutoff ADC value equal to or under 1.5 × 10⁻³ mm²/s was used to differentiate well-differentiated HCC from moderately and poorly-differentiated ones with a sensitivity of 100% and a specificity of 94.36%. ROC analysis showed that the optimal cutoff point of ADC value was 1.235 × 10⁻³ mm²/s in diagnosing poorly-differentiated HCCs. A cutoff ADC value equal to or above 1.235 × 10⁻³ mm²/s was used for differentiating poorly-differentiated HCC from well and moderately-differentiated ones with a sensitivity of 73.5% and a specificity of 96%. CONCLUSION: In clinical practice, ADC value is important for predicting histopathological differentiation of HCC and improving its diagnostic accuracy.

[Application of 3D FIESTA sequence in magnetic resonance sialography for obstructive salivary diseases].

OBJECTIVE: To investigate the value of 3D FIESTA sequence in magnetic resonance sialography (MRS) in the diagnosis of obstructive salivary diseases. METHODS: Eleven patients with obstructive salivary diseases underwent MRS, and three-dimensional (3D) reconstruction and virtual endoscopic images of the salivary gland ducts were obtained after MRS data post-processing for comparison with those of sialoendoscopy. RESULTS: The diagnostic accuracy of MRS was 72.7% for obstructive salivary diseases. The virtual endoscopy provided a visual field highly consistent with that by sialoendoscopy. CONCLUSION: MRS is capable of visualizing the tracts of salivary glands. MR virtual endoscopy can provide sufficient morphological and pathological data for preoperative assessment of salivary operations with sialoendoscopy.