The role of ancillary features for diagnosing hepatocellular carcinoma on CT: based on the Liver Imaging Reporting and Data System version 2017 algorithm.

AIM: To investigate the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) version 2017 for diagnosing hepatocellular carcinoma (HCC), by using major features only and combined major and ancillary features on computed tomography (CT). MATERIALS AND METHODS: A total of 147 HCC, 35 non-HCC malignancy, and 37 benign lesions in 205 patients at high risk of HCC were evaluated retrospectively, and the diagnostic performance of LI-RADS for diagnosing HCC were compared between using major features only and adopting major and ancillary features in combination. RESULTS: When using LR-5 as a predictor for diagnosing HCC, the diagnostic specificity (90.3% versus 91.7%), positive predictive value (92.3% versus 93.3%), and accuracy (68% versus 68.8%) were increased based on major and ancillary features in combination than just using major features on CT. When using LR-4/5 as a predictor for diagnosing HCC, the diagnostic sensitivity (78.9% versus 85.7%), negative predictive value (64.4% versus 72%), and accuracy (78.5% versus 82.2%) were increased while preserving a high specificity (77.8% versus 75%), according to major and ancillary features in combination rather than just using major features on CT. The LI-RADS categories of 8.7% (19/219) lesions were adjusted by adding the ancillary features on CT. CONCLUSION: Adding the ancillary features visible on CT can improve the diagnostic performance of the LI-RADS v2017 algorithm for diagnosing HCC, especially for LR-3 lesions.

LncRNA TERC alleviates the progression of osteoporosis by absorbing miRNA-217 to upregulate RUNX2.

OBJECTIVE: To elucidate the role of telomerase RNA elements (TERC) in alleviating osteoporosis (OP) by absorbing microRNA-217 (miRNAs-217) to regulate runt-related transcription factor 2 (RUNX2) level. MATERIALS AND METHODS: The serum levels of TERC and miRNA-217 in OP patients and healthy controls were determined. During the osteogenic process, the relative levels of alkaline phosphatase (ALP), RUNX2, and Osterix were determined in hMSCs. The regulatory effects of TERC, miRNA-217, and RUNX2 on ALP and RUNX2 levels in hMSCs were examined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. In addition, the changes in ALP activity and calcification ability in hMSCs influenced by them were assessed through ALP activity determination and alizarin red staining, respectively. The interaction of TERC/miRNA-217/RUNX2 regulatory loop and its role in influencing hMSCs osteogenesis were assessed by Dual-Luciferase Reporter Gene Assay and a series of rescue experiments, respectively. RESULTS: The downregulated TERC and upregulated miRNA-217 were identified in the serum of the OP patients. Consistently, the downregulated TERC and upregulated miRNA-217 were discovered in in vitro osteogenic process of hMSCs. The silence of TERC, or RUNX2 downregulated ALP and RUNX2 levels, decreased ALP activity and attenuated the calcification ability in hMSCs. The overexpression of miRNA-217 gave similar results. The binding relationship in TERC/miRNA-217/RUNX2 regulatory loop was verified. At last, rescue experiments suggested that TERC accelerated hMSCs osteogenesis by absorbing miRNA-217 to upregulate RUNX2. CONCLUSIONS: The serum level of TERC is lowly expressed in OP patients. TERC influences hMSCs osteogenesis by absorbing miRNA-217 to upregulate RUNX2, thus alleviating the progression of OP.

Feasibility assessment of a tunnel-ventilated, water-padded barn on alleviation of heat stress for lactating Holstein cows in a humid area.

The use of evaporative cooling for mitigating heat stress in lactating cows in humid areas is controversial. In Taiwan, Holstein cow performance is significantly restricted by hot and humid weather. This study investigated the efficacy of using a tunnel-ventilated, water-padded freestall (TP) barn for reducing heat stress in lactating cows. From August to October 2006, 36 cows allocated in a 3×3 Latin square were raised in 3 barn cooling treatments: a conventional freestall barn with fans and sprinklers in the feed line (Fan+SP, control), a TP barn, and a TP barn with sprinkler cooling (TP+SP). Daytime air speeds in the 3 barns were 1.23, 2.38, and 2.06 m/s, respectively. Both TP barns were more efficient than the control in reducing the daytime temperature and temperature-humidity index. The barn temperature was <26°C for an extra 4.2h per day, but the relative humidity was >96% in both TP barns. Cows in both TP barns had higher respiration rates and skin temperatures at 0300 h than cows in the Fan+SP barn. The TP environment increased the cows' serum cholesterol level and the activities of alkaline phosphatase and alanine aminotransferase, but blood partial pressure of CO(2) was not affected. Vaginal temperature was persistently high in cows in the TP barn; in the 2 SP barns, it decreased 0.4 to 0.6°C following sprinkling and milking. The intake activity and rumen digestion of cows raised in the 3 environments were similar. Cows in both TP barns ingested more dry matter. Cows in the TP+SP barn tended to produce more milk than those in the Fan+SP barn (25.4 vs. 24.7 kg). Although heat stress was not completely alleviated in these 3 barns, the TP+SP treatment resolved the negative effect of a previous TP barn built in 2004 on intake and milk yield by increasing air speed and using sprinkler cooling. Thus, it is expected that TP+SP barns will be beneficial in regions with high humidity. Adequate air speed and sprinkler cooling are likely to be key factors for further study.

Enucleation after fusion and activation enhances the development of reconstructed bovine embryos.

Effects of enucleation timing on enucleation rates, development and methylation levels of reconstructed bovine embryos were investigated. However, the enucleation rate of reconstructed embryos produced by the enucleation before fusion and activation (EBFA) was higher than that by the enucleation after fusion and activation (EAFA) procedure (80.7% vs. 59.1%, P<0.05). The blastocyst rate of reconstructed embryos cloned with ear fibroblasts in EBFA group was reduced (P<0.05) in comparison with that of EAFA group (24.6% vs. 34.4%). Two out of 11 recipients were pregnant and gave birth to two viable calves after transfer of 20 reconstructed EBFA embryos. Two out of seven recipients were pregnant and also gave birth to two calves, with one surviving, after transfer of 12 reconstructed embryos produced by EAFA procedure. Finally, the methylation level of satellite I gene of donor cells (69.8%) and reconstructed embryos in EBFA group (64.7%) were similar, which were both higher (P<0.05) than that of the reconstructed embryos in EAFA group (44.4%). The methylation level of satellite I gene of the reconstructed embryos in the IVF embryos (31.9%) was lower (P<0.05) than those in all other treatments. In conclusion, the reconstructed bovine embryos produced by the EAFA procedure revealed a better developmental competence with a lower methylation rate of satellite I gene than those produced by the EBFA procedure.

Immunotolerance reaction for allograft-limb in rats induced by gene-modified cell transfusion.

The therapeutic value of the transforming growth factor beta 1 (TGF-b) in transplantation has been reported; However, cell-mediated gene therapy using TGF-b is not applied to the organ transplantation widely. This study was to evaluate whether TGF-b-modified donor spleen cell specific transfusion in rat heterotopic allo-limb transplantation could induce tolerance tolerogenicity and prolong allograft's survival time. The Splenic T-cell in Wistar rats responsing to donor spleen cells which received TGF-b-transduced were severely impaired.The Survival time of Sprague-Dawley Allograft-limb in Wistar rats given TGF-b-modified donor spleen cells (5¥106 cells/well, administration of donor TGF-b-transduced donor spleen cells 7 days before transplantation) was extended modestly but significantly.

Differences in microstructural alterations of the hippocampus in Alzheimer disease and idiopathic normal pressure hydrocephalus: a diffusion tensor imaging study.

BACKGROUND AND PURPOSE: DTI can be used to assess the degradation of WM tracts by measuring the FA and MD. Decreased FA/increased MD values in the AD hippocampus have been reported by many studies. In contrast, only a few studies reported on hydrocephalus by using the DTI technique. In elderly patients with dementia and with dilated ventricles, it is often difficult to differentiate iNPH from AD with visual measurements on MR imaging. The aim of this study was to investigate the changes of microstructural integrity of the hippocampus in iNPH by using DTI and determining whether this method could be a new diagnostic tool to differentiate iNPH from AD. MATERIALS AND METHODS: We recruited 43 participants (15 healthy controls, 15 patients with AD, and 13 patients with iNPH). The FA and MD values were measured by using the region-of-interest method in the hippocampal head, body, and tail on both sides. Clinical history, neurologic examination, and neuropsychological assessment were included. RESULTS: The FA values were the lowest in the patients with AD, the patients with iNPH, and the healthy controls in this order. The MD values were the highest in the same order. These findings were consistent in the 3 subdivisions of the bilateral hippocampal regions. Hippocampal volume was not different between patients with iNPH and AD. CONCLUSIONS: The microstructural alterations of the hippocampus were more sensitive than the volumetric changes in AD and iNPH. DTI analysis might be a useful tool for discriminating AD from iNPH.

Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke.

BACKGROUND: We investigated the association between the presence of cerebral microbleeds and poor kidney function in patients with acute ischemic stroke. METHODS: We retrospectively examined consecutive acute ischemic stroke patients who underwent gradient echo MRI. The presence of cerebral microbleeds on gradient echo MRI was independently interpreted. The number and location of microbleeds were assessed. Demographics including age, sex, risk factors, and stroke subtype were obtained. Kidney function was estimated by measuring glomerular filtration rate (GFR) with the modification of diet in renal disease method. RESULTS: Of the 152 patients included, 45 (29.6%) patients had cerebral microbleeds on gradient echo MRI. The cerebral microbleeds were most commonly located in deep or infratentorial location (27/45 [60%]). Hypertension, presence of leukoaraiosis, old age, and low GFR were associated with the presence of cerebral microbleeds (p = 0.064, <0.001, 0.014, and <0.001). The mean GFR levels were lower in patients with cerebral microbleeds (65.15 +/- 22.54 vs 78.82 +/- 19.11 mL/min/1.73 m(2)). After the adjustment of risk factors, age, and sex, low GFR levels were associated with the presence of cerebral microbleeds (odds ratio, 3.85; 95% confidence interval, 1.52 to 9.76, p = 0.004). CONCLUSION: Impaired kidney function is associated with the presence of cerebral microbleeds in acute ischemic stroke.

High prevalence of unrecognized cerebral infarcts in first-ever stroke patients with cardioembolic sources.

BACKGROUND: With magnetic resonance imaging (MRI) analysis, we investigated the prevalence, clinical significance, and factors related to the presence of unrecognized cerebral infarcts in patients with first-ever ischaemic stroke. METHODS: We consecutively included patients who were admitted with first-ever stroke. Unrecognized cerebral infarct was defined as an ischaemic infarction or primary intracerebral hemorrhage on MRI irrelevant to the index stroke, without acute lesions on diffusion-weighted image. RESULTS: Of the total 203 patients, 78 (39.4%) patients were observed as having unrecognized cerebral infarct. Patients with high-risk cardioembolic sources (e.g., atrial fibrillation) more frequently had unrecognized stroke than those without (P = 0.008, 21/36 [58.3%] vs. 57/167 [34.1%]). On univariate analysis, male sex (P = 0.027) and cardioembolic source (P = 0.008) were associated with the presence of unrecognized cerebral infarcts. After adjustment for gender, age and risk factors, the presence of cardioembolic sources independently increased the risk of unrecognized cerebral infarct (P = 0.002, odds ratio 3.56, 95% confidence interval 1.58-8.02). Regarding clinical outcome at 3 months, the presence of unrecognized cerebral infarct was not associated with the poor clinical outcome. CONCLUSION: In our study, the presence of cardioembolic sources was an independent risk factor for the unrecognized cerebral infarct in patients with first-ever stroke.

Atypical manifestations of reversible posterior leukoencephalopathy syndrome: findings on diffusion imaging and ADC mapping.

Typically, reversible posterior leukoencephalopathy syndrome (RPLS) involves the parieto-occipital lobes. When regions of the brain other than the parieto-occipital lobes are predominantly involved, the syndrome can be called atypical RPLS. The purpose of this study is to find radiological and pathophysiological features of atypical RPLS by using diffusion-weighted imaging (D-WI). We retrospectively reviewed seven patients (two with eclampsia, one with cyclosporine neurotoxicity, and four with hypertensive encephalopathy) with atypical MR manifestations of RPLS. Changes in signal intensity on T2-weighted imaging (T2-WI) and D-WI, and ADC ratio, were analyzed. In patients with atypical manifestation of RPLS, high signal intensities on T2-WI were noted in the frontal lobe, basal ganglia, thalamus, brainstem, and subcortical white matter in regions other than the parieto-occipital lobes. These areas of increased signal intensities on T2-WI showed increased ADC values, representing vasogenic edema in all seven patients. This result should be very useful in differentiating atypical RPLS from other metabolic brain disorders that affect the same sites with cytotoxic edema.

Diffusion-weighted MRI and ADC mapping in FK506 neurotoxicity.

FK506 is a newly developed potent immunosuppressant for preventing rejection after organ transplantation. However, FK506 can induce central nervous system toxicity. Until now the pathogenic mechanism of FK506 neurotoxicity was unclear. We report the findings of diffusion-weighted MRI and apparent diffusion coefficient (ADC) mapping of a FK506 neurotoxicity patient who showed increased signal intensities in both parieto-occipital lobes on T(2) weighted images, diffusion-weighted images and ADC maps. These findings suggest that a vasogenic oedema rather than a cytotoxic oedema may play a pivotal role in FK506 neurotoxicity pathogenesis.

Sulfated colominic acid: an antiviral agent that inhibits the human immunodeficiency virus type 1 in vitro.

Colominic acid is a homopolymer of N-acetylneuraminic acid (NANA), which has an alpha-2,8 ketosidic linkage between its polymer units. In this study, colominic acids were sulfated under different conditions and their antiviral activities against human immunodeficiency virus type 1 (HIV-1) were examined. Sulfated colominic acids, containing 6-12% sulfur, blocked the expression of HIV-1 antigen in MT-4 cells or C8166 cells following exposure to MOLT-4/HTLV-IIIB or HIV-1[GUN-1]. The compounds inhibited syncytium formation upon co-cultivation of MOLT-4 cells (clone 8) with MOLT-4/HTLV-IIIB cells and abolished the production of HIV-1 p24 antigen in culture medium of peripheral blood lymphocytes (PBLs). HIV-1 reverse transcriptase (RT) activity was not directly affected by the drugs. The compounds did not prolong activated partial thromboplastin time (APTT) at 10 and 1.0 microgram/ml, suggesting that they may not have appreciable side effects in vivo. These agents were still able to block the expression of HIV-1 antigen even when the cells were infected with HIV-1 in RPMI-1640 medium containing high percentages of fetal calf serum (FCS). These properties may be therapeutically advantageous if these compounds were considered for possible clinical use.

Detection of neutralizing antibodies against human T-cell leukemia virus type 1 using a cell-free infection system and polymerase chain reaction.

We have developed a cell-free infection system to titrate neutralizing antibodies against human T-cell leukemia virus type 1 (HTLV-1) using the polymerase chain reaction (PCR). S+L-CCC (8C) feline kidney or U-251 MG human glioma cells were infected with a cell-free culture supernatant derived from HTLV-1-infected c77 feline cells. DNA was extracted from 8C or U-251 MG cells after incubation for 24 hr and amplified by PCR. The c77 cell supernatant gave discrete bands, whereas those of HTLV-1-positive T cells did not. When the inocula were treated with HTLV-1 antibody-positive human sera or the monoclonal or polyclonal antibody against the peptide 190-199 of HTLV-1 envelope protein gp46, the subsequent formation of HTLV-1 proviral DNA was inhibited. We determined the titers of neutralizing antibodies by densitometrically scanning the intensity of the PCR bands. These titers correlated well with those determined by the plaque assay using a pseudotype of vesicular stomatitis virus bearing the envelope antigens of HTLV-1. At high serum concentrations, many seronegative samples markedly inhibited the plating of the HTLV-1 pseudotype whereas they barely affected results obtained by PCR. Thus, the c77-PCR system can detect neutralizing antibodies against HTLV-1 even at low titers.

Spinal epidural granulocytic sarcoma preceding acute myelogenous leukemia.

A rare case of spinal epidural granulocytic sarcoma (GS) preceding acute myelogenous leukemia is described. A 10-year-old boy presented with lower leg weakness. The initial diagnosis was a histiocytic lymphoma, and he was treated accordingly. No evidence of bone marrow involvement was found at that time. The correct diagnosis of epidural GS was made possible in retrospect by using immunoperoxidase staining for lysozyme fourteen months later when the patient showed the full-blown features of leukemia. This rare tumor should be considered in the differential diagnosis of an epidural mass with cord compression in patients with or even without acute leukemia, because early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation.

Therapeutic results and prognostic predictors of childhood acute lymphoblastic leukemia: Cox regression analysis.

Determining the current status of therapeutic results of acute lymphoblastic leukemia (ALL), and identifying the important clinical predictors of survival and relapse are essential for establishing therapeutic strategies. Sixty-two children with ALL who were admitted to Chonnam University Hospital from January 1983 to June 1991 were studied. With a mean follow-up period of 53.7 months, the overall 5-year survival rate (5YSR) was 46.1%. The overall rate of 5-year event-free survival (EFS) was 25.4% and significantly differed between risk groups: 48.7% for standard, 16.3% for high, and 12.5% for very high (p < .05). Overall 4-year survival after initial relapse was 34.2% and there was no significant difference in survival between those who relapsed during maintenance therapy and those who relapsed after completing maintenance. The Cox proportional hazards model identified central nervous system (CNS) irradiation (P < 0.001) as having the most important influence upon EFS, followed by serum alanine aminotransferase level, platelet level, and age. On the other hand, CNS leukemia at diagnosis, followed by mediastinal mass, and hemoglobin level were found to be the most important prognostic predictors for relapse. On the basis that present results differ from those of developed countries, we suggest the necessity of a nation-wide cohort study to delineate the characteristics of Korean ALL in children, to make our own protocols, and ultimately to improve the therapeutic outcome.

Mass cytologic screening for cervical carcinoma in China. A review of 7,735,057 reported cases.

A review was made of cervical carcinoma screening in 7,735,057 cases based on 140 reports from 25 provinces and autonomous regions in the People's Republic of China. The average prevalence rate of carcinoma of the cervix was 138.74/10(5); the rate was higher in the mountainous districts, and was related to the early age of marriage, the number of children delivered and the existence of cervical lesions. Proper preventive measures imposed by the government, early detection and early treatment have brought about a marked decline of the prevalence and mortality rates. The repeated mass cytologic screenings have made radical cure of this disease possible. Concurrent geographic clustering of carcinomas of both the cervix and penis have been noted, and screening of spouses has been started.