Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma.

AIM: To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). MATERIALS AND METHODS: This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. RESULTS: The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CONCLUSION: CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.

Antimicrobial effects of three herbs (Brassica juncea, Forsythia suspensa, and Inula britannica) on membrane permeability and apoptosis in Salmonella.

AIMS: This study aimed synergistic effects of three herbs in Salmonella via increased membrane permeability and apoptosis. METHODS AND RESULTS: Using high-performance liquid chromatography, four types of phenylethyl glycosides and a lignan were detected in the herb mixture (Brassica juncea, Forsythia suspensa, and Inula britannica). During treatment with the herb mixture (1×, 2×, or 4× the MIC), viable cells decreased to 1·87 log CFU per ml (Salmonella Gallinarum) and 2·33 log CFU per ml (Salmonella Enteritidis) after 12 h of incubation according to inhibition of tricarboxylic acid cycle (P < 0·01). In addition, N-phenyl-1-naphthylamine uptake increased from 229·00 to 249·67 AU in S. Gallinarum and from 232·00 to 250·67 AU in S. Enteritidis (P < 0·05), whereas membrane potential decreased from 8855·00 to 3763·25 AU and from 8703·67 to 4300·38 AU, respectively. Apoptotic Salmonella cells were observed by confocal laser scanning microscopy and flow cytometry. Transmission electron microscopy observations with negative staining showed protein leakage from damaged Salmonella. CONCLUSIONS: These results showed the synergistic effect of the three herbs against avian pathogenic Salmonella induced by membrane damage and apoptosis. SIGNIFICANCE AND IMPACT OF THE STUDY: Salmonella causes enormous economic losses in the poultry industry. These results indicated that potency of natural antimicrobial agents due to apoptosis in Salmonella.

Application of peripherally inserted central catheter in acute myeloid leukaemia patients undergoing induction chemotherapy.

Increasingly, peripherally inserted central catheters (PICC) are applied in patients with haematological malignancies. The feasibility and safety of PICC for induction chemotherapy in acute myeloid leukaemia (AML) remain unclear. Medical records of 89 newly diagnosed adult de novo AML patients, who achieved complete remission, were retrospectively reviewed (PICC group, n = 43; intravenous [IV] line group, n = 46). Patients' clinical characteristics and the number of blind punctures for blood sampling were compared between these two groups, and risk factors associated with bacteraemia were identified by univariate analysis. Patients in the PICC group experienced significantly fewer blind punctures than those in the IV line group (3.3 ± 3.6 vs. 14.4 ± 6.0; p = .000); 20.9% of PICC patients had bacteraemia, compared with 23.9% in the IV line group (p = .803). Most patients (76.7%) removed their PICC because treatment was completed. PICC increased the quality of life in AML patients undergoing chemotherapy induction by reducing the number of blind blood punctures required. Bacteraemia in PICC patients was comparable to that in IV line patients. PICC is, therefore, a feasible and safe central venous device for use in AML patients.

Analysis of the coplanarity of functional pairs of semicircular canals using three-dimensional images reconstructed from temporal bone magnetic resonance imaging.

OBJECTIVES: This study was conducted to investigate the angles and orientation of semicircular canals, and the coplanarity of functional canal pairs. METHODS: Fluid signals in semicircular canals were reconstructed with three-dimensional reconstruction software using 20 temporal bone magnetic resonance images of normal subjects. The angles between each pair of semicircular canals were measured. RESULTS: The mean angles between the anterior and horizontal semicircular canal plane, the horizontal and posterior semicircular canal plane, and the anterior and posterior semicircular canal plane were 83.7°, 82.5° and 88.4°, respectively. Pairs of contralateral synergistic canal planes were formed 15.1° between the right and left horizontal semicircular canal planes, 21.2° between the right anterior and left posterior semicircular canal, and 21.7° between the left anterior and right posterior semicircular canal. CONCLUSION: Each semicircular canal makes an almost right angle with other canals, but synergistically acting functional canal pairs of both ears do not lie in exactly the same plane.

Chronic obstructive pulmonary disease and allied conditions is a strong independent risk factor for osteoporosis and pathologic fractures: a population-based cohort study.

BACKGROUND: Chronic obstructive pulmonary disease and allied conditions (COPD) is frequently associated with various comorbidities. This study examined the association between osteoporosis and pathologic fractures in a sample of patients with COPD. METHODS: In this cohort study, claims data from the National Health Insurance Research Database of Taiwan were used to evaluate the risk between COPD and osteoporosis. Using data from the Longitudinal Health Insurance Database 2000, we conducted a retrospective cohort study by investigating patients aged 20 years and older who were newly diagnosed with COPD and comparing them with controls without COPD during 2000-2010. In addition, we used univariable and multivariable Cox proportional hazards regression models to measure the association between COPD and the risk of osteoporosis. RESULTS: Our results revealed that COPD was significantly associated with a high risk of osteoporosis, regardless of whether the patients with COPD were corticosteroid users and irrespective of age and sex. After adjustment for covariates, the COPD patients exhibited a 1.54-fold higher risk of developing osteoporosis (hazard ratio 1.54, 95% confidence interval 1.44-1.64). COPD was a stronger risk factor for osteoporosis in men. Moreover, patients with severe COPD had a higher risk of osteoporosis or pathologic fractures. CONCLUSION: This study revealed that COPD, which shares the characteristics of inflammatory diseases, is associated with a higher risk of osteoporosis after adjustment for comorbidities.

Thermal conductivity of graphene laminate.

We have investigated thermal conductivity of graphene laminate films deposited on polyethylene terephthalate substrates. Two types of graphene laminate were studied, as deposited and compressed, in order to determine the physical parameters affecting the heat conduction the most. The measurements were performed using the optothermal Raman technique and a set of suspended samples with the graphene laminate thickness from 9 to 44 µm. The thermal conductivity of graphene laminate was found to be in the range from 40 to 90 W/mK at room temperature. It was found unexpectedly that the average size and the alignment of graphene flakes are more important parameters defining the heat conduction than the mass density of the graphene laminate. The thermal conductivity scales up linearly with the average graphene flake size in both uncompressed and compressed laminates. The compressed laminates have higher thermal conductivity for the same average flake size owing to better flake alignment. Coating plastic materials with thin graphene laminate films that have up to 600× higher thermal conductivity than plastics may have important practical implications.

Androgen metabolism in prostate cancer: from molecular mechanisms to clinical consequences.

Despite our most vigorous efforts, prostate cancer remains the second leading cause of cancer death in men. Understanding the intricacies of androgen metabolism is vital to finding therapeutic targets, particularly with progression of advanced prostate cancer after initial hormone therapy, where adrenal precursors are involved. Such is the case with castration-resistant prostate cancer, where adrenal androgens, for example, dehydroepiandrosterone, are a source for intratumoural synthesis of dihydrotestosterone. As prostate cancer progresses, androgen metabolism changes due to altered expression of steroidogenic enzymes and mutations in the components of the steroidogenic machinery. These alterations sustain disease and allow progression; mechanistically, they may also enable development of hormone therapy resistance. With the development of the newer agents, abiraterone acetate and enzalutamide, efforts have been made to better define the basis for response and resistance. This work can be carried out in cell lines, animal models, as well as with ex vivo analysis of tissues obtained from patients. Efforts to further elucidate the finer details of the steroidogenic pathway are necessary to move toward a curative paradigm for patients with localised disease at high risk for recurrence.

Developing comprehensive and Brief ICF core sets for morbid obesity for disability assessment in Taiwan: a preliminary study.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) provides a framework for measuring functioning and disability based on a biopsychosocial model. AIM: The aim of this study was to develop comprehensive and brief ICF core sets for morbid obesity for disability assessment in Taiwan. DESIGN: Observational SETTING: Other POPULATION: Twenty-nine multidisciplinary experts of ICF METHODS: The questionnaire contained 112 obesity-relevant and second-level ICF categories. Using a 5-point Likert scale, the participants rated the significance of the effects of each category on the heath status of people with obesity. Correlation between an individual's score and the average score of the group indicated consensus. The categories were selected for the comprehensive core set for obesity if more than 50% of the experts rated them as "important" in the third round of the Delphi exercise, and for the brief core set if more than 80% of the experts rated them "very important." RESULTS: Twenty-nine experts participated in the study. These included 18 physicians, 4 dieticians, 3 physical therapists, 2 nurses, and 2 ICF experts. The comprehensive core set for morbid obesity contained 61 categories. Of these, 26 categories were from the component body function, 8 were from body structure, 18 were from activities and participation, and 9 were from environmental factors. The brief core set for obesity disability contained 29 categories. Of these, 19 categories were from the component body function, 3 were from body structure, 6 were from activities and participation, and one was from environmental factors. The comprehensive and brief ICF core sets provide comprehensive information on the health effects of morbid obesity and concise information for clinical practice. CONCLUSION: Comprehensive and brief core sets were created after three rounds of Delphi technique. Further validation study of these core sets by applying to patients with morbid obesity is needed. CLINICAL REHABILITAITON IMPACT: The comprehensive ICF core set for morbid obesity provides comprehensive information on the health effects of morbid obesity; the brief core set can provide concise information for clinical practice.

Differentiation between intramedullary spinal ependymoma and astrocytoma: comparative MRI analysis.

AIM: To investigate magnetic resonance imaging (MRI) findings that could be used to differentiate intramedullary spinal ependymoma from astrocytoma, and to determine predictors for this differentiation. MATERIALS AND METHODS: MRI images of 43 consecutive patients with pathologically proven intramedullary spinal ependymoma (n = 24) and astrocytoma (n = 19) were comparatively evaluated with regard to size, location, margin, signal intensity, contrast enhancement, presence of syringohydromyelia, tumoural cyst, non-tumoural cyst, and haemorrhage. MRI findings and demographic data were compared between the two tumour groups using univariate and multivariate logistic regression analyses. RESULTS: In patients with ependymoma, older age and a larger solid component were more often observed than in astrocytoma. Central location, presence of enhancement, diffuse enhancement, syringohydromyelia, haemorrhage, and cap sign were more frequently observed in ependymoma. However, multivariate analysis revealed that syringohydromyelia was the only variable able to independently differentiate ependymoma from astrocytoma, with an odds ratio of 62.9 (95% CI: 4.38-903.22; p = 0.002). CONCLUSION: Among the various findings, the presence of syringohydromyelia is the main factor distinguishing ependymoma from astrocytoma.

Analysis of S gene mutation of the hepatitis B virus in adult liver transplant recipients showing resistance to hepatitis B immunoglobulin therapy.

BACKGROUND: A considerable proportion of recipients of liver transplantations who are presented hepatitis B immunoglobulin (HBIG) monotherapy for hepatitis B virus (HBV) prophylaxis develop HBIG resistance. In this study, we investigated the mutation patterns in the major hydrophilic region (MHR) of amino acid sequences 100 to 160. METHODS: Using the gene sequence analyzer for amino acid sequences 0 to 226 in the S/pre-S region we analyzed blood samples of 15 patients showing HBIG resistance after high-dose HBIG prophylaxis. RESULTS: Various mutations in the MHR were observed in 14/15 samples: Gly145Arg mutation in 8/13 Adr subtype and 1/2 Ayw subtype samples (60%). The next most common mutation was Gly165Trp in 8/13 Adr subtype but neither of 2 Ayw subtype samples (53.3%). Concurrent antiviral resistance was noted in 5 patients: lamivudine (n = 5), or entecavir (n = 3), but not adefovir, suggesting the occurrence of simultaneous, antiviral cross-resistances. Two patients underwent retransplantation due to the progression of HBV infection despite vigorous antiviral therapy. At diagnosis of HBV recurrence, the mean HBV DNA load was 6.5 × 10(6) copies/mL; 4 patients showed paradoxical coexistence of anti-HBs and HBsAg. Currently, 2 subjects show low-level HBV DNA replication in peripheral blood, although the other 12 had no DNA replication after prolonged antiviral therapy. CONCLUSIONS: This study suggested that various mutations in the "a" determinant were associated with HBIG resistance. Since treatment failure to rescue antiviral therapy was often associated with delayed detection of HBV recurrence rather than concurrent antiviral resistance, frequent HBV surveillance using more sensitive screening tests, such as HBeAg and HBV DNA polymerase chain reaction assay, seems to be mandatory.

Distinct features between longitudinally extensive transverse myelitis presenting with and without anti-aquaporin 4 antibodies.

OBJECTIVES: Longitudinally extensive transverse myelitis (LETM) with spinal cord lesions spanning three or more vertebral segments is a key feature of neuromyelitis optica (NMO). However, the role of anti-aquaporin 4 (anti-AQP4) antibody, a sensitive biomarker of NMO, in the conversion of LETM to NMO remains uncertain. METHODS: Thirty first-ever LETM patients were retrospectively analysed and divided into two groups according to the presence of anti-AQP4 antibodies. RESULTS: Eighteen (60%) patients presented with anti-AQP4 antibodies. Fifteen (83.33%) anti-AQP4 (+) LETM patients converted to NMO, while only three of 12 (25%, p = 0.002) anti-AQP4 (-) LETM patients progressed to NMO, over a mean follow-up period of 5.63 years. Seven (38.89%) anti-AQP4 (+) and one (8.33%) anti-AQP4 (-) LETM patients received interferon-ß1a treatment, respectively. Anti-AQP4 (+) LETM patients demonstrated a higher immunogamma globulin (IgG) index (0.68 ± 0.43 versus 0.47 ± 0.19, p = 0.018), annual relapse rate (0.72 ± 0.31 versus 0.42 ± 0.17, p = 0.01) and Kurtzke Expanded Disability Status Scale (4.28 ± 2.22 versus 2.67 ± 2.26, p = 0.031), than anti-AQP4 (-) LETM patients. In spinal magnetic resonance imaging (MRIs), more than half (58.33%) of the anti-AQP4 (+) LETM patients were observed to have central grey matter-predominant involvement in the axial view, while peripheral white matter-predominant involvement (51.85%) was the most common pattern observed in the anti-AQP4 (-) LETM patients. CONCLUSION: Anti-AQP4 (+) LETM demonstrated a high conversion rate to NMO (83.33%), suggesting that anti-AQP4 (+) LETM may represent an early, isolated syndrome of NMO spectrum disorder. The greater number of patients receiving interferon-ß treatment in anti-AQP4 (+) LETM may contribute to its high annual relapse rate.

ATXN8 -62 G/A promoter polymorphism and risk of Taiwanese Parkinson's disease.

BACKGROUND AND PURPOSE: We recently reported a novel -62 G/A polymorphism within ataxin 8 (ATXN8) gene promoter region, with -62 G displaying significantly higher luciferase activity compared with -62 A. Phenotypic variability in spinocerebellar ataxia type 8 (SCA8) has been suggested, and large SCA8 repeats were found in patients with Parkinson's disease (PD). We aimed to investigate the association of ATXN8 -62 G/A polymorphism with the risk of Taiwanese PD, and identify the trans-acting factor modulating the ATXN8 promoter activity. METHODS: A case-control study in a cohort of 569 PD cases and 547 ethnically matched controls was conducted by polymerase chain reaction (PCR) and restriction enzyme analysis. The trans-acting factor binding to the ATXN8 promoter was examined by chromatin immunoprecipitation (ChIP)-PCR assay, cDNA co-transfection and luciferase reporter assay. RESULTS: When genotype distribution was calculated by comparing the rare AA genotype with the GG + GA genotypes (recessive model), a significant difference was found (P = 0.035, 1 df). Individuals carrying AA genotype exhibited a decreased risk of developing PD (odds ratio: 0.73; 95% CI: 0.55-0.98, P = 0.035). After stratification by age, individuals over 60 years of age carrying AA genotype demonstrated a further decrease in the risk of developing PD (odds ratio: 0.64; 95% CI: 0.43-0.96, P = 0.030). ChIP-PCR and cDNA over-expression revealed that CCAAT/enhancer-binding protein alpha binds to the ATXN8 proximal promoter to upregulate ATXN8 expression in neuroblastoma SK-N-SH cells. CONCLUSIONS: Our data suggest that ATXN8 -62 G/A polymorphism plays a role in Taiwanese PD susceptibility.

Awareness of memory impairment increases the adherence to immunosuppressants in kidney transplant recipients.

OBJECTIVES: Nonadherence to immunosuppressive drugs is a concern among kidney transplantation recipients (KTRs). The adverse effects of immunosuppressive drugs can trigger nonadherence and lead to a great impact on the allograft survival. The aim of this prospective controlled study is to determine the major adverse effects of immunosuppressive drugs and their correlation with the nonadherence in kidney transplantation recipients. METHODS: All data were collected from medical and pharmacy records. We use modified Immunosuppressant Therapy Adherence Scale combined with Modified Transplant Symptom Occurrence and Symptom Distress scale to explore the relationship between symptom experience related to side effects of immunosuppressants and adherence. The risk of nonadherence was estimated by stepwise logistic regression while controlling for age, gender, education, and immunosuppressive medications. Multivariable analysis was performed using a single random effect of P < .2. RESULTS: In total, 412 KTRs completed the structured self-report instrument. The weekly pill counts were 84.2 ± 39.8. Overall, 21.4% of patients were nonadherent to immunosuppressive drugs. The most common adverse effects of immunosuppressive drugs were memory impairment (28.4%), insomnia (26.0%), gastrointestinal discomfort (21.4%), easy fatigue (22.1%), hand tremor (23.8%), and vision variation (29.1%). Multivariate analysis revealed that the adherence increased in patients with awareness of memory impairment (odds ratio 2.320, 95% confidence interval: 1.259-4.274, P = .007). There was no significant difference in the incidence of acute rejection, gender, age, and education between adherent and nonadherent patients. CONCLUSION: In summary, these results indicate a significant prevalence of nonadherence to immunosuppressive drugs in kidney transplantation recipients. Awareness of memory impairment significantly affected adherence to immunosuppressive drugs.

Presence of baseline prehypertension and risk of incident stroke: a meta-analysis.

OBJECTIVE: To qualitatively and quantitatively assess the association of prehypertension with incident stroke through a meta-analysis of prospective cohort studies. METHODS: We searched Medline, Embase, the Cochrane Library, and bibliographies of retrieved articles. Prospective cohort studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95%confidence intervals (CI) of stroke with respect to baseline prehypertension. RESULTS: Twelve studies with 518,520 participants were included. Prehypertension was associated with risk of stroke (RR 1.55, 95% CI 1.35-1.79; p < 0.001). Seven studies further distinguished a low prehypertensive population (systolic blood pressure [SBP] 120-129 mm Hg or diastolic blood pressure [DBP] 80-84 mm Hg) and a high prehypertensive population (SBP 130-139 mm Hg or DBP 85-89 mm Hg). Among persons with lower-range prehypertension, stroke risk was not significantly increased (RR 1.22, 0.95-1.57). However, for persons with higher values within the prehypertensive range, stroke risk was substantially increased (RR 1.79, 95% CI 1.49-2.16). CONCLUSIONS: Prehypertension is associated with a higher risk of incident stroke. This risk is largely driven by higher values within the prehypertensive range and is especially relevant in nonelderly persons. Randomized trials to evaluate the efficacy of blood pressure reduction in persons with this designation are warranted.

Patterns of accentuated grey-white differentiation on diffusion-weighted imaging or the apparent diffusion coefficient maps in comatose survivors after global brain injury.

AIM: To determine what disease entities show accentuated grey-white differentiation of the cerebral hemisphere on diffusion-weighted images (DWI) or apparent diffusion coefficient (ADC) maps, and whether there is a correlation between the different patterns and the cause of the brain injury. METHODS AND MATERIALS: The DWI and ADC maps of 19 patients with global brain injury were reviewed and evaluated to investigate whether there was a correlation between the different patterns seen on the DWI and ADC maps and the cause of global brain injury. The ADC values were measured for quantitative analysis. RESULTS: There were three different patterns of ADC decrease: a predominant ADC decrease in only the cerebral cortex (n=8; pattern I); an ADC decrease in both the cerebral cortex and white matter (WM) and a predominant decrease in the WM (n=9; pattern II); and a predominant ADC decrease in only the WM (n=3; pattern III). CONCLUSION: Pattern I is cerebral cortical injury, suggesting cortical laminar necrosis in hypoxic brain injury. Pattern II is cerebral cortical and WM injury, frequently seen in brain death, while pattern 3 is mainly WM injury, especially found in hypoglycaemic brain injury. It is likely that pattern I is decorticate injury and pattern II is decerebrate injury in hypoxic ischaemic encephalopathy.Patterns I and II are found in severe hypoxic brain injury, and pattern II is frequently shown in brain death, whereas pattern III was found in severe hypoglycaemic injury.

Femoral neck bone mineral density in ambulatory men with poliomyelitis.

UNLABELLED: We evaluated bilateral femoral neck bone mineral densities (FNBMDs) in 32 men with poliomyelitis and their matched controls. Men with poliomyelitis had significantly lower FNBMD in both legs, and FNBMD was lowest in their shorter legs. Knee extensor strength and regular exercise were important predictive factors associated with decreased FNBMD. INTRODUCTION: People with poliomyelitis (polio) are prone to leg fractures after mild trauma. The flaccid paralysis, asymmetric involvement, and underdeveloped growth of afflicted legs may lead to osteoporosis of either leg, characterized by different patterns. This study aimed to measure their femoral FNBMD and to explore the factors associated with changes in FNBMD in either leg. METHODS: We did a prospective study to evaluate bilateral FNBMD with dual-energy X-ray absorptiometry in 32 men with polio (age range, 41-57 years; mean, 47 years) and 32 age- and body mass index-matched controls. Measuring the difference in leg length, we classified the legs of each polio subject as "longer" or "shorter." In addition, we chose the right leg of each control as a reference leg. We then used the Mann-Whitney U test to compare FNBMD of these three groups of legs and searched for the factors associated with FNBMD using stepwise multiple regression analyses. RESULTS: Compared to the reference leg, men with polio had significantly lower FNBMD in both their longer and shorter legs, by 13% and 23%, respectively. The difference in FNBMD between the two legs of polio subjects was significant. Knee extensor strength and regular exercise were two important factors associated with bilateral FNBMD in men with polio. CONCLUSIONS: Men with polio had lower bilateral FNBMD. FNBMD of the shorter leg should be the choice for predicting the risk of hip fracture in men with polio because on average, the shorter leg has lower BMD.

Relationship between radiological characteristics and combined 1p and 19q deletion in World Health Organization grade III oligodendroglial tumours.

OBJECTIVE: The radiological characteristics of World Health Organization grade III oligodendroglial tumours in relation to chromosome 1p and 19q deletions were analysed. METHODS: 56 patients recently diagnosed with anaplastic oligodendroglioma (AO, n=49) or anaplastic oligoastrocytoma (AOA, n=7) were studied. Their preoperative magnetic resonance images were examined. Deletions of chromosome 1p and 19q were determined using the fluorescence in situ hybridisation method. Both 1p and 19q chromosomes had deletions (1p19q codeletion) in 39 patients (36 AO and 3 AOA). RESULTS: Tumors associated with the 1p19q codeletion were predominantly located in the frontal lobe (p=0.044). The magnetic resonance image characteristics of indistinct tumour borders (p=0.005 on T1, p=0.036 on T2) and a heterogeneous intratumoural signal intensity (p=0.033 on T1, p=0.041 on T2) were significantly correlated with the 1p19q codeletion. Analysis of patient survival showed those with the 1p19q-co-deleted tumours survived significantly longer than those lacking the 1p19q codeletion (p=0.042). The presence of a heterogeneous signal intensity in T2-weighted images, a characteristic significantly related to the 1p19q codeletion, indicated a favourable prognosis for patients' survival (HR; 0.125, 95% CI, 0.016 to 0.963, p=0.046) based on multivariate analysis. CONCLUSION: A relationship between radiological characteristics and molecular signatures in AO/AOAs was shown. It is believed that radiological characteristics have prognostic value as a surrogate marker for molecular characteristics.

A rare case of Amyand's hernia presenting as an enterocutaneous fistula.

The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1%. The condition is given the eponymous name Amyand's hernia. However in just 0.08% the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix and is most often misdiagnosed as an incarcerated inguinal hernia. As such it is rarely recognised prior to surgical exploration. We report a case of Amyand's hernia in an 85 year old woman, which presented as a right groin enterocutaneous fistula. CT scanning illustrated a fistulous tract in the right groin, which communicated with the caecum and the peritoneal cavity. She underwent laparotomy, which revealed that the appendix appeared inflamed, lay in the inguinal canal and was the origin of the enterocutaneous communication.

Temporal features of magnetic resonance imaging and spectroscopy in non-ketotic hyperglycemic chorea-ballism patients.

BACKGROUND: Non-ketotic hyperglycemic chorea-ballism (NKHCB) had special reversible hyperintense on T1-weighted imaging (T1WI) lesion in comparsion to gray matter. However, the mechanism accounts for these lesions is still unclear. METHODS: Patients diagnosed with NKHCB were recruited from 2002 to 2004. The demographic, clinical, magnetic resonance imaging (MRI), and spectroscopy (MRS) features were recorded at acute and remission phase. RESULTS: In 18 patients with NKHCB, the blood sugar level at onset was significantly higher than that after being free from chorea-ballism (419.50 +/- 257.33 vs. 198.22 +/- 53.97 mg/dl, P = 0.001). The serum osmolality dropped from 318.33 +/- 15.21 mOsm/kg at onset to 292.50 +/- 7.85 mOsm/kg after recovery (P < 0.001). All patients displayed T1 hyperintense lesions at contralateral basal ganglia at acute phase. Eight patients receiving follow-up MRI at remission phase, all T1 hyperintense lesions at the basal ganglia regressed. The ratios between choline-containing compounds and creatine at acute and remission phases were significant higher in lesion than in normal side, respectively (acute phase: 1.12 +/- 0.23 vs. 0.72 +/- 0.28, P = 0.038; remission phase: 1.23 +/- 0.47 vs. 0.68 +/- 0.15, P = 0.013). The lactate peaks present at 1.3 ppm on the lesion side either in acute or in remission phase of most case. CONCLUSIONS: The clinical, MRI, and MRS findings suggest that the mechanisms responsible for NKHCB may be a reversible ischaemia insult potentiated by hyperglycemia.