Comparative analysis of image quality and interchangeability between standard and deep learning-reconstructed T2-weighted spine MRI.

RATIONALE AND OBJECTIVES: MRI reconstruction of undersampled data using a deep learning (DL) network has been recently performed as part of accelerated imaging. Herein, we compared DL-reconstructed T2-weighted image (T2-WI) to conventional T2-WI regarding image quality and degenerative lesion detection. MATERIALS AND METHODS: Sixty-two patients underwent C-spine (n = 27) or L-spine (n = 35) MRIs, including conventional and DL-reconstructed T2-WI. Image quality was assessed with non-uniformity measurement and 4-scale grading of structural visibility. Three readers (R1, R2, R3) independently assessed the presence and types of degenerative lesions. Student t-test was used to compare non-uniformity measurements. Interprotocol and interobserver agreement of structural visibility was analyzed with Wilcoxon signed-rank test and weighted-κ values, respectively. The diagnostic equivalence of degenerative lesion detection between two protocols was assessed with interchangeability test. RESULTS: The acquisition time of DL-reconstructed images was reduced to about 21-58% compared to conventional images. Non-uniformity measurement was insignificantly different between the two images (p-value = 0.17). All readers rated DL-reconstructed images as showing the same or superior structural visibility compared to conventional images. Significantly improved visibility was observed at disk margin of C-spine (R1, p < 0.001; R2, p = 0.04) and dorsal root ganglia (R1, p = 0.03; R3, p = 0.02) and facet joint (R1, p = 0.04; R2, p < 0.001; R3, p = 0.03) of L-spine. Interobserver agreements of image quality were variable in each structure. Clinical interchangeability between two protocols for degenerative lesion detection was verified showing <5% in the upper bounds of 95% confidence intervals of agreement rate differences. CONCLUSIONS: DL-reconstructed T2-WI demonstrates comparable image quality and diagnostic performance with conventional T2-WI in spine imaging, with reduced acquisition time.

Ultrasound in Hepatic Veno-occlusive Disease (HVOD) after Pediatric Hematopoietic Stem Cell Transplantation (HSCT): Comparison of Diagnostic Criteria Including the Pediatric Criteria of European Society for Blood and Marrow Transplantation (EBMT).

The European Society for Blood and Marrow Transplantation (EBMT) has recently announced new diagnostic criteria for pediatric hepatic veno-occlusive disease (HVOD) after hematopoietic stem cell transplantation (HSCT). We retrospectively inspected 97 ultrasound exams of 60 pediatric HSCT patients, and compared its diagnostic value using the Baltimore, Seattle and pediatric EBMT criteria. Nine of the ten patients who were diagnosed as HVOD only in the EBMT criteria had severe or very severe HVOD. In the Seattle and EBMT criteria, portal vein velocity, peak systolic velocity and resistance index of hepatic artery, gallbladder wall thickening and ascites were statistically significant. No ultrasound variable showed significant association in the Baltimore criteria. All patients with portal vein velocity below 10 cm/s were in higher EBMT grade. A scoring system was developed, to evaluate the overall relationship of the ultrasound findings with the diagnosis of HVOD, showing fair (0.768 and 0.733) AUC in the ROC curve of EBMT and Seattle criteria.

Comparison of patient perceptions of primary care quality across healthcare facilities in Korea: A cross-sectional study.

Primary care is not well established in Korea despite its importance in population health. To reinforce the primary care system, understanding the public view of primary care will be essential. We aimed to compare the public perception of primary care qualities across types of healthcare facilities. We conducted a cross-sectional, web-based survey at a university in Seoul, South Korea, from October 2018 to February 2019. Using the Korean Primary Care Assessment Tool (K-PCAT), participants assessed the qualities of primary care services provided by the university health service (a university-based, patient-centered primary care model), community clinics, and hospitals. We compared K-PCAT scores across facilities and evaluated the factors associated with the differences using general linear models. A total of 5,748 responses were analyzed. K-PCAT total scores were highest for the university health service (61.0 ± 15.9) and lowest for hospitals (48.1 ± 14.5), with significant differences between facilities (P < .001). The university health service received the highest scores for first contact, comprehensiveness, personalized care, and family/community orientation; community clinics for continuity of care; and hospitals for care coordination and trust/satisfaction. Primary care facilities were rated higher than hospitals by individuals in good health, with low income levels, using ambulatory care more frequently, and spending less on medical expenses. In conclusion, the user-perceived primary care quality was higher for community-based primary care facilities than hospitals. The highest score was for the university health service, suggesting that setting-based, patient-centered primary care would be an effective model for restructuring the primary care system in Korea.

CORRELATION BETWEEN MACULAR MICROSTRUCTURES AND ANISEIKONIA AFTER IDIOPATHIC EPIRETINAL MEMBRANE REMOVAL.

PURPOSE: To analyze the correlation between preoperative measurements of macular microstructures and aniseikonia after epiretinal membrane removal. METHODS: This retrospective study included 32 eyes of 32 patients who underwent epiretinal membrane surgery and were followed up for 12 months. Spectral-domain optical coherence tomography was used to measure the thicknesses of the ganglion cell layer-inner plexiform layer, inner nuclear layer (INL), and outer retinal layer in macular microstructures. The new aniseikonia test was used to measure vertical and horizontal aniseikonia scores. RESULTS: There was a significant decrease in central macular thickness and ganglion cell layer-inner plexiform layer thickness at 6 and 12 months postoperatively (all P < 0.001). Vertical aniseikonia scores, horizontal aniseikonia scores, and INL and outer retinal layer thicknesses did not show significant changes. Vertical aniseikonia scores and horizontal aniseikonia scores were significantly associated with INL thicknesses of each meridian at each follow-up time point (all P < 0.05). Preoperative vertical and horizontal INL thicknesses were correlated with vertical aniseikonia scores and horizontal aniseikonia scores at 12 months postoperatively (P = 0.014 and P = 0.002, respectively). CONCLUSION: Aniseikonia values did not change after epiretinal membrane removal and were associated with INL thickness before and after surgery. Thus, preoperative INL thickness could be used as a predictor of surgical prognosis in epiretinal membrane patients.

PREDICTION OF MORPHOLOGIC DETERIORATION IN PATIENTS WITH LAMELLAR MACULAR HOLES.

PURPOSE: To analyze the morphologic evolution of idiopathic lamellar macular holes (LMHs) as determined by spectral domain optical coherence tomography, and evaluate the utility of retinal function assessments through multifocal electroretinography for predicting the likelihood of morphologic deterioration in LMHs. METHODS: Twenty-eight eyes of 28 patients with LMHs were examined by spectral domain optical coherence tomography at the initial visit and after 12 months. Lamellar macular holes were subdivided into morphologic deterioration (DET) and morphologic maintenance (MAI) groups based on the change in central retinal thickness during the follow-up period. Patients with LMHs were also examined by multifocal electroretinography at the initial visit. Multifocal electroretinography amplitudes were compared between DET and MAI groups, and discriminant function was calculated to predict morphologic deterioration in LMH eyes. RESULTS: During the follow-up period, morphologic deterioration was found in 8 (28.6%) of LMH cases. On multifocal electroretinography, amplitudes in the central ring (R1) and first paracentral ring (R2) were significantly lower in the DET than in the MAI group. Discriminant analysis performed on these two variables yielded a discriminant function with 75% of cases classified correctly. CONCLUSION: Multifocal electroretinography is a useful tool for predicting morphologic deterioration of LMHs. Lower multifocal electroretinography amplitudes in R1 and R2 predict an increased risk of subsequent deterioration.

Relationship Between Vertical and Horizontal Aniseikonia Scores and Vertical and Horizontal OCT Images in Idiopathic Epiretinal Membrane.

PURPOSE: The purpose of this study was to identify the relationship between aniseikonia scores in the vertical and horizontal meridians and the foveal microstructure on vertical and horizontal spectral-domain optical coherence tomography (SD-OCT) in patients with idiopathic epiretinal membrane (ERM). METHODS: All patients (n = 65) with unilateral ERM were examined, and the aniseikonia scores in the vertical (VAS) and horizontal (HAS) meridians were determined using the New Aniseikonia Test. Vertical and horizontal images passing through the fovea were obtained by axial SD-OCT in both eyes. The thicknesses of the ganglion cell layer + inner plexiform layer, inner nuclear layer (INL), and outer retinal layer were measured on the SD-OCT images, and color histograms were analyzed using Photoshop software. RESULTS: Of the 65 ERM patients, 81.5% (53 patients) had macropsia. The VAS and HAS were equal in 52.8% (28 patients). Multiple regression analysis revealed significant correlations between the VAS and vertical INL thickness (R = 0.388, P = 0.001) and between the HAS and horizontal INL thickness (R = 0.349, P = 0.001). The difference between VAS and HAS was proportional to the ratio of the vertical INL thickness to horizontal INL thicknesses (R = 0.370, P < 0.001). CONCLUSIONS: Eyes with ERM mostly presented macropsia. The aniseikonia scores in the vertical and horizontal meridians correlate well with INL thickness on the vertical and horizontal directions of SD-OCT images, respectively. Aniseikonia induced by ERM may be related to the INL thickening detected with SD-OCT.

Pellino 1 promotes lymphomagenesis by deregulating BCL6 polyubiquitination.

The signal-responsive E3 ubiquitin ligase pellino 1 (PELI1) regulates TLR and T cell receptor (TCR) signaling and contributes to the maintenance of autoimmunity; however, little is known about the consequence of mutations that result in upregulation of PELI1. Here, we developed transgenic mice that constitutively express human PELI1 and determined that these mice have a shorter lifespan due to tumor formation. Constitutive expression of PELI1 resulted in ligand-independent hyperactivation of B cells and facilitated the development of a wide range of lymphoid tumors, with prominent B cell infiltration observed across multiple organs. PELI1 directly interacted with the oncoprotein B cell chronic lymphocytic leukemia (BCL6) and induced lysine 63-mediated BCL6 polyubiquitination. In samples from patients with diffuse large B cell lymphomas (DLBCLs), PELI1 expression levels positively correlated with BCL6 expression, and PELI1 overexpression was closely associated with poor prognosis in DLBCLs. Together, these results suggest that increased PELI1 expression and subsequent induction of BCL6 promotes lymphomagenesis and that this pathway may be a potential target for therapeutic strategies to treat B cell lymphomas.

Efficacy of intravitreal anti-vascular endothelial growth factor or steroid injection in diabetic macular edema according to fluid turbidity in optical coherence tomography.

PURPOSE: To determine if short term effects of intravitreal anti-vascular endothelial growth factor or steroid injection are correlated with fluid turbidity, as detected by spectral domain optical coherence tomography (SD-OCT) in diabetic macular edema (DME) patients. METHODS: A total of 583 medical records were reviewed and 104 cases were enrolled. Sixty eyes received a single intravitreal bevacizumab injection (IVB) on the first attack of DME and 44 eyes received triamcinolone acetonide treatment (IVTA). Intraretinal fluid turbidity in DME patients was estimated with initial intravitreal SD-OCT and analyzed with color histograms from a Photoshop program. Central macular thickness and visual acuity using a logarithm from the minimum angle of resolution chart, were assessed at the initial period and 2 months after injections. RESULTS: Visual acuity and central macular thickness improved after injections in both groups. In the IVB group, visual acuity and central macular thickness changed less as the intraretinal fluid became more turbid. In the IVTA group, visual acuity underwent less change while central macular thickness had a greater reduction (r = -0.675, p = 0.001) as the intraretinal fluid was more turbid. CONCLUSIONS: IVB and IVTA injections were effective in reducing central macular thickness and improving visual acuity in DME patients. Further, fluid turbidity, which was detected by SD-OCT may be one of the indexes that highlight the influence of the steroid-dependent pathogenetic mechanism.

[A case of bacteremia by Atopobium rimae in a patient with liver cirrhosis].

Atopobium rimae, previously Lactobacillus rimae, is a strictly anaerobic, non-spore forming grampositive rod which was frequently isolated from odontogenic infection. We report a case of A. rimae bacteremia. A 47-yr-old man with liver cirrhosis was admitted to the hospital via emergency room due to fever and chill. His abdominal and pelvic computed tomography revealed a small abscess near the left adrenal gland. Three sets of blood cultures were taken and non-spore forming, grampositive rods were detected in all anaerobic vials. This isolate grew small nonhemolytic, gray-white translucent colonies on Brucella blood agar and was obligatory anaerobic on air-tolerance test. This organism was negative for catalase, indole, nitrate-reduction and beta-lactamase and failed to identify by Vitek ANI card (bioMerieux, France). 16S rRNA sequences of this showed 99.8% homology of the published sequence of A. rimae (GenBank accession number AF292371). Aspirates of periadrenal abscess grew Escherichia coli and Peptostreptococcus micros. He was treated with metronidazole and imipenem and follow-up cultures of blood were negative at days 4 and 10. To our knowledge, this is the first report of bacteremia of A. rimae.

Helicobacter pylori infection activates NF-kappaB signaling pathway to induce iNOS and protect human gastric epithelial cells from apoptosis.

Helicobacter pylori infection induces apoptosis and inducible nitric oxide synthase (iNOS) expression in gastric epithelial cells. In this study, we investigated the effects of NF-kappaB activation and iNOS expression on apoptosis in H. pylori-infected gastric epithelial cells. The suppression of NF-kappaB significantly increased caspase-3 activity and apoptosis in H. pylori-infected MKN-45 and Hs746T gastric epithelial cell lines as well as primary gastric epithelial cells. An NF-kappaB signaling pathway via NF-kappaB-inducing kinase and IkappaB kinase-beta activation was found to be involved in the inhibition of apoptosis in H. pylori-infected gastric epithelial cells. In gastric epithelial cells transfected with retrovirus containing IkappaBalpha superrepressor, iNOS mRNA and protein levels were reduced, indicating that H. pylori infection induced the expression of iNOS by activating NF-kappaB. Moreover, a NO donor, S-nitroso-N-acetylpenicillamine (100 microM), decreased caspase-3 activity and apoptosis in NF-kappaB-suppressed cells infected with H. pylori. These results suggest that NF-kappaB activation may play a role in protecting gastric epithelial cells from H. pylori-induced apoptosis by upregulating endogenous iNOS.

Brain tumor invasion model system using organotypic brain-slice culture as an alternative to in vivo model.

PURPOSE: The primary cause of local recurrence and therapeutic failure in the treatment of malignant gliomas is the invasion of tumor cells into the surrounding normal brain. While it is known that malignant gliomas infiltrate diffusely into regions of normal brain, it is frequently very difficult to unequivocally identify the solitary invading glioma cell in histopathological preparations, or in experimental glioma models. We have developed an experimental invasion assay system, which allows us to track the solitary invasive glioma cell, using human brain tissue obtained from routine craniotomies for seizures or trauma. METHODS: This tissue is cut into 1-mm thick slices and cultured in the upper chamber of Transwell culture dishes on top of a 0.4- micro m pore size polyester membrane, which is fed on medium provided in the lower chamber. Glioma cells are stably transfected with vectors containing a green fluorescent protein (GFP) cDNA. Stable, high-level expression GFP transfectants were selected by direct visualization under fluorescence microscope. In addition, various tumor spheroids are stained with vital dye, DiI, to track the invading cells. GFP-expressing glioma cells or stained spheroids were then implanted on the center of the brain slice, and the degree of brain tumor invasion into the brain tissue was evaluated at different time points by optical sectioning using a confocal microscope. RESULTS: We observed that GFP-expressing glioma cells or stained spheroids could be readily tracked and followed with this model system. Individual tumor cells that exhibited green or red fluorescence could be identified and their migration path through the brain slices unequivocally followed. CONCLUSION: This experimental invasion system may be of considerable utility in studying the process of brain tumor invasion and in evaluating its invasiveness in individual brain tumor because it not only provides a better representation of extracellular matrix molecules normally encountered by invading glioma cells, but also provides the fluorescent tag applied to the tumor cells.