Influence of different frequencies and insertion depths on the diagnostic accuracy of liver elastography by acoustic radiation force impulse imaging (ARFI)

Background

Acoustic Radiation Force Impulse Imaging (ARFI) is an innovative elastography for staging of liver fibrosis. We evaluated the diagnostic accuracy of different probes to perform ARFI at different insertion depths.

Methods

In a prospective study, 89 chronic HCV infected patients underwent ARFI elastography using both available probes (c-ARFI: C4-1-MHz; l-ARFI: L9-4 MHz) in comparison to Fibroscan^®. Variability of ARFI elastography at different insertion depths was systematically evaluated in 39 patients (44%). According to Fibroscan^® elastography, 32 patients (36%) presented with liver cirrhosis, 23 patients (26%) had significant fibrosis and 34 patients (38%) had no significant fibrosis.

Results

Mean propagation velocity with c-ARFI was 1.70 ± 0.67 m/s and 1.91 ± 0.87 m/s with l-ARFI. Results of both probes were correlated to each other (p < 0.001; r = 0.70) and to Fibroscan^® (p < 0.001, r = 0.82 and 0.84, respectively). In patients with significant fibrosis or with cirrhosis, mean values by l-ARFI were significantly higher than by c-ARFI (p < 0.001). For detection of liver cirrhosis, AUROC was 0.97 for c-ARFI (cut-off level 1.72 m/s) and 0.90 for l-ARFI (cut-off 2.04 m/s). Correlation coefficients of c-ARFI with Fibroscan^® were highest at an insertion depth of 5–6 cm (r = 0.882 and 0.864, respectively, p < 0.001) and at 3–4 cm for l-ARFI (r = 0.850 and 0.838, respectively, p < 0.001).

Conclusions

ARFI elastography with the linear and with the convex probes showed comparable validity and accuracy in the estimation of liver stiffness. The linear probe gave higher ARFI values. The most accurate insertion depth was 5–6 cm for c-ARFI and 3–4 cm for l-ARFI indicating that measurements should not be performed close to the liver capsule.     

Carpal bone postures and motions are abnormal in both wrists of patients with unilateral scapholunate interosseous ligament tears

PURPOSE: The recent ability to measure 3-dimensional in vivo carpal kinematics has facilitated the noninvasive study of complex carpal bone motion. METHODS: In this study we examined the flexion/extension carpal kinematics of both wrists in 8 patients with unilateral scapholunate interosseous ligament (SLIL) tears by using computed tomographic (CT) imaging and a markerless bone registration technique. Carpal bone neutral posture and flexion/extension motion of both wrists of the injured patients were compared with the same parameters in wrists of 10 uninjured male and female volunteers (normals). RESULTS: The neutral posture of the injured scaphoid and lunate were significantly more extended than those of normals. In these patients, however, the postures of the scaphoid and lunate in the contralateral uninjured wrists also were abnormal and were similar to those of the injured wrist. In addition, extension of the lunate and flexion of the scaphoid in both the injured and uninjured wrist were significantly different from normal but not different from each other. CONCLUSIONS: This study was unable to attribute altered carpal posture and motion to SLIL tears because abnormalities were found in both wrists of patients with unilateral injury. The etiology of abnormal wrist kinematics in the asymptomatic wrist of patients with unilateral tears of the scapholunate ligament is not known.     

产后阴道炎应用妇肤康喷雾剂治疗效果观察

目的：探讨妇肤康喷雾剂在产后阴道炎治疗中的应用效果。方法选择2012年7月至2013年6月该院80例产后阴道炎患者作为研究对象。对照组患者采用甲硝唑栓治疗,试验组患者采用妇肤康喷雾剂治疗。比较两组患者在治疗效果和不良反应方面的差异性。结果与对照组比较,试验组总有效率明显较高,不良反应发生率明显较低,组间比较差异有统计学意义（P＜0．05）。结论妇肤康喷雾剂在产后阴道炎治疗中具有良好的应用效果,疗效确切、不良反应小,值得临床推广应用。     

Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid

Background A fine needle aspiration (FNA) diagnosis of a Hürthle cell neoplasm is associated with a 20% risk of malignancy. We sought to determine if the primary tumor size correlated with the risk of malignancy in patients with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Methods Between January 2000 and November 2006, 57 patients underwent a thyroidectomy with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Patient histories, FNA reports, operative notes, and pathology reports were retrospectively reviewed. Statistical analysis was performed. Results The overall rate of malignancy in patients with Hürthle cell neoplasms was 21%. The average tumor size was 3.2 cm, with malignant tumors being significantly larger than benign tumors (5.0 vs. 2.7 cm, p < 0.01). The risk of malignancy directly correlated with tumor size. No malignancies were seen in tumors 2 cm or smaller (0/15). The risk of malignancy was only 13% (6/46) in tumors 4 cm or smaller and increased to 55% (6/11) in tumors larger than 4 cm. All tumors larger than 6 cm were malignant (4/4). Conclusions Tumor size correlates directly with malignant potential in patients with Hürthle cell neoplasms of the thyroid. Among our patients, malignancy was not present in any tumors 2 cm or smaller and was present in all tumors larger than 6 cm. Because the risk of malignancy is greater than 50% in patients with a tumor larger than 4 cm, consideration should be given for an initial total thyroidectomy in these patients. This work was supported in part by Friends of Endocrinology, The Gerald Heller Family Foundation, The Helen and Sanford Diller Foundation, and the Bell Charitable Trust.     

Enhanced inflammatory hyperalgesia after recovery from burn injury

Severe burn induces severe pain. While chronic as well as acute pain syndromes are reported, the peripheral mechanisms of burn-induced chronic pain syndromes have not been studied. We tested the hypothesis that burn induces plastic changes in primary afferent nociceptors that predispose to chronic pain states. Mechanical nociceptive thresholds were measured using the Randall–Selitto paw-withdrawal test in male Sprague-Dawley rats, before and following a small (<1% total body surface area) partial-thickness thermal injury to the dorsal surface of one hind paw. This burn induced mechanical hyperalgesia, which lasted over 2 weeks. After recovery, local injection of prostaglandin E2 (PGE₂), to mimic re-injury, induced an enhanced and markedly prolonged mechanical hyperalgesia compared to the hyperalgesic effect of PGE₂ in the control contralateral paw. This prolonged PGE₂-induced hyperalgesia was reversed by a selective inhibitor of protein kinase C-epsilon (PKC). Our findings suggest PKC as a peripheral mechanism for burn-induced chronic pain syndromes.     

The dystrophin gene and cognitive function in the general population

The aim of our study is to investigate whether single-nucleotide dystrophin gene (DMD) variants associate with variability in cognitive functions in healthy populations. The study included 1240 participants from the Erasmus Rucphen family (ERF) study and 1464 individuals from the Rotterdam Study (RS). The participants whose exomes were sequenced and who were assessed for various cognitive traits were included in the analysis. To determine the association between DMD variants and cognitive ability, linear (mixed) modeling with adjustment for age, sex and education was used. Moreover, Sequence Kernel Association Test (SKAT) was used to test the overall association of the rare genetic variants present in the DMD with cognitive traits. Although no DMD variant surpassed the prespecified significance threshold (P<1 × 10⁻⁴), rs147546024:A>G showed strong association (β=1.786, P-value=2.56 × 10⁻⁴) with block-design test in the ERF study, while another variant rs1800273:G>A showed suggestive association (β=−0.465, P-value=0.002) with Mini-Mental State Examination test in the RS. Both variants are highly conserved, although rs147546024:A>G is an intronic variant, whereas rs1800273:G>A is a missense variant in the DMD which has a predicted damaging effect on the protein. Further gene-based analysis of DMD revealed suggestive association (P-values=0.087 and 0.074) with general cognitive ability in both cohorts. In conclusion, both single variant and gene-based analyses suggest the existence of variants in the DMD which may affect cognitive functioning in the general populations.