Three-dimensional susceptibility-weighted imaging at 7 T using fractal-based quantitative analysis to grade gliomas

Introduction

Susceptibility-weighted imaging (SWI) with high- and ultra-high-field magnetic resonance is a very helpful tool for evaluating brain gliomas and intratumoral structures, including microvasculature. Here, we test whether objective quantification of intratumoral SWI patterns by applying fractal analysis can offer reliable indexes capable of differentiating glial tumor grades.

Methods

Thirty-six patients affected by brain gliomas (grades II–IV, according to the WHO classification system) underwent MRI at 7 T using a SWI protocol. All images were collected and analyzed by applying a computer-aided fractal image analysis, which applies the fractal dimension as a measure of geometrical complexity of intratumoral SWI patterns. The results were subsequently statistically correlated to the histopathological tumor grade.

Results

The mean value of the fractal dimension of the intratumoral SWI patterns was 2.086?±?0.413. We found a trend of higher fractal dimension values in groups of higher histologic grade. The values ranged from a mean value of 1.682?±?0.278 for grade II gliomas to 2.247?±?0.358 for grade IV gliomas (p?=?0.013); there was an overall statistically significant difference between histopathological groups.

Conclusion

The present study confirms that SWI at 7 T is a useful method for detecting intratumoral vascular architecture of brain gliomas and that SWI pattern quantification by means of fractal dimension offers a potential objective morphometric image biomarker of tumor grade.     

European School of Internal Medicine (ESIM) in Brighton: experiences and reflections

The European School of Internal Medicine (ESIM) is a meeting aimed at young physicians training in internal medicine throughout Europe. Since 1998 the school has been held annually, and in this report we reflect on our experiences during the recent school in Brighton in July 2010. The school combined a broad mix of lectures, workshops and case presentations covering a variety of rare diseases, and both faculty and residents participated with noticeable enthusiasm, making this a special experience for all of us. The school also provided an opportunity to compare and discuss topical professional issues in internal medicine in Europe and was a memorable social gathering for physicians who share a strong interest in internal medicine.     

Prenatal cases with rare RIT1 variants causing severe fetal hydrops and death

We describe two clinical prenatal cases with rare de novo RIT1 variants, which showed more severe clinical manifestations than other Noonan Syndrome genotypes, resulting in fetal death. Extra attention is recommended when these variants are detected.     

Gastrectomy impact on the gut microbiome in patients with gastric cancer: A comprehensive review

Gastric cancer is one of the most common malignancies worldwide and gastrectomy remains the only potentially curative treatment option for this disease. However, the surgery leads to significant physiological and anatomical changes in the gastrointestinal (GI) tract including loss of the gastric barrier, an increase in oxygenation levels in the distal gut, and biliary diversion after gastrectomy. These changes in the GI tract influence the composition of the gut microbiome and thus, host health. Gastrectomy-induced dysbiosis is characterized by increased abundance of typical oral cavity bacteria, an increase in aero-tolerant bacteria (aerobes/facultative anaerobes), and increased abundance of bile acid-transforming bacteria. Furthermore, this dysbiosis is linked to intestinal inflammation, small intestinal bacterial overgrowth, various GI symptoms, and an increased risk of colorectal cancer.     

Association between anthropometric indexes and cardiovascular risk factors

The aim of this study was to assess the associations of the body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with ischemic heart disease (IHD) and risk factors of IHD in the Lithuanian population aged 25 to 70 years. The cross-sectional health survey was carried out in Kaunas, which is the second largest city in Lithuania, and in five regions randomly selected from the northern, southern, eastern, western and central parts of Lithuania. Data from 2048 subjects (936 men and 1112 women) were analyzed. In both sexes, the odds ratios for reduced high density lipoprotein cholesterol, elevated triglycerides, high fasting blood glucose, and hypertension rose with an increasing quartile of BMI, WC, and WHtR. The likelihood of having IHD was statistically significantly higher in the fourth quartile of these anthropometric measures when compared to the first one. Comparison of the logistic regression models revealed that the models with WHtR best fit the prediction of IHD risk. Compared with BMI and WC, WHtR showed a stronger association with IHD and its risk factors in the Lithuanian adult population.