Adenosine pharmacological stress is commonly used for the detection of ischemia by myocardial perfusion imaging (MPI) using radiotracers and gated single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. Recently, a phenomenon, splenic switch-off (SSO), has been observed where reduced perfusion to the spleen occurs after adenosine, suggesting an adequate effect of adenosine on the heart. The aim of the study is to evaluate the SSO effect in adenosine stress 99mTc tetrofosmin MPI studies using semiquantitative analysis of SPECT/CT data. Seventeen adenosine MPI studies were selected. Each study included stress and rest, which were reoriented in short, horizontal, and vertical long axes. Also, data were reconstructed in the body transaxial, coronal, and sagittal planes. In the resulting images, the spleen was identified on the CT component, and regions of interest were drawn on the spleen, thoracic vertebra, and myocardium. The ratios spleen/vertebra (S/VAd and S/VRst) and myocardium/vertebra (M and M/t) were calculated. Statistical analysis was done using a paired t test. Mean age was 60.35 years, with 9 males (53%). Mean S/VAd was 0.98 ± 0.38 and S/VRst 1.87 ± 0.87 (t = -3.707, P < 0.01). The mean M/VAd was 2.86 ± 1.65 and M/VRst 3.75 ± 2.41 (t = -1.323, P = 0.204). Using the method outlined, especially the S/V ratio, evaluation of the SSO can be achieved from the acquired data, which shows promise as a marker for adequate effectiveness of adenosine stress in doubtful cases.
Caregivers may be at risk of exposure to scattered radiation during paediatric chest computed tomography (CT) examinations. This study re-evaluated the effects of physical shielding on paediatric chest CT under controlled experimental conditions using an anthropomorphic paediatric phantom, with an emphasis on the organ dose distribution, scattered radiation relevant to caregivers, and image quality. The phantom was scanned using two CT protocols: with and without bismuth shielding applied to the anterior chest region. Organ doses were measured using real-time scintillation detectors placed in multiple internal organs at the anterior chest surface location corresponding to the breast. Scattered radiation was assessed at caregiver-relevant positions adjacent to the CT gantry using personal dosimeters positioned at the thyroid, eye, abdominal, and gonadal levels. Image quality was evaluated through region-of-interest-based analyses, including the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and Hounsfield unit line profile assessments. The results demonstrated that physical shielding primarily altered the dose distribution in the anterior thoracic regions, including a marked reduction in the breast dose, while doses to the posterior and distant organs were minimally affected. In addition, scattered radiation measurements indicated reduced exposure at caregiver-relevant locations when shielding was applied. Quantitative image analysis showed that shielding-induced changes in the SNR and CNR were measurable but did not compromise the interpretability of the lung parenchyma and other diagnostically relevant regions under controlled conditions. Under these conditions, without automatic exposure control (AEC), physical shielding modified the anterior organ dose distribution and reduced scattered radiation while preserving stable image characteristics. Although the routine clinical use of physical shielding is not advocated, these findings provide quantitative reference data to clarify its potential benefits and limitations in paediatric-specific contexts and support further investigations incorporating AEC and clinical image validation.
Multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS v2.1) is widely used for prostate cancer evaluation but is limited by interobserver variability. The PRIMARY score standardizes intraprostatic prostate-specific membrane antigen (PSMA) PET interpretation; however, data using 18F-PSMA-1007, particularly in sub-Saharan Africa, remain limited. To compare the diagnostic performance of 18F-PSMA-1007 PET/computed tomography (CT) and mpMRI and evaluate the association of primary lesion standardized uptake value (SUVmax) and PRIMARY score with adverse clinicopathologic features. This retrospective study included 61 men with biopsy-confirmed prostate cancer who underwent both 18F-PSMA-1007 PET/CT and mpMRI between January 2023 and February 2025. PRIMARY and PI-RADS scores were assigned from PET/CT and mpMRI, respectively. Histopathology served as the reference standard. Sensitivity, positive predictive value (PPV), diagnostic accuracy, and associations between SUVmax and clinicopathologic features were analyzed. PET/CT demonstrated sensitivity of 88.3% and diagnostic accuracy of 86.9%, comparable to mpMRI (86.7 and 85.3%, respectively). Both modalities showed a PPV of 98.1%. SUVmax greater than or equal to 12 was significantly associated with nodal metastases (P = 0.040), distant metastases (P = 0.028), higher Gleason score (P = 0.015), elevated prostate specific antigen (PSA; P = 0.018), seminal vesicle invasion (P = 0.001), and bladder or rectal invasion (P = 0.036). Higher PRIMARY scores also trended toward higher Gleason grade and PSA. 18F-PSMA-1007 PET/CT demonstrated diagnostic performance comparable to mpMRI. SUVmax greater than or equal to 12 (PRIMARY score 5) was associated with aggressive clinicopathologic features, supporting the applicability of the PRIMARY score framework in this sub-Saharan African cohort.
Traumatic stapediovestibular luxation is a rare but potentially devastating condition that may cause severe vertigo and hearing loss. Optimal management remains controversial because surgical manipulation around the stapes carries the risk of additional inner ear damage, whereas some patients recover with conservative treatment alone. Two patients presented with vertigo and hearing impairment after accidental penetrating ear trauma caused by cotton swabs. High-resolution computed tomography demonstrated stapes footplate invagination into the vestibule in both cases. In Case 1, early surgical repositioning of the stapes was performed on the third day after injury because of complete footplate invagination accompanied by bone-conduction hearing loss and severe vertigo. In Case 2, conservative management was selected because bone-conduction thresholds were preserved and vestibular symptoms improved spontaneously. In Case 1, postoperative recovery included rapid resolution of vertigo and improvement of bone-conduction thresholds, particularly at low frequencies. In Case 2, vestibular symptoms resolved without surgery, although a mild residual air-bone gap remained. Bone-conduction deterioration, degree of footplate displacement, severity of vertigo, and depth of invagination on high-resolution computed tomography appear to be key factors for treatment selection. Conservative management may be safely continued in selected cases with mild posterior partial luxation and stable bone-conduction, whereas early surgical decision-making is essential when surgery is indicated to optimize vestibular and auditory outcomes.
To determine whether achieved sealing length (SL) at the first postoperative computed tomography angiography (CTA) and its subsequent change over time are associated with later endoleak type 1A (EL1A) after infrarenal endovascular aortic repair. Secondary aims were to describe longitudinal remodeling of SL and to assess the association between persistent type 2 endoleak (EL2) and SL trajectories. This retrospective study analyzed SL and sealing surface measured on postoperative CTA, using the first postoperative CTA as the reference examination. We examined whether the first postoperative seal, its subsequent change over time, and prior persistent EL2 were associated with later EL1A. Trajectories of ΔSL and Δsealing surface were modeled using spline mixed-effects models. Time to EL1A was analyzed using Cox models with predictors at the first CTA and pre-event change, including a joint baseline-plus-change model. Landmark analyses were used to assess sealing behavior and EL1A risk. Type 2 endoleak was treated as a time-varying exposure, and its association with subsequent EL1A was evaluated using landmark Cox analyses at 12, 24, 36, and 60 months. Among 501 patients, 346 were included in the longitudinal cohort; after a median follow-up time of 56 months (interquartile range, 28-95 months), 73 developed EL2, 39 developed EL1A, and 8 experienced both events. Baseline sealing at the first postoperative CTA and sealing deterioration were independently associated with EL1A in joint models (SL and sealing surface). Type 2 endoleak was associated with differential SL remodeling (interaction P < .001), with progressive divergence after ~24 months. In exploratory landmark analyses, EL2 was associated with higher subsequent EL1A hazard (36-month hazard ratio [HR] = 2.48; P = .030; 60-month HR = 3.14; P = .008), persisting after adjustment for sealing state and change up to the landmark. Both the first postoperative infrarenal seal and its variation during follow-up were associated with later EL1A. Persistent EL2 was associated with sealing deterioration, whereas its association with subsequent EL1A should be considered exploratory because few patients experienced both events.Clinical ImpactIn infrarenal endovascular aneurysm repair, both the sealing length achieved at the first postoperative computed tomography angiography and its longitudinal change were associated with later type 1A endoleak (EL1A). Persistent type 2 endoleak was associated with less favorable sealing evolution and may identify patients with reduced seal stability and exploratory higher subsequent EL1A risk.
Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare malignancy primarily affecting the upper aerodigestive tract. It is strongly associated with Epstein-Barr virus (EBV) infection; thus, EBV-negative cases are extremely rare, and their clinicopathological features and treatment responses are not well defined. A 75-year-old male presented with a persistent skin defect in the medial canthal area of the left eye. He had been treated with antibiotics for presumed cellulitis for 2 months, but the symptoms persisted, and the skin defect worsened. Surgical debridement revealed an irregularly shaped white mass extending into the paranasal sinus. Incisional biopsy revealed atypical lymphocytic infiltration favoring ENKTL. EBV in situ hybridization was negative, supporting the diagnosis of EBV-negative ENKTL. Staging examinations, including whole-body computed tomography and positron emission tomography, revealed localized disease involving only the orbit and paranasal sinuses. The patient was treated with etoposide, ifosfamide, cisplatin, and dexamethasone chemotherapy. After the first cycle, the patient developed severe neutropenia, and the chemotherapy dose was reduced by 40% for the second cycle. After 2 cycles of etoposide, ifosfamide, cisplatin, and dexamethasone chemotherapy, consolidation radiation therapy was recommended. After 2 cycles of chemotherapy, positron emission tomography showed metabolic complete remission. At 3 months after the second cycle of chemotherapy, the skin defect had completely healed, and follow-up computed tomography showed disease remission. Cutaneous manifestations of ENKTL can mimic benign inflammatory conditions such as cellulitis, leading to delayed diagnosis. Clinicians should maintain a high index of suspicion and perform early tissue biopsy for atypical ulcerative lesions in the periorbital and nasal areas, even in the absence of typical EBV positivity.
Frailty and sarcopenia are associated with adverse postoperative outcomes in elderly patients undergoing gastrectomy for gastric cancer. However, large-scale evidence remains limited. This study aimed to investigate the associations of frailty and sarcopenia with postoperative outcomes and long-term survival in this population. This retrospective study included patients aged ≥70 years who underwent gastrectomy for gastric cancer between December 2011 and May 2021 and had preoperative comprehensive geriatric assessment and abdominal computed tomography. Frailty was defined as a multidimensional frailty score >6, and sarcopenia was defined as the L3 skeletal muscle index in the lowest tertile for each sex. The patients were categorized as non-frail/non-sarcopenic (NF/NS), frail or sarcopenic (F or S), or frail and sarcopenic (F/S). A total of 508 patients (mean age, 77.6±4.6 years; 64.0% male) were analyzed. Eighty-two patients (16.1%) experienced Clavien-Dindo grade ≥II complications within 30 days. In multivariable logistic regression analysis, the F/S group was an independent predictor of postoperative complications (odds ratio, 2.73; 95% confidence interval [CI], 1.07-6.98; P=0.036). In multivariable Cox regression analysis, both the F or S and F/S groups showed significantly worse overall survival (hazard ratio [HR], 2.17 and 3.11, respectively; both P<0.001). The F/S group showed significantly worse cancer-specific survival (HR, 2.46; 95% CI, 1.02-5.93; P=0.046). Combined frailty and sarcopenia were independently associated with worse postoperative outcomes and survival in elderly patients with gastric cancer. Either condition alone was also associated with worse overall survival, suggesting a dose-response relationship and highlighting the importance of comprehensive geriatric assessment.
This study aimed to explore the effects of different breath-holding times (20, 18 and 15 s) on PET/computed tomography (PET/CT) image quality and metabolic parameters of hypermetabolic lung nodules. We hope that our findings will elucidate the clinical feasibility of short-duration breath-hold PET imaging. Compared to free-breathing PET group, all breath-hold groups showed significantly higher tumour-to-background ratio but lower signal-to-noise ratio (all P < 0.05). Importantly, the 18 s breath-hold group demonstrated overall image quality, fusion scores and contrast-to-noise ratio comparable to those of the 20-s group, without statistically significant differences (all P > 0.05). Moreover, the 18-s group exhibited a more favourable signal-to-noise ratio profile than the 15-s group. Metabolically, all breath-hold scans significantly increased maximum standardized uptake value (SUVmax) and mean SUV while reducing metabolic tumour volume and total lesion glycolysis relative to free-breathing (P < 0.05). Notably, there were no significant differences in key quantitative metrics, including maximum SUV, peak SUV, metabolic tumour volume and total lesion glycolysis, among the three breath-hold groups. The consistency of peak SUV across groups further supports its reliability as a robust parameter under reduced acquisition times. The 18-s breath-hold protocol is a valid clinical alternative to the 20-s acquisition, offering comparable image quality and metabolic data while superior efficiency and patient tolerability, making it an ideal choice for routine practice.
This finite element analysis study aimed to compare the biomechanical performance of implants made from polyetheretherketone (PEEK), 30% short carbon fiber-reinforced PEEK (30% SCFR-PEEK), 60% continuous carbon fiber-reinforced PEEK (60% CCFR-PEEK), and titanium in a full-arch fixed implant restoration for the edentulous maxilla. A three-dimensional finite element model of an edentulous maxilla was constructed from Cone-Beam Computed Tomography (CBCT) data. The bone was modeled with a 2 mm cortical layer surrounding a cancellous core. Four implants supporting a full-arch prosthesis were simulated. Implants materials were assigned properties from literature (PEEK: 4.1 GPa; 30% SCFR-PEEK: 18 GPa; 60% CCFR-PEEK: 150 GPa; titanium: 110 GPa). Three occlusal loading conditions (centric, lateral, protrusive) were applied. The maximum von Mises stress values and stress distribution in the implants, cortical bone, and cancellous bone was analyzed. Implant stress was highest in 60% CCFR-PEEK, followed by titanium, 30% SCFR-PEEK, and PEEK. Cortical bone stress was lowest around stiff implants (60% CCFR-PEEK, titanium) and highest around PEEK and 30% SCFR-PEEK. The 30% SCFR-PEEK group showed the smallest implant-bone stress gradient and the most uniform stress distribution. The 30% SCFR-PEEK implant exhibited superior biomechanical compatibility for maxillary complete-arch rehabilitation. Its intermediate stiffness promoted physiological stress transfer to peri-implant bone.
Asthma-like features, defined as a high blood eosinophil count (BEC), atopy, and bronchodilator reversibility, characterize patients with chronic obstructive pulmonary disease (COPD) under optimal treatment. However, whether these features contribute to the phenotype of mucus plugging has not been elucidated. In this study, we aimed to examine the functional and clinical outcomes related to mucus plugging in patients with and without asthma-like features. Mucus plug score was assessed using inspiratory computed tomography (CT) scans in participants from the Hokkaido COPD cohort study who underwent CT examinations using the same protocol, were categorized based on asthma-like features, and completed the St. George's Respiratory Questionnaire (SGRQ). To evaluate the association between mucus plug score and pulmonary function indices, multivariate analyses were performed to examine the relationships between the mucus plug score and percent predicted forced expiratory volume in 1 s (%FEV1) or residual volume (RV)/total lung capacity (TLC). These analyses were adjusted for BEC or CT-derived airway indices (total airway wall volume, functional small airway disease, and emphysema index) based on asthma-like feature categorization, in addition to univariate analyses. The mucus plug score was negatively associated with %FEV1 and FEV1/forced vital capacity in patients with (N = 45) and without (N = 46) asthma-like features and was positively associated with RV/TLC in those without asthma-like features. As the mucus plug score increased, the SGRQ score worsened in both groups. Multivariate analysis revealed a correlation between mucus plug score and RV/TLC (estimate [95% confidence interval], 1.27 [0.30, 2.25]), but not %FEV1, in patients without asthma-like features, and between mucus plug score and %FEV1 (- 1.26 [- 2.33, - 0.20]), but not RV/TLC, in patients with asthma-like features, after adjusting for proximal airway, small airway, and emphysema indices. Asthma-like features may differentiate the functional role of mucus plugging observed on CT scans in patients with COPD. Further studies are needed to validate these findings and clarify the underlying pathophysiology for improved disease management.
Modern contraceptives have contributed to reduction of unintended pregnancy among the women of reproductive age (15 to 49) globally. Use of long-term reversible contraceptives is low (13%) in Uganda yet they are cost-effective. This study aimed to identify factors influencing preference of short-term reversible contraceptives over long-term methods among women of reproductive age attending the family planning clinic at Lira Regional Referral Hospital (LRRH). We performed a mixed-methods cross-sectional study, in which structured interviews were administered to 220 family planning users from December 2022-February 2023, data were analyzed using IBM SPSS Statistics version 29 and cleaned prior to analysis. Descriptive statistical analyses were performed to summarize participant characteristics and contraceptive preferences, and results were presented using tables and figures. Frequencies, percentages, and cross-tabulations were computed. Bivariate analysis using binary logistic regression was conducted to assess associations between independent variables and preference for short-term versus long-term reversible contraceptive methods. Crude odds ratios (CORs) with 95% confidence intervals (CI) were reported. Variables with a p-value ≤ 0.05 at bivariate analysis were included in a multivariate binary logistic regression model to identify independent predictors of contraceptive method preference. Adjusted odds ratios (AORs) with 95% CI were calculated, and statistical significance was set at p-value ≤ 0.05. Qualitative data were audio-recorded, transcribed verbatim, and analyzed using applied thematic analysis. Atlas.ti version 23 was used to support data organization and coding. Analysis followed an iterative process involving open coding, development of summary memos, and construction of a structured codebook. Related codes were grouped into overarching domains, with sub-themes used to organize emerging patterns. Coded transcripts were reviewed and synthesized, and representative participant quotes were selected to provide contextual understanding of factors influencing women's contraceptive method preferences. Discrepancies in coding and interpretation were resolved through consensus discussions among the research team. Ethical approval was obtained from Gulu Research and Ethics Committee (GUREC), and administrative clearance from Lira Regional Referral Hospital and Informed consent /assent from study participants. Of 220 women 63.6% preferred short term, 36.4% preferred long-term reversible contraceptive methods. Age between 25-34 years were 47.7%, 91.8% were married, and 70.5% attained primary education. Reasons for preference of short-term contraceptives were; less side effects 50%, protection for a short period of time 21.4%, confidentiality 28.6%. Partners approval (AOR: 0.253, 95% CI: 0.194-0.680, P=0.006), was significantly associated with short term preference. Providers cited confidentiality, quick return to fertility, and of methods availability as influence for short-term preference. This study found that women of reproductive age predominantly preferred short-term reversible contraceptive methods. Despite the effectiveness and cost-efficiency of long-acting contraceptives, their uptake remains low due to socio-cultural factors, misconceptions, and health system barriers. Strengthened client-centered counseling, consistent method availability, community education, and male engagement are essential to improve informed choice and increase uptake of long-acting reversible contraceptives.
Accurate detection of cervical lymph node metastasis in head and neck cancer (HNC) is essential for guiding neck dissection. The lymph node-to-primary tumor maximum standardized uptake value (SUVmax) ratio (NTR), derived from [18F]fluorodeoxyglucose PET/computed tomography ([18F]FDG PET/CT), has emerged as a robust and reproducible imaging biomarker. This study aimed to evaluate the diagnostic value of NTR for predicting cervical nodal metastasis in patients with HNC. This retrospective study included 167 patients with surgically treated HNC who underwent neck dissection. All patients received contrast-enhanced CT/MRI and [18F]FDG PET/CT before treatment. The diagnostic performance was evaluated using histopathology as the reference standard. Clinical and imaging factors were analyzed, and a scoring model was constructed. On visual interpretation, [18F]FDG PET/CT outperformed CT/MRI, showing higher sensitivity (87.5 vs. 77.4%) and specificity (75.7 vs. 68.6%), but its positive predictive value (PPV) remained suboptimal (69.1%). Multivariate analysis identified SUVmax of cervical lymph nodes (P = 0.049) and NTR (P = 0.038) as independent predictors. A scoring model incorporating these predictors was developed. When visual interpretation was combined with the scoring model, visually positive nodes were stratified into high-risk (PPV: 86.8%), intermediate-risk (PPV: 41.1%), and low-risk (PPV: 36.3%) for refined discrimination of metastatic potential. Integration of visual assessment with an NTR-based scoring model enhances the diagnostic accuracy of [18F]FDG PET/CT in evaluating cervical lymph node metastasis in HNC. This combined approach may improve diagnostic confidence and help minimize unnecessary neck dissections.
Central vein stenosis or occlusion is a significant cause of vascular access dysfunction in patients with chronic kidney disease (CKD). Typically related to intraluminal factors such as long-term cuffed hemodialysis catheters or thrombus formation, central venous stenosis may also result from extrinsic compression by adjacent musculoskeletal or vascular structures. Here we report a case of central vein stenosis secondary to extrinsic compression caused by pericardial effusion. A 68-year-old woman with CKD secondary to immunoglobulin A nephropathy underwent left forearm arteriovenous fistula (AVF) creation before dialysis initiation and developed severe edema of the left upper limb. Computed tomography revealed stenosis of the left brachiocephalic vein for which percutaneous transluminal angioplasty was performed; recanalization was achieved. However, the thrombus in the brachiocephalic vein persisted; therefore, anticoagulation therapy and a pericardiocentesis were performed, resulting in the draining of more than 2 L of fluid. Thereafter, the thrombus disappeared, stenotic lesion improved, and upper-limb edema improved. Throughout this case, clinicians should be aware of this potential complication caused by a massive pericardial effusion, and additionally, prompt combination therapy, that is, endovascular therapy, anticoagulation therapy, or pericardiocentesis, could maintain a patent AVF.
Accurate localization of small pulmonary nodules during thoracoscopic lung resection remains challenging, and the selection of preoperative localization methods largely relies on surgeon experience. This study aimed to integrate radiomic features and clinical characteristics to develop a data-driven patient clustering approach and to explore the suitability of different preoperative localization methods across patient subgroups. Patients who underwent thoracoscopic wedge resection or segmentectomy with virtual navigation bronchoscopy (VNB) localization, computed tompgraphy (CT)-guided localization, or no localization were retrospectively included. Radiomic features were extracted from preoperative CT images and integrated with clinical and nodule characteristics. Unsupervised K-means clustering was applied. Within each cluster, perioperative outcomes were compared among localization methods. In addition, supervised learning models were constructed to predict cluster assignment and intraoperative blood loss. A total of 925 patients were included, and 3 stable clusters were identified. In Cluster 0, VNB localization was associated with lower intraoperative blood loss than CT-guided localization [wedge resection: 50 (20, 70) ml versus 70 (50, 100) ml, P = .004; segmentectomy: 50 (20, 100) ml versus 100 (50, 100) ml, P = .002]. In Cluster 2, CT-guided localization was associated with lower intraoperative blood loss than VNB localization [wedge resection: 50 (30, 90) ml versus 100 (50, 110) ml, P = .005; segmentectomy: 90 (50, 100) ml versus 105 (85, 170) ml, P = .011], along with a higher localization success rate. The supervised model demonstrated stable performance in predicting cluster assignment (macro-area under the curve = 0.863) and intraoperative blood loss (macro-area under the curve range: 0.813-0.850). VNB localization and CT-guided localization demonstrated distinct advantages across different clusters. These findings support a data-driven, individualized strategy for preoperative localization selection.
Angiomyolipoma is a mesenchymal tumor that originates predominantly from perivascular epithelioid cells and is generally considered benign. It is commonly found in the kidneys and rarely in extrarenal locations. Herein, we report a case of angiomyolipoma misdiagnosed as right adrenal angiomyolipoma. A 69-year-old male was diagnosed with a space-occupying lesion in the right adrenal gland. Preoperative abdominal computed tomography showed a 38 × 28-mm non-uniformly enhanced mass in the right adrenal gland. We performed laparoscopic resection of the right adrenal mass. The procedure was successful, and the tumor was completely removed. Based on the initial postoperative pathological report, the lesion was diagnosed as an angiomyolipoma. However, after being verified and certified by a national-level pathology center, this diagnosis was determined to be incorrect. The final pathological diagnosis was adrenal adenoma. For such difficult-to-distinguish pathological diagnoses, routine immunohistochemical identification is recommended. In this case, surgical management of a 4-cm adrenal mass resulted in a favorable treatment outcome. We report this case to draw clinical attention to the therapeutic value of tumors measuring 3-4 cm.
Herein, we report a DFT study of a 4+3 cycloaddition reaction involving a theoretically proposed oxyallylic cation stabilized by a chiral sulfoximine group. The growing importance of the sulfoximine functional group in chemistry cannot be overstated. Computed energy profiles indicate that the reaction is feasible, and geometric and topological analyses (QTAIM, ESP, and NCI) of all transition-states elucidate bonding and the non-covalent interactions stabilizing the favored pathway. The results reveal a strong preference for the endo pathway with modest diastereoselectivity.
Cerebral cavernous malformations (CCMs) are common brain hemangioma that can occur sporadically or be inherited. CCM is one of the major causes of hemorrhagic stroke and neurological deficits in children. There are no pharmacological treatments for CCM. Clinical observations suggest that estrogen may have important roles in CCM, however, it has not been investigated. Hence, we investigated the role of estrogen and its nuclear receptors estrogen receptor- α (Esr1) in experimental CCM.To determine the role of endothelial ESR1 in CCM, we crossed homozygous endothelial Esr1 (Esr1fl/fl) mice into Ccm1iECKO mice. Micro-computed tomography (micro-CT) imaging was used to analyze CCM burden. To determine the therapeutic potential of estrogen, we treated Ccm1iECKO mice with estradiol (E2, a clinically approved estrogen). Gene and protein expressions were assessed in human umbilical vein endothelial cells (HUVECs).Homozygous deletion of endothelial Esr1 in Ccm1iECKO mice significantly increased CCM lesion volume compared to littermate controls. KLF2/4 and downstream expressions in HUVECs were further increased by ESR1 depletion. This correlated with increased lesion burden in Ccm1iECKOEsr1fl/fl mice. Furthermore, we demonstrated E2 treatment in Ccm1iECKO mice prevented CCM pathogenesis by normalizing KLF2/4 and downstream expressions. Our study demonstrates ESR1 as a novel targeted therapeutic option for CCM.
Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction, and acute pancreatitis associated with SMAS is extremely uncommon. The causal relationship is usually inferred from persistent duodenal obstruction, exclusion of other etiologies, and resolution after decompression. A 19-year-old male with a history of esophageal atresia repair, previous upper abdominal surgery, refractory epilepsy, severe developmental delay, and a bedridden status presented with recurrent vomiting and acute pancreatitis. Pancreatitis recurred over a period of 4 years despite repeated conservative management and eventually increased to approximately once per month. Contrast-enhanced computed tomography revealed marked gastric and duodenal dilation, compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and a narrowed aortomesenteric angle of 18°. Other causes of pancreatitis, including gallstones, pancreaticobiliary maljunction, and infection, were excluded. Recurrent acute pancreatitis associated with SMAS-related duodenal obstruction was diagnosed. Conservative treatment included bowel rest, nasogastric decompression, intravenous fluid and electrolyte correction, and prokinetic medication. Because recurrent pancreatitis persisted, laparoscopic duodenojejunostomy with omega-loop reconstruction was performed at age 23. Dense intra-abdominal adhesions precluded safe intracorporeal anastomosis; therefore, extracorporeal side-to-side duodenojejunostomy was completed. Postoperative contrast studies confirmed unobstructed passage through the anastomosis, with no leakage or residual obstruction. During 3 years of follow-up, no pancreatitis recurrence, bile reflux, or readmission occurred, and the patient's weight increased. Although causality cannot be definitively established from a single case, surgical duodenal decompression may be considered in selected patients with recurrent pancreatitis associated with persistent SMAS-related duodenal obstruction after the exclusion of alternative causes and failure of conservative management. Continued long-term surveillance is required after omega-loop reconstruction.
Morphological studies of Weber Type A lateral malleolar fractures (LMFs) are scarce, and no classification criteria exist specifically for this fracture type. Therefore, our objective is to describe the distribution of Weber Type A LMF and propose a classification based on three-dimensional computed tomography (CT) and fracture mapping techniques. We retrospectively reviewed 586 patients presenting with lateral malleolar fractures at our hospital between June 2016 and May 2024. CT data were reconstructed and reduced using software, and fracture lines were delineated. Fracture lines from all patients were superimposed to generate fracture maps and heatmaps. Fracture section area (FSA) was also measured for each case. Using the Kolmogorov-Smirnov test to assess the normality of the data distribution and the Kruskal-Wallis test to compare the FSA values among different fracture subtypes. A total of 81 Weber type A LMFs were included. Based on the fracture morphology and its relationship with the fibular obscure tubercle (FOT) and inferior tip of the fibula (ITF), Weber type A LMFs were classified into three types: Type I: Anteroinferior (25 cases, 30.9%); Type II: Posteroinferior (32 cases, 39.5%); Type III: Metaphyseal (24 cases, 29.6%). This study revealed the morphological characteristics of Weber type A LMF, enhanced understanding of the underlying injury mechanisms, and provided guidance for making diagnostic and therapeutic decisions.
To evaluate the diagnostic efficacy of dual-source CT (DSCT) dual-energy technology in determining the differentiation degree and presence of serosal invasion in colorectal cancer (CRC), using normalized iodine concentration (NIC), electron density, and effective atomic number (Z) as diagnostic markers. A retrospective analysis was conducted on 102 patients clinically diagnosed and pathologically confirmed with CRC. Dual-energy images from both arterial and venous phases were obtained using third-generation DSCT. NIC values were computed. The study analyzed the diagnostic value of DSCT dual-energy technology, utilizing multiple parameters, in assessing the differentiation degree of CRC and the presence of serosal invasion. For differentiating high/moderate differentiation from low differentiation, the AUCs of NIC and Z were 0.899 and 0.914 in the arterial phase and 0.865 and 0.891 in the venous phase, respectively. For detecting serosal invasion, the arterial-phase AUCs of NIC and Z were 0.963 and 0.944, respectively, and the venous-phase AUC of NIC was 0.962. ρ showed no significant diagnostic value in these comparisons. DSCT dual-energy technology, through NIC and effective atomic number, offers significant diagnostic value for evaluating both the differentiation degree and serosal invasion in CRC, providing a novel approach for preoperative assessment.