CT Ratio Research Articles

Arrhythmogenic Right Ventricular Dysplasia Diagnosed in a Patient with Long-term Undiagnosed Syncope

Arrhythmogenic Right Ventricular Dysplasia (ARVD) is an inherited cardiomyopathy which represents progressive replacement of right ventricular myocardium with fibrofatty tissue. In the present case, a 42-year-old male presented to the hospital as he fell down, due to syncope. He had a history of recurrent syncopal in past 4-5 years. His chest radiogram revealed cardiomegaly (CT ratio 0.64), repeat electrocardiogram showed symmetric T-wave inversions and epsilon waves in right precordial V1, V2 and V3 leads, and echocardiogram revealed mild left ventricular dysfunction (ejection fraction - 45%) and dilated right atrium and ventricle. Cardiac Magnetic Resonance Imaging (MRI) confirmed the diagnosis of ARVD.The patient was advised for the placement of an Automatic Implantable Cardioverter Defibrillator (AICD), but he denied for this treatment. Thus, he was managed with anti-arrhythmic drugs and was advised for regular follow-up. The patient was followed-up for six months where episodes of syncope had significantly reduced to one in six months but need of AICD implantation was still there to avoid sudden cardiac death.

Is Type and Crossmatch Really Necessary for Transurethral Resection of Prostate? A Retrospective Study from a Tertiary Care Center in Northern India

Background and Objectives: Rate of blood transfusion is considerably low in transurethral resection of the prostate (TURP). We follow type and crossmatch (TC) policy in TURP. The objective was to assess the suitability of TC policy along with the impact of preoperative (preop) prostate weight and hemoglobin (Hb) on the pattern of blood ordering (whether demand for TC was sent or not). Methods: Retrospective analysis of TURP patients was done from 2014 to 2017. Patients were divided into 2 groups on the basis of whether the demand for TC was sent or not. The age, preop prostate weight and preop Hb of patients where demand for TC sent was compared with patients where TC demand was not sent. Crossmatch to transfusion ratio (Crossmatch to transfusion ratio C/T ratio), Transfusion probability (%T) and Transfusion index (TI) were calculated. Results: Among the total 92 TURP patients, 42.4% (39/92) had TC samples sent preoperatively. Only three patients (3.2%, 3/92) required transfusion intraoperatively. CT ratio was 23.6, %T was 7.6% and TI was 0.07. Preop prostate weight and Hb were significantly higher and lower, respectively, for the group where request for TC was sent. Transfusion probability was also higher for this group. Conclusion: The blood utilization indices show the inadequate utilization of blood and that TC policy is unnecessary. Type and screen policy can be used for patients with large prostate and/or low Hb while type and hold would be appropriate for rest of the patients. Change in pretransfusion policy would reduce workforce and reagent wastage along with efficient inventory management.

Investigation into changes in blood transfusion indicators and returning blood products along with the cause of returning and cost calculation

Background and Objectives: Blood is a valuable source, and the wastage of blood products could impose severe impacts on healthcare. This study investigates the changes in blood transfusion indices and blood product transfusion from 2018 to 2019 in public hospitals affiliated to Kashan University of Medical Sciences. Materials and Methods: This descriptive cross-sectional study was carried out using a researcher-made checklist across five public hospitals in Kashan, Iran. The amount of cross-match/transfusion, transfusion index (TI), and T% (transfusion probability) indices were calculated and analyzed. Results: In 2018, we ordered a total of 19741 blood product units, among which 18,723 units (94.8%) were transfused. In addition, we ordered a total of 15,323 units of blood products in 2019, and 14,223 units (92.8%) were transfused. The CT ratio was 1.04 in 2018 and 1.06 in 2019, with a 2% increase. The transfused probability (T %) percentage in the studied public hospitals in 2018 was 38.04%, whereas the rate was 36.7% in 2019, with a 3.5% decline. In 2018, the TI in the studied hospitals was 0.96 and decreased to 0.85 (11%) in 2019. Moreover, the TI was higher than 0.5 in hospitals, except for Shahid Rajaei Hospital. Based on the results, the cost of blood products was 74459499405 Rials ($ 690526) in 2018 and 79073079143 Rials ($ 612115) in 2019, with a 6% increase. Conclusions: Blood order and transfusion enjoyed good conditions in public hospitals affiliated to Kashan University of Medical Sciences, though the blood order pattern was unfavorable in Shahid Rajaei Hospital.

Destroyed Lung Syndrome: A Review of 31 Published Cases

Background: Destroyed lung is a lung condition commonly caused by tuberculosis. Other causes include bronchiectasis, aspergilloma, emphysema, etc. It is characterized by extensive lung destruction and reduced lung function. Chest X-ray, chest CT, bronchography, and ventilation-perfusion ratio scan are the commonest radiologic diagnostic tools. Treatment of choice may include pneumonectomy. The study aims to highlight the common causes of destroyed lung and the major presenting complaints based on age, sex and affected lungs. Method: Published cases from English medical journals were evaluated and analyzed. Results: 31 published cases on destroyed lung were reviewed. 58.1% showed that the left lung was the most commonly affected lung. The condition was more common in males (71%). Based on our review, the commonest causes are pneumonia and tuberculosis at 25.9% and 22.8%, respectively. Conclusion: Pneumonia and Tuberculosis seem to be the commonest causes of destroyed lung based on our review, with left sided affectation being more predominant.

The proximity of a highway increases CO2 respiration in forest soil and decreases the stability of soil organic matter

Roadways traverse many forest areas and they often have harmful effects on forest soils, including the modified stability of soil organic matter (SOM). Soil CO2 respiration is an important indicator of SOM biological stability. The aim of this study was to test the hypotheses that a roadway will (1) modify the composition of the cation exchange capacity of adjacent forest soils, and (2) significantly decrease the stability of SOM. Two study sites were established in Scots pine and Silver fir stands, located close to the S7 highway in central Poland, which was opened to traffic in 1984. From each site, samples were taken at 2, 12 and 22 m from the forest edge. Soil CO2 respiration was determined using closed chamber incubation with an alkali trap. We also conducted a comprehensive analysis of soil chemical properties. The stoichiometric ratios of chosen chemical parameters to total carbon (Ct) were calculated. In both sites, we observed increased soil pH and CO2 respiration in the vicinity of the highway, as well as increased ratios of exchangeable calcium (Ca), magnesium (Mg) and sodium (Na) to Ct. In the fir site, the humic and fulvic acids, the dissolved organic carbon (DOC) content and aluminum (Al) to Ct ratio were depleted in close proximity to the highway. We suggest that the combined effect of Ca and Na ions, originating from winter de-icing, caused the depletion of Al and hydrogen (H) in the soil close to the forest edge and, therefore, resulted in lower SOM stability expressed as the decreased DOC and pyrophosphate-extractable carbon content, as well as the release of CO2. We conclude that the changes of SOM stability with distance were the effect of modification of ion-exchange relationships (particularly base cations versus Al3+ with H+) rather than forest stand species or intrinsic SOM properties (like functional groups, the recalcitrance of bindings etc.). Our work supports earlier studies, confirming the significant impact of Al and H on SOM stability.

Quantitative MDCT and MRI assessment of hepatic steatosis in genotype 4 chronic hepatitis C patients with fibrosis

BackgroundHepatic steatosis has been shown to worsen the course of liver disease in chronic hepatitis C (CHC) patients, and it may reduce the efficacy of antiviral therapy and accelerate disease progression. In this cross-sectional study, we aimed to evaluate the role of multidetector computed tomography and magnetic resonance imaging (MRI) in the quantitative assessment and grading of hepatic steatosis to evaluate the association between hepatic steatosis and fibrosis in Egyptian genotype 4-CHC (G4-CHC) patients.ResultsHistopathological hepatic steatosis was found in 70.3% of 155 patients. No correlation was found between the CT ratio and pathological hepatic steatosis. Proton density fat fraction, T1-fat fraction, and fat percentage correlated with histological steatosis grading (r = 0.953, p < 0.001; r = 0.380, p = 0.027 and r = 0.384, p = 0.025, respectively). An agreement between steatosis grading by histology and 1H-MRS was found in 74.2% of patients. Compared to other MRI modalities, proton density fat fraction had the highest area under the receiver operating characteristic curve (AUC), with 0.910, 0.931, and 0.975 for mild, moderate, and severe steatosis, respectively. The cutoff with the best ability to predict steatosis was > 4.95 for a proton density fat fraction (AUC = 0.958) with 95.8% sensitivity, 90% specificity, 78.5% positive predictive value, and 96.1% negative predictive value.Conclusion1H-MRS had good diagnostic performance in predicting hepatic steatosis in G4-CHC patients, and hence, it may offer a useful noninvasive quantitative modality for grading steatosis with clinical applicability, especially in those where a liver biopsy cannot be done.

Catalytic cracking of scrap tire-generated fuel oil from pyrolysis of waste tires with zeolite ZSM-5

ABSTRACT Power generation without environmental impairment is a challenging task for humankind. Presently pyrolysis process using various catalysts is among the finest technologies for generating alternate energy. This research aims to explore the pyrolysis of discarded bus/truck tires with zeolite ZSM-5. A fixed-bed reactor was employed to pyrolyse scrap tires at a temperature range of 300–580°C. Furthermore, it investigates the temperature and catalyst-to-tire ratio impact on the evolved oils’ generation and composition. Density, kinematic viscosity, and gross calorific value of the obtained oil, are analysed. CT ratio has increased the gas generation but decreases oil production. Elemental analysis of pyrolytic liquid oil revealed carbon percentage increment and decrement of sulphur percentage when CT ratio was increased. FT-IR showed data revealed the strong presence of aromatic compounds and other valuable hydrocarbons in the upgraded pyrolytic oils. The pyrolytic oil showed provided a high calorific value of 40.38 MJ/kg, comparable to conventional diesel oil of 42 MJ/kg. GC-MS analysis identified a higher amount of o-xylene, toluene, naphthalene, and d-limonene in derived oil when the CT ratio of the process was increased from 0.1 to 0.25, denoting the capability of the evolved oil as an alternative energy source and value-added chemical substances.

Telomere Length In Granulocyte, Mononuclear, CD34 and CD3 Cell Fractions In Primary Myelofibrosis and Age Matched Controls

BackgroundTelomeres are repetitive, noncoding DNA sequences that cap the ends of chromosomes to provide genome protection during cell division. Telomere shortening is a normal component of cellular aging and shortened telomeres are also associated with cancer. Leukocyte telomere lengths in patients with myeloproliferative neoplasms (MPN), especially in those with myelofibrosis (MF) and polycythemia vera (PV), have been shown to be shorter than normal controls and inversely correlate to JAK2V617F allele burden (Experimental hematology. 2013;41:627). There is inadequate information on the contribution of fractioned peripheral blood samples to the relative measurement of telomere length in MF, especially in the context of age-matched controls. MethodsPeripheral blood collected from each individual was subjected to density gradient centrifugation to enrich for granulocyte and mononuclear cell fractions. Antibody labeled magnetic bead separation was applied to a portion of the mononuclear cells to enrich for CD34+ and CD3+ fractions. DNA was isolated and telomere length was determined using quantitative PCR (qPCR) with primer sets specific to telomere repeat regions and a single copy gene. Relative telomere length of each sample was determined by calculating the Ct ratio of the telomere region and single copy gene. Quantitative PCR was used to measure JAK2V617F allele burden. ResultsThe study population included 20 patients with MF and 16 normal controls. Telomere length characterization in age-stratified normal controls indicated a clear effect of aging on telomere length, with significant differences for all cell fractions, especially when comparing age <50 years to age >65 years, and most pronounced for CD34-positive cells (Figure 1a; p=0.003). In MF, patients age 50-65 years displayed significantly shorter telomere lengths, in all cell fractions, compared to age-matched controls (Figure 1b; p=0.0001). The difference was most pronounced in CD34-positive cells (Figure 1b). However, older MF patients (age >65 years) did not differ in their telomere lengths of the aforementioned cell fractions, when compared to their age-matched controls; a trend for significance was seen for CD34-positive cells (Figure 1c; p=0.07). In MF, JAK2V617F allele burden was inversely correlated to telomere lengths of both granulocytes and mononuclear cells, in the younger (age 50-65 years; p=0.03) but not the older (age >65 years; p=0.76). [Display omitted] ConclusionsWe demonstrate the importance of age, age-matched controls, and specific peripheral blood cell fractions in the assessment of telomere length in MF. We identify CD34-positive cell fractions as the most reliable in assessing telomere length in MF but its value might be limited in patients older than age 65 years. It should be noted, however, that our results do not undermine the value of intra-patient comparison of telomere lengths, as might be necessary to monitor during treatment affecting telomerase activity. Disclosures:No relevant conflicts of interest to declare.

Cementless femoral stems with lower canal fill ratio have similar mid-term to long-term outcomes to those with adequate fill ratio in Dorr type C femurs.

Lower canal fill ratio was reported to correlate with aseptic loosening in many studies. However, the most widely used standard of fill ratio seemed inapplicable to Dorr type C femurs. We aimed to adapt the method of measuring the fill ratio in Dorr type C femurs and compare the outcomes among patients with different fill ratios. Twenty patients with Corail stems implanted in their Dorr type C femurs received spectrum CT to evaluate the whole-stem's fill ratio. Pearson Correlation Coefficient was calculated to assess the correlation between the fill ratio in X-ray film and spectrum CT. Then 87 THAs were involved in this study, divided into the fill ratio ≤ 80% group and the fill ratio > 80% group. Clinical and radiological outcomes were evaluated with a mean follow-up of 8.2years. Fill ratio at 2cm below the lesser trochanter in anterior-posterior X-ray film correlated with the whole-stem's fill ratio (r = 0.50, P = 0.02). Survival rate of stem, function scores, and radiological outcomes between the two groups showed no significant difference. In the fill ratio > 80% group, intraoperative fracture was significantly higher (19% VS 5%, P < 0.05). Patients with lower fill ratios at 2cm below the lesser trochanter did not have poorer functional scores or more subsidence, but had a lower intraoperative fracture rate. The revision rates of the two groups presented no significant difference, but this result need to be confirmed in larger cohort in the future. In Dorr type C femurs, risk of fracture and the special morphology of the femur should be noted, and high fill ratio is not the most decisive factor for stem size selecting.

Scatter-to-primary ratio in dentomaxillofacial cone-beam CT: effect of field of view and beam energy.

The aim of this study was to evaluate the effect of field of view (FOV) and beam energy on the scatter-to-primary ratio (SPR) in dental cone-beam CT (CBCT). An anthropomorphic phantom representing an adult male (ATOM Max 711-HN, Norfolk, VA, USA) was scanned using the 3D Accuitomo 170 CBCT (J. Morita, Kyoto, Japan) using 11 FOVs. During each scan, half of the X-ray beam was blocked. Each scan was performed at three exposure settings with varying beam energy and equal radiation dose: 90 kV 5 mA, 77 kV 7.5 mA and 69 kV 10 mA. The SPR was estimated by measuring the grey values in the blocked and non-blocked regions of the RAW data. The effect of FOV on SPR was evaluated using Dunn's multiple comparison test, and the effect of the exposure settings was compared using a Wilcoxon signed rank test. Larger FOVs showed increased scatter. FOVs with a shorter isocenter-detector distance showed a particularly high SPR. Most intercomparisons between FOVs were statistically significant. The largest difference was found between 17 × 12 cm and 6 × 6 cm (lower jaw), with the former showing a 4.9-fold higher SPR. The effect of beam energy was relatively small and varied between FOV sizes and positions. While the choice of FOV size and position is determined by the diagnostic region of interest, the image quality deterioration for large FOVs due to scatter provides another incentive to limit the FOV size as much as possible.

The role of polymorphisms rs2070744 and rs1799983 eNOS gene in patients with POAG: a systematic review and meta-analysis.

Glaucoma is a progressive disease of the optic nerve that has several underlying causes, but in most cases, the cause is unknown. Given the importance of the role of nitric oxide in the occurrence of ocular nerve damage and the effect of eNOS gene polymorphic sites on protein function, to better understand the mechanism of formation of POAG, the relationship between polymorphisms rs2070744 and rs1799983 eNOS gene with POAG risk was investigated in this study using meta-analysis. In this study, systematic review and meta-analysis of study data related to the study of polymorphisms rs2070744 and rs1799983 eNOS gene in patients with POAG using the keywords eNOS, NOS3, Gluuc8898, POAG, primary open-angle glaucoma. It was extracted from SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engines without a time limit until May 2020. To perform the analysis of qualified studies, the model of random effects was used and the inconsistency of studies with the I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis (Version 2). In a review of 16 studies (9 studies on polymorphism rs2070744 and seven studies on polymorphism rs1799983) with a sample size of 1631 subjects and a control group of 2405 subjects related to polymorphism rs2070744 and a group of 1456 subjects and a control group of 2240 subjects related to polymorphism 9997 rs1, the odds ratio of TT, CT, and CC genotypes was reported to be 0.95, 1.01, and 1.14, respectively, and the odds ratio of GG, GT and TT genotypes to be 0.88, 0.97, and 1.31, respectively, was reported in patients with POAG. The results of our systematic review and meta-analysis study show that the eNOS gene polymorphisms rs2070744 and rs1799983 may increase the risk of POAG among individuals. However, further studies are needed to confirm these findings.

DPP9 sequesters the Cterminus of NLRP1 to repress inflammasome activation.

Nucleotide-binding domain and leucine-rich repeat pyrin-domain containing protein1 (NLRP1) is an inflammasome sensor that mediates the activation of caspase-1 to induce cytokine maturation and pyroptosis1-4. Gain-of-function mutations of NLRP1 cause severe inflammatory diseases of the skin4-6. NLRP1 contains a function-to-find domain that auto-proteolyses into noncovalently associated subdomains7-9, and proteasomal degradation of the repressive N-terminal fragment of NLRP1 releases its inflammatory C-terminal fragment (NLRP1CT)10,11. Cytosolic dipeptidyl peptidases 8 and 9 (hereafter, DPP8/DPP9) both interact with NLRP1, and small-molecule inhibitors of DPP8/DPP9 activate NLRP1 by mechanisms that are currently unclear10,12-14. Here we report cryo-electron microscopy structures of the human NLRP1-DPP9 complex alone and with Val-boroPro (VbP), an inhibitor of DPP8/DPP9. The structures reveal a ternary complex that comprises DPP9, full-length NLRP1 and the NLRPTCT. The binding of the NLRP1CT to DPP9 requires full-length NLRP1, which suggests that NLRP1 activation is regulated by the ratio of NLRP1CT to full-length NLRP1. Activation of the inflammasome by ectopic expression of the NLRP1CT is consistently rescued by co-expression of autoproteolysis-deficient full-length NLRP1. The Nterminus of the NLRP1CT inserts into the DPP9 active site, and VbP disrupts this interaction. Thus, VbP weakens the NLRP1-DPP9 interaction and accelerates degradation of the N-terminal fragment10 to induce inflammasome activation. Overall, these data demonstrate that DPP9 quenches low levels of NLRP1CT and thus serves as a checkpoint for activation of the NLRP1inflammasome.

Anatomical patterns of condensed tannin in fine roots of tree species from a cool-temperate forest

Condensed tannin (CT) is an important compound in plant biological structural defence and for tolerance of herbivory and environmental stress. However, little is known of the role and location of CT within the fine roots of woody plants. To understand the role of CT in fine roots across diverse species of woody dicot, we evaluated the localization of CT that accumulated in root tissue, and examined its relationships with the stele and cortex tissue in cross-sections of roots in 20 tree species forming different microbial symbiotic groups (ectomycorrhiza and arbuscular mycorrhiza). In a cool-temperate forest in Japan, cross-sections of sampled roots in different branching order classes, namely, first order, second to third order, fourth order, and higher than fourth order (higher order), were measured in terms of the length-based ratios of stele diameter and cortex thickness to root diameter. All root samples were then stained with ρ-dimethylaminocinnamaldehyde solution and we determined the ratio of localized CT accumulation area to the root cross-section area (CT ratio). Stele ratio tended to increase with increasing root order, whereas cortex ratio either remained unchanged or decreased with increasing order in all species. The CT ratio was significantly positively correlated to the stele ratio and negatively correlated to the cortex ratio in second- to fourth-order roots across species during the shift from primary to secondary root growth. Ectomycorrhiza-associated species mostly had a higher stele ratio and lower cortex ratio than arbuscular mycorrhiza-associated species across root orders. Compared with arbuscular mycorrhiza species, there was greater accumulation of CT in response to changes in the root order of ectomycorrhiza species. Different development patterns of the stele, cortex and CT accumulation along the transition from root tip to secondary roots could be distinguished between different mycorrhizal associations. The CT in tissues in different mycorrhizal associations could help with root protection in specific branching orders during shifts in stele and cortex development before and during cork layer formation.

Baseline ASPECTS and hypoperfusion intensity ratio influence the impact of first pass reperfusion on functional outcomes

BackgroundFirst pass reperfusion (FPR) has been established as a key performance metric in mechanical thrombectomy (MT). The impact of FPR may be more relevant in fast progressors. We aim to...

Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite: A Phantom Study on Diagnostic Performance.

The aim of this study was to determine the diagnostic performance of dual-energy computed tomography (DECT) to detect and distinguish crystal deposits in a phantom. The primary objective was to determine the cutoff DECT ratio and the cross-sectional area (CSA) of a crystal deposit necessary to differentiate monosodium urate (MSU), calcium pyrophosphate (CPP), and calcium hydroxyapatite (HA) using DECT. Our secondary objective was to determine the concentration for limit of detection for MSU, CPP, and HA crystal deposits. Exploratory objectives included the comparison between 2 generations of DECT scanners from the same manufacturer as well as different scanner settings. We used a cylindrical soft tissue phantom with synthetic MSU, CPP, and HA crystals suspended in resin. Crystal suspension concentration increased with similar attenuation between MSU, CPP, and HA in conventional CT. The phantom was scanned on 2 dual-source DECT scanners, at 2 dose levels and all available tube voltage combinations. Both scanners had a tin (Sn) filter at the high-energy spectra. Dual-energy CT ratios were calculated for a given tube voltage combination by dividing linear regression lines of CT numbers against concentration. Dual-energy CT ratios were compared using an analysis of covariance. Receiver operating characteristic curves and corresponding areas under the curve (AUCs) were calculated for individual crystal suspension comparisons (HA vs CPP, MSU vs CPP, and MSU vs HA). At standard clinical scan settings with 8 mGy and 80/Sn150 kV, the DECT ratios were as follows: CPP, 2.02 (95% confidence interval [CI], 1.98-2.07); HA, 2.00 (95% CI, 1.96-2.05); and MSU, 1.09 (95% CI, 1.06-1.11). Ratios varied numerically depending on the scanner and tube voltage combination. Monosodium urate crystal DECT ratios were significantly different from HA and CPP (P < 0.001), whereas DECT ratios for HA and CPP crystals did not differ significantly (P = 0.99). The differentiation of MSU crystals from both calcium crystals (HA and CPP) was excellent with an AUC of 1.00 (95% CI, 1.00-1.00) and an optimal cutoff DECT ratio of 1.43:1.40 depending on the scanner. In addition, differentiation of MSU and calcium-containing crystals (HA and CPP) required a CSA of minimum 4 pixels of crystal at standard clinical scan conditions. In contrast, differentiation between CPP and HA crystals was moderate with AUCs ranging from 0.66 (95% CI, 0.52-0.80) to 0.80 (95% CI, 0.69-0.91) and an optimal cutoff DECT ratio of 2.02:2.06 depending on the scanner. Furthermore, differentiation between CPP and HA crystals required a CSA of minimum 87 pixels of crystal at standard clinical scan conditions, corresponding to a region of interest of 3.7 mm diameter. When scanning at highest possible spectral separation and maximum dose of 50 mGy, the limit of detection for crystals within a region of interest of 50 pixels was 14 mg/cm3 for MSU and 2 mg/cm3 for both CPP and HA. This phantom study shows that DECT can be used to detect MSU, CPP, and HA crystal deposits. Differentiation of CPP and HA was not possible in crystals deposits less than 3.7 mm in diameter, but MSU could accurately be differentiated from CPP and HA crystal deposits at standard clinical scan conditions.

Relationship between Methylenetetrahydrofolate Reductase C677T Gene Polymorphism and Autism Susceptibility: A Meta-Analysis

To explore the correlation between 5,10-methylenetetrahydrofolate reductase C677T gene polymorphism and autism susceptibility and to provide the evidence-based medicine for the prevention and treatment of autism. The retrieval database includes the VIP Chinese Science and Technology journal database, China National Knowledge Infrastructure, Wanfang database, PubMed, Wiley online library and Web of science. Chinese retrieval form: “Autism” and “methylenetetrahydrofolate reductase”. English retrieval form: “methylenetetrahydrofolate reductase”) and (“autism” or “autism spectrum disorders”) and (“C677T” or “polymorphism” or “genotype”). The retrieved time was till June 30, 2020 and the languages were limited to Chinese or English. Stata 12.0 software was used for meta-analysis, the evaluation indexes including heterogeneity test, merged effect, sensitivity analysis and publication bias evaluation. Based on the inclusion and exclusion criteria, 11 articles were included in the analysis. The meta-analysis shows that T/C allele odds ratio=0.56 (p<0.001), indicating that the T allele of methylenetetrahydrofolate reductase C677T may be an Autism spectrum disorder risk factor. The odds ratio of genotype CT vs. CC was 1.44 (p<0.001), the odds ratio of genotype TT vs. CC was 3.05 (p<0.001), the odds ratio of genotype TT+CT vs. CC was 1.81 (p<0.001), the odds ratio of genotype TT vs. CT+CC was 2.52 (p<0.001). CT, TT and TT+CT genotypes were positively correlated with autism susceptibility, indicating that CT, TT and TT+CT genotypes may increase the risk of autism susceptibility. Methylenetetrahydrofolate reductase C677T gene polymorphism has a positive correlation with autism susceptibility.

Bilateral adrenal enhancement revised\u2014adrenal-to-spleen ratio as an appropriate mortality predictor

PurposeTo investigate whether adrenal gland radiodensities alone or set in relation to either the inferior vena cava (IVC) or the spleen can predict hospital mortality in intensive care unit patients.MethodsOne hundred thirty-three intensive care patients (90 males, age: 66.3 ± 14.5 years) with an acute clinical deterioration were included in this retrospective analysis. CT attenuation (Hounsfield units) of adrenal glands, IVC, and spleen was evaluated by 2 radiologists separately. Adrenal-to-IVC and adrenal-to-spleen ratios were calculated. Receiver operating characteristic (ROC) analysis, combined with the Matthews correlation coefficient (MCC) as a classifier, was used to assess which parameter is the most suitable for short-term, intermediate-term, and overall mortality prediction. Interrater agreement was assessed using intraclass correlation coefficient (ICC).ResultsThe highest discriminative power to distinguish between deceased and survivors was found for the adrenal gland-to-spleen ratio for the 72-h mortality. A threshold of > 1.4 predicted 72-h mortality with a sensitivity of 79.31% and a specificity of 98.08% (area und the curve (AUC) = 0.94; p < 0.0001; MCCs = 0.81). The positive likelihood ratio was 41; the positive predictive value was 92.20%. Adrenal gland-to-spleen ratio was also best suited to predict the 24-h and overall mortality. ICCs of HU measurements in adrenal gland, IVC, and spleen indicated a high interrater agreement (ICC 0.95–0.99).ConclusionsTo conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.

Optimization of the differentiation and quantification of high-Z nanoparticles incorporated in medical devices for CT-guided interventions.

Material differentiation has been made possible using dual-energy computed tomography (DECT), in which the unique, energy-dependent attenuating characteristics of materials can provide new diagnostic information. One promising application is the clinical integration of biodegradable polymers as temporary implantable medical devices impregnated with high-atomic number (high-Z) materials. The purpose of this study was to explore the incorporation of high atomic number (high-Z) contrast materials in a bioresorbable inferior vena cava filter for advanced CT-based monitoring of its location and differentiating from surrounding materials. Imaging optimization and calibration studies were performed using a body phantom. The dual-energy CT (DECT) ratios for iron, zirconium, barium, gadolinium, ytterbium, tantalum, tungsten, gold, and bismuth were generated for peak kilovoltage combinations of 80/150Sn, 90/150Sn, and 100/150Sn kVp in dual-source CT via linear regression of the CT numbers at low and high energies. A secondary calibration of the material map to the nominal material concentration was generated to correct for use of materials other than iodine. CT number was calibrated to the material concentration based on single-energy CT (SECT) with additional filtration (150Sn kVp). These quantification methods were applied to monitoring of biodegradable inferior vena cava filters (IVCFs) made of braided poly(p-dioxanone) sutures infused with ultrasmall bismuth nanoparticles (BiNPs) implanted in an adult domestic pig. Qualitative material differentiation was optimal for high-Z (>73) contrast agents in DECT. However, quantification became nonlinear and inaccurate as the K-edge of the material increased. Using the high-energy (150Sn kVp) data component as a SECT scan, the linearity of quantification curves was maintained with lower limits of detection than with DECT. Among the materials tested, bismuth had optimal differentiation from iodine in DECT while maintaining increased contrast in high-energy SECT for quantification (11.5% error). Coating the IVCF with BiNPs resulted in markedly greater radiopacity (maximum CT number, 2028HU) than that of an uncoated IVCF (maximum CT number, 127HU). Using DECT imaging and processing, the BiNP-IVCF could be clearly differentiated from iodine contrast injected into the inferior vena cava of the pig. These findings may improve widespread integration of medical devices incorporated with high-Z materials into the clinic, where technical success, possible complications, and device integrity can be assessed intraoperatively and postoperatively via DECT imaging.

S1121 Role of Markers of Heavy Metal Metabolism in Identification of Hepatic Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease (NAFLD)

INTRODUCTION: Fibrosis & nonalcoholic steatohepatitis (NASH) are important predictors of long term prognosis in patients with non-alcoholic fatty liver disease (NAFLD). Oxidative stress (OS) has been shown to play a central role in progression of NAFLD, & changes in proteins associated with metal homeostasis may exacerbate OS. We investigated relationship of proteins related to transition metal metabolism with fibrosis in NAFLD. METHODS: Adult patients (>18y) who underwent liver biopsy for clinically suspected NAFLD at our institution were included. We retrospectively collected serum levels of ceruloplasmin (Cp), ferritin, iron, & transferrin saturation (Tsat) within 3 months of liver biopsy & calculated Cp/Tsat ratio (CT ratio) & Cp/Ferritin ratio (CF ratio). Histologic features were scored by an experienced pathologist using Non-alcoholic Steatohepatitis Clinical Research Network criteria. Fibrosis was staged as (0 - 4). Independent T test were used to compare the means & receiver operating characteristics (ROC) curves were plotted for assessing area under curve (AUC), sensitivity (Sn) & specificity (Sp). RESULTS: 174 patients were included in final analysis. The mean age of subjects was 48 y. Baseline features are depicted in Table 1. Biopsy proven NASH was seen in 61.5% of liver biopsies. No fibrosis was seen in 29.3% of liver biopsies & Stage 1, 2,3& 4 fibrosis were seen in 29.9%, 10.9%, 14.3% & 15.55% of samples. Mean Tsat was significantly higher (24.41% v/s 38.27%, P < 0.0001) & Cp (mg/dl) (27.82 v/s 24.91, P = 0.03) significantly lower between patients with advanced fibrosis (AF) (3-4) v/s early fibrosis (EF) (0-2). The mean CT ratio was also higher in patients with EF v/s AF (1.54 v/s 1.02, P = 0.01). The mean Tsat of patients with fibrosis v/s without fibrosis was higher (31.4% v/s 21.57% P < 0.005) however mean Cp (mg/dl) values were not significantly different (27.88 v/s 27.58, P = 0.42). The ROC curves show CF ratio (Figure 1) at a cut off of 0.10 had AUC = 0.61 (Sn = 70%, Sp = 52% P = 0.01) to detect any fibrosis & CT ratio (Figure 2) at a cut off 0.86 had AUC = 0.65 (Sn = 69%, Sp = 50% P = 0.002) for differentiating EF v/s AF. CONCLUSION: Our data reveals changes in ceruloplasmin: transferrin system, which decreases the content of toxic ions of Fe2+ in NAFLD. Tsat, Cp, CF ratio & CT ratio are useful non-invasive biomarkers in identifying NAFLD patients with fibrosis. Markers of heavy metal metabolism can spare patients from liver biopsies & can be potential therapeutic targets in future.Table 1.: Demographic and histological features of study populationFigure 1.: ROC curve for fibrosis stage determination (0 vs 1-4) based on CF RATIO.Figure 2.: ROC curve for fibrosis stage determination (0-2 vs 3-4) based on CT Ratio.

Diameter of Superior Rectal Vein - CT Predictor of KRAS Mutation in Rectal Carcinoma.

BackgroundThe purpose of this study was to investigate the feasibility of CT parameters to predict the presence of KRAS mutations in rectal cancer patients. The relationship between the presence of a KRAS mutation and pathological findings was evaluated simultaneously.MethodsEighty-nine patients (29 females, 60 males, age 27–90, mean 59.7±12 years) with pathologically proven rectal cancer were enrolled. A KRAS mutation test was completed following surgery. Parameters evaluated on CT included the tumor location, the diameter of the superior rectal vein (SRV) and inferior mesenteric vein (IMV), the presence of calcification, ulceration, lymph node enlargement (LNE), distant metastasis, tumor shape (intraluminal polypoid mass, infiltrative mass, or bulky), circumferential extent (C0–C1/4, C1/4–C1/2, C1/2–C3/4, or C3/4–C1), enhanced pattern (homogeneous or heterogeneous), CT ratio, and the length of the tumor (LOT). Pathological findings included lymphovascular emboli, signet ring cell, peripheral fat interval infiltration, focal ulcer, lymph node metastasis, tumor pathological type, and differentiation extent. The correlations between KRAS status and CT parameters, and KRAS status and pathological findings were investigated. The accuracy of CT characteristics for predicting KRAS mutation was evaluated.ResultsA KRAS mutation was detected in 42 cases. On CT image, the diameter of the SRV was significantly increased in the KRAS mutation group compared to in the KRAS wild-type group (4.6±0.9 mm vs 4.2±0.9 mm, p=0.02), and LNE was more likely to occur in the KRAS mutation group (73.3% vs 26.7%, p=0.03). There was no significant difference between the KRAS mutation group and the KRAS wild-type group on the other CT parameters (location, IMV, calcification, ulcer, distant metastasis, tumor shape, enhanced pattern, circumferential extent, CT ratio, and LOT). In the pathological findings, a KRAS mutation was more likely to occur in the middle differentiation group (p=0.03). No significant difference was found between the KRAS mutation group and the KRAS wild-type group in the presence of lymphovascular emboli, signet ring cell, peripheral fat interval infiltration, focal ulcer, lymph node metastasis, and tumor pathological type. With the best cut-off value of 4.07 mm, the AUC of the SRV to predict a KRAS mutation was 0.63 with a sensitivity of 76.2% and a specificity of 48.9%.ConclusionIt was feasible to use the diameter of the SRV to predict a KRAS mutation in rectal cancer patients, and LNE also can be regarded as an important clue on preoperative CT images.