Grade Of Atrophy Research Articles

Prevalence of Isolated Idiopathic Teres Minor Atrophy: A Retrospective Study

Introduction. Isolated idiopathic teres minor atrophy is a relatively understudied condition characterized by selective atrophy of the teres minor muscle without any identifiable underlying pathology. This study aimed to determine the prevalence of isolated idiopathic teres minor atrophy. Methods. Data were collected retrospectively by examining magnetic resonance imaging scans of the right and left shoulders of individuals aged 18 years or older performed at the Medical Centre of Majmaah University, Al Majma’ah, Saudi Arabia, between February 2019 and October 2022. Teres minor atrophy was classified using the original Goutallier classification system to assess fatty infiltration. In addition, demographics, including age, gender, and nationality, were collected. Associated imaging-based factors, such as teres minor and deltoid muscle edema, rotator cuff muscle tears, and injuries to the labrum and quadrilateral space, were also documented. Results. Among the 2, 194 patients studied, 59 (2.7%) were diagnosed with isolated idiopathic teres minor atrophy, aged 27 to 75 years. Females comprised 59.3% of the affected individuals, and the majority of cases were Saudi nationals (81.4%). The right side was affected in 61% of cases. Nearly half of the affected individuals (50.9%) were classified as grade 2, while 25.4% were classified as grade 4. Patients with grade 3 and grade 4 isolated idiopathic teres minor atrophy were significantly older than those with grade 2 (58.29 ± 7.12 and 57.93 ± 12.34 versus 49.96 ± 11.72, respectively (p=0.029). No statistically significant associations were found between the demographic characteristics of individuals (age and gender) and the pattern of teres minor fatty involvement. Conclusions. The incidence of isolated idiopathic teres minor atrophy was found to be 2.7%. Age was the main statistically significant factor associated with isolated idiopathic teres minor atrophy and the grade of teres minor atrophy. Other evaluated factors, including gender and the pattern of involvement, did not demonstrate any statistically significant associations.

Significance of intrarenal vascular lesions in Ig A nephropathy prognosis

BackgroundImmunoglobulin A nephropathy (IgAN) is the predominant primary glomerulonephritis globally and remains a subject of active research with a focus on understanding its course and prognosis. Although vascular lesions are associated with IgAN, the current histopathological grading systems do not consider intrarenal vascular lesions when predicting patient prognosis. Therefore, this retrospective study conducted at Kyungpook National University Hospital between October 2016 and December 2021, aimed to elucidate the significance of intrarenal vascular lesions in IgAN by comparing the clinical data of patients with and without such lesions.MethodsData of patients with biopsy-confirmed primary IgAN between October 2016 and June 2021 at Kyungpook National University Hospital (Daegu, South Korea) were collected, and their medical records were reviewed. All slides from these 138 cases were independently pathologically reviewed by two nephropathologists (Y. J. K. and M. S. K.) using light microscope. The vascular lesions included in this study were fibrous intimal thickening, arteriolar wall thickening, and arteriolar hyalinosis. All cases were reviewed according to the Oxford Classification of IgA Nephropathy (2016) and Haas classification.ResultsOf the 138 patients, 88 exhibited at least one intrarenal vascular lesion. Patients with arteriolar wall thickening demonstrated a reduced estimated glomerular filtration rate (eGFR), elevated serum creatinine level and urine protein-to-creatinine ratio, an increased proportion of global glomerulosclerosis, and a higher histologic grade of interstitial fibrosis and tubular atrophy at the time of biopsy.ConclusionArteriolar wall thickening in IgAN are associated with reduced eGFR and global glomerulosclerosis. Moreover, reduced eGFR and global glomerulosclerosis are correlated with the progression to end-stage renal disease. Although the direct correlation between vascular lesions and end-stage renal disease is not entirely clear, a marginally significant association (log-rank test, p = 0.06) was observed with arterial wall thickening. This study suggests the potential importance of vascular lesions in the prognosis of IgAN, encouraging further investigation using larger cohort studies to establish a clearer association.

Evaluation of urinary volatile organic compounds as a novel metabolomic biomarker to assess chronic kidney disease progression

BackgroundThere is a need to develop accurate and reliable non-invasive methods to evaluate chronic kidney disease (CKD) status and assess disease progression. Given it is recognized that dysregulation in metabolic pathways occur from early CKD, there is a basis in utilizing metabolomic biomarkers to monitor CKD progression. Volatile Organic Compounds (VOCs), a form of metabolomic biomarker, are gaseous products of metabolic processes in organisms which are typically released with greater abundance in disease conditions when there is dysregulation in metabolism. How urinary VOCs reflect the abnormal metabolic profile of patients with CKD status is unknown. Our study aimed to explore this.MethodsIndividuals aged 18–75 years undergoing kidney biopsy were included. Pre-biopsy urine samples were collected. All biopsy samples had an interstitial fibrosis and tubular atrophy (IFTA) grade scored by standardized assessment. Urine supernatant was extracted from residue and sampled for stir bar sorptive extraction followed by Gas chromatography–mass spectrometry (GC-MS) analysis. Post-processing of GC-MS data separated complex mixtures of VOCs based on their volatility and polarity. Mass-to-charge ratios and fragment patterns were measured for individual VOCs identification and quantification. Linear discriminant analysis (LDA) was performed to assess the ability of urinary VOCs in discriminating between IFTA 0 (‘no or minimal IFTA’ i.e. <10%, IFTA), IFTA 1 (‘mild IFTA’ i.e. 10–25% IFTA) and IFTA ≥ 2 (‘moderate or severe IFTA’ i.e. >25% IFTA). Linear regression analysis adjusting for age, sex, estimated glomerular filtration rate, diabetes mellitus (DM) status, and albuminuria was conducted to determine significantly regulated urinary VOCs amongst the groups.Results64 study participants (22 individuals IFTA 0, 15 individuals IFTA 1, 27 individuals IFTA ≥ 2) were included. There were 34 VOCs identified from GC-MS which were statistically associated with correct classification between the IFTA groups, and LDA demonstrated individuals with IFTA 0, IFTA 1 and IFTA ≥ 2 could be significantly separated by their urinary VOCs profile (p < 0.001). Multivariate linear regression analysis reported 4 VOCs significantly upregulated in the IFTA 1 compared to the IFTA 0 group, and 2 VOCs significantly upregulated in the IFTA ≥ 2 compared to the IFTA 1 group (p < 0.05). Significantly upregulated urinary VOCs belonged to one of four functional groups - aldehydes, ketones, hydrocarbons, or alcohols.ConclusionsWe report novel links between urinary VOCs and tubulointerstitial histopathology. Our findings suggest the application of urinary VOCs as a metabolomic biomarker may have a useful clinical role to non-invasively assess CKD status during disease progression.

Comparative analysis of macular characteristics in mCNV and contralateral eyes.

To illustrate the characteristics of perforating scleral vessels in macular regions between mCNV eyes and contralateral eyes in unilateral mCNV patients. This was a retrospective study that included patients with unilateral naive mCNV. The study aimed to identify and analyze the distribution of perforating scleral vessels (PSVs) in the macular region of mCNV eyes and contralateral eyes. The central macular choroidal thicknesses (mChT) were measured using optical coherence tomography angiography (OCTA). The grades of myopic atrophic maculopathy (MAM) and macular myopic diffuse chorioretinal atrophy (DCA) were evaluated within groups. The number of PSVs and mChT were compared between contralateral and mCNV eyes based on the grade of DCA. The ROC curves were utilized to explore the diagnostic indexes for mCNV. A total of 102 eyes from 51 patients with unilateral mCNV were included. There was no significance in the severity of MAM or the grade of DCA between mCNV eyes and contralateral eyes (p = 0.074, p = 0.054, respectively). The mean number of PSVs in mCNV eyes was fewer than the contralateral eyes [1.00 (1.00-2.00) vs. 2.00 (0.75-3.00), p = 0.030]. The mChT in mCNV eyes was thinner than the contralateral eyes [36.00 (25.00-53.75) μm vs. 46.00 (31.00-75.25) μm, p = 0.001]. The mean grade of DCA in mCNV eyes was higher than that in contralateral eyes [3.00 (3.00-3.00) vs. 3.00 (2.00-3.00), p = 0.004]. When DCA involved the macular region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 2.00 (1.00-3.00), p = 0.042]. Similarly, when DCA involved the foveal region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 3.00 (2.00-4.00), p = 0.004]. The grade of DCA and mChT were valuable factors for predicting mCNV eyes (AUC = 0.6566, p = 0.021; AUC = 0.6304, p = 0.029; respectively). When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV (AUC = 0.7430, p = 0.003). The mean amount of PSVs was significantly lower in the mCNV eyes compared to the contralateral eyes. When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV. Myopic eyes with a higher grade of DCA and a thinner mChT were more likely to develop mCNV.

The relationship between the duration and the retraction and atrophy grades in traumatic isolated full-thickness supraspinatus tears in young patients

BackgroundThe study aimed to determine the grade of retraction and atrophy according to the time elapsed in traumatic isolated full-thickness supraspinatus (SS) tears in young patients.MethodsOne thousand twenty-six patients, who underwent arthroscopic shoulder surgery, were retrospectively reviewed. Pre-operative magnetic resonance imaging (MRI) of 69 patients aged 18 to 40 years with isolated traumatic full-thickness SS lesions remaining after exclusion criteria were evaluated for tendon retraction and atrophy grades. SS retraction was determined from a T2-weighted oblique coronal MRI slice, and the atrophy grade was determined from the T1-weighted oblique sagittal MRI slice. The patients were divided into four groups 0–1 month, 1–3 months, 3–6 months, and 6–12 months according to the time between trauma and MRI. The relationship of tendon retraction and muscle atrophy with elapsed time was evaluated, in addition, comparisons between groups were made.ResultsThirty-one (45%) of the patients were female and their mean age was 30 ± 7.3 (18–40) years. The mean age of men was 30.5 ± 6.9 (18–39) years (p = 0.880). The time between rupture and MRI was moderately correlated with retraction and strongly correlated with atrophy grades (r = 0.599, 0.751, respectively). It was observed that there was a statistically significant difference between the 1st (0–1 month) and 2nd (1–3 months) groups (p = 0.003, 0.001, respectively), and between the 2nd and 3rd (3–6 months) groups (p = 0.032, 0.002, respectively), but there was no significant difference between the 3rd and 4th (6–12 months) groups (p = 0.118, 0.057, respectively). In addition, there was a moderate correlation between tendon retraction and atrophy grades (r = 0.668). Power (1- b) in post hoc analysis was calculated as 0.826.ConclusionsThe current study, supported by arthroscopy, showed that there is a moderate and strong positive correlation between the time elapsed after trauma and the level of retraction and degree of atrophy in traumatic full-thickness SS tears, and demonstrated the importance of early surgical intervention in young patients.

Pattern of Testicular Atrophy in Bilateral Orchidectomy Specimens from Patients with Advanced Prostate Cancer

Introduction: One of the palliative treatment modalities for advanced prostate cancer (Pca) is bilateral Orchidectomy. Histopathological analysis of submitted Orchidectomy specimens may display normal to various grades of testicular atrophy. Advancing age may be related to testicular atrophy as well as pre-treatment with luteinizing hormone releasing hormone agonist [LHRH(a)], drugs and chronic illnesses. We retrospectively examined results of Orchidectomy specimens submitted for histopathological analysis. Materials and Methods: Bilateral orchidectomy specimen results of twenty seven (27) patients diagnosed with Pca were retrospectively studied. Their clinical information and ancillary laboratory results were retrieved. Of the 27 patients, two (7.4%) patients had no prior treatments for Pca, while twenty patients (74.1%) and five patients (18.5%) had prior exposure to anti-androgens and LHRH(a) respectively. In the histo-analysis, the specimens were graded from normal to various degrees of atrophy. Data collated were analyzed using Statistical package for social sciences (SPSS) version 20.0 software. Results: The mean age of all patients was 68.52±7.266 years, ranging from 51-87 years. Mean PSA was 59.811+38.84ng/ml, while mean Gleason score was 8.30+8.69. On the whole, 3 patients (11.1%) had normal testes, 16 patients (59.3%) and 8 patients (29.6%) respectively had mild and moderate grades of testicular atrophy. Age correlated positively with the grades of atrophy. Conclusion: Degree of testicular atrophy is widely noted to correlate with age and depends less on pre-treatment in the setting of advanced prostate cancer.

Biocompatible 3D-Printed Devices With Adipose Stem Cells in the Regenerative Process of Sciatic Nerve Lesions in Rodent Models: An Experimental Study.

Peripheral nerve injuries are a significant clinical challenge. The rat sciatic nerve serves as an ideal model for studying nerve regeneration. Extensive research has been conducted to unravel the intricate mechanisms involved in peripheral nerve regeneration, aiming to develop effective therapeutic strategies for nerve injury patients. Research including different types of materials that can be used as nerve guides like synthetic polymershave been investigated for their biocompatibility and molding properties. Among multiple stem cell types, adipose-derived stem cells (ASCs), bone marrow-derived mesenchymal stem cells (BM-MSCs), and induced pluripotent stem cells (iPSCs) have shown neuroprotective and regenerative important properties. The purposes of our study were to develop a protocol for rat sciatic nerve injury treated with 3D-printed guide and adipose stem cells to investigate nerve regeneration through histologic examination and biomechanical characteristics of muscular tissue. We use 20 (100%) male Wistar rats, measuring between 350 g ± 35 g, whounderwent complete transection of the right sciatic nerve, resulting in a 1 cm defect. The group was separated into three subgroups: the first subgroup (n = 8) was treated with a 3D-printed guide with adiposestem cells, the second subgroup (n = 8) was treated with a 3D-printed guide without adiposestem cells, and the third subgroup (n = 4) was the control group. At four, eight, and 12 weeks, we measured with ultrasonography the grade of muscular atrophy. At 12 weeks, we harvested the sciatic nerve and performed a histological examination and mechanical investigation of the tibialis anterior muscle. On the examined specimen of the first subgroup, cross-sectioned nerve structures were present, surrounded by a mature fibro-adipose connective tissue, with blood vessels. In the second subgroup, no nerve structure was observed on the examined sections, but in the polymorphic inflammatory infiltrate and control group, no signs of regeneration were found. The present study shows a promising potential when utilizing adipose stem cell-based therapies for promoting peripheral nerve regeneration following large (>1 cm) nerve defects knowing that at this size, regeneration is impossible with known treatments.

Clinical Characteristics of Patients With Previous Helicobacter pylori Infection-Induced Atrophic Gastritis.

Patients with atrophic gastritis unrelated to autoimmune gastritis (AIG) and without active Helicobacter pylori (H.pylori)infection or previous eradication therapy are considered to have previous Helicobacter pylori infection-induced atrophic gastritis (PHIG). This study aimed to clarify the clinical characteristics of patients with PHIG. Consecutive patients who underwent upper gastrointestinal endoscopy during the study period were enrolled in the study. Pepsinogen and gastrin levels, H. pylori serology, and endoscopic atrophic grade were assessed. Patients were divided into five groups based on their H. pylori status and disease history (PHIG, without H. pylori infection, with active H. pylori infection, with successful H. pylori eradication, and AIG). Their gastric cancer risk status was classified according to the ABC method of serological gastric cancer screening. Of 536 consecutive patients who underwent upper gastrointestinal endoscopy during the study period, 318 were included (31 with PHIG, 77 without H. pylori infection, 101 with active H. pylori infection, 80 with successful H. pylori eradication, and 29 with AIG). Of the 31 patients with PHIG, 21 (68%) were H. pylori-seronegative,and 20 (65%) were classified as group A (normal pepsinogen, H. pylori-seronegative). Patients with PHIG accounted for 90.1% of the patients at high risk for gastric cancer misclassified as group A. The pepsinogen and H. pylori serological profiles of patients with PHIG were similar to those of patients with successful H. pylori eradication more than six years previously. A receiver-operating characteristic curve (ROC) analysis that included 13 patients with AIG and without active H. pylori infection and no previous eradication therapy and 31 patients with PHIG revealed that an endoscopic atrophy grade of O-III or greater according to the Kimura-Takemoto classification can predict AIG. Two-thirds of the patients with PHIG were misclassified as being at low risk (group A) according to the ABC method, suggesting that endoscopy is necessary for group A patients. The results of the serological evaluation of PHIG indicated that patients with PHIG may have experienced spontaneous H. pylori eradication, possibly because of the use of antibiotics for other conditions. Autoimmune gastritis should be considered in the presence of grade 0-III or greater gastric mucosal atrophy in patients with suspected PHIG, even if the autoantibody and histological findings are not available.

#1846 Oxalate nephropathy in diabetic kidney disease: another factor to take into account?

Abstract Background and Aims Patients with diabetes mellitus (DM) have an increased urinary excretion of oxalate. Around 40% of patients with oxalate nephropathy have DM. The aim of this study was to describe the prevalence of tubular deposits of calcium oxalate (CaOx) crystals in patients with diabetic kidney disease (DKD) and investigate its association with renal survival. Method We performed an observational retrospective study that included patients with DKD in renal biopsies performed at our centre between January 1999 and December 2021. We revised the biopsy specimens for the presence of intratubular CaOx crystals. We excluded patients with a histological findings of non-diabetic kidney disease and those lost to follow-up. Renal survival was defined as a state free from developing end-stage kidney disease (ESKD) requiring renal replacement therapy. Results The study included 87 patients with a mean age of 63.1 ± 13 years, 73.5% were male, and 88.5% had type 2 DM (11.5% type 1 DM). Baseline GFR at the moment of kidney biopsy was 38.5 ± 23 ml/min, and baseline median proteinuria was 3.46 (1.35-5.70) g/day. We found intratubular CaOx deposits in 11 biopsies (12.6%). These findings were only found in patients with type 2 DM (14.3% vs 0%), and was more frequently present in patients with a history of renal stones (33.3% vs 11.1%). There were no differences in baseline GFR, proteinuria or vintage of DM between patients with intratubular CaOx deposits and those with no signs of oxalte nephropathy. CaOx deposition was not associated with other histological lesions such as percentage of glomerular sclerosis, grade of interstitial fibrosis and/or tubular atrophy, interstitial inflammation, arterial hyalinosis or arteriosclerosis. After a median follow-up of 41 months, 49.4% of patients developed ESKD while 26.4% died without progressing to ESKD. The patients who progressed to ESKD had a higher baseline serum creatinine (2.56 ± 1.45 vs 1.98 ± 1.07 ml/min, p = 0.037) and lower serum albumin (3.08 ± 0.70 vs 3.57 ± 0.74 g/dl, p = 0.003). In the regression analysis there was no association between intratubular CaOx deposits and progression to ESKD (OR = 2.96, 95% CI 0.73-12.03). In the adjusted model, no histological lesions were associated with renal survival. In the survival analysis, the presence of intratubular CaOx deposits was not associated with neither renal nor patient survival. Conclusion Oxalate nephropathy, defined as the presence of intratubular CaOx deposits in kidney biopsies, may be found in patients with DKD. In our cohort, 14.3% of type 2 DM patients with DKD had concomitant oxalate nephropathy. Its presence was not associated with a worse renal or patient survival.

Metabolic Factors Associated with Endoscopic Atrophy, Intestinal Metaplasia, and Gastric Neoplasms in Helicobacter pylori-Positive Patients.

Previous studies demonstrate an association between metabolic factors and Helicobacter pylori-related gastric cancer. However, the association of gastric atrophy or intestinal metaplasia (IM) with these factors remains unknown. Data on 1603 Helicobacter pylori-positive patients who underwent esophagogastroduodenoscopy between 2001 and 2021 were evaluated. The outcome measures were endoscopic atrophy, IM grade, and the incidence of endoscopically diagnosed and pathologically confirmed gastric neoplasms. Clinical factors associated with these findings were also determined. Advanced age; successful Helicobacter pylori eradication; and comorbidities including diabetes mellitus (DM), hypertension, dyslipidemia, and fib4 index were significantly associated with endoscopic gastric atrophy grade. Male sex; advanced age; and comorbidities including DM, hypertension, dyslipidemia, hyperuricemia, fatty liver, aortic calcification, and fib4 index were also significantly associated with endoscopic IM grade, whereas advanced age, successful Helicobacter pylori eradication, DM, fatty liver, and fib4 index were significantly associated with the incidence of gastric neoplasms. Several metabolic disorders, including DM, hypertension, dyslipidemia, hyperuricemia, and fatty liver disease, are risk factors for advanced-grade gastric atrophy, intestinal metaplasia, and gastric neoplasms. Risk stratification according to these factors, particularly those with metabolic disorders, would affect EGD surveillance for Helicobacter pylori-positive patients.

ExKidneyBERT: a language model for kidney transplant pathology reports and the crucial role of extended vocabularies.

Pathology reports contain key information about the patient's diagnosis as well as important gross and microscopic findings. These information-rich clinical reports offer an invaluable resource for clinical studies, but data extraction and analysis from such unstructured texts is often manual and tedious. While neural information retrieval systems (typically implemented as deep learning methods for natural language processing) are automatic and flexible, they typically require a large domain-specific text corpus for training, making them infeasible for many medical subdomains. Thus, an automated data extraction method for pathology reports that does not require a large training corpus would be of significant value and utility. To develop a language model-based neural information retrieval system that can be trained on small datasets and validate it by training it on renal transplant-pathology reports to extract relevant information for two predefined questions: (1) "What kind of rejection does the patient show?"; (2) "What is the grade of interstitial fibrosis and tubular atrophy (IFTA)?" Kidney BERT was developed by pre-training Clinical BERT on 3.4K renal transplant pathology reports and 1.5M words. Then, exKidneyBERT was developed by extending Clinical BERT's tokenizer with six technical keywords and repeating the pre-training procedure. This extended the model's vocabulary. All three models were fine-tuned with information retrieval heads. The model with extended vocabulary, exKidneyBERT, outperformed Clinical BERT and Kidney BERT in both questions. For rejection, exKidneyBERT achieved an 83.3% overlap ratio for antibody-mediated rejection (ABMR) and 79.2% for T-cell mediated rejection (TCMR). For IFTA, exKidneyBERT had a 95.8% exact match rate. ExKidneyBERT is a high-performing model for extracting information from renal pathology reports. Additional pre-training of BERT language models on specialized small domains does not necessarily improve performance. Extending the BERT tokenizer's vocabulary library is essential for specialized domains to improve performance, especially when pre-training on small corpora.

Clinical application of machine learning-based pathomics signature of gastric atrophy.

The diagnosis of gastric atrophy is highly subjective, and we aimed to establish a model of gastric atrophy based on pathological features to improve diagnostic consistency. We retrospectively collected the HE-stained pathological slides of gastric biopsies and used CellProfiler software for image segmentation and feature extraction of ten representative images for each sample. Subsequently, we employed the Least absolute shrinkage and selection operator (LASSO) to select features and different machine learning (ML) algorithms to construct the diagnostic models for gastric atrophy. We selected 289 gastric biopsy specimens for training, testing, and external validation. We extracted 464 pathological features and screened ten features by LASSO to establish the diagnostic model for moderate-to-severe atrophy. The range of area under the curve (AUC) for various machine learning algorithms was 0.835-1.000 in the training set, 0.786-0.949 in the testing set, and 0.689-0.818 in the external validation set. LR model had the highest AUC value, with 0.900 (95% CI: 0.852-0.947) in the training set, 0.901 (95% CI: 0.807-0.996) in the testing set, and 0.818 (95% CI: 0.714-0.923) in the external validation set. The atrophy pathological score based on the LR model was associated with endoscopic atrophy grading (Z=-2.478, P=0.013) and gastric cancer (GC) (OR=5.70, 95% CI: 2.63-12.33, P<0.001). The ML model based on pathological features could improve the diagnostic consistency of gastric atrophy, which is also associated with endoscopic atrophy grading and GC.

Suture Contamination During Arthroscopic Rotator Cuff Repair Is Associated With Significantly Higher Retear Rates in Magnetic Resonance Imaging: A Matched-Pair Analysis

PurposeTo evaluate the correlation between suture contamination and rotator cuff tendon retear after arthroscopic rotator cuff repair. MethodsPatients undergoing primary arthroscopic rotator cuff repair from April 1st, 2020 to September 30th, 2022 were enrolled. Those younger than 18 years, with a history of prior shoulder surgeries or shoulder infection episodes, or who declined participation, were excluded. A 5 cm section of the first-cut suture, originating from the anchor eyelet ends, in each rotator cuff repair surgery was subjected to bacteria culture and polymerase chain reaction (PCR) analysis. Patients with positive culture findings were matched 1:1 to those with negative culture reports based on age, sex, tear size as well as involved tendons, preoperative fatty infiltration grade (Goutallier grade) and preoperative muscle atrophy grade (Warner score). Postoperative rotator cuff tendon retear assessments were conducted at the 6-month mark using the Sugaya classification via magnetic resonance imaging. The Wilcoxon signed-rank test was used for matched-pair comparisons between the groups. ResultsA total of 141 patients (60 males and 81 females) with a mean age of 61.0 ± 8 years were finally enrolled. Twenty-six patients (18 males and 8 females) had a positive culture, while 115 patients (42 males and 73 females) had a negative culture. After the propensity score matching process, 24 culture-negative patients (16 males and 8 females) were selected as the culture-negative group. Age, fatty infiltration grade, and muscle atrophy grade were not significantly different between matched groups. The retear grade in the culture-positive group was found to be significantly higher than that in the culture-negative group (P = 0.020) under the matched-pair comparison. C. acnes. was the most prevalent bacterial species responsible for suture contamination. ConclusionsThe matched-pair analysis revealed that the presence of bacterial contamination on sutures was associated with a higher risk of retear in MRI following arthroscopic rotator cuff repair.

Evaluation of the relationship between the severity of sarcopenia and osteoporosis: A magnetic resonance imaging and dual-energy X-ray absorptiometry study

This study aimed to investigate the presence of sarcopenia which was graded according to Magnetic Resonance (MR) imaging in paraspinal muscles and explore the degree of osteoporosis by bone mineral density. Lumber MR images of 69 female patients complaining of back pain and Dual-Energy X-ray absorptiometry (DXA) examinations were evaluated retrospectively. On MR imaging, the degree of sarcopenia in the paraspinal muscles of these patients was graded as normal, moderate and severe according to the simplified 3-Tier classification which is considered a Modified Goutallier classification by two radiologists. DXA examinations were categorized based on the t-score, with scores above -2.5 denoting osteopenia and scores below -2.5 indicating osteoporosis. Grades of atrophy in paraspinal muscles were found to be normal (n=15, 21.7%), moderate (n=43, 62.3%) and severe (n=11, 15.9%). The degree of paraspinal muscle atrophy was found to be lower in patients with osteopenia compared to patients with osteoporosis by both observers. (Radiologist 1 p: 0.284, radiologist 2 p: 0.047). As the degree of atrophy in the paraspinal muscles increases, the DXA t score decreases in some osteoporotic patients. Paraspinal muscle atrophy detected on lumbar MRI and DXA T scores are correlated in patients with low back pain. Identifying pathways affecting both bone and muscle units will facilitate developmental entities aiming to treat both conditions.

The impact of paraspinal muscle morphology on functional outcome in patients with degenerative lumbar spine disease undergoing surgery - A prospective observational study

IntroductionParaspinal muscle atrophy has been implicated in low back pain (LBP) as well as degenerative disc disease, lumbar spinal stenosis, and disc herniation. The objective of the study was to determine the association of paraspinal muscle morphology with functional outcomes in patients undergoing spine surgery in degenerative spine diseases. Research questionCan the degree of paraspinal muscle atrophy be a reliable prognostic indicator of post-operative functional outcome in patients undergoing surgery for degenerative lumbar spine disease? Materials and methodsForty-one patients with degenerative lumbar spine disease planned for surgery were included. Pre-operative and postoperative MRI-based muscle morphology including total cross-sectional area (TCSA) and muscle atrophy were recorded. Association between muscle parameters and functional status as indicated from the visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed, and compared between prior and after surgery. ResultsThe MF and ES cross-sectional area on MRI was in proportion to the functional status. (higher ODI and VAS). Preoperative MF TCSA was positively correlated with preoperative ODI ((r = −0.441, p = = 0.032), preoperative VAS (r = −0.338, p = 0.048) and was negatively correlated with change in ODI (r = −0.268, p = 0.016) while preoperative ES TCSA was negatively correlated with preoperative ODI (r = −0.420, p = 0.003). Preoperative ODI, change in ODI and preoperative VAS had significant correlation with muscle atrophy (p < 0.05). There was a positive correlation between preoperative ODI with Grade 2 (r = 0.332, p = 0.016) and Grade 3 (r = 0.299, p = 0.048) MF muscle; and Grade 2 (r = 0.308, p = 0.067) and Grade 3 (r = 0.202, p = 0.018) ES muscles atrophy. The change in ODI, negatively correlated with Grade 3 MF and ES atrophy (r = −0.332, p = 0.018 and r = −0.286, P = 0.011 respectively). Linear regression analysis showed duration of symptom (p = 0.005) was positively associated with preoperative ODI. Age and BMI were negatively associated with improvement in ODI. (p = 0.073, 0.098 respectively). Discussion and conclusionPreoperative paraspinal muscle area is an independent variable that affects preoperative functional status. The grade of paraspinal muscle atrophy is a good predictor of preoperative, postoperative and improvement in functional status.

Prediction of acute rejection in renal allografts using shear-wave dispersion slope.

To evaluate the role of shear-wave dispersion slope for predicting renal allograft dysfunction. We retrospectively reviewed 128 kidney transplant recipients (median age, 55years [interquartile range, 43-62years]; male, 68) who underwent biopsy for allograft evaluation from November 2022 to February 2023. Cortex and renal sinus fat stiffness and shear-wave dispersion slope were obtained at shear-wave elastography (SWE). Cortex-to-sinus stiffness ratio (SR) and dispersion slope ratio (DSR)-related clinical and pathologic factors were evaluated using multivariable linear regression analysis. We conducted univariate and multivariate analyses for multiparametric ultrasound (US) parameters for identifying acute rejection and calculated the area under the receiver operating curve (AUC) values. Of 128 patients, 31 (24.2%) demonstrated acute rejection. The SR value did not differ between patient groups (1.21 vs. 1.20, p = 0.47). Patients with acute rejection demonstrated a higher DSR than those without rejection (1.4 vs. 1.21, p < 0.01). Interstitial fibrosis and tubular atrophy grade (IFTA; coefficient, 0.11/grade; p = 0.04) and renal transplant and biopsy interval (coefficient, 0.00007/day; p = 0.03) were SR determinant factors, whereas only IFTA grade (coefficient, 0.10/grade; p = 0.01) for DSR. Multivariate analysis revealed mean resistive index (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02-1.14, p = 0.01) and DSR value (OR 16.0, 95% CI 3.0-85.8, p = 0.001) as independent factors for predicting acute rejection. An AUC of 0.74 for detecting acute rejection was achieved by combining the resistive index and DSR value. Shear-wave dispersion slope obtained at SWE may help identify renal allograft dysfunction. Acute rejection in renal allografts is a major cause of allograft failure, but noninvasive diagnosis is a challenge. Shear-wave dispersion slope can identify acute rejection non-invasively. • The interstitial fibrosis and tubular atrophy grade was a determinant factor for stiffness ratio and shear-wave dispersion slope ratio between cortex and renal sinus fat. • Shear-wave dispersion slope ratio between cortex and renal sinus fat could identify acute rejection in renal allografts. • A shear-wave dispersion slope has a potential to reduce unnecessary renal biopsy for evaluating renal allografts.

Factors affecting progression of non-Alzheimer dementia: a retrospective analysis with long-term follow-up.

Non-Alzheimer's dementias, including vascular dementia (VaD), frontotemporal dementia (FTD), Lewy body dementia (LBD), and Parkinson's disease dementia (PDD), possess unique characteristics and prognostic factors that remain poorly understood. This study aims to investigate the temporal course of these subtypes and identify the impact of functional, neuropsychiatric, and comorbid medical conditions on prognosis. Additionally, the relationship between hippocampal atrophy, white matter intensities, and disease progression will be examined, along with the identification of key covariates influencing slow or fast progression in non-Alzheimer's dementias. A total of 196 patients with non-Alzheimer's dementias who underwent at least three comprehensive evaluations were included, with proportions of VaD, FTD, LBD, and PDD being 50, 19.39, 19.90, and 10.71%, respectively. Patient demographics, comorbidities, neuropsychiatric and neuroimaging parameters, and global evaluation were analyzed using appropriate statistical methods. The study followed patients for a mean duration of 62.57 ± 33.45 months (ranging from 11 to 198 months). The results from three different visits for each non-AD dementia case demonstrated significant differences in various measures across visits, including functional capacity (BDLAS), cognition (MMSE), and other neuropsychological tests. Notably, certain genotypes and hippocampal atrophy grades were more prevalent in specific subtypes. The results indicate that Fazekas grading and hippocampal atrophy were significant predictors of disease progression, while epilepsy, extrapyramidal symptoms, thyroid dysfunction, coronary artery disease, diabetes mellitus, hypertension, stroke, hyperlipidemia, sleep disorders, smoking, and family history of dementia were not significant predictors. BDLAS and EDLAS scores at the first and second visits showed significant associations with disease progression, while scores at the third visit did not. Group-based trajectory analysis revealed that non-AD cases separated into two reliable subgroups with slow/fast prognosis, showing high reliability (Entropy = 0.790, 51.8 vs. 48.2%). This study provides valuable insights into the temporal course and prognostic factors of non-Alzheimer's dementias. The findings underscore the importance of considering functional, neuropsychological, and comorbid medical conditions in understanding disease progression. The significant associations between hippocampal atrophy, white matter intensities, and prognosis highlight potential avenues for further research and therapeutic interventions.

The Importance of 1-Year Protocol Biopsy in the Long-Term Prognosis of Kidney Transplants—5-Years Follow-Up

Protocol biopsies are performed to detect subclinical pathologies that may lead to future graft dysfunction. However, they are not routinely performed interventions in every transplant center. There is no established regimen for performing them. The study aimed to evaluate if protocol biopsies can improve long-term patient outcomes after detecting early disorders and modifying treatment. Our observational study included 61 patients who underwent protocol biopsy 12 months after the transplantation. Based on the biopsy results, patients with abnormal histologic material (n=37) were divided into 3 study groups as follows: patients with mild inflammatory lesions (n=21), patients with interstitial fibrosis and tubular atrophy (IFTA) grade II to III (n=12), and patients with BK virus nephropathy (n=4). The control group (n=24) included kidney recipients with IFTA 0 to I grade. Outcomes after 5-year follow-up were evaluated. Five years after the biopsy, patients in the control group had stable graft function (5-year change in serum creatinine was -0.09 mg/dL). An increase in serum creatinine levels was observed in patients with IFTA II to III compared with the control group (0.14 mg/dL, P=.04). Immunosuppressive treatment was modified in the group with mild inflammatory changes and in the BKV group after the biopsy result. In the group with mild inflammatory lesions, renal function was stable (change of serum creatinine was -0.01 mg/dL, P=.51). In the BKV nephropathy group, there was a significant reduction in serum creatine levels (-0.48 mg/dL, P=.016). The analysis showed no diagnostic value for serum creatinine concentration (95% CI 0.49-0.78, P=.08). Protocol biopsies are useful for detecting early pathologies and preventing allograft failure. They greatly benefit patients with detectable pathology that can be treated or in whom therapy modification is possible.

Comparative Profile of Celiac Disease Between Children and Adults in Western Algeria Region

Background: This study was performed to describe the main differences and similarities of celiac disease according to age and highlight the clinical features, diagnosis, associations of the disease, complications, and response to a gluten-free diet in children and adults. Methods: A retrospective study was conducted on a series of patients (n = 223) diagnosed with celiac disease during infancy (&lt; 2 years) and childhood (≥ 2 years) versus a series of adult patients (≥ 17 years). Results: A total of 223 patients were included in this study, 40, 109, and 74 of whom were infants, children, and adults, respectively. The age of diagnosis was delayed in adults, with a mean value of 21.07 ± 12.49 years versus 03.37 ± 3.93 and 6.53 ± 3.77 years in infants and children, respectively (P &lt; 0.001). The clinical manifestations in infants and children were defined as digestive disorders, mainly chronic diarrhea (P = 0.004), similar in adults. Nevertheless, the extra digestive manifestations were predominant in adults, and anemia was the most frequent manifestation (51.4%) versus 30% (n = 12) and 33.9% (n = 37) in infants and children, respectively (P = 0.026), while weight loss in adults affected 52.7% (P for the difference between the three age groups = 0.004). In adults, there was a higher frequency of associated autoimmune diseases, including hypothyroidism (8.1% versus 4.6% in children), Crohn’s disease (5.4% versus 0.0% in children), and lupus (0.9% versus 0.0% in children) (P &lt; 0.001). Serology was strongly positive in all three age groups but with no significant difference between them (P = 0.184). The difference between the three age groups concerning the immunoglobulin G (IgG) anti-transglutaminase (a-tTG) assay positivity was statistically significant (P &lt; 0.001). The partial grade of villous atrophy was dominant in all three groups. Good adherence to the diet was more noticeable in children than adults (P = 0.001). Conclusions: Celiac disease presents differences between adults and children. The atypical clinical presentation is dominant in adults. Children present a positive serology and good adherence to the diet.

Arteriolosclerosis CSVD: a common cause of dementia and stroke and its association with cognitive function and total MRI burden.

Arteriolosclerosis cerebral small vessel disease (CSVD) is a common type of CSVD. This study aimed to explore the factors associated with cognitive function and total MRI burden related to the disease. The demographic characteristics, clinical manifestations, cognitive function score, Barthel Index (BI), blood test index, and follow-up results of arteriolosclerosis CSVD patients treated for the first time in our hospital from January 2014 to August 2022 were collected. White matter hyperintensity (WMH) Fazekas score, total MRI burden, and cerebral atrophy grade were evaluated according to brain MRI findings. Factors associated with CSVD cognitive function were analyzed by binary logistic regression. The correlative factors related to the total MRI burden of CSVD were analyzed by ordered multiple logistic regression. A total of 146 patients were included in this study, of which 132 cases (90.4%) had hypertension. There were 108 patients (74.0%) with cognitive dysfunction, 97 patients (66.4%) with balance and gait disorders, and 83 patients (56.8%) with moderate-to-severe dependence in daily life (BI ≤ 60 points). Of 146 patients, 79 (54.1%) completed clinical and imaging follow-ups for a median of 3 years. The number of patients with cognitive impairment and BI ≤ 60 points after follow-up significantly increased compared with the first admission (P < 0.001). There were also significant differences in total MRI burden (P = 0.001), WMH Fazekas score, and cerebral atrophy grade (P < 0.001). Mean age (P = 0.012), median deep WMH Fazekas score (P = 0.028), and median deep (P < 0.001) and superficial (P =0.002) cerebral atrophy grade of patients with cognitive impairment at first admission were all higher than those with non-cognitive impairment. Multivariate analysis showed that deep cerebral atrophy was independently and significantly associated with cognitive impairment of CSVD (P = 0.024), and hypertension was significantly and independently associated with total MRI burden (P = 0.001). The disease course of arteriolosclerosis CSVD may be related to cognitive function and total MRI burden. Deep cerebral atrophy was an independent risk factor for cognitive dysfunction in arteriolosclerosis CSVD, and hypertension was an independent risk factor for total MRI burden.