Mucosal Enhancement Research Articles

Arterial Mucosal Linear Enhancement at Contrast-enhanced MRI to Exclude Residual Tumor after Neoadjuvant Chemotherapy and Radiation Therapy for Rectal Cancer.

Background A watch-and-wait regimen for locally advanced rectal cancer after neoadjuvant chemotherapy and radiation therapy (NCRT) relies on identifying complete tumor response. However, the concordance between a complete response at combined T2-weighted and diffusion-weighted MRI (T2DWI) and pathologic complete response (pCR; ie, ypT0N0) in the tumor is unsatisfactory. Purpose To assess whether identification of mucosal linear enhancement (MLE) at arterial-phase contrast-enhanced (CE) T1-weighted MRI is associated with ypT0 status in patients with locally advanced rectal cancer after NCRT and to evaluate whether combining MLE at CE T1-weighted MRI and negative lymph node metastasis (LNM) at T2DWI can improve identification of pCR. Materials and Methods This retrospective study included patients with locally advanced rectal cancer who underwent total mesorectal excision after NCRT between July 2020 and July 2023 at a tertiary referral academic center. Restaging MRI included T2DWI and arterial-phase CE T1-weighted MRI for primary tumor assessment and T2DWI for evaluation of LNM status. Imaging features associated with ypT0 status were identified at multivariable regression analysis. Results In total, 239 patients (mean age, 58 years ± 12 [SD]; 180 male patients) were assessed. MLE was more common in the ypT0 group than in the ypT1-4 group after NCRT (73% vs 4%, respectively; P < .001). MLE was associated with higher odds of ypT0 status in an adjusted analysis (odds ratio, 137; 95% CI: 25, 767; P < .001). The combination of MLE and negative LNM status achieved an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.79, 0.88) for pCR. Conclusion MLE at CE MRI was associated with higher odds of complete tumor response. Combining MLE and negative LNM status showed good performance for identifying complete tumor response and may exclude residual tumors after NCRT in patients with locally advanced rectal cancer. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Schoellnast in this issue.

Mucosal Linear Enhancement after Neoadjuvant Chemoradiation Therapy for Rectal Cancer.

Mucosal Linear Enhancement after Neoadjuvant Chemoradiation Therapy for Rectal Cancer.

Dual-energy CT in acute cholecystitis- features predicting culture-positive bile and outcome

PurposeLow mono-energetic CT has been shown to improve visualization of acute abdominal inflammatory processes. We aimed to determine its utility in patients with acute cholecystitis and potential added value in clinical decision making. MethodsSixty-seven consecutive patients with radiological signs of cholecystitis on contrast-enhanced dual-layer CT imaging were retrospectively identified over a four-year period (2/17–8/21). A ranked Likert scale was created for imaging findings present in acute cholecystitis, including gallbladder mucosal integrity and enhancement and pericholecystic liver parenchymal enhancement. These rankings were correlated with laboratory data, followed by sensitivity, specificity, and odds-ratios calculations. ResultsMucosal integrity and pericholecystic liver enhancement were better seen on low-energetic images by unanimous consensus. Presence of pericholecystic liver enhancement and poorer mucosal wall integrity correlated with positive bile cultures (sensitivity: 93.8 % and 96.9 %, specificity: 37.5 and 50.0 %; odds-ratio: 9.0[1.1–68.1 95 %CI] and 31.0 [2.7–350.7 95 %CI], p = 0.017 and p ≤ 0.001) in patients undergoing cholecystostomy (n = 40/67). Moreover, binary regression modeling showed that the strongest predictor variable for bile culture positivity was the score for pericholecystic liver enhancement (Exp(B) = 0.6, P = 0.022). By contrast, other laboratory markers and other imaging findings (such as GB wall thickness) showed lower sensitivities (76–82 %), specificities (16–21 %) and odds ratios (0.2–4.4) for the prediction of infected bile. ConclusionsPericholecystic liver enhancement and gallbladder wall integrity are better visualized on low-DECT images. These findings also potentially predict bile culture positivity in patients with cholecystitis, which may influence clinical management including the need for intervention.

Hepatic Portovenous Gas in a Young Male

Hepatic portal venous gas is diagnosed via computed tomography due to unusual imaging features. Hepatic portal venous gas when linked with pneumatosis intestinalis has a high mortality rate and required urgent intervention. We present a case of a 35 year-old male patient with a 12 hour history of generalised abdominal pain, watery diarrhoea and vomiting. He had a background of gout and alcoholism. He had an unmeasurable blood pressure and sinus tachycardia when he was first seen. The patient was stabilized after undergoing vigorous intravenous fluid resuscitation, and he was then sent for a CT scan. A considerable amount of hepatic portovenous gas was seen on the CT scan, coupled with dilated and diffusely aberrant small and large bowel with mucosal enhancement.

Case report of mucosal ischemia following left hepatectomy: Unveiling a rare postoperative complication

Introduction: Gastric Mucosal Ischemia (GMI) following left hepatectomy is a rare post operative complication, never described in literature. The presented image illustrates the uncommon postoperative complication of Gastric Mucosal Ischemia (GMI) following Liver Resection (LR). Case presentation: A 60-year-old woman underwent left hepatectomy with lymphadenectomy for intrahepatic cholangiocarcinoma. The patient developed intense abdominal pain in 9th Postoperative Day (POD). The subsequent CT scan described: “a 6 cm biloma, pressing and displacing the antral region of the stomach, air emboli in the short gastric veins, edematous wall thickening of the fundus with regions of reduced or absent mucosal enhancement, highlighted with green arrows”. Following conservative treatment, the patient fully recovered, being discharged on the 28th POD. Conclusion: GMI is an infrequent complication encountered after LR. In this case it is attributed to an exceptional observation: the mechanical effects of the biloma causing compression and displacement of gastric vessels, resulting in compromised blood supply to the gastric mucosa and subsequent ischemia.

Polysaccharide from Atractylodes macrocephala Koidz Binding with Zinc Oxide Nanoparticles as a Novel Mucosal Immune Adjuvant for H9N2 Inactivated Vaccine.

H9N2 avian influenza poses a significant public health risk, necessitating effective vaccines for mass immunization. Oral inactivated vaccines offer advantages like the ease of administration, but their efficacy often requires enhancement through mucosal adjuvants. In a previous study, we established a novel complex of polysaccharide from Atractylodes macrocephala Koidz binding with zinc oxide nanoparticles (AMP-ZnONPs) and preliminarily demonstrated its immune-enhancing function. This work aimed to evaluate the efficacy of AMP-ZnONPs as adjuvants in an oral H9N2-inactivated vaccine and the vaccine's impact on intestinal mucosal immunity. In this study, mice were orally vaccinated on days 0 and 14 after adapting to the environment. AMP-ZnONPs significantly improved HI titers, the levels of specific IgG, IgG1 and IgG2a in serum and sIgA in intestinal lavage fluid; increased the number of B-1 and B-2 cells and dendritic cell populations; and enhanced the mRNA expression of intestinal homing factors and immune-related cytokines. Interestingly, AMP-ZnONPs were more likely to affect B-1 cells than B-2 cells. AMP-ZnONPs showed mucosal immune enhancement that was comparable to positive control (cholera toxin, CT), but not to the side effect of weight loss caused by CT. Compared to the whole-inactivated H9N2 virus (WIV) group, the WIV + AMP-ZnONP and WIV + CT groups exhibited opposite shifts in gut microbial abundance. AMP-ZnONPs serve as an effective and safe mucosal adjuvant for oral WIV, improving cellular, humoral and mucosal immunity and microbiota in the gastrointestinal tract, avoiding the related undesired effects of CT.

Optimal CT windowing on low-monoenergetic images using a simplex algorithm-based approach for abdominal inflammatory processes

Background:ObjectivesTo determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy spectral CT (DECT). MethodsA retrospective study of 30 patients with clinically proven pancreatitis (15/30) or pyelonephritis (15/30) with inflammatory lesions visible on DECT scans were selected to serve as reference populations. 50 keV low-monoenergetic images in the portal venous phase were iteratively evaluated by 6 abdominal radiologists in twenty-one different windows (7-350HU center; 120-580HU width), selected using a simplex optimization algorithm. Each reader graded the conspicuity of the parenchymal hypodense lesions and image background quality. Three-dimensional contour maps expressing the relationship between overall reader grade and window center and width were constructed and used to find the ideal window for inflammatory pancreatic and renal processes and the image background quality. Finally, 15 appendicitis cases were reviewed on optimal pancreas and kidney windows and the manufacturer recommended conventional abdominal window settings for conventional imaging. ResultsConvergence to optimal windowing was achieved based upon a total of 3,780 reads (21 window settings × 6 readers × 15 cases for pancreas and kidney). Highest conspicuity grade (>4.5 ± 0.0) for pancreas inflammatory lesions was seen at 116HU/430HU, whereas hypodense pyelonephritis had highest conspicuity at 290HU/570HU. This rendered an ideal “compromise” window (>4 ± 0.2) of 150HU/450HU which differed substantially from conventional manufacturer recommended settings of 50HU/380HU (2.1 ± 1.0, p = 0.00001). Appendix mucosal enhancement was best visualized at manufacturer settings. ConclusionsOptimal visualization of inflammatory processes in abdominal organs on 50 keV low-monoenergetic images may require tailored refinement of window settings.

Toll-like Receptor Ligands Enhance Vaccine Efficacy against a Virulent Newcastle Disease Virus Challenge in Chickens.

To enhance the efficacy of the current Newcastle disease vaccine, we have selected potential adjuvants that target well-characterized pattern recognition receptors: the toll-like receptors (TLRs). Imiquimod is a small-molecule activator of TLR7, which is a sensor of dsDNA. ODN-1826 is a mimetic of CpG DNA and ligates TLR21 (a chicken homologue of TLR9 in mammals). The activation of TLRs leads to antiviral responses, including the induction of type I interferons (IFNs). In this study, birds were vaccinated intranasally with a live LaSota strain with or without imiquimod or ODN-1826 (50 µg/bird). Two weeks after vaccination, the birds were challenged with a virulent Newcastle disease virus (chicken/CA/212676/2002). Both adjuvants (imiquimod or ODN-1826) induced higher and more uniform antibody titers among vaccinated birds compared with the live vaccine-alone group. In addition, adjuvanted vaccines demonstrated greater protective efficacy in terms of the reduction in virus-shedding titer and the number of birds shedding the challenge virus at 2 and 4 days post-challenge. A differential expression of antiviral and immune-related genes was observed among groups from tissues (Harderian gland, trachea, cecal tonsil, and spleen) collected 1 and 3 days after treatment. These results demonstrate the potential of TLR-targeted adjuvants as mucosal vaccine enhancers and warrant a further characterization of immune correlates and optimization for efficacy.

Mastoid fluid signal in acute cerebral venous thrombosis is is associated with increased clot burden

PurposeMastoid air cell abnormalities in the form of hyperintense T2 fluid signal have been reported in cases of acute Cerebral Venous Thrombosis (CVT) without otologic infection and have been hypothesized to be a result of venous congestion rather than infectious mastoiditis. The aim of this study was to investigate a link between the spectrum of mastoid abnormalities and clot burden in patients with acute CVT. MethodsA retrospective study of adult patients admitted to the National Institute of Mental Health and Neurosciences between 2016 and 2023 who were diagnosed with acute CVT and had no clinical evidence of active or recent ear infections was conducted. Pre- and post-contrast MR Images were analyzed to identify the dural sinuses and/or cerebral veins involved and the presence of fluid signal in the mastoid. Fluid signal in the mastoid was graded from 0 to 3 as described by Shah et al- no fluid signal (grade 0), thin curvilinear hyperintensities (grade 1), thick crescenteric hyperintensities (grade 2), and complete hyperintensity (grade 3). Clot Burden Score (CBS) was calculated by assigning one point for each sinus involved, one point for extension of thrombus into the intracranial Internal Jugular Vein (IJV), one point for thrombosis of cortical veins and one point for thrombosis of deep cerebral veins. ResultsA total of 89 patients with acute CVT were included in the final analysis. Median time from presentation to MRI was 2 days (range 0–13). 51 patients (57.3%) had fluid signal in the mastoid air cells on T2-weighted images, of whom 33 showed mucosal contrast enhancement. Higher grade of fluid signal in the mastoid was present ipsilateral to the side of venous thrombosis in 59 out of 60 patients with posterior fossa CVT. CBS was significantly different between patients with different grades of fluid signal (p = 0.002). Grade 2–3 fluid signal was associated with higher clot burden (CBS > 3) in both the entire study population (n = 89) – OR = 8.281, 95 %CI: 2.758–24.866 (p < 0.001) and among patients with posterior fossa CVT – OR = 4.375, 95 %CI: 1.320–14.504 (p = 0.016). Among patients with posterior fossa CVT, grade 2–3 fluid signal was associated with left sided transverse and/or sigmoid sinus thrombosis – OR = 5.600, 95 %CI: 1.413–22.188 (p = 0.014), and extension of thrombosis into the IJV – OR = 4.606, 95 %CI: 1.162–18.262 (p = 0.030). ConclusionT2 fluid signal in the mastoid is associated with venous congestion in adults with acute CVT without evidence of otologic infection. Moderate-to-severe T2 fluid signal in the mastoid air cells is associated with increased clot burden.

Pictorial Review of Post COVID-19 Acute Invasive Fungal Sinusitis: Clinical Radiologists' Perspective.

Acute invasive fungal sinusitis (AIFS) is a rapidly progressive infection predominantly seen in immunocompromised patients. There is an increasing incidence of AIFS post COVID-19 infection. Yet, there is sparse literature regarding spectrum of cross-sectional imaging findings (CT and MRI) in these patients, which is prudent for appropriate timely surgical intervention. This study aims to highlight spectrum of imaging findings in patients with post-COVID-19 AIFS integrating the clinical details from presentation to follow-up. We retrospectively reviewed the demographics, clinical details and radiological imaging of 31 histopathological proven cases of post COVID-19 AIFS. MR and CT images of these patients were retrieved from the PACS and analysed. 90-day follow-up of these patients was obtained. Statistical analysis was performed using descriptive statistics. Cross-sectional imaging showed nasal cavity involvement in all patients, bilateral in (15, 48%) cases; predominant involvement of maxillary (31, 100%) followed by ethmoid sinuses (29, 93.5%) was seen. MR showed patchy/complete loss of normal mucosal enhancement in the turbinates and sinuses as predominant imaging finding. Maxillary sinus walls erosions were seen in 28 cases (90%). Rhino-orbital and rhino-orbito-cerebral mycosis was seen in 24 (77%) and 14 (45%) respectively. Optic nerve-sheath complex was involved in 15 (48%) cases. Cerebral involvement was seen in form of meningeal enhancement, cerebritis, ischemic changes, cavernous sinus and intracranial arterial thrombosis and aneurysms. Comprehensive knowledge of imaging features of AIFS and recognition of extent of their spread allows radiologists to play pivotal role in alerting the clinician for appropriate therapy to avoid protracted and fatal outcome.

Potent Intestinal Mucosal Barrier Enhancement of Nostoc commune Vaucher Polysaccharide Supplementation Ameliorates Acute Ulcerative Colitis in Mice Mediated by Gut Microbiota.

Ulcerative colitis (UC) is evolving into a global burden with a substantially increasing incidence in developing countries. It is characterized by inflammation confined to mucosa and is recognized as an intestinal barrier disease. The intestinal microbiota plays a crucial role in UC pathogenesis. N. commune has long been appreciated as a healthy food and supplement worldwide and polysaccharides account for 60%. Here, we examined the amelioration of N. commune polysaccharides against acute colitis in mice induced by DSS and assessed the mediating role of gut microbiota. An integrated analysis of microbiome, metabolomics, and transcriptomics fully elaborated it markedly enhanced intestinal mucosal barrier function, including: increasing the relative abundance of Akkermansia muciniphila, uncultured_bacterium_g__norank_f__Muribaculaceae, and unclassified_g__norank_f__norank_o__Clostridia_UCG-014; decreasing microbiota-derived phosphatidylcholines and thromboxane 2 levels mapped to arachidonic acid metabolism; improving mucin2 biosynthesis and secretion; enhancing ZO-1 and occludin expression; reducing neutrophil infiltration; regulating the level of colitis-related inflammatory cytokines; involving inflammation and immune function-associated signaling pathways. Further, the mediation effect of gut microbiota was evaluated by administering a cocktail of antibiotics. In conclusion, our results demonstrated that N. commune polysaccharides predominantly reinforced the gut microbiota-mediated intestinal mucosal barrier to confer protection against UC and exhibited dramatic prebiotic-like functions, providing an alternative or complementary treatment for UC.

Small-Bowel Mucormycosis at Dual-Energy CT.

HomeRadiologyVol. 307, No. 5 PreviousNext Reviews and CommentaryFree AccessImages in RadiologySmall-Bowel Mucormycosis at Dual-Energy CTLoic Demir, Paul Calame Loic Demir, Paul Calame Author AffiliationsFrom the Department of Radiology (L.D., P.C.) and EA 4662 Nanomedicine Laboratory, Imagery and Therapeutics (P.C.), University of Bourgogne Franche-Comté, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France.Address correspondence to P.C. (email: [email protected]).Loic DemirPaul Calame Published Online:Jun 20 2023https://doi.org/10.1148/radiol.223271MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 22-year-old woman with acute myeloid leukemia was treated with allograft and immunosuppressants. Five days later, she developed abdominal pain and underwent CT of the abdomen, which showed isolated small-bowel wall thickening with normal enhancement. A second CT examination was performed 3 days later due to worsening febrile abdominal pain; this examination showed diffuse small-bowel wall thickening. Dual-energy CT images showed focal defects of the normal small-bowel mucosal enhancement suggestive of nonperforated necrotizing infectious enterocolitis (Figure, Movie). She underwent small-bowel resection. Pathologic analysis of resected samples showed focal areas of transmural necrosis due to multiple vascular mycotic thrombi (Figure).Images in a 22-year-old female patient with a primary history of allograft-treated acute myeloid leukemia complicated by mucormycotic ulcerative-necrotic enterocolitis. (A) Conventional and (B) iodine density images in the same axial section of the portal phase of abdominal CT. The dual-energy CT images show dilatated small bowel (★) associated with a lack of wall enhancement (arrowhead), which contrasts with the adjacent hyperenhanced mucosa (arrow). (C) A photograph of the gross small-bowel resection specimen shows focal ileal ischemic ulceration (arrowheads).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Movie file of iodine density merged with virtual noncontrast in axial CT sections. The scale shows iodine concentration in milligrams of iodine per milliliter. A = anterior, F = front, L = left, P = posterior, R = right.Download Original Video (19.0 MB)Mucormycosis is caused by fungi of the subphylum mucoromycotina, which are zygomycetes that invade vessels, causing thrombosis and eventually parenchymal necrosis. Small-bowel mucormycosis is the least common site; mortality is high (1). Mucormycosis may mimic ischemic bowel (2,3). Dual-energy CT improved bowel wall visualization and highlighted the defects in the mucosa readily, which expedited surgical management—a key prognostic point (1).Disclosures of conflicts of interest: L.D. No relevant relationships. P.C. No relevant relationships.

Pneumatosis cystoides intestinalis: when the location of the air may be a pitfall

Pneumatosis cystoides intestinalis (PCI) is a rare and generally benign condition characterized by air within the walls of the small intestines or colon. Moreover, it may be a cause of free air in peritoneum. To correctly manage this entity when found at CT, it is of crucial importance for the radiologist to recognize and distinguish it from life-threatening causes of pneumatosis intestinalis or pneumoperitoneum. This differentiation may be challenging and the absence of additional findings (bowel wall thickening, altered contrast mucosal enhancement, fat stranding, dilated bowel, ascites, and the presence of portal venous gas) may be very helpful in suggesting the diagnosis. In this short communication we present a case of PCI in an asymptomatic 60-year old woman with a history of uterine carcinoma. The patient underwent a colonoscopy after a positive result of fecal occult blood test; the colonoscopy showed the presence of multiple grape-like nodules in the splenic flexure of the colon and biopsies were performed to exclude malignity of the findings. Then, a CT was conducted and it showed the presence of multiple, thin-walled, air-filled submucosal cysts in the splenic flexure of the colon. The endoscopic and CT findings, together with the absence of abdominal symptoms and altered laboratory test, allowed to establish the diagnosis of PCI. The patient was managed conservatively. Moreover, some free air bubbles were found in the pneumoperitoneum at one-year and two-year follow-up CTs, without abdominal symptoms.

Computed tomography features of gastric leiomyoma versus gastric stromal tumor: a case–control study with propensity score matching

To differentiate gastric leiomyomas (GLs) and gastric stromal tumors (GSTs) based on preoperative enhanced computed tomography characteristics. Twenty-six pathologically confirmed GLs were propensity score-matched to 26 GSTs in a 1:1 ratio based on sex, age, tumor site, and tumor size. Tumor shape and contour, mucosal ulceration, growth pattern, enhancement pattern and degree, longest diameter, and longest diameter/vertical diameter ratio were compared between the groups. Hemorrhage, calcification, peripheral invasion, and distant metastasis were also included in the regression analysis for differentiation of the two tumors. Mucosal ulceration was significantly more frequent in GSTs than GLs. The enhancement degree of GSTs was significantly higher than that of GLs in the arterial and portal venous phases. Using enhancement degrees of 18 HU and 23 HU in the arterial phase and venous phase as cutoff values, respectively, we found that an enhancement degree of <18 HU in the arterial phase was an independent influential factor for diagnosis of GLs. No significant differences were found in other morphological characteristics. GLs did not metastasize or invade adjacent tissues. A low enhancement degree in GLs is the most valuable quantitative feature for differentiating these two similar tumors.

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

Abstract Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion (n = 3), vascular narrowing (n = 3), and pseudoaneurysm (n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.

Early Oral Administration of Ginseng Stem-Leaf Saponins Enhances the Peyer's Patch-Dependent Maternal IgA Antibody Response to a PEDV Inactivated Vaccine in Mice, with Gut Microbiota Involvement.

Neonatal piglets during the first week of life are highly susceptible to porcine epidemic diarrhoea virus (PEDV) infection, with mortality rates reaching 80-100%. Passive lactogenic immunity remains the most effective way to protect neonates from infection. Although safe, inactivated vaccines provide little or no passive protection. Here, we administered ginseng stem-leaf saponins (GSLS) to mice before parenteral immunization with an inactivated PEDV vaccine to investigate the effect of GSLS on the gut-mammary gland (MG)-secretory IgA axis. Early oral GSLS administration potently increased PEDV-specific IgA plasma cell generation in the intestine, facilitated intestinal IgA plasma cell migration to the MG by enhancing the chemokine receptor (CCR)10-chemokine ligand (CCL)28 interaction, and ultimately promoted specific IgA secretion into milk, which was dependent on Peyer's patches (PPs). Additionally, GSLS improved the gut microbiota composition, especially increasing probiotic abundance, and these microflora members promoted the GSLS-enhanced gut-MG-secretory IgA axis response and were regulated by PPs. In summary, our findings highlight the potential of GSLS as an oral adjuvant for PEDV-inactivated vaccines and provide an attractive vaccination strategy for lactogenic immunity induction in sows. Further studies are required to evaluate the mucosal immune enhancement efficacy of GSLS in pigs.

Evaluation of the normal gastrointestinal tract in cats using dual-phase computed tomography.

In cats, although ultrasonography remains the preferred modality to evaluate the gastrointestinal tract, computed tomographic (CT) examination of the abdomen is commonly performed. However, a normal description of the gastrointestinal tract is lacking. This study describes the conspicuity and contrast enhancement pattern of the normal gastrointestinal tract in cats using dual-phase CT. Pre- and dual-phase postcontrast (early scan at 30 seconds and late scan mean at 84seconds) abdominal CT exams of 39 cats without history, clinical signs or diagnosis of gastrointestinal disease were reviewed. The gastrointestinal tract was examined for conspicuity and enhancement pattern using commercially available viewing software (Osirix, v.6.5.2), and diameters of 16 gastrointestinal segments were recorded and compared with published radiographic and ultrasonographic reference values. Of the 624 gastrointestinal segments, 530 (84.9%) were identified on precontrast studies and 545 (87.3%) segments on postcontrast studies. Of the gastrointestinal wall segments, 257 (41.2%) were identified on precontrast studies and 314 (50.3%) on postcontrast studies. Gastrointestinal segment diameters correlated well with published normal values, whereas wall thickness measurements usually were smaller compared with sonographic normal values. Early mucosal surface enhancement was frequently seen in the gastric cardia and fundus and ileocolic junction, and a mainly transmural wall enhancement in other gastrointestinal segments. Dual-phase CT allows for the identification of gastrointestinal tract segments and walls in cats. Contrast enhancement improves conspicuity and demonstrates wall layering in the cardia, fundus and ileocolic junction.

Role of MR enterography versus ileo-colonoscopy in the assessment of inflammatory bowel diseases

BackgroundInflammatory bowel disease (IBD) is widespread and rapidly rising in developing countries. It remains a significant issue in Western culture with a prevalence of more than 0.3%. Symptom control has been the only focus of treatment before the discovery that many individuals with IBD continue to have disease activity even in the absence of clinical symptoms. Therefore, treatment goals now include establishing clinical remission, steroid-free remission, and mucosal healing, which may eventually be complemented by transmural healing in cross-sectional imaging modalities. Magnetic resonance enterography (MRE), computed tomography enterography, and small-bowel ultrasound are now reliable methods for staging intramural lesions and extramural consequences in CD and for determining disease activity and severity. Recently literature suggests the incorporation of (MRE) for periodic reevaluation of IBD patients, as it offers small-bowel, colonic, and extra-enteric assessment as well as monitors the response to the anti-inflammatory therapy. The purpose of the current study was to compare MRE with ileo-colonoscopy findings in the diagnosis of IBD features, specifically Crohn's disease, and ulcerative colitis, as well as in the detection of disease exacerbation (Activity).ResultsThis study used MRE and ileo-colonoscopy to assess chronic inflammatory bowel disease patients; the patient population (n = 30) was made up of (14/30, 46.7%) females and (16/30, 53.3%) males, with a mean age of 32 ± SD 13 years. MRE alone detected lymphadenopathy in 73.3% of patients, and mural thickening with a mean of 4.1 ± SD 5.1 mm. It has detected mucosal enhancement with 80% sensitivity and 60% specificity. However, it was unable to detect mucosal erosions or ulceration.ConclusionsMRE is sensitive, inexpensive, noninvasive, and radiation-free for inflammatory bowel disease detection, with 86.7% diagnostic accuracy for affected areas. Unlike ileo-colonoscopy, it could examine the entire small intestine, precisely measure the affected loop, and detect activity signs such as mural thickening and lymphadenopathy. Only ileo-colonoscopy could detect mucosal degradation and superficial ulcers. IBD treatment protocols should incorporate MRE for small-bowel, colonic, and extra-enteric assessment, monitoring of disease activity, and anti-inflammatory therapy response.

Differences in Clinical Characteristics and Surgical Outcomes of Patients with Ischemic and Hemorrhagic Pituitary Adenomas

Ischemia and hemorrhage of pituitary adenomas (PA) caused important clinical syndrome. However, the differences on clinical characteristics and surgical outcomes between these two kinds apoplexy were less reported. A retrospective analysis was made of patients with pituitary apoplexy between January 2013 and June 2018. Baseline and clinical characteristics before surgery were reviewed. All patients underwent transsphenoidal surgery and were followed up at least 1 year. Total 67 cases (5.8%) among 1147 pituitary tumor patients were enrolled, which consisted of 28 (~2.4%) ischemic PA and 39 (~3.4%) hemorrhagic PA. There were more male patients in the ischemic group compared with hemorrhagic group (78.6% vs 53.8%, p=0.043). However, the mean age, tumor size and functional tumor ratio were significant higher in the hemorrhagic group. Headache was more common in ischemic PA (82.1%) than that of hemorrhagic PA (51.3%, p=0.011). Magnetic resonance imaging findings found that mucosal thickening and enhancement of the sphenoid sinus was observed in 15 ischemic PA patients (n=27, 55.6%), but none in patients with hemorrhagic PA (n=38, p<0.0001). It was worth noting that the rate of pre-surgical hypopituitarism in ischemic PA patients were seemed higher than that in hemorrhagic PA patients, but not significant. The two groups got a total tumor resection rate at 94.1% and 92.9%, independently. No significant difference on the operative time, blood loss in operation and complications in perioperative period was observed in two groups. After operation, cranial nerve symptoms recovered to normal at 81.8% of ischemic PA patients and 82.6% of hemorrhagic PA patients. Importantly, the incidence of postoperative hypopituitarism partially decreased in both groups, among which the rate of hypothyroidism in ischemic PA patients significantly decreased from 46.4% to 18.5% (p=0.044). Patients with ischemic PA presented different clinical characteristics to the hemorrhagic ones. Transsphenoidal surgery should be considered for the patients with neuro-ophthalmic deficits and might benefit for pituitary function recovery of the apoplectic adenoma patients, especially pituitary thyroid axis in ischemic PA patients.

Current Regulatory Considerations for Mucosal Permeation Enhancers

Current Regulatory Considerations for Mucosal Permeation Enhancers