High Signal Intensity of the Cochlear Modiolus on Unenhanced T1-Weighted Images in Classical Infratentorial Superficial Siderosis

Background: Superficial siderosis (SS) results from chronic bleeding in the subarachnoid space. SS can be classified as infratentorial SS (i-SS) and supratentorial SS (s-SS). The cochlear modiolus (CM) normally shows low signal intensity (SI) on Tl-weighted images (T1WI). We noticed persistently high SI of the CM on unenhanced thin-sliced T1WI in patients with i-SS. The purpose of this study was to evaluate the correlation between SS and high SI of the CM on unenhanced T1WI. Methods: This retrospective study analyzed three cases with i-SS, eight cases with s-SS, and 23 normal controls (NC) evaluated on unenhanced thin-sliced T1WI with a three-dimensional spoiled gradient-recalled echo sequence. CM-T1SI scores of 0, 1, and 2 indicated low, iso, and high SI, respectively. In cases with scores of 2 evaluated several times, all scores were reviewed for each case. The CM-T1SI ratio was defined as the contrast ratio between the CM and the cerebellum. Differences between the three groups were statistically analyzed based on the CM-T1SI score and ratio. Receiver operative curve (ROC) analysis was used to determine the cut-off values for differentiating the i-SS group from the NC group based on the CM-T1SI ratio. Results: Two patients with i-SS had a score of 2 on all evaluations. The CM-T1SI score and ratio differed significantly between the i-SS and NC groups. The accuracy of the CM-T1SI ratio for discriminating i-SS from NC was 98.9% at a cutoff value of 0.628. Conclusion: High SI of the CM on unenhanced TIWI can be an additional characteristic finding of i-SS

Liver-specific γ-glutamyl carboxylase-deficient mice display bleeding diathesis and short life span

Liver-Specific γ-Glutamyl Carboxylase-Deficient Mice Display Bleeding Diathesis and Short Life Span. Azuma K, Tsukui T, Ikeda K, Shiba S, Nakagawa K, et al. PLOS ONE. 2014. 9(2) doi:10.1371/journal.pone.008864

Macrophage centripetal migration drives spontaneous healing process after spinal cord injury.

Traumatic spinal cord injury (SCI) brings numerous inflammatory cells, including macrophages, from the circulating blood to lesions, but pathophysiological impact resulting from spatiotemporal dynamics of macrophages is unknown. Here, we show that macrophages centripetally migrate toward the lesion epicenter after infiltrating into the wide range of spinal cord, depending on the gradient of chemoattractant C5a. However, macrophages lacking interferon regulatory factor 8 (IRF8) cannot migrate toward the epicenter and remain widely scattered in the injured cord with profound axonal loss and little remyelination, resulting in a poor functional outcome after SCI. Time-lapse imaging and P2X/YRs blockade revealed that macrophage migration via IRF8 was caused by purinergic receptors involved in the C5a-directed migration. Conversely, pharmacological promotion of IRF8 activation facilitated macrophage centripetal movement, thereby improving the SCI recovery. Our findings reveal the importance of macrophage centripetal migration via IRF8, providing a novel therapeutic target for central nervous system injury

Acid-suppressive effects of generic omeprazole: Comparison of three brands of generic omeprazole with original omeprazole

Background: Generic omeprazole contains the same active ingredient as original omeprazole and require verification of the bioequivalence with original omeprazole. However, very few clinical studies have been reported. Aims: A prospective, randomised, open-label, crossover study to compare acid-suppressive effect of generic omeprazole with that of original omeprazole. Subjects: Seven healthy Helicobacter pylori-negative subjects of CYP2C19 extensive metaboliser. Methods: Intragastric pH was measured for 24 h without medications (placebo) and on day 7 of repeated administration of 10 mg once daily after breakfast of original omeprazole, Omeprazon, or three brands of generic omeprazole, Omeprazole-Towa, Ovulanze or Omerap. Results: Median values of intragastric pH and percentages of time with pH > 4 for 24 h were significantly higher with administration of any omeprazole formulation compared with placebo (P 4 with Omeprazole-Towa and Omerap were not significantly higher than placebo. Compared with Omeprazon, these two parameters for 24 h showed significantly greater inter-subject variations with Omeprazole-Towa (P < 0.05 and P < 0.01, F-test) and Ovulanze (P < 0.05). Conclusions: Acid-suppressive effects of some brands of generic omeprazole are not the same as original omeprazole. These differences might be reflected in clinical outcomes

Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results

Study Design This retrospective case series enrolled 13 patients who underwent posterior fixation with both transdiscal screws for diffuse idiopathic skeletal hyperostosis (TSDs) and pedicle screws (PSs) to treat spinal injury accompanied by diffuse idiopathic skeletal hyperostosis (DISH). Purpose To describe the usefulness, feasibility, and biomechanics of TSD. Overview of Literature Vertebral bodies accompanied by DISH generally have lower bone mineral density than normal vertebral bodies because of the stress shielding effect. This phenomenon tends to makes screw fixation challenging. To our knowledge, solutions for this issue have not previously been reported. Methods Patients were assessed using the data on surgical time, estimated intraoperative blood loss, mean number of stabilized intervertebral segments, number of screws used, perioperative complications, union rate, and the three-level EuroQol five-dimensional questionnaire (EQ5D-3L) score at the final follow-up. The Hounsfield unit (HU) values of the screw trajectory area, and the actual intraoperative screw insertion torque of TSDs and PSs were also analyzed and compared. Results The surgical time and estimated intraoperative blood loss were 165.9±45.5 minutes and 71.0±53.4 mL, respectively. The mean number of stabilized intervertebral segments was 4.6±1.0. The number of screws used was 4.9±1.3 for TSDs and 3.0±1.4 for PSs. One death occurred after surgery. The union rate and EQ5D-3L scores were 100% and 0.608±0.128, respectively. The HU value and actual intraoperative screw insertion torque of TSDs were significantly better than those of PSs (p<0.001, p=0.033). Conclusions We were able to achieve stable surgical outcomes using the combination of TSDs and PSs. The HU value and actual intraoperative screw insertion torque were significantly higher for TSDs than for PSs. Based on these results, when treating thoracolumbar spinal fractures accompanied by DISH in elderly populations, the TSD could be a stronger anchor than the PS

Primary Gastrointestinal Stromal Tumor of the Liver with Cystic Changes

Gastrointestinal stromal tumors (GISTs) are known to originate specifically from the intestinal cells of Cajal located in the gastrointestinal mesenchyme. GISTs developing outside of the digestive tract have barely been reported. We encountered a first case of large primary GISTs in the liver with cystic changes. A 63-year-old man with a past history of brain infarction visited our hospital. The computed tomography (CT) revealed a 6-cm and a 10-cm mass in the right and the caudal lobe of the liver, respectively. These tumors have marginal enhancement in the arterial phase; however, they presented as hypodense in the internal tumor sites. Both liver tumors had cystic changes. Gastrointestinal examinations using endoscopy revealed no other gastrointestinal tumors, and [18F]-fluoro-2-deoxy-D-glucose positron emission tomography/CT revealed multiple bone metastases in addition to the liver tumors. The liver tumor specimens were composed of spindle cells, and the immunohistochemical staining for c-Kit and for DOG1, as discovered on GIST, was positive. The patient was diagnosed with primary hepatic GIST with cystic changes

Estimation of radioactivity in single photon emission computed tomography for sentinel lymph node biopsy in a torso phantom study

Objectives: Number of lymph nodes to be removed are determined from residual counts. Estimating residual radioactivity in lymphatic nodes before a biopsy in advance is useful for reducing surgical operation time. The purpose of this study was to estimate total radioactivity of a small hot spot in single-photon emission computed tomography (SPECT) of a torso phantom. Methods: Cross-calibration study was performed to convert counts in SPECT images to radioactivity. A simulation study was performed to estimate the size of volume of interest (VOI) covering a hot spot corrupted with full width at half maximum (FWHM) between 8 and 16 mm. The estimation of total radioactivity was validated in a torso phantom study using small sources. Results: True radioactivity was approximately equal to integrated values of hot spots using the VOI with a diameter of 40 mm in our simulation study. The difference was less than18% in cases of more than 9.4 kBq. Conclusions: The total radioactivity in small sources simulating a typical sentinel node was estimated from SPECT images using a VOI of 40 mm in a torso phantom study. Because the difference from actual values were less than 10% on average when radioactivities were more than 9.4 kBq, the total radioactivity of a lymph node can be estimated in a clinical examination

Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in 40–69-years subjects

[Background] Visceral fat obesity can be defined quantitatively by abdominal computed tomography, however, the usefulness of measuring visceral fat area to assess the etiology of gastrointestinal reflux disease has not been fully elucidated. [Methods] A total of 433 healthy subjects aged 40–69 years (234 men, 199 women) were included in the study. The relationship between obesity-related factors (total fat area, visceral fat area, subcutaneous fat area, waist circumference, and body mass index) and the incidence of reflux erosive esophagitis was investigated. Lifestyle factors and stomach conditions relevant to the onset of erosive esophagitis were also analyzed. [Results] The prevalence of reflux erosive esophagitis was 27.2% (118/433; 106 men, 12 women). Visceral fat area was higher in subjects with erosive esophagitis than in those without (116.6 cm2 vs. 64.9 cm2, respectively). The incidence of erosive esophagitis was higher in subjects with visceral fat obesity (visceral fat area ≥ 100 cm2) than in those without (61.2% vs. 12.8%, respectively). Visceral fat obesity had the highest odds ratio (OR) among obesity-related factors. Multivariate analysis showed that visceral fat area was associated with the incidence of erosive esophagitis (OR = 2.18), indicating that it is an independent risk factor for erosive esophagitis. In addition, daily alcohol intake (OR = 1.54), gastric atrophy open type (OR = 0.29), and never-smoking history (OR = 0.49) were also independently associated with the development of erosive esophagitis. [Conclusions] Visceral fat obesity is the key risk factor for the development of reflux erosive esophagitis in subjects aged 40–69 years