Tag: pubmed

Clin Orthop Relat Res. 2022 Nov 4. doi: 10.1097/CORR.0000000000002450. Online ahead of print.

ABSTRACT

BACKGROUND: Legg-Calvé-Perthes disease (LCPD) is a childhood hip disease characterized by osteonecrosis of the femoral head. Because severe deformity of the femoral head can cause secondary osteoarthritis in adulthood, progressive collapse should be prevented in children with a necrotic epiphysis. The prognosis of patients with LCPD generally worsens as the age at disease onset increases, and the appropriate treatment for late-onset LCPD remains unclear. Based on the limited effect of nonoperative treatment using a nonweightbearing brace, flexion varus osteotomy (FVO) was introduced in 2010 as an initial treatment for late-onset LCPD in place of brace treatment, which we used in our institution before that time.

QUESTIONS/PURPOSES: We asked, (1) Which treatment, FVO or a nonweightbearing brace, is associated with a lower likelihood of progressive femoral head collapse in children whose diagnosis of LCPD was made at the age of ≥ 8 years and who were followed for a minimum of 3 years after their intervention? (2) What proportion of patients in the brace group had surgery despite the treatment, and what percentage of children in the FVO group had a second operation to remove hardware and/or additional operations?

METHODS: The initial treatment was applied in 181 patients with LCPD between 1995 and 2018 in our institution. Patients whose disease onset was at ≥ 8 years old (late-onset LCPD) with complete clinical and radiologic data were considered potentially eligible. In 2010, treatment for these patients changed from brace treatment to FVO for all patients. A total of 35% (42 of 121) of patients who were treated with a nonweightbearing brace between 1995 and 2009 and 40% (24 of 60) of patients who were treated with FVO between 2010 and 2018 were eligible. Among patients treated with a brace, 21% (nine of 42 patients) were excluded because of hospital transfer (three patients), short-term follow-up (three), the period from onset to the first visit was ≥ 7 months (two), and inability to use the brace because of mental incapacity (one patient). In patients treated with FVO, 12% (three of 24 patients) were excluded (two patients with a period from onset to the first visit ≥ 7 months and one with a comorbidity and multiple-epiphyseal dysplasia). Among the remaining patients, 79% (33 of 42 patients) were classified into the brace group and 88% (21 of 24 patients) were classified into the FVO group for analyses. There were no overlapping patients at the timepoint when the treatment strategy for late-onset LCPD changed. In the FVO group, subtrochanteric osteotomy with 35° to 40° of flexion and 15° to 20° of varus was performed using a locking compression plate for pediatric use. Patient demographics, radiographic parameters, and the assessment of femoral head deformity using the Stulberg classification were compared between the two groups. There was a greater proportion of boys than girls in both groups (brace: 88% and FVO: 86%), and there were no differences in the distribution of genders between the groups (p = 0.82). The right side was more frequently treated in the brace group, but there was no difference in laterality between the groups (brace: 58% right and FVO: 62% left; p = 0.16). There was no difference between groups in the median age at disease onset (9.0 years [range 8.0 to 12.5 years] in the brace group and 9.6 years [range 8.0 to 12.4 years] in the FVO group; p = 0.26). There was no difference between the groups in the period of treatment from onset (1.7 ± 1.9 months in the brace group and 1.5 ± 1.5 months in the FVO group; p = 0.73) or the follow-up period (6.7 ± 2.1 years in the brace group and 6.2 ± 2.1 years in the FVO group; p = 0.41). The LCPD stage at the first visit was assessed using the modified Waldenström classification. The intraobserver and interobserver values of the modified Waldenström classification, evaluated using kappa statistics, were excellent (kappa value 0.89 [95% CI 0.75 to 0.97]; p < 0.01) and good (kappa value 0.65 [95% CI 0.43 to 0.87]; p < 0.01). The radiographic degree of collapse at the maximum fragmentation stage was assessed using the lateral pillar classification. The intraobserver and interobserver reliabilities of the lateral pillar classification were excellent (kappa value 0.84 [95% CI 0.73 to 0.94]; p < 0.01) and excellent (kappa value 0.83 [95% CI 0.71 to 0.94]; p < 0.01). The degree of femoral head deformity at the most recent follow-up examination was compared between the groups in terms of the Stulberg classification, in which Classes I and II were classified as good and Classes III through V were classified as poor. The intraobserver and interobserver reliabilities of the Stulberg classification were good (kappa value 0.74 [95% CI 0.55 to 0.92]; p < 0.01) and good (kappa value 0.69 [95% CI 0.50 to 0.89]; p < 0.01). The evaluators were involved in the patients’ clinical care as part of the treating team.

RESULTS: Good radiographic results (Stulberg Class I or II) were obtained more frequently in the FVO group (76% [16 of 21 patients]) than in the brace group (36% [12 of 33 patients]), with an odds ratio of 5.6 (95% CI 1.7 to 18.5; p < 0.01). In the brace group, a subsequent femoral varus osteotomy was performed in 18% (six of 33) of patients with progressive collapse and hinge abduction, and implant removal surgery was performed approximately 1 year after the first procedure. This traditional varus osteotomy was occasionally performed in patients who were considered for conversion from nonoperative treatment before 2009 because FVO had not yet been introduced. In the FVO group, all patients (n = 21) had a second procedure to remove the implant at a mean of 10.5 ± 1.2 months postoperatively. Additional procedures were performed in 24% (five of 21) of patients, including a second FVO for progressive collapse (one patient), guided growth for a limb length discrepancy (one patient), and flexion valgus osteotomy for coxa vara in patients with a limb length discrepancy (three patients).

CONCLUSION: Our historical control study found that FVO may increase the possibility of obtaining good radiographic results (Stulberg Class I or II) compared with brace treatment for patients with late-onset LCPD, although surgical interventions after the first and second implant removal procedures may be indicated. Surgeons can consider FVO if they encounter patients with late-onset LCPD, which is a challenging condition. A larger study with long-term follow-up is needed to confirm the efficacy of FVO.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:36374570 | DOI:10.1097/CORR.0000000000002450

Adv Clin Exp Med. 2022 Nov 14. doi: 10.17219/acem/154858. Online ahead of print.

ABSTRACT

BACKGROUND: Placenta previa is a pregnancy condition associated with the development of complications related to placental insufficiency, including hypertension, preeclampsia and perinatal mortality. Dysfunction in uteroplacental arteries causes the release of cytokines, leukotrienes and immunomodulatory hormones, which leads to an inflammatory reaction.

OBJECTIVES: The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway and vascular endothelial growth factor (VEGF) are known to play crucial roles in inflammation and angiogenetic regulation. This study aimed to demonstrate the morphometric and immunohistochemical effects on inflammation and angiogenesis underlying placenta previa.

MATERIAL AND METHODS: Twenty pregnant patients with placenta previa and 20 healthy pregnant patients, all between 30 and 38 weeks gestational age, were included in the study. The gestational age of the pregnancies was determined according to the last date of menstruation and/or ultrasonographic measurements. Blood samples and clinical data were obtained from the prenatal patient groups. Samples were taken from the connecting stem region from both groups.

RESULTS: The mean difference between the control and placenta previa patients was statistically significant for the parameters of blood vessels in villi, diameter of floating small villus, decidual cells, syncytial knots, congestion in blood vessels, fibrinoid accumulation, and inflammation. Significant degeneration and apoptotic changes in the syncytial cells of the root villi and an increase in syncytial nodes and bridges were observed in the placenta previa specimens. In the connecting stem region of the placenta previa samples, blood vessel dilatation, endothelial cell hyperplasia and a higher number of syncytial nodes were observed. In the immunohistochemical examination of the placenta previa samples, an increase in NF-κB and VEGF expression was observed in the endothelial cells, syncytial cells and Hofbauer cells.

CONCLUSIONS: Vascular endothelial growth factor was found to stimulate endothelial cell proliferation and migration, and to significantly affect angiogenesis during the developmental process of the placenta and remodeling of the uterine vessels, inducing NF-κB signaling and apoptotic development during cytotrophoblastic invasion in the vascularization of the placenta.

PMID:36374543 | DOI:10.17219/acem/154858

JMIR Form Res. 2022 Nov 14;6(11):e40765. doi: 10.2196/40765.

ABSTRACT

BACKGROUND: Smartphones are increasingly used in health research. They provide a continuous connection between participants and researchers to monitor long-term health trajectories of large populations at a fraction of the cost of traditional research studies. However, despite the potential of using smartphones in remote research, there is an urgent need to develop effective strategies to reach, recruit, and retain the target populations in a representative and equitable manner.

OBJECTIVE: We aimed to investigate the impact of combining different recruitment and incentive distribution approaches used in remote research on cohort characteristics and long-term retention. The real-world factors significantly impacting active and passive data collection were also evaluated.

METHODS: We conducted a secondary data analysis of participant recruitment and retention using data from a large remote observation study aimed at understanding real-world factors linked to cold, influenza, and the impact of traumatic brain injury on daily functioning. We conducted recruitment in 2 phases between March 15, 2020, and January 4, 2022. Over 10,000 smartphone owners in the United States were recruited to provide 12 weeks of daily surveys and smartphone-based passive-sensing data. Using multivariate statistics, we investigated the potential impact of different recruitment and incentive distribution approaches on cohort characteristics. Survival analysis was used to assess the effects of sociodemographic characteristics on participant retention across the 2 recruitment phases. Associations between passive data-sharing patterns and demographic characteristics of the cohort were evaluated using logistic regression.

RESULTS: We analyzed over 330,000 days of engagement data collected from 10,000 participants. Our key findings are as follows: first, the overall characteristics of participants recruited using digital advertisements on social media and news media differed significantly from those of participants recruited using crowdsourcing platforms (Prolific and Amazon Mechanical Turk; P<.001). Second, participant retention in the study varied significantly across study phases, recruitment sources, and socioeconomic and demographic factors (P<.001). Third, notable differences in passive data collection were associated with device type (Android vs iOS) and participants’ sociodemographic characteristics. Black or African American participants were significantly less likely to share passive sensor data streams than non-Hispanic White participants (odds ratio 0.44-0.49, 95% CI 0.35-0.61; P<.001). Fourth, participants were more likely to adhere to baseline surveys if the surveys were administered immediately after enrollment. Fifth, technical glitches could significantly impact real-world data collection in remote settings, which can severely impact generation of reliable evidence.

CONCLUSIONS: Our findings highlight several factors, such as recruitment platforms, incentive distribution frequency, the timing of baseline surveys, device heterogeneity, and technical glitches in data collection infrastructure, that could impact remote long-term data collection. Combined together, these empirical findings could help inform best practices for monitoring anomalies during real-world data collection and for recruiting and retaining target populations in a representative and equitable manner.

PMID:36374539 | DOI:10.2196/40765

JMIR Public Health Surveill. 2022 Nov 14;8(11):e39314. doi: 10.2196/39314.

ABSTRACT

BACKGROUND: Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults.

OBJECTIVE: This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China.

METHODS: This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults.

RESULTS: Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid.

CONCLUSIONS: SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible.

PMID:36374533 | DOI:10.2196/39314

Med Sci Sports Exerc. 2022 Nov 14. doi: 10.1249/MSS.0000000000003083. Online ahead of print.

ABSTRACT

INTRODUCTION: Patellofemoral pain (PFP) is a common overuse injury associated with physical activity including walking. The risk for PFP may increase if walking biomechanics change during a bout of walking. Since walking for exercise is often recommended to previously sedentary adults, this would be a cause for concern. The purpose of this study was to determine any differences in walking biomechanics associated with PFP between sedentary and active young women initially and following 30 minutes of walking for exercise.

METHODS: Fifteen sedentary and 15 active young women walked overground for 5 trials of three-dimensional gait analysis before and after a 30-minute treadmill walk. Peak knee flexion angle and extensor moment were compared between groups and before and after the 30-minute walk.

RESULTS: Comparing groups at baseline, peak knee flexion angle and peak knee extensor moment were not statistically significantly different between groups. Following the 30-minute walk, peak knee flexion angle and extensor moment increased slightly in both groups.

CONCLUSIONS: Smaller, not larger, peak knee flexion angle and extensor moment during walking have been associated with increased risk of PFP. Therefore, sedentary and active young women can walk for 30 minutes without further detrimental changes to walking biomechanics that may increase their risk of PFP.

PMID:36374524 | DOI:10.1249/MSS.0000000000003083

Anal Chem. 2022 Nov 14. doi: 10.1021/acs.analchem.2c02902. Online ahead of print.

ABSTRACT

The accuracy and ease of metabolite assignments from a complex mixture are expected to be facilitated by employing a multispectral approach. The two-dimensional (2D) ¹H-¹³C heteronuclear single quantum coherence (HSQC) and 2D ¹H-¹H-total correlation spectroscopy (TOCSY) are the experiments commonly used for metabolite assignments. The 2D ¹H-¹³C HSQC-TOCSY and 2D ¹H-¹³C heteronuclear multiple-bond correlation (HMBC) are routinely used by natural products chemists but have seen minimal usage in metabolomics despite the unique information, the nearly complete ¹H-¹H and ¹H-¹³C and spin systems provided by these experiments that may improve the accuracy and reliability of metabolite assignments. The use of a ¹³C-labeled feedstock such as glucose is a routine practice in metabolomics to improve sensitivity and to emphasize the detection of specific metabolites but causes severe artifacts and an increase in spectral complexity in the HMBC experiment. To address this issue, the standard HMBC pulse sequence was modified to include carbon decoupling. Nonuniform sampling was also employed for rapid data collection. A dataset of reference 2D ¹H-¹³C HMBC spectra was collected for 94 common metabolites. ¹³C-¹³C spin connectivity was then obtained by generating a covariance pseudo-spectrum from the carbon-decoupled HMBC and the ¹H-¹³C HSQC-TOCSY spectra. The resulting ¹³C-¹³C pseudo-spectrum provides a connectivity map of the entire carbon backbone that uniquely describes each metabolite and would enable automated metabolite identification.

PMID:36374521 | DOI:10.1021/acs.analchem.2c02902

JAMA Neurol. 2022 Nov 14. doi: 10.1001/jamaneurol.2022.4178. Online ahead of print.

ABSTRACT

IMPORTANCE: Physical activity is associated with cognitive health, even in autosomal dominant forms of dementia. Higher physical activity is associated with slowed cognitive and functional declines over time in adults carrying autosomal dominant variants for frontotemporal lobar degeneration (FTLD), but whether axonal degeneration is a potential neuroprotective target of physical activity in individuals with FTLD is unknown.

OBJECTIVE: To examine the association between physical activity and longitudinal neurofilament light chain (NfL) trajectories in individuals with autosomal dominant forms of FTLD.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included individuals from the ALLFTD Consortium, which recruited patients from sites in the US and Canada. Symptomatic and asymptomatic adults with pathogenic variants in one of 3 common genes associated with FTLD (GRN, C9orf72, or MAPT) who reported baseline physical activity levels and completed annual blood draws were assessed annually for up to 4 years. Genotype, clinical measures, and blood draws were collected between December 2014 and June 2019; data were analyzed from August 2021 to January 2022. Associations between reported baseline physical activity and longitudinal plasma NfL changes were assessed using generalized linear mixed-effects models adjusting for baseline age, sex, education, functional severity, and motor symptoms.

EXPOSURES: Baseline physical activity levels reported via the Physical Activity Scale for the Elderly. To estimate effect sizes, marginal means were calculated at 3 levels of physical activity: 1 SD above the mean represented high physical activity, 0 SD represented average physical activity, and 1 SD below the mean represented low physical activity.

MAIN OUTCOMES AND MEASURES: Annual plasma NfL concentrations were measured with single-molecule array technology.

RESULTS: Of 160 included FTLD variant carriers, 84 (52.5%) were female, and the mean (SD) age was 50.7 (14.7) years. A total of 51 (31.8%) were symptomatic, and 77 carried the C9orf72 variant; 39, GRN variant; and 44, MAPT variant. Higher baseline physical activity was associated with slower NfL trajectories over time. On average, NfL increased 45.8% (95% CI, 22.5 to 73.7) over 4 years in variant carriers. Variant carriers with high physical activity demonstrated 14.0% (95% CI, -22.7 to -4.3) slower NfL increases compared with those with average physical activity and 30% (95% CI, -52.2 to -8.8) slower NfL increases compared with those with low physical activity. Within genotype, C9orf72 and MAPT carriers with high physical activity evidenced 18% to 21% (95% CI, -43.4 to -7.2) attenuation in NfL, while the association between physical activity and NfL trajectory was not statistically significant in GRN carriers. Activities associated with higher cardiorespiratory and cognitive demands (sports, housework, and yardwork) were most strongly correlated with slower NfL trajectories (vs walking and strength training).

CONCLUSIONS AND RELEVANCE: In this study, higher reported physical activity was associated with slower progression of an axonal degeneration marker in individuals with autosomal dominant FTLD. Physical activity may serve as a primary prevention target in FTLD.

PMID:36374516 | DOI:10.1001/jamaneurol.2022.4178

JAMA Neurol. 2022 Nov 14. doi: 10.1001/jamaneurol.2022.4038. Online ahead of print.

ABSTRACT

IMPORTANCE: The Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful when considering an ICM in routine poststroke clinical care.

OBJECTIVE: To determine the association between commonly assessed risk factors and poststroke detection of new AF in the STROKE AF cohort monitored by ICM.

DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified analysis of a randomized (1:1) clinical trial that enrolled patients between April 1, 2016, and July 12, 2019, with primary follow-up through 2020 and mean (SD) duration of 11.0 (3.0) months. Eligible patients were selected from 33 clinical research sites in the US. Patients had an index stroke attributed to large- or small-vessel disease and were 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor. A total of 496 patients were enrolled, and 492 were randomly assigned to study groups (3 did not meet inclusion criteria, and 1 withdrew consent). Patients in the ICM group had the index stroke within 10 days before insertion. Data were analyzed from October 8, 2021, to January 28, 2022.

INTERVENTIONS: ICM monitoring vs site-specific usual care (short-duration external cardiac monitoring).

MAIN OUTCOMES AND MEASURES: The ICM device automatically detects AF episodes 2 or more minutes in length; episodes were adjudicated by an expert committee. Cox regression multivariable modeling included all parameters identified in the univariate analysis having P values <.10. AF detection rates were calculated using Kaplan-Meier survival estimates.

RESULTS: The analysis included the 242 participants randomly assigned to the ICM group in the STROKE AF study. Among 242 patients monitored with ICM, 27 developed AF (mean [SD] age, 66.6 [9.3] years; 144 men [60.0%]; 96 [40.0%] women). Two patients had missing baseline data and exited the study early. Univariate predictors of AF detection included age (per 1-year increments: hazard ratio [HR], 1.05; 95% CI, 1.01-1.09; P = .02), CHA2DS2-VASc score (per point: HR, 1.54; 95% CI, 1.15-2.06; P = .004), chronic obstructive pulmonary disease (HR, 2.49; 95% CI, 0.86-7.20; P = .09), congestive heart failure (CHF; with preserved or reduced ejection fraction: HR, 6.64; 95% CI, 2.29-19.24; P < .001), left atrial enlargement (LAE; HR, 3.63; 95% CI, 1.55-8.47; P = .003), QRS duration (HR, 1.02; 95% CI, 1.00-1.04; P = .04), and kidney dysfunction (HR, 3.58; 95% CI, 1.35-9.46; P = .01). In multivariable modeling (n = 197), only CHF (HR, 5.06; 95% CI, 1.45-17.64; P = .05) and LAE (HR, 3.32; 1.34-8.19; P = .009) remained significant predictors of AF. At 12 months, patients with CHF and/or LAE (40 of 142 patients) had an AF detection rate of 23.4% vs 5.0% for patients with neither (HR, 5.1; 95% CI, 2.0-12.8; P < .001).

CONCLUSIONS AND RELEVANCE: Among patients with ischemic stroke attributed to large- or small-vessel disease, CHF and LAE were associated with a significantly increased risk of poststroke AF detection. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy. However, the study was not powered for clinical predictors of AF, and therefore, other clinical characteristics may not have reached statistical significance.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02700945.

PMID:36374508 | DOI:10.1001/jamaneurol.2022.4038

J Cosmet Dermatol. 2022 Nov 14. doi: 10.1111/jocd.15500. Online ahead of print.

ABSTRACT

BACKGROUND: Wrinkles are the most visible sign in skin aging and for which many people seek different aesthetic procedures. Treatment options varies from invasive to non-invasive procedures. Combining platelet rich plasma and fractional carbon dioxide laser (CO₂ ) has been used frequently for showing promising results in treating photoaged skin generally and wrinkles specifically since the microscopic thermal zones created by the fractional laser facilitates the delivery of the plasma into the dermis which aids the process of collagen induction and skin rejuvenation.

AIM OF THE WORK: To compare and assess the clinical efficacy of fractional CO₂ laser alone versus combined fractional CO₂ laser and platelet rich plasma in treatment of facial rhytides (in terms of size, depth, and overall appearance).

SUBJECTS AND METHODS: Twenty-six female patients were selected and each face was split into 2 halves a control side (Laser + saline) and an experimental side (Laser + platelet rich plasma). Treatment plan was 1 laser session per month for a total of 4 sessions. Clinical objective evaluation was done by the Antera camera in addition to assessment by two blinded dermatologists.

RESULTS: The combined treatment was as effective in improving wrinkles as fractional CO₂ laser alone. Antera camera scores showed statistical significance in overall wrinkles measurements on each side equally.

CONCLUSION: Both treatment modalities gave optimum cosmetic results with no significant difference noticed when compared with each other, although overall satisfaction with wrinkles and skin were statistically greater than the initial satisfaction scores.

PMID:36374507 | DOI:10.1111/jocd.15500

Jpn J Radiol. 2022 Nov 14. doi: 10.1007/s11604-022-01358-y. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to find useful imaging features on non-contrast-enhanced magnetic resonance imaging (MRI) that can divide patients with thymic epithelial tumor (TET) into clinical stage I-II and III-IV groups under assumption that contrast media are contraindicated.

MATERIALS AND METHODS: This retrospective study included 106 patients (median age, 60 years; range, 27-82 years; 62 women) with surgically resected TET who underwent MRI between August 1986 and July 2015. All cases were classified according to the 2015 WHO classification and staged using the eighth edition of the TNM system. Two radiologists independently evaluated 14 categories of MRI findings; the findings in patients with stage I-II were compared with those of patients with stage III-IV using a logistic regression model. Disease-specific survival associated with significant findings was calculated using the Kaplan-Meier method.

RESULTS: Univariate analysis showed that stage III-IV patients were more likely to have tumors with an irregular contour, heterogeneity on T1WI, low-signal intensity on T2WI, irregular border with lung, findings of great vessel invasion (GVI) (hereafter, GVI sign), pericardial thickening/nodule, and lymphadenopathy (all, P < 0.01). On multivariable analysis, only two findings, irregular border between tumor and lung (odds ratio [OR], 272.8; 95% CI 26.6-2794.1; P < 0.001) and positive GVI sign (OR, 49.3; 95% CI 4.5-539.8; P = 0.001) remained statistically significant. Patients with one or both features had significantly worse survival (log-rank test, P < 0.001).

CONCLUSION: For patients with TET who are unable to receive contrast for preoperative staging, the two image findings of an irregular border between tumor and lung and the positive GVI sign on non-contrast-enhanced MRI could be helpful in determining stage III-IV disease which is associated with a worse survival.

PMID:36374474 | DOI:10.1007/s11604-022-01358-y