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Role of Contrast-Enhanced Ultrasound as a Second-Line Diagnostic Modality in Noninvasive Diagnostic Algorithms for Hepatocellular Carcinoma

  • Hyo-Jin Kang;Jeong Min Lee;Jeong Hee Yoon;Joon Koo Han
    • Korean Journal of Radiology
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    • v.22 no.3
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    • pp.354-365
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    • 2021
  • Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar's test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion: The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

A study on the characteristics and pathogenicity of Aeromonas veronii isolated from infected goldfish (Carassius auratus) (피부 궤양이 발생한 금붕어(Carassius auratus)에서 분리한 Aeromonas veronii의 특성 및 병원성 분석)

  • Hyeon Ki Jung;Min Su Kim;Sok Ho Kim;Min Soon Choi
    • Journal of fish pathology
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    • v.37 no.1
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    • pp.79-88
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    • 2024
  • Aeromonas spp. infections have been reported to cause significant economic losses not only in the ornamental fish industry but also in aquaculture. In December 2022-January 2023, an Aeromonas infection occurred on a goldfish in korea, A gram-negative bacterium was isolated from the skin and internal organs of infected goldfish (Carassius auratus). The results showed that the isolate was identified as Aeromonas veronii using 16S rDNA targeted oilgpnucleotide primers, furthermore characteristics of A. veronii was confirmed by enterotoxin gene, infectious experiment, antibiotic resistance. In-vivo pathogenicity of isolates to goldfsh resulted in 100% mortality in challenged host within one week of post experiment injection. As a result of PCR analysis targeting three enterotoxin-encoding genes, cytotoxic enterotoxin (act) was identified in A. veronii isolate in this study. Antimicrobial susceptibility pattern of isolate showed it was to susceptible to most antimicrobial agents tested but resistant to ampicillin, imipenem, meropenem and clindamycin.

GC Capillary Column Installation (가스 크로마토그래피 캐필러리 컬럼 설치 가이드)

  • Matt James;Kirsty Ford
    • FOCUS: LIFE SCIENCE
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    • no.1
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    • pp.2.1-2.6
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    • 2024
  • This article provides detailed instructions for the correct installation, maintenance, and troubleshooting of capillary gas chromatography (GC) columns. It emphasizes the importance of proper installation to ensure optimal performance and longevity of the column. The document covers various aspects such as column trimming, installation, conditioning, testing, storage, and ferrule selection. The installation process involves ensuring that the heated zones of the GC are cool before placing the column cage in the column oven. It is essential to avoid sharp bends or stress on the capillary column during installation and to connect the front end of the column into the GC inlet at the recommended insertion distance. The document also provides guidance on trimming the column, including the use of a ceramic wafer or capillary column cutter to achieve a clean, burr-free cut. For previously used columns, it recommends removing any capillary caps, positioning the nut and ferrule, and trimming 1-2 cm from the column. After installation, the column should be purged with carrier gas to remove any oxygen and avoid oxidizing the column. Conditioning the column involves ramping to the upper isothermal temperature limit and maintaining this temperature for a specified duration. It is crucial to maintain carrier gas flow during conditioning and not exceed the upper temperature limit of the column to avoid phase damage. The document also discusses testing column performance using a suitable method and performing a test injection to assess performance. It provides recommendations for column storage, including flame-sealing the capillary ends or using retention gaps for long-term storage. Additionally, it emphasizes the importance of routine maintenance and replacement of GC consumables to extend the column's lifetime. Ferrule selection is another important aspect covered in the article, with a variety of ferrule materials available for different applications. The characteristics of common ferrule options are presented in a table, including temperature limits, reusability, and suitability for specific detector types.

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Beneficial effect of metformin on tolerance to analgesic effects of sodium salicylate in male rats

  • Elham Akbari;Dawood Hossaini;Farimah Beheshti;Mahdi Khorsand Ghaffari;Nastran Roshd Rashidi;Masoumeh Gholami
    • The Korean Journal of Pain
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    • v.37 no.3
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    • pp.211-217
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    • 2024
  • Background: Tolerance to the analgesic effects of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) is a major concern for relieving pain. Thus, it is highly valuable to find new pharmacological strategies for prolonged therapeutic procedures. Biguanide-type drugs such as metformin (MET) are effective for neuroprotection and can be beneficial for addressing opioid tolerance in the treatment of chronic pain. It has been proposed that analgesic tolerance to NSAIDs is mediated by the endogenous opioid system. According to the cross-tolerance between NSAIDs, especially sodium salicylate (SS), and opiates, especially morphine, the objective of this study was to investigate whether MET administration can reduce tolerance to the anti-nociceptive effects of SS. Methods: Fifty-six male Wistar rats were used in this research (weight 200-250 g). For induction of tolerance, SS (300 mg/kg) was injected intraperitoneally for 7 days. During the examination period, animals received MET at doses of 50, 75, or 100 mg/kg for 7 days to evaluate the development of tolerance to the analgesic effect of SS. The hot plate test was used to evaluate the drugs' anti-nociceptive properties. Results: Salicylate injection significantly increased hot plate latency as compared to the control group, but the total analgesic effect of co-treatment with SS + Met50 was stronger than the SS group. Furthermore, the effect of this combination undergoes less analgesic tolerance over time. Conclusions: It can be concluded that MET can reduce the analgesic tolerance that is induced by repeated intraperitoneal injections of SS in Wister rats.

The risk of confusion between AstraZeneka COVID-19 vaccine side effects and signs of COVID-19 infection: a case report

  • Mahin Nomali;Mahdieh Afzali
    • Clinical and Experimental Vaccine Research
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    • v.11 no.1
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    • pp.125-128
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    • 2022
  • Post-vaccination side effects of AstraZeneca (AZ) coronavirus disease 2019 (COVID-19) vaccine are common. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection immediately after the first dose of AZ COVID-19 vaccine has not been reported. In this case, a 30-year-old female without a past medical history of SARS-CoV2 infection presented to an outpatient clinic with lightheadedness and weakness 2 hours after getting the first dose of the AZ COVID-19 vaccine. Blood pressure (BP) was 80/60 mm Hg, and oxygen saturation (SpO2) was 98%. After administering normal saline intravenous fluid, the BP was 110/80 mm Hg. On the first day, fever (oral temperature of 39℃), sweating, dry cough, sore throat, and injection-site pain were presented. On the second day, diarrhea, productive cough, and hypotension occurred in addition to fever (oral temperature of 39.9℃). The fever did not stop and productive cough, change in smell, and fatigue were reported. SpO2 was 96%. On the third day, no abnormality of the spiral lung computed tomography and the positive reverse transcriptase-polymerase chain reaction (RT-PCR) test were reported. Simultaneously, two out of three members of the family became symptomatic on the second day and their RT-PCR tests were positive. Dexamethasone ampule, Cefixime tablet, Acetaminophen tablet, and Diphenhydramine syrup were prescribed. After a week, fever subsided and SpO2 was 98%. After 3 weeks of self-quarantine at home, her general condition improved. Despite the similarity between SARS-CoV2 infection signs and symptoms and AZ COVID-19 vaccine side effects, none of the approved vaccines contain the live virus that causes disease. Therefore, any unusual post-vaccination signs and symptoms should not be attributed to the vaccine itself and need to be considered for further evaluations and early actions in order to prevent the spread of the disease in society.

Functional recovery after transplantation of mouse bone marrow-derived mesenchymal stem cells for hypoxic-ischemic brain injury in immature rats (저산소 허혈 뇌 손상을 유발시킨 미성숙 흰쥐에서 마우스 골수 기원 중간엽 줄기 세포 이식 후 기능 회복)

  • Choi, Wooksun;Shin, Hye Kyung;Eun, So-Hee;Kang, Hoon Chul;Park, Sung Won;Yoo, Kee Hwan;Hong, Young Sook;Lee, Joo Won;Eun, Baik-Lin
    • Clinical and Experimental Pediatrics
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    • v.52 no.7
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    • pp.824-831
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    • 2009
  • Purpose : We aimed to investigate the efficacy of and functional recovery after intracerebral transplantation of different doses of mouse mesenchymal stem cells (mMSCs) in immature rat brain with hypoxic-ischemic encephalopathy (HIE). Methods : Postnatal 7-days-old Sprague-Dawley rats, which had undergone unilateral HI operation, were given stereotaxic intracerebral injections of either vehicle or mMSCs and then tested for locomotory activity in the 2nd, 4th, 6th, and 8th week of the stem cell injection. In the 8th week, Morris water maze test was performed to evaluate the learning and memory dysfunction for a week. Results : In the open field test, no differences were observed in the total distance/the total duration (F=0.412, P=0.745) among the 4 study groups. In the invisible-platform Morris water maze test, significant differences were observed in escape latency (F=380.319, P<0.01) among the 4 groups. The escape latency in the control group significantly differed from that in the high-dose mMSC and/or sham group on training days 2-5 (Scheffe's test, P<0.05) and became prominent with time progression (F=6.034, P<0.01). In spatial probe trial and visible-platform Morris water maze test, no significant improvement was observed in the rats that had undergone transplantation. Conclusion : Although the rats that received a high dose of mMSCs showed significant recovery in the learning-related behavioral test only, our data support that mMSCs may be used as a valuable source to improve outcome in HIE. Further study is necessary to identify the optimal dose that shows maximal efficacy for HIE treatment.

Comparative Study on the Regimens with Pyrazinamide or Ofloxacin in the retreatment of pulmonary tuberculosis (폐결핵 재치료에서 Pyrazinamide 복합처방과 Ofloxacin 복합처방의 효과에 관한 비교 연구)

  • Choi, In Hwan;Park, Seung Kyu;Kim, Kyeong Ho;Kim, Jin Ho;Kim, Cheon Tae;Song, Sun Dae
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.871-881
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    • 1996
  • Objective: In the early short-term therapy of pulmonary tuberculosis, PZA is used for the first two months on 6EHRZ therapy but PZA is not effective in the case of long-tenn use PZA for retreatment in the sensitive relapse or acquired drug resistance for PZA. But in the endemic area as Korea, if we can't use PZA in the retreatment of pulmonary tuberculosis, we can't expect the success for retreatment of pulmonary tuberculosis, therefore we need new drugs substituting for PZA. In these days, 4 - fluoroquinolone derivatives were investigated and only ofloxacin and ciprofloxacin of derivatives were known to be effective but the effectiveness was also not certain because the result was experimental or combined with other bacteriocidal drugs and datas on effectiveness of pulmonary tuberculosis were so little. Therefore these drugs should be use with other two or three strong-acting drugs in the last period of retreatment of pulmonary tuberculosis. The ofloxacin or ciprofloxacin is used in some area in Korea but randomly and needed more study. We did this study for proving the effectiveness of these drugs and establishment of retreatment regimen for pulmonary tuberculosis. Methods: Retrospective cohort study of 83 drug-resistant pulmonary tuberculosis patients at National Masan Tuberculosis Hospital from Jan. 1994 to dec. 1995 was made. All the patients taken medicine for 2nd ami-tuberculosis regimens for the first lime. We separated the patients by two groups.(Group I : OFX+ PTA + CS+PAS + Injection, Group II: PZA + PTA+ CS + PAS + Injection). We compared the difference between two groups and tested the confidence limit about results after treatment by $\chi$2-test and T-test. Results : 1. The age distribution was most frequent in fourth decade(29.2% in Group I, 37.1% in Group II) and the mean age was 43.9 year in Group I, and 39.0 year in Group II, but had no significant difference between two groups. The sex distribution was more frequent in the males(68.8% in Group I, 85.7% in Group II), but had no significant difference. 2. Family history was 29.2% in Group I, 28.6% in Group II, but had no significant difference. 3. In the respect of extent of disease, far-advanced stare was 60.4% in Group I, 74.3% in Group II, but had no significant difference. 4. The side effects for drugs showed in 58.3% in Group I and 65.7% in Group II, and the gastrointestinal trouble showed 25.0% in Group and arthralgia 34.3% in Group II predominantly respectively and had the significant difference(p<0.05). 5. The negative conversion rate on sputum AFB smear was 87.5% in Group I and 80.0% in Group II, but had no significant difference. But the negative conversion rate on sputum AFB culture was 83.3% in Group I and 57.1 % in Group II and had the significant difference(p<0.05). 6. The success rate of treatment was 87.5 % in Group I and 83.3 % in Group II but had no significant difference. Conclusion : In the retreatment of pulmonary tuberculosis, ofloxacin is useful drug for the patients who are not available to use PZA and can be use effectively substituting for PZA.

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The Effect of Gd-EOB-DPTA on the Stiffness Value of Magnetic Resonance Elastography in Evaluating Hepatic Fibrosis (간 섬유화 평가를 위한 MR elastography의 경직도에 대한 Gd-EOB-DTPA의 영향)

  • Lee, Jeong Eun;Lee, Jeong Min;Lee, Ye Ji;Yoon, Jeong-Hee;Lee, Kyung Bun;Han, Joon Koo;Choi, Byung Ihn
    • Investigative Magnetic Resonance Imaging
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    • v.17 no.3
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    • pp.215-223
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    • 2013
  • Purpose : To evaluate the effect of gadoxetic acid on the measurement of the stiffness value of MR elastography (MRE) used to evaluate hepatic fibrosis (HF). Materials and Methods: MRE was obtained in 32 patients with clinically suspected chronic liver disease, both before and after injection of gadoxetic acid. Two independent reviewers measured the stiffness values of the liver parenchyma on elastograms. The mean liver stiffness values were compared in the pre- and post-contrast MREs using the paired t-test. Intra-rater and inter-rater correlation was assessed using the intraclass correlation coefficient (ICC). The accuracy, sensitivity, and specificity of both pre- and post-contrast MREs was evaluated for the diagnosis of significant HF (${\geq}F2$) using cut off value of 3.1 kPa. Results: There were no significant differences in the stiffness values of the liver parenchyma on pre- and post-contrast MREs (p = 0.15 and 0.38 for each reader, respectively). Regarding intra-rater correlation, excellent agreement was noted on rater 1(ICC = 0.998) and rater 2 (ICC = 0.996). Excellent correlation regarding the measured stiffness values was noted on both pre- and post-contrast MREs (ICC = 0.988 for pre-contrast, ICC = 0.993 for post-contrast). The accuracy, sensitivity, and specificity of the pre- and post-contrast MREs for differentiating significant HF (${\geq}F2$) from ${\geq}F1$ were same as 71%, 60%, and 100%, respectively. Conclusion: As there was no significant difference in the stiffness measurements seen on MREs before and after administration of gadoxetic acids, it is therefore acceptable to perform MRE after contrast injection in order to evaluate HF.

Appearance Rates of Several Substances into Cerebrospinal Fluid of Histamine-treated Rabbits (히스타민 투여시 토끼 뇌척수액으로의 물질 출현율)

  • Kim, Won-Shik;Shin, Dong-Hoon
    • The Korean Journal of Physiology
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    • v.2 no.2
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    • pp.21-31
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    • 1968
  • The appearance rates of antipyrine and urea into cerebrospinal fluid from blood were studied in the rabbits which were in the state of hypotension and of high permeability in the capillary beds following injection of histamine. The alteration in the distribution of electrolytes among various compartments of the brain and the permeability characteristics in the blood-cerebrospinal fluid barrier were also observed. Adult male rabbits, weighing around 2 kg, were used. Twenty four rabbits were divided into 3 groups. Besides the control group, histamine treated rabbits were categorized into 2 groups. $H_1$ consisted of the rabbits showing moderate responses to histamine and ranging from 62 to 80 mmHg in their mean anterial blood pressure. The animals which belong to $H_2-group$ showed severe responses to histamine and the mean anterial blood pressures dropped to 30-50 mmHg. Animals were anesthetized with nembutal, 30mg/kg i.v. The mean arterial blood pressure was read by means of the mercury manometer connected to the femoral artery. The animals, treated with histamine, were kept in hypotensive state at least for 40 minutes before the administration of the test-substances. The test-substances, 300 mg of urea and 200 mg of antipyrine, were dissolved in 3 ml of distilled water and were injected into the ear vein of the rabbit. After 10 minutes elapsed arterial blood sample was taken from the femoral artery and cerebrospinal fluid from the cisterna magna. Brain tissues were also analysed with respect to electrolytes in order to observe the disturbances in the electrolytes balance as well as in the function of the central nervous system. The results obtained were as follow: 1. The ratio of antipyrine concentration in cerebrospinal fluid to that of arterial blood plasma, that was the distribution ratio, was close to unity, revealing a well established equilibrium between the compartments of blood and cerebrospinal fluid in 10 minutes. In other words, there was no diffusion barrier with regard to antipyrine. The ratios over unity which were frequently seen in the histamine treated animals were attributable to the early penetration of the substance into the cerebrospinal fluid. 2. The appearance rates of urea into the cerebrospinal fluid in the histamine treated rabbits were higher in comparison with those of in the control animals. The increasing tendency in the rates was particularly remarkable in the $H_2-group$, showing the enhanced penetration of urea across the boondary. 3. In the htisamine treated $H_2-group$ the concentration of potassium in the blood plasma and cerebrospinal fluid well exceeded the control values and showed 8.5 and 9.0 mEq/l in average, respectively. Simultaneous drops in the brain tissue water were noticed, suggesting the leakage of intracellular potassium. 4. There was a coincidence in the rising pattern of potassium in the blood plasma and in the cerebrospinal fluid of $H_2-group$ and at least partial removal of the blood-cerebrospinal fluid barrier with respect to potassium was suggested in these animals. 5. The concentration of sodium in the blood plasma or in the cerebrospinal fluid showed no significant changes following histamine injection. However, sodium in the brain tissue revealed slight elevation in the histamine treated groups. 6. The ratios of the concentrations of potassium to those of sodium, [K]/[Na] in the brain tissues, were 1.92 in the control 1.82 in the $H_1$ and 1.52 in the $H_2-group$, respectively. The marked drop in the $H_2-group$ might represent neural dysfunction in the extremely hypotensive rabbits.

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Effect of Thermal Method on the Activation of Brown Adipose Tissue (온열 요법이 갈색지방세포 활성화에 미치는 영향)

  • You, Yeon Wook;Lee, Chung Wun;Seon, Ahn Jeong;Lee, Dong Eun;Moon, Jong Wun;Kim, Yun Cheol;Park, So Hyeon;Kim, Tae-Sung
    • The Korean Journal of Nuclear Medicine Technology
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    • v.25 no.2
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    • pp.48-54
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    • 2021
  • Purpose In 18F-FDG PET/CT, the absorption of 18F-FDG due to the activation of Brown Adipose Tissue (BAT) greatly interferes with the discrimination of lymph node malignant metastasis. Warming the patient's body temperature before and after injection of 18F-FDG to prevent FDG absorption by BAT is a safe and non-pharmacological approach. The purpose of this study was to identify and select patients with a high potential for BAT activation in advance, and to investigate whether BAT can inhibit FDG absorption when the body temperature is raised for a short time by directly applying heat to the target patient. Materials and Methods Among the patients who underwent 18F-FDG PET/CT at the National Cancer Center from January 2020 to December 2020, 825 female patients (415 in the thermal group, 410 in the non-thermal group) under 50 years old were included. The thermal group was administered heat for 10 minutes before injection of 18F-FDG. For statistical analysis, the Z test comparing the ratios between the two groups was used, and logistic regression analysis was performed to correct for important variables (BMI, outdoor temperature, blood sugar) according to the results of the previous retrospective study. Results Among 825 patients, 19 patients with BAT activated (Thermal group: 5(1.2%), Non-thermal group: 14(3.41%)) accounted for 2.3% of the total. As a result of performing the Z test to compare the ratios between the two groups, the activation of BAT in the thermal group was significantly decreased (P=0.034). In the univariate logistic regression analysis, the activation of BAT was also decreased in the thermal group (OR: 0.34, P<0.05). In the multivariate results, BAT activation increased in patients younger than 45 years old (OR: 4.46, P<0.05) and outdoor temperature less than 13.2 degrees (OR: 9.97, P<0.05). BAT activation tended to decrease in the thermal group, but there was no significant difference (OR: 0.37, P=0.066). Conclusion We confirmed that the activation of BAT tends to decrease by 62.5% in the group subjected to the thermal method, and it will be of great help in preventing FDG absorption of BAT more effectively in the future.