Objective: This study aimed to evaluate the endometrial transcriptomic patterns in the early secretory phase (ESP) and mid-secretory phase (MSP) of the natural menstrual cycle before in vitro fertilization and embryo transfer (IVF-ET). Methods: Thirty patients whose endometrial tissues were obtained from the ESP or MSP of a natural menstrual cycle immediately before IVF-ET were included. Endometrial dating was histologically confirmed as ESP (cycle days 16-18) or MSP (cycle days 19-21), according to the noyes criteria. The patients were divided into two groups depending on the IVF-ET outcome: pregnant (n=14; 7 in ESP and 7 in MSP) or non-pregnant (n=16; 8 in ESP and 8 in MSP). Differentially expressed genes (DEGs) in the MSP, compared to the ESP, were identified using NanoString nCounter (NanoString Technologies, Seattle, WA, USA) data for both the pregnant and non-pregnant groups. Results: Thirteen DEGs in the pregnant group and 11 DEGs in the non-pregnant group were identified in the MSP compared to those in the ESP. In both groups, adrenoceptor alpha 2A, interleukin 1 receptor-associated kinase 2, a disintegrin and metalloproteinase with thrombospondin repeats 15 (ADAMTS15), serpin family E member 1, integrin subunit beta 3, transmembrane protein 252 (TMEM252), huntingtin associated protein 1, C2 calcium-dependent domain containing 4A, and integrin subunit alpha 2 were upregulated in the MSP, compared to the ESP. TMEM37, galactosidase beta 1 like 2, Rho family GTPase 3, and cytochrome P450 family 24 subfamily A member 1 were upregulated in the MSP only in the pregnant group. ADAMTS8 was downregulated and monoamine oxidase A was upregulated in the MSP only in the non-pregnant group. Conclusion Transcriptomic patterns in the endometrium immediately before IVF-ET appear to differ according to the IVF-ET outcome. These novel DEGs, which have not been previously studied, may have functional significance during the window of implantation and serve as potential biomarkers of endometrial receptivity.

A 65-year-old male patient with an end-stage renal disease was diagnosed with coronavirus disease 2019 (COVID-19) by reverse transcription polymerase chain reaction. The patient complained of cough, sputum, and respiratory distress that worsened three days ago. The patient required mechanical ventilation and extracorporeal mentrane oxygenation. On day 9, convalescent plasma collected from a 34-year old man who recovered from COVID-19 45 days ago was administered. The patient showed immediate clinical improvement. However, on day 14, the patient’s clinical course worsened again. On day 19 and day 24, vancomycin-resistant Enterococcus faecium bacteremia and methicillin-resistant Staphylococcus aureus pneumonia were found. After long-term supportive care, he slowly recovered. He was discharged on day 91 without any oxygen requirement. This case report suggests that convalescent plasma therapy might just provide a short-term relief and that persistent effort for critical care is necessary to save patients from severe COVID-19.

OBJECTIVE: To investigate the image quality, radiation dose, and intermodality agreement of cervical spine CT using spectral shaping at 140 kVp by a tin filter (Sn140-kVp) in comparison with those of conventional CT at 120 kVp. MATERIALS AND METHODS: Patients who had undergone cervical spine CT with Sn140-kVp (n = 58) and conventional 120 kVp (n = 49) were included. Qualitative image quality was analyzed using a 5-point Likert scale. Quantitative image quality was assessed by measuring the noise and attenuation within the central spinal canals at C3/4, C6/7, and C7/T1 levels. Radiation doses received by patients were estimated. The intermodality agreement for disc morphology between CT and MRI was assessed at C3/4, C5/6, C6/7, and C7/T1 levels in 75 patients who had undergone cervical spine MRI as well as CT. RESULTS: Qualitative image quality was significantly superior in Sn140-kVp scans than in the conventional scans (p < 0.001). At C7/T1 level, the noise was significantly lower and the decrease in attenuation was significantly less in Sn140-kVp scans, than in the conventional scans (p < 0.001). Radiation doses were significantly reduced in Sn140-kVp scans by 50% (effective dose: 1.0 ± 0.1 mSv vs. 2.0 ± 0.4 mSv; p < 0.001). Intermodality agreement in the lower cervical spine region tended to be better in Sn140-kVp acquisitions than in the conventional acquisitions. CONCLUSION: Cervical spine CT using Sn140-kVp improves image quality of the lower cervical region without increasing the radiation dose. Thus, this protocol can be helpful to overcome the artifacts in the lower cervical spine CT images.
Artifacts ; Humans ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; Noise ; Spinal Canal ; Spine ; Tin

OBJECTIVE: To investigate the relationships of T2 *-corrected 6-echo Dixon volumetric interpolated breath-hold examination (VIBE) imaging-based fat fraction (FF) and R2 * values with bone mineral density (BMD); determine their associations with sex, age, and menopause; and evaluate the diagnostic performance of the FF and R2 * for predicting osteopenia and osteoporosis. MATERIALS AND METHODS: This study included 153 subjects who had undergone magnetic resonance (MR) imaging, including MR spectroscopy (MRS) and T2 *-corrected 6-echo Dixon VIBE imaging. The FF and R2 * were measured at the L4 vertebra. The male and female groups were divided into two subgroups according to age or menopause. Lin's concordance and Pearson's correlation coefficients, Bland-Altman 95% limits of agreement, and the area under the curve (AUC) were calculated. RESULTS: The correlation between the spectroscopic and 6-echo Dixon VIBE imaging-based FF values was statistically significant for both readers (pc = 0.940 [reader 1], 0.908 [reader 2]; both p < 0.001). A small measurement bias was observed for the MRS-based FF for both readers (mean difference = −0.3% [reader 1], 0.1% [reader 2]). We found a moderate negative correlation between BMD and the FF (r = −0.411 [reader 1], −0.436 [reader 2]; both p <0.001) with younger men and premenopausal women showing higher correlations. R2 * and BMD were more significantly correlated in women than in men, and the highest correlation was observed in postmenopausal women (r = 0.626 [reader 1], 0.644 [reader 2]; both p < 0.001). For predicting osteopenia and osteoporosis, the FF had a higher AUC in men and R2 * had a higher AUC in women. The AUC for predicting osteoporosis was highest with a combination of the FF and R2 * in postmenopausal women (AUC = 0.872 [reader 1], 0.867 [reader 2]; both p < 0.001). CONCLUSION: The FF and R2 * measured using T2 *-corrected 6-echo Dixon VIBE imaging can serve as predictors of osteopenia and osteoporosis. R2 * might be useful for predicting osteoporosis, especially in postmenopausal women.
Area Under Curve ; Bias (Epidemiology) ; Bone Density ; Bone Diseases, Metabolic ; Bone Marrow ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Menopause ; Osteoporosis ; Spine

BACKGROUND AND OBJECTIVES: Non-statin therapy plus lower intensity statin might be an alternative in patients with coronary artery disease (CAD). A recent data suggested an anti-inflammatory therapy can reduce recurrent cardiovascular events and pioglitazone is also an intriguing inflammatory-modulating agent. However, limited data exist on whether pioglitazone on top of statins further attenuates plaque inflammation. METHODS: Statin-naïve patients with stable CAD and carotid plaques of ≥3 mm were randomly prescribed moderate dose atorvastatin (20 mg/day), or moderate dose atorvastatin plus pioglitazone (30 mg/day) for 3 months. The primary endpoint was the change in the arterial inflammation of the carotid artery measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during 3 months. RESULTS: Of the 41 randomized patients, 33 underwent an evaluation by fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT; 17 atorvastatin plus pioglitazone and 16 atorvastatin patients). The addition of pioglitazone significantly improved the insulin sensitivity and increased the high-density lipoprotein cholesterol after 3 months. Although a reduction in the (FDG) uptake by pioglitazone on top of atorvastatin in carotid arteries with plaque showed marginally statistical significance in the entire patient group (atorvastatin plus pioglitazone; −0.10±0.07 and atorvastatin −0.06±0.04, p=0.058), pioglitazone showed a further reduction of the fluorodeoxyglucose (FDG) uptake among patients who had a baseline FDG uptake above the median (atorvastatin plus pioglitazone; −0.14±0.04 and atorvastatin −0.03±0.03, p < 0.001). CONCLUSIONS Pioglitazone demonstrated marginally significant anti-inflammatory effects in addition to moderate dose atorvastatin. This may have been due to the lack of power of the study. However, pioglitazone may have an anti-inflammatory effect in those patients with high plaque inflammation (Trial registry at ClinicalTrials.gov, NCT01341730).

OBJECTIVE: The purpose of this study was to describe the ultrasonographic findings of angioleiomyoma based on pathological subtypes. MATERIALS AND METHODS: Thirty-nine patients with subcutaneous angioleiomyomas in the extremities were retrospectively reviewed by two radiologists and a pathologist. Sonographic images were analyzed to evaluate each tumor's anatomic location, size, shape, margin, heterogeneity, echogenicity, associated findings, and vascularity. RESULTS: Angioleiomyomas were divided into 3 subtypes: capillary (n = 16), venous (n = 22), and cavernous (n = 1). The one cavernous angioleiomyoma was a hypoechoic mass with rich vascularity. Hypoechogenicity was more frequently observed for venous tumors (77.3%) than for capillary tumors (43.8%), and isoechogenicity was more frequently observed for capillary tumors (56.2%) than for venous tumors (22.7%). Moderate vascularity was more frequently observed for venous tumors (59.1%) than for capillary tumors (12.5%), and little vascularity was more frequently observed for capillary tumors (62.5%) than for venous tumors (13.6%). The aforementioned findings including echogenicity (p = 0.034) and vascularity (p = 0.003) were statistically significant. CONCLUSION: Awareness of sonographic findings of angioleiomyomas based on pathologic subtypes could be helpful for diagnosing angioleiomyoma and could increase diagnostic accuracy for superficial soft-tissue masses in our practice.
Angiomyoma* ; Capillaries ; Extremities* ; Humans ; Population Characteristics ; Retrospective Studies ; Ultrasonography

BACKGROUND AND OBJECTIVES: Non-statin therapy plus lower intensity statin might be an alternative in patients with coronary artery disease (CAD). A recent data suggested an anti-inflammatory therapy can reduce recurrent cardiovascular events and pioglitazone is also an intriguing inflammatory-modulating agent. However, limited data exist on whether pioglitazone on top of statins further attenuates plaque inflammation. METHODS: Statin-naïve patients with stable CAD and carotid plaques of ≥3 mm were randomly prescribed moderate dose atorvastatin (20 mg/day), or moderate dose atorvastatin plus pioglitazone (30 mg/day) for 3 months. The primary endpoint was the change in the arterial inflammation of the carotid artery measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during 3 months. RESULTS: Of the 41 randomized patients, 33 underwent an evaluation by fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT; 17 atorvastatin plus pioglitazone and 16 atorvastatin patients). The addition of pioglitazone significantly improved the insulin sensitivity and increased the high-density lipoprotein cholesterol after 3 months. Although a reduction in the (FDG) uptake by pioglitazone on top of atorvastatin in carotid arteries with plaque showed marginally statistical significance in the entire patient group (atorvastatin plus pioglitazone; −0.10±0.07 and atorvastatin −0.06±0.04, p=0.058), pioglitazone showed a further reduction of the fluorodeoxyglucose (FDG) uptake among patients who had a baseline FDG uptake above the median (atorvastatin plus pioglitazone; −0.14±0.04 and atorvastatin −0.03±0.03, p < 0.001). CONCLUSIONS: Pioglitazone demonstrated marginally significant anti-inflammatory effects in addition to moderate dose atorvastatin. This may have been due to the lack of power of the study. However, pioglitazone may have an anti-inflammatory effect in those patients with high plaque inflammation (Trial registry at ClinicalTrials.gov, NCT01341730).
Arteritis ; Atherosclerosis ; Atorvastatin Calcium ; Carotid Arteries ; Carotid Stenosis ; Cholesterol ; Coronary Artery Disease ; Electrons ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Insulin Resistance ; Lipoproteins ; PPAR gamma

OBJECTIVE: To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis. MATERIALS AND METHODS: We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (Ecc(SAX)), radial strain (Err(SAX)) from mid-ventricular level short-axis cine views and LV longitudinal strain (Ell(LV)), radial strain (Err(Lax)) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. RESULTS: During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, Ecc(SAX), Err(SAX), Ell(LV), and Err(Lax) values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an Err(Lax) value ≤ 9.48%. Multivariable backward regression analysis revealed that Err(Lax) values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CONCLUSION: CMR-derived Err(Lax) values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Heart Ventricles ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Myocarditis* ; Retrospective Studies ; Ventricular Dysfunction

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.
Ankle Injuries ; Ankle Joint* ; Ankle* ; Diagnosis ; Emergencies ; Exercise Test ; Ligaments ; Orthopedics ; Pathology ; Tendons ; Ultrasonography*

BACKGROUND: The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. METHODS: This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). RESULTS: Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively. CONCLUSION: Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis.
Allografts* ; Aortic Valve* ; Aortitis ; Follow-Up Studies ; Freedom ; Heart ; Heart Transplantation ; Hemodynamics ; Humans ; Mortality ; Reoperation ; Retrospective Studies ; Survival Rate ; Thromboembolism ; Tissue Donors ; Transplant Recipients