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Ki-67 proliferation index is widely used for differentiating between high and low-grade gliomas, but differentiating between the same grade IV appears to be more problematic, and the point about its prognostic value for GBM patients remains unclear. To reduce the possibility to find a marked histological heterogeneity, and may contain areas that could be diagnosed as lower grade, in this study we considered a large group of patients with IDH wild-type Glioblastoma (IDH-WT GBM) and we have analyzed previously reported prognostic factors, in regards to their relationship with the Ki-67 expression index.

We explore the prognostic impact of ki-67 index status in 127 patients affected by IDH-WT GBM. We therefore analyzed clinical characteristics, tumor genetics, dimension and clinical outcomes. We selected a total of 127 patients affected by newly diagnosed IDH-WT GBM who underwent surgery, radiation, and chemotherapy in our Institution in the period ranging between January 2014 and December 2016 RESULTS The volume of the lesion had a strong association with the Ki67 overexpression. In particular lesions whose volume was greater than 45  cm

, presented a higher percentage of Ki67 expression demonstrating that greater tumors are more likely associated to higher values of Ki67 percentages. On a multivariate analysis, it was possible to outline that Ki67 was significant a predictor of shorter PFS independently from the age of the patients, the volume of the lesion and preoperative KPS.

There is a correlation between percentage staining of Ki-67 and OS in our cohort of patients with IDH-WT GBM. This is only the third observational study documenting a positive correlation between Ki-67 and overall survival in GBM and the first one demonstrates that percentage Ki-67 staining >20 % predicts poorer progression free survival in IDH-WT GBM.

20 % predicts poorer progression free survival in IDH-WT GBM.It is important to be familiar with normal anatomic variants in order to not to mistake them for pathology. It is well known that the middle ear ossicles have varying normal morphology on gross anatomy, but can also be malformed in certain congenital syndromes or eroded in the setting of chronic ear infection or cholesteatoma. This case series describes the pneumatized ossicle on imaging, a rare normal anatomic variant.

The aim of this study was to analyze the prevalence, location and clinical relevance of extravascular findings (EVFs) on magnetic resonance angiography (MRA) of the run-off vasculature.

In this retrospective study, we analyzed run-off MRAs of 194 consecutive patients (45 women and 149 men, median age 68years, IQR 58-74years). Our patient cohort consisted predominantly of individuals with known (n=165, 85%) or suspected (n=15, 8%) peripheral artery disease (PAD). All MRA examinations were performed between 2012 and 2018 on a 3 Tesla MRI scanner using a standardized protocol. Two radiologists re-evaluated the MRA images to identify EVFs, which were classified into findings with major (category I), moderate (category II) and minor (category III) clinical significance.

A total of 501 EVFs were found in 172 of the 194 patients (89%). Twenty-seven findings (5%) were assigned to category I, 189 (38%) to category II and 285 (57%) to category III. 23 of 194 patients (12%) had at least one EVF with major clinical relevance (category I). Most of the 27 category I EVFs were observed in the soft tissues (n=13, 48%). The remaining category I EVFs were found in the musculoskeletal (n=7, 26%), urogenital (n=4, 15%), lymphatic (n=2, 7%) and gastrointestinal (n=1, 4%) system. The majority of the category I EVFs were infectious (n=14, 52%) or neoplastic (n=10, 37%) pathologies.

Clinically relevant EVF can be encountered frequently on run-off MRA examinations. These results illustrate the importance of evaluating all organ systems when reporting MRA examinations, despite the clinical focus being the patients’ vascular status.

Clinically relevant EVF can be encountered frequently on run-off MRA examinations. These results illustrate the importance of evaluating all organ systems when reporting MRA examinations, despite the clinical focus being the patients’ vascular status.Spontaneous breast hematoma is a rare complication of therapeutic anticoagulation therapy with few cases reported in the literature. We present a case of spontaneous breast hematoma resulting in hypotension and symptomatic anemia. Angiography demonstrated multiple sites of hemorrhage within the breast, which was treated with gelatin sponge embolization. This case highlights the role of interventional radiology in the treatment of breast hematoma, as well as reviews the arterial vascular anatomy of the breast.Karst wetland is a special, complex and fragile type of wetland. With increasing economic and agricultural activities, the negative impacts of human activities on water quality particularly on karst wetland is also increasing. In this paper multiple datasets and methods including hydrological, hydrochemical and stable isotope data were used to elucidate the distribution and transport of nitrate pollution in Huixian karst wetland under the influence of seasonal hydrodynamic changes and human activities. Hydrodynamic conditions around the wetland during both wet and dry seasons show large differences due to the complex exchange between surface water and groundwater. The northern recharge area receives rainfall recharge with rapid responses in groundwater level, temperature and electrical conductivity, while those responses are relatively stable in the central area where the surface water interacts with groundwater frequently. However, their diurnal variations are significant. In the western drainage area where groundwater always discharges to rivers, the groundwater levels show sharp responses after rainfall, but their temperatures are stable. In addition, δ15N and δ18O of nitrate suggest that the nitrate pollution mainly comes from NH4+ in fertilizer and rainfall, soil nitrogen, animal feces and livestock manure. learn more The nitrate concentrations of most surface waters are lower during the wet season, affected by the dilution and mixing effect of heavy rainfall and agricultural activities. Nitrate distributions show considerable spatial variability during the dry season, especially in the wells located in residential areas which are mainly polluted by nearby residents. This study highlights the vulnerability of karst wetlands and presents methods that are significant for ecological restoration as well as development of karst water resources in karst areas.