Purpose
To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs).
Methods
The ...databases of MEDLINE, EMBASE and Cochrane library were searched up to 3 Jun, 2018. In this meta-analysis, data of volume reduction rates (VRRs) at the 3-, 6- and 12-month follow-up, and complications are obtained to evaluate the effectiveness and safety of cMWA and uMWA for the treatment of BTNs.
Results
Nine studies involving 1461 patients with 1845 BTNs were included. The pooled VRR at the 3-month follow-up after MWA therapy reached 54.3% (95% CI: 45.3–63.3%,
I
2
= 97.6%), 73.5% (95% CI: 66.7–80.3%,
I
2
= 94.9%) at the 6-month follow-up, and 88.6% (95% CI: 84.9–92.4%,
I
2
= 92.7%) at the 12-month follow-up. The pooled proportions of overall, major and minor complications were 52.4% (95% CI: 29.8–74.9%;
I
2
= 99.5%), 4.8% (95% CI: 2.7–7.0%;
I
2
= 55.9%) and 48.3% (95% CI: 31.2–65.4%;
I
2
= 99.7%). Both cMWA and uMWA achieved similar pooled VRR at the 3-month follow-up (58.4 vs 45.3%,
P
= 0.07) and pooled proportion of major complications (4.9 vs 5.0%,
P
= 0.49), while uMWA had higher pooled proportions of overall and minor complications than cMWA (97.8 vs 29.7%,
P
< 0.01; 97.8 vs 21.0%,
P
< 0.01), with more patients suffering pain and skin burn after uMWA (100 vs 5.5%,
P
< 0.01; 47.2 vs 0.2%,
P
< 0.01).
Conclusion
MWA is an effective treatment modality for BTNs. When considering the patient’s comfort, cMWA would be a more preferable procedure with less complications.
Ischemic accumulation of succinate causes cerebral damage by excess production of reactive oxygen species. However, it is unknown whether ischemic accumulation of succinate affects neural stem cell ...proliferation. In this study, we established a rat model of cerebral ischemia/reperfusion injury by occlusion of the middle cerebral artery. We found that succinate levels increased in serum and brain tissue (cortex and hippocampus) after ischemia/reperfusion injury. Oxygen-glucose deprivation and reoxygenation stimulated primary neural stem cells to produce abundant succinate. Succinate can be converted into diethyl succinate in cells. Exogenous diethyl succinate inhibited the proliferation of mouse-derived C17.2 neural stem cells and increased the infarct volume in the rat model of cerebral ischemia/reperfusion injury. Exogenous diethyl succinate also increased the succinylation of the Rho family GTPase Cdc42 but repressed Cdc42 GTPase activity in C17.2 cells. Increasing Cdc42 succinylation by knockdown of the desuccinylase Sirt5 also inhibited Cdc42 GTPase activity in C17.2 cells. Our findings suggest that ischemic accumulation of succinate decreases Cdc42 GTPase activity by induction of Cdc42 succinylation, which inhibits the proliferation of neural stem cells and aggravates cerebral ischemia/reperfusion injury.
Purpose: To evaluate whether local tumor progression (LTP) would be further reduced when contrast-enhanced ultrasound (CEUS)-CT/MR fusion imaging was used as intraprocedural assessment method in ...hepatocellular carcinoma (HCC) thermal ablation compared with routine CEUS.
Materials and methods: This prospective non-randomized study was conducted from December 2010 to July 2012. CEUS-CT/MR fusion imaging and routine CEUS were used for treatment response assessment in the ablation procedure of 146 HCCs and 122 HCCs, respectively. Supplementary ablations were performed immediately if necessary. The primary technique efficacy rate, LTP rate and overall survival (OS) rate were calculated.
Results: For CEUS-CT/MR fusion imaging and routine CEUS, the technical success rate, technique efficacy rate and supplementary ablation rate were 86.3% (126/146) and 98.4% (120/122) (p = .000), 99.2% (125/126) and 94.2% (113/120) (p = .032), and 14.3% (18/126) and 4.2% (5/120) (p = .006), respectively. The cumulative LTP rate and OS rate were not significantly different between fusion imaging group and routine CEUS group. However, for lesions that were larger than 3 cm or close to major vessels (41 lesions in fusion imaging group and 44 lesions in routine CEUS group, who received transcatheter arterial chemoembolization before ablation), the cumulative LTP rate was significantly lower in fusion imaging group than in routine CEUS group (p = .032).
Conclusion: Although intraprocedural CEUS-CT/MR fusion imaging has certain limitations in application, it might provide a potential more efficient method compared with routine CEUS in reducing LTP in HCC thermal ablation, especially for difficult ablation lesions.
To assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after ...hepatocellular carcinoma (HCC) ablation.
Ninety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.
The success rate of image fusion was 96.2% (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3-13) min. The CEUS image quality was good in 36.1% (53/147) and medium in 63.9% (94/147) of the cases. By supplementary ablation, 21.8% (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95% confidence interval, 1.070-78.571; p = 0.043).
CEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.
To comprehensively understand the current ecological status of rivers within Three Gorges Reservoir catchment (TGRC), and provide a baseline and tools for the future assessment, macroinvertebrates ...from 26 tributaries were collected in April, 2010, and a multi-metric index based on macroinvertebrates (SXMMI) and the corresponding rating criteria for assessment were established. Five metrics, including percent model affinity (PMA), percentage of individuals of 1st dominant taxa (Dom01Pct), Hilsenhoff biotic index (HBI), total taxa number (TotalTax), and the taxa number of Ephemeroptera, Plecoptera, and Trichoptera (EPTTax) were selected to join into the final index system by several steps. A combination of an “a priori” (experts judgment) and an “a posteriori” (PMA) approach was used to improve the accuracy of pre-classification. According to the results of assessment, the ecological status of the 26 tributaries in TGRC was not good; the rates high and good were relatively low, and there was a trend the ecological status in most tributaries deteriorates from upstream to downstream. The results of multivariate analysis and relationships among the SXMMI, the latent environment gradient, and abiotic and biotic parameters indicated that our final index was a robust assessment tool. In future, the SXMMI should be refined and verified with additional data.
To evaluate the independent contribution of miRNAs to the missing heritability in CYP3A4/5 functionality and atorvastatin metabolism, the relationships among three levels of factors, namely (1) ...clinical characteristics, CYP3A4/5 genotypes, and miRNAs, (2) CYP3A4 and CYP3A5 mRNAs, and (3) CYP3A activity, as well as their individual impacts on atorvastatin metabolism, were assessed in 55 human liver tissues. MiR-27b, miR-206, and CYP3A4 mRNA respectively accounted for 20.0%, 5.8%, and 9.5% of the interindividual variations in CYP3A activity. MiR-142 was an independent contributor to the expressions of CYP3A4 mRNA (partial R(2) = 0.12, P = 0.002) and CYP3A5 mRNA (partial R(2) = 0.09, P = 0.005) but not CYP3A activity or atorvastatin metabolism. CYP3A activity was a unique independent predictor of variability of atorvastatin metabolism, explaining the majority of the variance in reduction of atorvastatin (60.0%) and formation of ortho-hydroxy atorvastatin (78.8%) and para-hydroxy atorvastatin (83.9%). MiR-27b and miR-206 were found to repress CYP3A4 gene expression and CYP3A activity by directly binding to CYP3A4 3'-UTR, while miR-142 was found to indirectly repress CYP3A activity. Our study indicates that miRNAs play significant roles in bridging the gap between epigenetic effects and missing heritability in CYP3A functionality.
Abstract Purpose To investigate the value of double contrast-enhanced ultrasonography (DCEUS) in the detection of periampullary cancer. Materials and Methods Ninety-nine patients with surgery or ...biopsy-proven periampullary cancer who underwent both DCEUS and magnetic resonance imaging (MRI) examinations before operation were enrolled in our study. DCEUS in which intravenous microbubbles were used in combination with oral contrast agent and MRI were performed preoperatively to make a detection diagnosis of periampullary cancer. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DCEUS, B-mode ultrasonography (BUS) and MRI were calculated and compared. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of BUS, DCEUS and MRI in the detection. Stratified analyses were performed for different pathological types and different sizes of periampullary lesions. The inter- and intra-observer reliability of DCEUS for cancer detection was also investigated. Result There were no significant differences in sensitivity, specificity, PPV, NPV or accuracy between DCEUS and MRI (all P ＞0.05). ROC analysis showed that the accuracy of DCEUS or MRI was higher than that of BUS ( P ＜0.001), while no significant differences were noted in the accuracy between DCEUS and MR. In the 76 cases of periampullary cancer, DCEUS appeared to be superior to BUS for ampullary carcinoma, duodenum carcinoma and for lesions with an average diameter of less than 3 cm. DCEUS appeared equal to BUS in other groups. No significant differences were noted between DCEUS and MRI in the stratified analysis. A considerably well agreement between DCEUS and MRI was obtained using Kappa analysis (k = 0.649, P ＜0.001). The intra- and inter-observer reproducibility were both good for detection of periampullary cancer by DCEUS, with a Kappa values of 0.783 ( P ＜0.01) and 0.732 ( P ＜0.01), respectively. Conclusion DCEUS provides an available and useful imaging modality in the detection of periampullary cancer. This technique can aid in displaying the invisible periampullary region in BUS and may also become an effective supplemental method to MRI.
To investigate whether plasma miRNAs targeting CYP3A4/5 have an impact on the variance of pharmacokinetics of clopidogrel.
The contribution of 13 miRNAs to the CYP3A4/5 gene expression and activity ...was investigated in 55 liver tissues. The association between plasma miRNAs targeting CYP3A4/5 mRNA and clopidogrel pharmacokinetics was analyzed in 31 patients with coronary heart disease who received 300 mg loading dose of clopidogrel.
Among 13 miRNAs, miR-142 was accounting for 12.2% (p = 0.002) CYP3A4 mRNA variance and 9.4% (p = 0.005) CYP3A5 mRNA variance, respectively. Plasma miR-142 was negatively associated with H4 Cmax (r = -0.5269; p = 0.0040) and associated with H4 AUC0-4h (r = -0.4986; p = 0.0069) after 300 mg loading dose of clopidogrel in coronary heart disease patients.
miR-142 could account for a part of missing heritability of CYP3A4/5 functionality related to clopidogrel activation.
A series of marine natural gas fields were recently discovered in oolitic dolomites of the Lower Triassic Feixianguan formation, northeastern Sichuan Basin, southwest China. The mechanism forming ...these reservoir dolomites is debatable, limiting the ability to characterize these reservoir successfully. Based on the investigation of the representative Dukouhe, Luojiazhai, and Puguang areas, this issue was addressed by examining the distribution, petrology, and geochemistry of the dolomites, the most comprehensive study to date was provided. Dolomitization occurred at a very early stage of diagenesis, as shown by the petrological features of the rock fabric. Vadose silt, which is composed primarily of dolomitic clasts, is found in the primary and secondary pores of the oolitic dolomite. This indicates that the overlying strata were subjected to dolomitization when the Feixianguan formation was located in the vadose zone. Therefore, it may be inferred that the dolomitization which occurred before the formation was exposed to meteoric conditions. The spatial distribution and geochemical characteristics of the dolomite indicate that dolomitization occurred as a result of seepage reflux. The degree of dolomitization decreases with increasing distance from the evaporative lagoon. Furthermore, the type and porosity of the dolomite vary in different zones of the upward-shoaling sequence, with the porosity gradually decreasing from the highest layer to the lowest layer. This reflects a close relationship between dolomitization and seawater evaporation during the formation of the dolomite. Geochemical analysis provided further evidence for the relationship between the dolomitization fluid and the coeval seawater. The
87
Sr/
86
Sr and δ
13
C isotopes, as well as the abundances of trace elements, Fe and Mn, indicate that seawater concentrated by evaporation acted as the dolomitization fluid. These results also show that dolomitization most likely occurred in a semi-closed diagenetic environment. Therefore, the main mechanism of oolitic dolomite formation is seepage reflux, which occurred at an early stage of diagenesis.
To explore the efficacy and safety of endoscopic submucosal enucleation (ESE) for gastric submucosal tumors (SMTs) originated from muscularis propria.
A total of 116 patients with gastric SMT ...originated from muscularis propria underwent ESE in Department of Gastroenterology of the Taizhou Hospital between July 2006 and March 2011. The occurrence of intra-operative and post-operative complications and corresponding treatment were recorded. After the treatment of ESE, the patients were followed up endoscopically.
The success rate of operation was 96.6%. The mean time of the procedure was (51.9±16.3) min. Complications included intra-operative bleeding (n=9, 7.8%), perforation (n=20, 17.2%), and post-operative bleeding (n=3, 2.6%). Among them, 5 cases (4.3%) required surgical intervention. None of patient had other complications such as peritoneal abscess or peritonitis. The mean hospitalization time after ESE was 6.1 days. The median follow-up period was 12 months (range, 3-48 months) and there was no residual
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