Objective: To analyze the contrast-enhanced ultrasonography (CEUS) characteristics and microvessel density (MVD) of thyroid carcinomas vs. benign thyroid lesions, and to determine the value of CEUS ...in the clinical diagnosis of thyroid carcinoma. Methods: Forty-five patients (34 women, 11 men; mean age, 45.95 ± 12.20 years) with 57 thyroid nodules underwent preoperative CEUS with SonoVue (injected as a bolus via an elbow vein). The CEUS data were analyzed using QLAB quantitative analysis software. The enhancement patterns and quantitative parameters of thyroid carcinoma were evaluated.Additionally, immunohistochemistry was performed to evaluate MVD. Results: Most malignant nodules showed hypo-enhancement, and this enhancement pattern had 68.18% sensitivity and 92.31% specificity in diagnosing thyroid carcinomas. Most benign nodules showed ring enhancement, which had 46.15% sensitivity and 100% specificity in diagnosing benign nodules. Compared with the peripheral glandular tissue, thyroid carcinomas had significantly smaller peak intensities (PI) and wash-in slopes (P ＜ 0.05). Malignant nodules had significantly lower MVD than benign nodules (P ＜ 0.05). A positive correlation was between the PI and MVD (P ＜ 0.01). Conclusion: CEUS can improve the diagnosis of thyroid carcinomas, and is a useful complement to conventional ultrasonography.
Background The Oxford classification of immunoglobulin A (IgA) nephropathy (IgAN) provides a histopathologic grading system that is associated with kidney disease outcomes independent of clinical ...features. We evaluated the Oxford IgAN classification in a large cohort of patients from China. Study Design Retrospective study. Setting & Participants 1,026 adults with IgAN from 18 referral centers in China. Inclusion criteria and statistical analysis were similar to the Oxford study. Predictors Histologic findings of mesangial hypercellularity score, endocapillary proliferation, segmental sclerosis or adhesion, crescents, necrosis, and tubular atrophy/interstitial fibrosis. Clinical features, blood pressure, estimated glomerular filtration rate (eGFR), proteinuria, and treatment modalities. Outcomes Time to a 50% reduction in eGFR or end-stage renal disease (the combined event); the rate of eGFR decline (slope of eGFR); proteinuria during follow-up. Results Compared with the Oxford cohort, the Chinese cohort had a lower proportion of patients with mesangial hypercellularity (43%) and endocapillary proliferation (11%), higher proportion with segmental sclerosis or adhesion (83%) and necrosis (15%), and similar proportion with crescents (48%) and tubular atrophy/interstitial fibrosis (moderate, 24%; severe, 3.3%). During a median follow-up of 53 (25th-75th percentile, 36-67) months, 159 (15.5%) patients reached the combined event. Our study showed that patients with a mesangial hypercellularity score higher than 0.5 were associated with a 2.0-fold (95% CI, 1.5-2.8; P <0.001) higher risk of the combined event than patients with a score of 0.5 or lower. Patients with tubular atrophy/interstitial fibrosis of 25%-50% and >50% versus <25% were associated with a 3.7-fold (95% CI, 2.6-5.1; P <0.001) and 15.1-fold (95% CI, 9.5-24.2; P <0.001) higher risk of the combined event, respectively. Endocapillary proliferation, glomerular crescents, and necrosis were not significant. Limitations Retrospective study; the therapeutic interventions were miscellaneous. Conclusions We confirmed the associations of mesangial hypercellularity and tubular atrophy/interstitial fibrosis with kidney disease outcomes.
To compare outcomes of transarterial chemoembolization with radiofrequency (RF) ablation in treatment of recurrent hepatocellular carcinoma (HCC) after resection within Barcelona Clinic Liver Cancer ...(BCLC) stage 0/A.
From January 2007 to December 2011, 110 consecutive patients with recurrent HCC meeting BCLC stage 0/A criteria underwent transarterial chemoembolization (n = 78; mean tumor size, 1.9 cm ± 1.0) or RF ablation (n = 32; mean tumor size, 1.9 cm ± 0.6) as initial treatment. The primary outcome was overall survival (OS). Kaplan-Meier method was used to construct survival curves, which were compared by log-rank test. Prognostic factors for OS were analyzed using univariate and multivariate Cox proportional hazard models.
No significant differences between baseline clinical characteristics of the 2 treatment groups were identified. The 1-, 3-, and 5-year OS rates were 89.7%, 61.0%, and 36.6% for the transarterial chemoembolization group and 90.1%, 72.8%, and 60.0% for the RF ablation group. There was no significant difference in OS rates between the groups (P = .159). Subgroup analysis indicated that RF ablation achieved better survival than transarterial chemoembolization among patients ≤ 55 years old and patients with BCLC stage 0 (P = .036 and P = .045). Multivariate analysis revealed that serum albumin (≤ 35 g/L) (hazard ratio = 2.797; 95% confidence interval, 1.366-2.726; P = .005) and α-fetoprotein (> 400 ng/mL) (HR = 2.336; 95% CI, 1.210-4.508; P = .011) levels before treatment were 2 significant risk factors for poor prognosis.
Transarterial chemoembolization might provide a similar OS as RF ablation in patients with recurrent BCLC stage A HCC. However, RF ablation could provide better OS in patients with recurrent BCLC stage 0 HCC.
Low-level carotid baroreflex stimulation (LL-CBS) appears to have a potential antiarrhythmogenic effect.
The purpose of this study was to investigate effects of short-term LL-CBS on an atrial ...fibrillation (AF) canine model.
Group 1 (LL-CBS in the 6 hour-rapid atrial pacing model): Anesthetized dogs underwent 6 hours of rapid atrial pacing (RAP) with concomitant LL-CBS in last 3 hours (LL-CBS group; n = 7) or without (control group; n = 6). Effective refractory period (ERP), ERP dispersion, and window of vulnerability to AF were determined. Left stellate ganglion (LSG) neural activity and heart rate variability were analyzed. Group 2 (LL-CBS on electrically or mechanically induced AF with acetylcholine): In subgroup 1, sustained AF was induced by injecting acetylcholine (Ach; 10 mM) into the anterior right ganglionated plexus at baseline and after 3-hour LL-CBS (n = 7) or sham operation (n = 6). In subgroup 2, Ach was applied onto the right atrial appendage. The time of duration of AF and the average AF cycle length were determined in both subgroups.
Group 1: LL-CBS reversed the RAP-induced ERP shortening and increase in ERP dispersion and window of vulnerability (P < .05). The activation of LSG, decrease in high frequency, and increase in low frequency and low frequency/high frequency ratio induced by RAP were also reversed by LL-CBS (P < .05). After 6-hour RAP, plasma norepinephrine and angiotensin II concentrations were significantly lower in the LL-CBS group than in the control group (P < .05). Group 2: The AF duration was shortened and the average AF cycle length was prolonged markedly in both subgroups (P < .01) by LL-CBS.
LL-CBS can reverse RAP-induced atrial electrical remodeling and suppress electrically or mechanically induced AF with Ach, and the anti-AF effect is attributed to attenuation of autonomic nerve remodeling, including inhibition of the LSG activity.
Programmed death-1 (PD-1) plays a vital role in down-modulating immune responses and maintaining peripheral tolerance.
The authors have investigated the inducible expression of PD-1 on activated T ...cells from patients with ankylosing spondylitis (AS). Thirty patients with AS and 31 unrelated healthy controls (HCs) were recruited in this study. The expression of PD-1 on T cells harvested from nonstimulated (t0) or stimulated cultures with phytohemagglutinin for 24 hours (t24) was determined by flow cytometry. The multiple levels of the PD-1 expression on stimulated and nonstimulated cells from each individual's sample (t24/t0) represented as the degree of the inducible effect on PD-1 expression.
The expression of PD-1 on nonstimulated T cells presented no significant difference between AS group and HC group (P > 0.05). After stimulation, the degree of effect on PD-1 expression of CD4+, CD4+CD25+, CD4+CD25 high, CD4+CD25 low and CD4+CD25- T cells were significantly lower in patients with AS than those in HC group (1.9 ± 0.9 versus 3.6 ± 2.3, 9.7 ± 7.4 versus 17.8 ± 12.6, 87.8 ± 48.6 versus 157.3 ± 117.0, 3.7 ± 1.4 versus 7.3 ± 2.4, 0.5 ± 0.3 versus 1.1 ± 0.6, respectively, P < 0.05). However, there was no significant difference of the effect on all lymphocytes and CD8+ T cells between patients with AS and HCs (P > 0.05).
The decreased inducible expression of PD-1 on active T lymphocytes, especially on CD4+CD25 high and CD4+CD25+ T cells, may be one of important factors involved in the development of AS.
Summary Hormone receptor status is an integral component of decision-making in breast cancer management. IHC4 score is an algorithm that combines hormone receptor, HER2, and Ki-67 status to provide a ...semiquantitative prognostic score for breast cancer. High accuracy and low interobserver variance are important to ensure the score is accurately calculated; however, few previous efforts have been made to measure or decrease interobserver variance. We developed a Web-based training tool, called “Score the Core” (STC) using tissue microarrays to train pathologists to visually score estrogen receptor (using the 300-point H score), progesterone receptor (percent positive), and Ki-67 (percent positive). STC used a reference score calculated from a reproducible manual counting method. Pathologists in the Athena Breast Health Network and pathology residents at associated institutions completed the exercise. By using STC, pathologists improved their estrogen receptor H score and progesterone receptor and Ki-67 proportion assessment and demonstrated a good correlation between pathologist and reference scores. In addition, we collected information about pathologist performance that allowed us to compare individual pathologists and measures of agreement. Pathologists' assessment of the proportion of positive cells was closer to the reference than their assessment of the relative intensity of positive cells. Careful training and assessment should be used to ensure the accuracy of breast biomarkers. This is particularly important as breast cancer diagnostics become increasingly quantitative and reproducible. Our training tool is a novel approach for pathologist training that can serve as an important component of ongoing quality assessment and can improve the accuracy of breast cancer prognostic biomarkers.
Testosterone can improve glucose metabolism through multiple cellular mechanisms. However, it remains unclear as to whether hypogonadal men with type 2 diabetes mellitus (T2DM) can benefit from ...testosterone replacement therapy (TRT).
To assess the relative effect of TRT on glycolipid metabolism among hypogonadal men with T2DM.
: Electronic literature searches of the Cochrane Library, PubMed, MEDLINE, and EMBASE databases were conducted, up to the end of October 2020. Only studies that used randomized controlled trials (RCTs) were included in our systematic review. Main outcome measures From these studies, we extracted certain outcomes including changes in insulin resistance, glucose metabolism, and lipid parameters.
There were a total of 8 studies that met our criteria. Four of these studies either did not have a consistent treatment strategy, or the control groups used untreated patients rather than patients that had been given a placebo. Thus, results from these four studies contributed to the variability in treatment outcomes. In four of the examined RCTs, there was no change in either the dose or the type of antidiabetic medication prescribed. Based on the homeostatic model assessment of insulin resistance, the pooled WMD was −0.34, 95% confidence interval (CI; −1.02, 0.34), P = .33; For fasting plasma glucose, the pooled WMD was −0.27, 95% CI (−1.02, 0.48), P = .48, the pooled WMD for HbA1c% was −0.00, 95% CI (−1.08, 1.08), P = 1.00.
Although certain RCTs showed that TRT improved insulin resistance and glycolipid metabolism when compared with the placebo or untreated control groups, these findings may partly be due to changes in antidiabetic therapy during the course of the study. In the current meta-analysis, analyses showed that TRT did not significantly improve insulin resistance or glycolipid metabolism. Future studies need to be rigorous in design and delivery, and comprehensive descriptions of all aspects of their methods should be included to further enable a more accurate appraisal and interpretation of the results.
Yu X, Wei Z, Liu Y, et al. Effects of Testosterone Replacement Therapy on Glycolipid Metabolism Among Hypogonadal Men with T2DM: A Meta-Analysis And System Review Of Randomized Controlled Trials. Sex Med 2021;9:100403.
Abstract Rhabdomyosarcoma rarely metastasizes to the breast. We report a case of a pediatric patient who initially presented with a right breast mass and pancytopenia, which was subsequently ...diagnosed as alveolar rhabdomyosarcoma. Despite initial favorable response to chemotherapy, a new metastatic focus was found in the contralateral breast 10 months later.
Acute fibrinous and organizing pneumonia (AFOP) is an extremely rare, relatively new, and distinct histological pattern of acute lung injury characterized predominately by the presence of ...intra-alveolar fibrin and associated organizing pneumonia. AFOP may be idiopathic or associated with a wide spectrum of clinical conditions. It has a variable clinical presentation from mild respiratory symptoms to that similar to the acute respiratory distress syndrome. Currently there is no consensus on treatment, and corticosteroids previously were of unclear benefit. To date, there are less than 40 cases of AFOP reported in the literature and only one has been linked to hematopoietic stem cell transplantation. Here we report the first case series of 2 patients who developed AFOP following allogenic stem cell transplant that were successfully treated with high-dose corticosteroids.
The
gene family is an important transcription factor family that regulates meristem formation, organ morphogenesis, signal transduction, and fruit development. A total of 24 genes of the TALE family ...were identified and analyzed in tomato. The 24 SlTALE family members could be classified into five BELL subfamilies and four KNOX subfamilies.
genes were unevenly distributed on every tomato chromosome, lacked syntenic gene pairs, and had conserved structures but diverse regulatory functions. Promoter activity analysis showed that cis-elements responsive to light, phytohormone, developmental regulation, and environmental stress were enriched in the promoter of
genes, and the light response elements were the most abundant. An abundance of TF binding sites was also enriched in the promoter of
genes. Phenotype identification revealed that the
(
) mutant fruits showed significantly enhanced chloroplast development and chlorophyll accumulation, and a significant increase of chlorophyll fluorescence parameters in the fruit shoulder region. Analysis of gene expression patterns indicated that six
genes were highly expressed in the
fruit shoulder region, and four
genes were highly expressed in the parts with less-developed chloroplasts. The protein-protein interaction networks predicted interaction combinations among these
genes, especially between the BELL subfamilies and the KNOX subfamilies, indicating a complex regulatory network of these
genes in chloroplast development and green fruit shoulder formation. In conclusion, our result provides detailed knowledge of the
gene for functional research and the utilization of the
gene family in fruit quality improvement.
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