Value of shear wave elastography with maximal elasticity in differentiating benign and malignant solid focal liver lesions

BACKGROUNDIt is important to differentiate benign and malignant focal liver lesions (FLLs) accurately. Despite the wide use and acceptance of shear wave elastography (SWE), its value for assessing the elasticity of FLLs and differentiating benign and malignant FLLs is still investigational. Previous studies of SWE for FLLs used mean elasticity as the parameter to reflect the stiffness of FLLs. Considering the inhomogeneity of tumor stiffness, maximal elasticity (Emax) might be the suitable parameter to reflect the stiffness of FLLs and to differentiate malignant FLLs from benign ones.AIMTo explore the value of SWE with Emax in differential diagnosis of solid FLLs.METHODSWe included 104 solid FLLs in 95 patients and 50 healthy volunteers. All the subjects were examined using conventional ultrasound (US) and virtual touch tissue quantification(VTQ) imaging. A diagnosis of benign or malignant FLL was made using conventional US. Ten VTQ values were acquired after 10 consecutive measurements for each FLL and each normal liver, and the largest value was recorded as Emax.RESULTSThere were 56 cases of malignant FLLs and 48 cases of benign FLLs in this study. Emax of malignant FLLs (3.29 ± 0.88 m/s) was significantly higher than that of benign FLLs (1.30 ± 0.46 m/s, P < 0.01) and that of livers in healthy volunteers (1.15 ± 0.17 m/s, P < 0.01). The cut-off point of Emax was 1.945, and the area under the curve was 0.978. The sensitivity and specificity of Emax were 92.9% and 91.7%, respectively, higher (but not significantly) than those of conventional US (80.4% for sensitivity and 81.3% for specificity). Combined diagnosis of conventional US and Emax using parallel testing improved the sensitivity to 100% with specificity of 75%.CONCLUSIONSWE is a convenient and easy method to obtain accurate stiffness information of solid FLLs. Emax is useful for differential diagnosis of FLLs, especially in combination with conventional US.     

二肽基肽酶-4抑制剂对2型糖尿病患者血糖和胰岛功能的影响

目的 探讨口服降糖药二肽基肽酶-4（DPP-4）抑制剂对T2DM患者的临床疗效及安全性.方法 对32例口服降糖药及胰岛素治疗血糖控制不佳的T2DM患者使用DPP-4抑制剂进行12周的治疗观察,测定治疗前后BMI、SBP、DBP、TC、TG、FPG、2 hPG、Scr、谷丙转氨酶（AST）、HbA1 c、FC-P及2 hC-P水平.同时计算胰岛素抵抗指数[HOMA-IR（C-P）]及胰岛β细胞功能指数[HOMA-β（C-P）].结果 12周后FPG[（7.94±0.52）mmol/L]、2 hPG[（12.29±1.07） mmol/L]、HbA1c[（8.44±0.50）％]均较治疗前下降（P＜0.01）,FC-P水平[（6.52±0.13） pmol/L]、2 hC-P水平[（7.83±0.17） pmol/L]及HOMA-β均增加（P＜0.01）.研究期间均无严重低血糖事件发生. 结论 DPP-4抑制剂可降低T2DM患者FPG、2 hPG、HbA1c水平,同时改善胰岛β细胞功能,且无明显不良反应,安全性较好.     

血清甘油三酯对初诊妊娠期糖尿病患者胰岛β细胞功能及胰岛素抵抗的影响

目的 探讨血清甘油三酯（TG）水平对初诊妊娠期糖尿病（GDM）患者的胰岛β细胞功能及胰岛素抵抗的影响.方法 纳入2012年1月至2014年4月入住于上海交通大学附属第一人民医院产科病房,孕24～ 30周的439例初诊GDM患者.收集其一般资料、血脂,行75 g口服葡萄糖耐量试验和胰岛素释放试验,分别计算稳态模型评估β细胞功能指数（HOMA-β）、稳态模型评估胰岛素抵抗指数（HOMA-IR）和定量胰岛素敏感性检测指数（QUICKI）,并将GDM患者以空腹血清甘油三酯（TG）水平分成下三分位T1（1.25 ～ 2.30 mmol/L,n=146）组、中三分位T2（＞2.30 ～ 3.10 mmol/L,n=146）组和上三分位T3（＞3.10 ～ 22.03 mmol/L,n=147）组.三组数据比较采用方差分析,并用逐步多因素线性回归模型分析影响初诊GDM患者HOMA-IR的相关因素.结果 与T1组相比,T2组和T3组GDM患者的体质指数（BMI）较高（均P＜0.05）;T3组的总胆固醇（TC）明显升高（P＜0.05）;T2组和T3组的TG水平明显升高（均P＜0.05）;T3组的高密度脂蛋白胆固醇（HDL-C）水平明显降低（P＜0.05）;T3组的空腹血糖（FPG）水平和服糖后1h血糖（1 hPG）水平较高（均P＜0.05）;T2组和T3组的空腹胰岛素（FINS）水平明显升高（均P＜0.05）;T3组的餐后1h胰岛素（1 hINS）水平较高（P＜0.05）;T2组和T3组的服糖后2h胰岛素（2 hINS）水平明显升高（均P＜0.05）.同时,与T1组相比,T2组和T3组HOMA-IR升高（分别为2.0±1.3、2.7±1.2、3.3±2.7）,QUICKI指数降低（分别为1.5±0.5、1.2±0.4、1.1±0.4）,差异均有统计学意义（F=16.745、21.110,均P＜O.05）;而三组间的HOMA-β无明显差异.逐步多因素线性回归模型显示：BMI[标准化回归系数（β）=0.210]、TG（β=0.135）、2 hINS （β=0.394）和年龄（β=-0.118）与初诊GDM患者HOMA-IR显著相关（均P＜0.05）.结论 随着空腹血清TG水平的升高,初诊GDM患者胰岛素抵抗加重,胰岛素敏感?     

Two-micron (Thulium) Laser Prostatectomy: An Effective Method for BPH Treatment

The two-micron (thulium) laser is the newest laser technique for treatment of bladder outlet obstruction resulting from benign prostatic hyperplasia (BPH). It takes less operative time than standard techniques, provides clear vision and lower blood loss as well as shorter catheterization times and hospitalization times. It has been identified to be a safe and efficient method for BPH treatment regardless of the prostate size.     

新诊断2型糖尿病患者血清spexin水平与内脏脂肪面积及代谢指标的相关性分析

目的研究新诊断2型糖尿病（T2DM）患者血清spexin水平与腹部内脏脂肪面积（visceral fat area, VFA）的关系,探寻其与各代谢指标的相关性。方法新诊断T2DM患者分为T2DM内脏型肥胖组（T2DM-ob组）和T2DM非内脏型肥胖组（T2DM-nonob组）,正常血糖且非内脏型肥胖者为正常对照组（NC组）,测量BMI、腰围、臀围、腰臀比（WHR）、收缩压（SBP）和舒张压（DBP）,欧姆龙DUALSCANHDS-2000测量VFA与皮下脂肪面积（subcutaneous fat area, SFA）及内脏脂肪与皮下脂肪比率（visceral fat to subcutaneous fat ratio, VSR）。行口服葡萄糖耐量试验,测定空腹血糖（FPG）、餐后2h血糖（PPG2h）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）及餐后2h胰岛素（PINS2h）,计算HOMA-IR,用ELISA测定血清spexin水平。结果T2DM-ob组BMI、腰围、臀围、总胆固醇（TC）、HOMA-IR、VFA、SFA、VSR均较T2DM-nonob组升高,血清spexin水平较T2DM-nonob组和NC组均明显降低（P<0.05）,VFA与BMI、腰围、WHR、FPG、PPG2h、HbA1c、丙氨酸转氨酶（ALT）、HOMA-IR显著正相关,与高密度脂蛋白胆固醇（HDL-C）呈显著负相关（P<0.05）。spexin水平与VFA、VSR、BMI、WHR、FPG、PPG2h、HbA1c、HOMA-IR呈显著负相关,与HDL-C呈显著正相关,多元回归分析发现HbAlc、VSR为spexin的独立影响因素（P<0.05）。结论新诊断T2DM患者血清spexin水平与VFA密切相关,spexin及VFA与血糖、血脂及胰岛素抵抗显著相关,spexin可能在T2DM患者的内脏脂肪代谢中有重要作用。     

补体系统与肝脏疾病的研究进展

补体系统由30余种生物蛋白组成,是体内重要的效应系统。补体的各种固有成分在不同激活物的作用下被顺序活化,通过共同的末端通路形成膜攻击复合物,在许多生理活动中发挥重要的作用。血浆中的补体成分80%~90%在肝脏中合成,肝细胞同时表达多种补体受体。最近的研究表明,补体系统也参与了各种肝脏疾病的发病机制,如慢性病毒性肝炎、自身免疫性肝炎等。本文就补体系统与肝脏疾病的研究进展作一综述。     

Molecular biology of testicular germ cell tumors: Unique features awaiting clinical application

Testicular germ cell tumors (TGCTs) are the most common solid tumors in young adult men characterized by distinct biologic features and clinical behavior. Both genetic predispositions and environmental factors probably play a substantial role in their etiology. TGTCs arise from a malignant transformation of primordial germ cells in a process that starts prenatally, is often associated with a certain degree of gonadal dysgenesis, and involves the acquirement of several specific aberrations, including activation of SCF–CKIT, amplification of 12p with up-regulation of stem cell genes, and subsequent genetic and epigenetic alterations. Their embryonic and germ origin determines the unique sensitivity of TGCTs to platinum-based chemotherapy. Contrary to the vast majority of other malignancies, no molecular prognostic/predictive factors nor targeted therapy is available for patients with these tumors. This review summarizes the principal molecular characteristics of TGCTs that could represent a potential basis for development of novel diagnostic and treatment approaches.     

拔除下切牙矫治在改善Bohon指数中的作用

目的：探讨拔除下颌切牙进行矫治,通过改变Bolton指数来进行代偿治疗中的作用。方法：采用回顾性研究的方法,对9例由于各种原因需拔除单个下颌切牙或配合拔除其它牙齿进行矫治的病例进行分析比较。结果：9个病例矫治时间为19-23个月,均采用直丝弓矫治技术。治疗结束后拔牙间隙均全部关闭,前牙覆胎覆盖关系基本正常,后牙咬耠关系较好。结论：部分上颌需要减数的成人骨性Ⅱ类病例,下颌可以考虑拔除一个下切牙矫治;某些轻、中度的成人骨性Ⅲ类患者也可拔除一个下切牙结合上颌邻面去釉进行矫治。拔除下颌切牙矫治在诊断设计时应权衡利弊,严格控制适应症,以获得良好、稳定的矫治效果。     

Up-regulation of microRNA-155 promotes cancer cell invasion and predicts poor survival of hepatocellular carcinoma following liver transplantation

Purpose  

MicroRNAs play important roles in cancer development, progression, and metastasis. The aim of this study was to determine whether altered microRNA-155 expression is associated with hepatocellular carcinoma (HCC) recurrence and prognosis following orthotopic liver transplantation (OLT).     

Growth and differentiation of neural stem cells in a three-dimensional collagen gel scaffold

Collagen protein is an ideal scaffold material for the transplantation of neural stem cells. In this study, rat neural stem cells were seeded into a three-dimensional collagen gel scaffold, with suspension cultured neural stem cells being used as a control group. Neural stem cells, which were cultured in medium containing epidermal growth factor and basic fibroblast growth factor, actively expanded and formed neurospheres in both culture groups. In serum-free medium conditions, the processes extended from neurospheres in the collagen gel group were much longer than those in the suspension culture group. Immunofluorescence staining showed that neurospheres cultured in collagen gels were stained positive for nestin and differentiated cells were stained positive for the neuronal marker βIII-tubulin, the astrocytic marker glial fibrillary acidic protein and the oligodendrocytic marker 2’,3’-cyclic nucleotide 3’-phosphodiesterase. Compared with neurospheres cultured in suspension, the differentiation potential of neural stem cells cultured in collagen gels increased, with the formation of neurons at an early stage. Our results show that the three-dimensional collagen gel culture system is superior to suspension culture in the proliferation, differentiation and process outgrowth of neural stem cells.