Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method

Purpose

To compare the diagnostic performance of 5-point scoring system and strain ratio by sonoelastography in the assessment of solid breast lesions.

Material and methods

One hundred and eighty-seven solid masses in 155 patients were scanned by two-dimensional ultrasonography and sonoelastography. Elasticity scores were determined with a 5-point scoring method, and the strain ratio was based on the comparison of the average strain measured in the lesion with the adjacent breast tissue in the same depth. Pathological results were taken as gold standards to compare the diagnostic efficacy of two methods with clinical diagnostic test and receiver operating characteristic (ROC) curves.

Results

Among 187 lesions, 130 were benign and 57 were malignant. The mean scores (1.62 ± 0.69 vs 4.07 ± 0.26, P < 0.05) and strain ratios (2.06 ± 1.27 vs 6.66 ± 4.62, P < 0.05) were significantly higher of malignant than benign lesions. The area under the curve for the 5-point scoring system and for strain ratio-based elastographic analysis was 0.892 and 0.909, respectively (P > 0.05). For 5-point scoring, sonoelastography had 84.2% sensitivity, 84.6% specificity, 84.5% accuracy, 70.6% positive predictive value and 92.4% negative predictive value. When a cutoff point of 3.06 was used, sensitivity, specificity, accuracy, positive and negative predictive values were 87.7%, 88.5%, 88.2%, 76.9% and 94.3%, respectively for the strain ratio (P > 0.05).

Conclusions

The 5-point scoring system and strain ratio has similar diagnostic performance, and the strain ratio could be more objective to differentiate the masses when those masses were difficult to be judged by using 5-point scoring system in sonoelastographic images.     

Quantitative chemical exchange sensitive MRI using irradiation with toggling inversion preparation

Chemical exchange (CE) sensitive MRI contrast acquired with an off‐resonance irradiation pulse is affected by other relaxation mechanisms, such as longitudinal and transverse relaxations. In particular, for intermediate CEs, the effect of transverse relaxation often dominates CE contrast. Since water relaxation rates can change significantly in many pathological conditions or during physiological challenge, it is crucial to separate these relaxation effects in order to obtain pure CE contrast. Here we proposed a novel acquisition scheme in which a toggling inversion pulse is applied prior to the off‐resonance irradiation. By combined acquisition of irradiation images with and without an inversion pulse at both the labile proton frequency and the reference frequency, longitudinal and transverse relaxation contributions are cancelled, and the quantification of CE parameters, such as the exchange rate and the labile proton concentration, can be simplified. Furthermore, the CE‐mediated relaxation rate can be readily determined with a relatively short irradiation pulse and without approaching the steady state, therefore, reducing the limitations on hardware and specific absorption rate requirements. The signal characteristics of the proposed method are evaluated by numerical simulations and phantom experiments. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.     

宫腔镜与阴道超声检查子宫腔内病变临床价值探讨

目的对比宫腔镜检查（HS）与阴道超声检查（TVS）诊断子宫腔内病变的价值。方法对235例患者同时采用HS和TVS，并与最后的病理结果对照。结果HS对子宫内膜息肉和子宫内膜增生的敏感性和特异性分别是94．37％、81.7％和90．74％、98％；均高于TVS的71.2％、63％和77.2％、94％。TVS对子宫内膜癌诊断的敏感性是100％，高于HS的敏感性84.62％，但其特异性仅为66．67％，低于HS的敏感性91．67％。结论HS结合直视下活检是宫内疾病诊断的金标准。而TVS因其无创、低价、重复性好，可作为初筛方法。     

Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: a meta-analysis

Objectives

To compare the diagnostic performances of computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET or PET/CT) for detection of metastatic lymph nodes in patients with ovarian cancer.

Methods

Relevant studies were identified with MEDLINE and EMBASE from January 1990 to July 2010. We estimated the weighted summary sensitivities, specificities, OR (odds ratio), and summary receiver operating characteristic (sROC) curves of each imaging technique and conducted pair-wise comparisons using the two-sample Z-test. Meta-regression, subgroup analysis, and funnel plots were also performed to explain the between-study heterogeneity.

Results

Eighteen eligible studies were included, with a total of 882 patients. PET or PET/CT was a more accurate modality (sensitivity, 73.2%; specificity, 96.7%; OR [odds ratio], 90.32). No significant difference was detected between CT (sensitivity, 42.6%; specificity, 95.0%; OR, 19.87) and MR imaging (sensitivity, 54.7%; specificity, 88.3%; OR, 12.38). Meta-regression analyses and subgroup analyses revealed no statistical difference. Funnel plots with marked asymmetry suggested a publication bias.

Conclusion

FDG-PET or FDG-PET/CT is more accurate than CT and MR imaging in the detection of lymph node metastasis in patients with ovarian cancer.     

Combination of high-intensity focused ultrasound with nanoscale ultrasound contrast agent in treatment of rabbit breast VX2 tumors: a pilot study

To demonstrate ultrasound contrast agents to be important potentiators of high-intensity focused ultrasound (HIFU), we prospectively assessed the effectiveness of HIFU combined with nanoscale ultrasound contrast agents for the treatment of breast VX2 tumors in rabbits. We found that the change of grayscale value in the target area in the HIFU+nanobubble group was significantly higher than that in the HIFU+phosphate-buffered saline (PBS) group after irradiation (P<.01). The size of coagulation necrosis was also significantly larger in the HIFU+nanobubble group when compared to that in the HIFU+PBS group (P<.001). In conclusion, our study suggested that adding nanoscale ultrasound contrast agents may improve the treatment efficacy of HIFU for breast VX2 tumors in rabbits.     

Evaluation of a five-gene signature associated with stromal infiltration for diffuse large B-cell lymphoma

BACKGROUNDDiffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma. The development of immunotherapy greatly improves the patient prognosis but there are some exceptions. Thus, screening for better biomarkers for prognostic evaluation could contribute to the treatment of DLBCL patients.AIMTo screen the novel mediators involved in the development of DLBCL.METHODSThe {"type":"entrez-geo","attrs":{"text":"GSE60","term_id":"60"}}GSE60 dataset was applied to identify the differentially expressed genes (DEGs) in DLBCL, and the principal components analysis plot was used to determine the quality of the included samples. The protein-protein interactions were analyzed by the STRING tool. The key hub genes were entered into to the GEPIA database to determine their expressions in DLBCL. Furthermore, these hub gene alterations were analyzed in cBioportal. The UALCAN portal was employed to analyze the expression of the hub genes in different stages of DLBCL. The Estimation of Stromal and Immune cells in Malignant Tumor tissues using Expression data Score was conducted to evaluate the correlation between the gene expression and tumor purity. The gene-gene correlation analysis was conducted in the GEPIA. The stromal score analysis was conducted in TIMER to confirm the correlation between the gene expression and infiltrated stromal cells. The correlation between the indicated genes and infiltration level of cancer-associated fibroblasts (CAFs) was also completed in TIMER with two methods, MCP-Counter and Tumor immune dysfunction and exclusion. The correlation between fibronectin (FN1) protein level and secreted protein acidic and cysteine-rich (SPARC) messenger ribonucleic acid expression was confirmed in the cBioportal.RESULTSThe top 20 DEGs in DLBCL were identified, and the principal components analysis plot confirmed the quality of the significant DEGs. The pairwise correlation coefficient analysis among all samples showed that these DEGs have a certain co-expression pattern. The DEGs were subjected to STRING to identify the hub genes, alpha-2-macroglobulin (A2M), cathepsin B (CTSB), FN1, matrix metallopeptidase 9 (MMP9), and SPARC. The five hub genes were confirmed to be overexpressed in DLBCL. The cBioportal portal detected these five hub genes that had gene alteration, including messenger ribonucleic acid high amplification and missense mutation, and the gene alteration percentages of A2M, FN1, CTSB, MMP9, and SPARC were 5%, 8%, 5%, 2.7%, and 5%, respectively. Furthermore, the five hub genes had a potential positive correlation with tumor stage. The correlation analysis between the five genes and tumor purity confirmed that the five genes were overexpressed in DLBCL and had a positive correlation with the development of DLBCL. More interestingly, the five genes had a significant correlation with the stromal infiltration scores. The correlation analysis between the fives genes and CAFs also showed a significant value, among which the top two genes, FN1 and SPARC, had a remarkable co-expression pattern.CONCLUSIONThe top DEGs were identified, and the five hub genes were overexpressed in DLBCL. Furthermore, the gene alterations were confirmed and the positive correlation with tumor purity revealed the overexpression of the five genes and close association with the development of DLBCL. More interestingly, the five genes were positively correlated with stromal infiltration, especially in CAFs. The top two genes, FN1 and SPARC, showed a co-expression pattern, which indicates their potential as novel therapeutic targets for DLBCL.     

An exploratory analysis of functional staging using an item response theory approach

Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach.

Objectives

To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.

Design

Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.

Setting

Follow-up interviews conducted in patients' homes.

Participants

Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions.

Interventions

Not applicable.

Main Outcome Measures

AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients' functioning performances.

Results

We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits.

Conclusions

An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work.     

Expression and clinical significance of the stem cell marker CD133 in hepatocellular carcinoma

Background: Although the primitive haematopoietic and neuronal stem cell marker CD133 is known to be present in cancer stem cells (CSCs) in hepatocellular carcinoma (HCC), the postresection prognostic impact of CD133 in HCC patients remains limited. Methods: Sixty‐three resected specimens were collected from HCC patients. The expression of CD133 protein was analysed by immunohistochemistry and the association of CD133 expression with clinicopathological characteristics, tumour recurrence and survival of the patients was evaluated. Results: Immunohistochemical analysis of 63 HCC tissue specimens revealed that CD133 positive tumour cells were frequently present in HCC. Increased CD133 immunostaining was found in 26 specimens (41.3%). Increased CD133 expression levels were correlated with increased tumour grade, advanced disease stage, and elevated serum alpha‐fetoprotein levels. Kaplan–Meier analysis indicated that patients with increased CD133 levels had shorter overall survival and higher recurrence rates compared with patients with low CD133 expression. Multivariate analyses revealed that increased CD133 expression was an independent prognostic factor for survival and tumour recurrence in patients with HCC. Conclusions: These findings suggest that reactivated CD133 positive cells are frequently present in HCC. Additionally, increased CD133 expression corresponds with higher stage tumours in HCC, thus indicating a poor prognosis for patients. These data support the CSC hypothesis.     

家兔挤压伤后心肌组织与心功能变化的对比研究

目的通过对家兔挤压伤后心肌病理组织学改变的观察,对比心脏超声技术评价其心脏整体功能的变化情况,讨论挤压伤后对心肌组织继发损伤及心脏整体功能变化的机制。方法采用42只家兔制作挤压伤家兔动物模型,将其随机分为对照组、解压即刻组、解压后6、12、24、48、72 h共7组,每组6只;光镜观察心肌细胞结构。全自动生化分析仪检测血清尿素氮、肌酐、钾离子、钙离子、肌酸激酶、肌红蛋白浓度变化,多功能复合心脏超声测量心脏整体功能。结果挤压伤后12～24 h血清肌酸激酶、肌酸激酶同工酶、肌钙蛋白I显著升高,光镜下可见心肌细胞肿胀、间质水肿等改变。超声检测心脏整体收缩及舒张功能指标均显著下降。结论严重挤压伤后可致心肌组织继发损伤及心功能障碍,在解压后逐渐加重,至解压后12～24 h达到峰值,持续至伤后72 h后逐渐缓解;多功能复合心脏超声技术能够较精准、客观、快捷评估挤压伤后心脏继发受损的情况。     

浅谈从肝论治冠心病

冠心病属于中医"胸痹""心痛"的范畴,气机不畅是主要病机。肝与心在情志、五行、经络上相关联。现代医学认为抑郁和焦虑是冠心病的心理社会危险因素。因此,冠心病的治疗常从肝论治。