Prognostic and Immunotherapeutic Predictive Value of CAD Gene in Hepatocellular Carcinoma: Integrated Bioinformatics and Experimental Analysis.

Hepatocellular carcinoma (HCC) is a common type of cancer that ranks first in cancer-associated death worldwide. Carbamoyl-phosphate synthetase 2, aspartate transcarbamylase, and dihydroorotase (CAD) are the key components of the pyrimidine pathway, which promotes cancer development. However, the function of CAD in HCC needs to be clarified. In this study, the clinical and transcriptome data of 424 TCGA-derived HCC cases were analyzed. The results demonstrated that high CAD expression was associated with poor prognosis in HCC patients. The effect of CAD on HCC was then investigated comprehensively using GO annotation analysis, KEGG enrichment analysis, Gene Set Enrichment Analysis (GSEA), and CIBERSORT algorithm. The results showed that CAD expression was correlated with immune checkpoint inhibitors and immune cell infiltration. In addition, low CAD levels in HCC patients predicted increased sensitivity to anti-CTLA4 and PD1, while HCC patients with high CAD expression exhibited high sensitivity to chemotherapeutic and molecular-targeted agents, including gemcitabine, paclitaxel, and sorafenib. Finally, the results from clinical sample suggested that CAD expression increased remarkably in HCC compared with non-cancerous tissues. Loss of function experiments demonstrated that CAD knockdown could significantly inhibit HCC cell growth and migration both in vitro and in vivo. Collectively, the results indicated that CAD is a potential oncogene during HCC metastasis and progression. Therefore, CAD is recommended as a candidate marker and target for HCC prediction and treatment.

Histogram analysis based on unenhanced CT for identifying thymoma and lymphoma among prevascular mediastinal incidentalomas.

OBJECTIVE: To determine whether histogram analysis based on unenhanced CT can play a role in the differential diagnosis of thymoma and lymphoma from thymic hyperplasia and cyst (mean CT attenuation > 10 HU). MATERIALS AND METHODS: This retrospective study included consecutive asymptomatic participants who have prevascular mediastinal lesions incidentally detected by unenhanced CT between December 2013 and August 2020, and with definitive diagnosis by pathology or additional radiologic work-ups. A total of thirteen histogram parameters on enhanced CT were calculated for each lesion, then were compared between tumor (thymoma + lymphoma) and non-tumor (hyperplasia + cyst). Receiver operating characteristic analysis was conducted to investigate the performance of histogram parameter for identifying tumor. RESULTS: The study population included 192 patients (106 men and 86 women) with a mean age of 50.5 years at the time of CT examination. Of them, 94 patients have tumor (87 thymomas and 7 lymphoma) and 98 have non-tumor (48 thymic hyperplasia and 50 cysts). Nine of the thirteen histogram parameters revealed significant difference between the two groups, including median, minimum, range, 10th percentile, 90th percentile, kurtosis, skewness, uniformity and entropy. No significant difference was observed in the mean CT attenuation between groups. Higher median was found to be independent predictors for distinguishing tumor from non-tumor, and can achieve an area under the curve (AUC) of 0.785 (95% confidence interval [95% IC], 0.720-0.841). CONCLUSIONS: Histogram analysis based on unenhanced CT may be able to provide some help in the differential diagnosis of incidental lesions in prevascular mediastinal. GRAND SUPPORT: This study was sponsored by Natural Science Foundation of Shanghai (No. 21ZR1459700).

Colorectal liver metastases: Correlations of contrast-enhanced ultrasound features with tumor clinicopathological factors and clinical outcomes following conversion therapy.

OBJECTIVE: To explore the prognostic impact of contrast-enhanced ultrasound (CEUS) features for initially unresectable colorectal liver metastases (CLMs) in a clinical setting of conversion therapy. METHODS: Between March 2015 and November 2020, consecutive patients with CLMs who received conversion treatment were prospectively enrolled. All participants underwent liver CEUS at baseline. The primary endpoint was conversion resection rate (R0 and overall resection). Secondary endpoints were objective response rate (ORR), overall survival (OS), and progression-free survival (PFS). RESULTS: 104 participants who completed conversion treatment were included. CEUS enhancement pattern was correlated with index lesion (size and echogenicity), primary (site, differentiation, perineural invasion, and RAS genotype) and serum (CA19-9 level) characteristics (P = <0.001-0.016). CEUS enhancement pattern was significantly associated with R0 resection rate, ORR, PFS, and OS (P = 0.001-0.049), whereas enhancement degree was associated with PFS and OS (P = 0.043 and 0.045). Multivariate analysis showed that heterogeneous enhancement independently predicted R0 and overall resection (P = 0.028 and 0.024) while rim-like enhancement independently predicted ORR and OS (P = 0.009 and 0.026). CONCLUSION: CEUS enhancement pattern was significantly associated with tumor characteristics and clinical outcomes following conversion therapy, and thus might be of prognosis impact for initially unresectable CLMs.

Effect of iron-loaded sludge biochar amendments on phytoremediation potential of Cr-contaminated soils by Leersia hexandra swartz.

In this study, the effect of iron-loaded sludge biochar (ISBC) with different amendment dosages (mass ratio of biochar to soil equal to 0, 0.01, 0.025 and 0.05) on the phytoremediation potential of Leersia hexandra swartz (L. hexandra) to Cr-contaminated soil was investigated. With increasing ISBC dosage from 0 to 0.05, plant height, aerial tissue biomass and root biomass increased from 15.70 cm, 0.152 g pot-1 and 0.058 g pot-1 to 24.33 cm, 0.304 g pot-1 and 0.125 g pot-1, respectively. Simultaneously, the Cr contents in aerial tissues and roots increased from 1039.68 mg kg-1 to 2427.87 mg kg-1 to 1526.57 mg kg-1 and 3242.62 mg kg-1, respectively. Thus, the corresponding bioenrichment factor (BCF), bioaccumulation factor (BAF), total phytoextraction (TPE) and translocation factor (TF) values were also increased from 10.52, 6.20, 0.158 mg pot-1 (aerial tissue)/0.140 mg pot-1 (roots) and 0.428 to 15.15, 9.42, 0.464 mg pot-1 (aerial tissue)/0.405 mg pot-1 (roots) and 0.471, respectively. The significant positive effect of ISBC amendment was primarily attributed to the following three aspects: 1) the root resistance index (RRI), tolerance index (TI) and growth toxicity index (GTI) of L. hexandra to Cr were increased from 100%, 100% and 0%-216.88%, 155.02% and 42.18%, respectively; 2) the bio-available Cr content in the soil was decreased from 1.89 mg L-1 to 1.48 mg L-1, while the corresponding TU (toxicity units) value was declined from 0.303 to 0.217; 3) the activities of urease, sucrase and alkaline phosphatase in soil were increased from 0.186 mg g-1, 1.40 mg g-1 and 0.156 mg g-1 to 0.242 mg g-1, 1.86 mg g-1 and 0.287 mg g-1, respectively. In summary, ISBC amendment was able to significantly improve the phytoremediation of Cr-contaminated soils by L. hexandra.

[Removal Performance and Mechanism of Potassium Permanganate Modified Coconut Shell Biochar for Cd(â ¡) and Ni(â ¡) in Aquatic Environment].

In this study, coconut shell biochar modified by KMnO4 (MCBC) was used as the adsorbent, and its removal performance and mechanism for Cd(Ⅱ) and Ni(Ⅱ) were discussed. When the initial pH and MCBC dosage were separately 5 and 3.0 g·L-1, respectively, the removal efficiencies of Cd(Ⅱ) and Ni(Ⅱ) were both higher than 99%. The removal of Cd(Ⅱ) and Ni(Ⅱ) was more in line with the pseudo-second-order kinetic model, indicating that their removal was dominated by chemisorption. The rate-controlling step for Cd(Ⅱ) and Ni(Ⅱ) removal was the fast removal stage, for which the rate depended on the liquid film diffusion and intraparticle diffusion (surface diffusion). Cd(Ⅱ) and Ni(Ⅱ) were mainly attached to the MCBC via surface adsorption and pore filling, in which the contribution of surface adsorption was greater. The maximum adsorption amounts of Cd(Ⅱ) and Ni(Ⅱ) by MCBC were individually 57.18 mg·g-1 and 23.29 mg·g-1, which were approximately 5.74 and 6.97 times that of the precursor (coconut shell biochar), respectively. The removal of Cd(Ⅱ) and Zn(Ⅱ) was spontaneous and endothermic and had obvious thermodynamic characteristics of chemisorption. Cd(Ⅱ) was attached to MCBC through ion exchange, co-precipitation, complexation reaction, and cation-π interaction, whereas Ni(Ⅱ) was removed by MCBC via ion exchange, co-precipitation, complexation reaction, and redox. Among them, co-precipitation and complexation were the main modes of surface adsorption of Cd(Ⅱ) and Ni(Ⅱ). Additionally, the proportion of amorphous Mn-O-Cd or Mn-O-Ni in the complex may have been higher. These research results will provide important technical support and theoretical basis for the practical application of commercial biochar in the treatment of heavy metal wastewater.

Distinct radiological features of lymphoepithelioma-like intrahepatic cholangiocarcinoma: comparison with classical intrahepatic cholangiocarcinoma.

BACKGROUND: Lymphoepithelioma-like intrahepatic cholangiocarcinoma (LEICC) has been recently introduced as a genetically distinct of intrahepatic cholangiocarcinoma (ICC). We aimed to investigate whether LEICC has distinct radiological characteristics in comparison with classical ICC, and to determine MRI features that can be used to differentiate LEICC from classical ICC. METHODS: Five hundred and sixty-seven consecutive patients who underwent surgical resection or liver transplantation for ICC between 2014 and 2021 were retrospectively identified. Among them, 30 patients with LEICC (LEICC-cohort) and 116 with stage-matched classical ICC (control-cohort) were finally included. Pre-operative MRI data were compared between the two cohorts. Multivariable logistic regression analysis was performed to determine relevant imaging features suggesting the diagnosis of LEICC over classical ICC. RESULTS: LEICCs showed significantly higher frequencies of a non-rim arterial phase hyperenhancement (APHE), washout on post-arterial images and a smooth margin, as well as less frequencies of perilesional enhancement and liver capsular retraction when compared with classical ICCs (P < 0.05 for all). The multivariate analysis revealed that non-rim APHE (odds ratio, 10.863; 95% CI [3.295-35.821]; P < 0.001) and the absence of perilesional enhancement (odds ratio, 3.350; 95% CI [1.167-9.619]; P = 0.025) are significant independent imaging features that suggest the diagnosis of LEICCs over classical ICCs. CONCLUSIONS: Compared with classical ICCs, LEICCs do have distinct radiological characteristics. A smooth margin, non-rim APHE, washout on post-arterial images, absent perilesional enhancement and absent liver capsular retraction are useful MRI features that could help to differentiate LEICCs from classical ICCs.

Prognostic value of preoperative CT features for disease-free survival in patients with primary gastric gastrointestinal stromal tumors after resection.

PURPOSE: Tumor size is an important prognostic factor without consideration of the necrotic and cystic components within tumor for patients with gastrointestinal stromal tumors (GISTs). We aimed to extract the enhancing viable component from the tumor using computed tomography (CT) post-processing software and evaluate the value of preoperative CT features for predicting the disease-free survival (DFS) after curative resection for patients with primary gastric GISTs. METHODS: 132 Patients with primary gastric GISTs who underwent preoperative contrast-enhanced CT and curative resection were retrospectively analyzed. We used a certain CT attenuation of 30 HU to extract the enhancing tissue component from the tumor. Enhancing tissue volume and other CT features were assessed on venous-phase images. We evaluated the value of preoperative CT features for predicting the DFS after surgery. Univariate and multivariate Cox regression analyses were performed to find the independent risk factor for predicting the DFS. RESULTS: Of the 132 patients, 68 were males and 64 were females, with a mean age of 61 years. The median follow-up duration was 60 months, and 28 patients experienced disease recurrence and distant metastasis during the follow-up period. Serosal invasion (p < 0.001; HR = 5.277) and enhancing tissue volume (p = 0.005; HR = 1.447) were the independent risk factors for predicting the DFS after curative resection for patients with primary gastric GISTs. CONCLUSION: Preoperative contrast-enhanced CT could be useful for predicting the DFS after the surgery of gastric GISTs, and serosal invasion and enhancing tissue volume were the independent risk factors.

Ultrashort time-to-echo T2* and T2* relaxometry for evaluation of lumbar disc degeneration: a comparative study.

BACKGROUND: To compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard. METHODS: UTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed. RESULTS: UTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = - 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715-0.876. CONCLUSIONS: UTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.

Long noncoding RNA BCRP3 stimulates VPS34 and autophagy activities to promote protein homeostasis and cell survival.

BACKGROUND: Autophagy plays important roles in cell homeostasis and protein quality control. Long non-coding RNAs (lncRNAs) have been revealed as an emerging class of autophagy regulators, but the majority of them function in regulating the expression of autophagy-related genes. LncRNAs that directly act on the core autophagic proteins remain to be explored. METHODS: Immunofluorescence staining and Western blotting were used to evaluate the function of BCRP3 in autophagy and aggrephagy. RNA immunoprecipitation and in vitro RNA-protein binding assay were used to evaluate the interaction of BCRP3 with its target proteins. Phosphatidylinositol 3-phosphate ELISA assay was used to quantify the enzymatic activity of VPS34 complex. qRT-PCR analysis was used to determine BCRP3 expression under stresses, whereas mass spectrometry and Gene Ontology analyses were employed to evaluate the effect of BCRP3 deficiency on proteome changes. RESULTS: We identified lncRNA BCRP3 as a positive regulator of autophagy. BCRP3 was mainly localized in the cytoplasm and bound VPS34 complex to increase its enzymatic activity. In response to proteotoxicity induced by proteasome inhibition or oxidative stress, BCRP3 was upregulated to promote aggrephagy, thereby facilitating the clearance of ubiquitinated protein aggregates. Proteomics analysis revealed that BCRP3 deficiency under proteotoxicity resulted in a preferential accumulation of proteins acting in growth inhibition, cell death, apoptosis, and Smad signaling. Accordingly, BCRP3 deficiency in proteotoxic cells compromised cell proliferation and survival, which was mediated in part through the upregulation of TGF-ß/Smad2 pathway. CONCLUSIONS: Our study identifies BCRP3 as an RNA activator of the VPS34 complex and a key role of BCRP3-mediated aggrephagy in protein quality control and selective degradation of growth and survival inhibitors to maintain cell fitness.

Utility of preoperative computed tomography features in predicting the Ki-67 labeling index of gastric gastrointestinal stromal tumors.

PURPOSE: To evaluate the value of preoperative computed tomography (CT) features including morphologic and quantitative features for predicting the Ki-67 labeling index (Ki-67LI) of gastric gastrointestinal stromal tumors (GISTs). METHODS: We retrospectively included 167 patients with gastric GISTs who underwent preoperative contrast-enhanced CT. We assessed the morphologic features of preoperative CT images and the quantitative features including the maximum diameter of tumor, total tumor volume, mean total tumor CT value, necrosis volume, necrosis volume ratio, enhanced tissue volume, and mean CT value of enhanced tissue. Potential predictive parameters to distinguish the high-level Ki-67LI group (>4%, n = 125) from the low-level Ki-67LI group (≤4%, n = 42) were compared and subsequently determined in multivariable logistic regression analysis. RESULTS: Growth pattern (p = 0.036), shape (p = 0.000), maximum diameter (p = 0.018), total tumor volume (p = 0.021), mean total tumor CT value (p = 0.009), necrosis volume (p = 0.006), necrosis volume ratio (p = 0.000), enhanced tissue volume (p = 0.027), and mean CT value of enhanced tissue (p = 0.004) were significantly different between the two groups. Multivariate logistic regression analysis indicated that lobulated/irregular shape (odds ratio [OR] = 3.817; p = 0.000) and high necrosis volume ratio (OR = 1.935; p = 0.024) were independent factors of high-level Ki-67LI. CONCLUSIONS: Higher necrosis volume ratio in combination with lobulated/irregular shape could potentially predict high expression of Ki-67LI for gastric GISTs.

Identifying response in colorectal liver metastases treated with bevacizumab: development of RECIST by combining contrast-enhanced and diffusion-weighted MRI.

OBJECTIVES: Response evaluation criteria in solid tumors (RECIST) often fail to identify clinically meaningful response to bevacizumab-containing therapy in colorectal liver metastasis (CRLM). This study aimed to develop RECIST by combining contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI). METHODS: A total of 126 patients with CRLM who underwent hepatic resection after bevacizumab-containing chemotherapy were split into initial analyses cohort (N = 42, with 76 indexed liver metastases) and validation cohort (N = 84). In lesion-based analyses, percentage decrease of arterial enhancement area and percentage increase of apparent diffusion coefficient (ADC) value from baseline to post-chemotherapy were measured. Their optimal cutoff values for distinguishing pathology-confirmed major and minor response were determined. Then, the developed RECIST (D-RECIST) was established by combining functional and size-based items. Survival relevance of D-RECIST and RECIST was examined in the validation cohort. RESULTS: Percentage decrease of arterial enhancement area and increase of ADC value significantly differed between lesions of pathologic major or minor response, with optimal cutoffs of approximately 33% and 19%, respectively. Patients defined as responders by D-RECIST had a significantly longer median disease-free survival (DFS) than non-responders (p = 0.021; 12.9 versus 8.6 months). No significant difference was observed with RECIST (p = 0.524). In a Cox regression model, D-RECIST- but not RECIST-defined responses independently predicted the DFS (p = 0.034 and 0.811). CONCLUSIONS: D-RECIST-defined responses provided significant prognostic information, and thus may serve as a better response evaluation approach than RECIST in CRLM treated with bevacizumab-containing therapy. KEY POINTS: • Changes in arterial enhancement area and apparent diffusion coefficient value are associated with pathological response in colorectal liver metastases treated with bevacizumab. • The MRI-based response criteria developed by combining size-based and functional features can provide significant prognostic information.

Bifunctional mechanisms of autophagy and apoptosis regulations in melanoma from Bacillus subtilis natto fermentation extract.

Melanoma is one of the most dangerous malignant epidermal cancers. Natto freeze-drying extract (NFDE) and natto water extract (NWE) were isolated from natto, soybeans fermented by Bacillus subtilis natto, which were assessed as potential anti-melanoma agents. Cell cytotoxicity assays revealed significant anti-melanoma effects of NFDE and NWE in a dose-dependent manner, and exhibited low influences on normal skin cells, including Hs68, HaCaT and adipose tissue-derived stem cells (ADSCs), respectively. Through a flow cytometer assay and autophagy acridine orange staining, the cellular death phenomenon shifted from autophagy to apoptosis with the increased dosages. Reactive oxygen species (ROS) were enhanced using DCFDA (2,7-dichlorodihydrofluorescein diacetate) staining when melanoma cells were treated with the extract. NFDE and NWE treatments increase the oxidative stress of cancer cells and cause apoptosis by inhibiting AMP-activated protein kinase (AMPK). NFDE and NWE were considered to play a critical role in cell death through ROS adjustment, autophagy regulation and apoptosis promotion.

Impact of visceral adipose tissue on the accuracy of T-staging by CT in colon cancer.

OBJECTIVE: Accuracy of preoperative T-staging for colon cancer remains disappointing and may potentially influenced by patients' individual characteristics including visceral adipose tissue (VAT). We sought to clarify the impact of VAT on the accuracy of T-staging by CT. METHODS: This study of 216 consecutive patients who underwent elective surgery was conducted in a single cancer center, to control other potentially confounding factors. Patients were divided into accurate- and mis-staging groups according to the comparison between preoperative CT-defined (cT) and postoperative pathologic T-stages (pT). Patients' individual characteristics, including CT-based VAT at L2/L3 level, age, sex, body mass index (BMI), tumor location, present of bowel obstruction and pathologic subtype, were compared between the two groups. Association between VAT and mis-staging was assessed using multivariate logistic regression to adjust for confounders. RESULTS: Of the 216 patients, 84 (39%) were mis-staged by CT. The mean VAT in accurate-staging group was significantly higher than that in mis-staging group (146.8 ±â€¯66.1 cm2 vs 98.1 ±â€¯44.7 cm2, P < 0.001), with an optimal cutoff point of 122 cm2 for predicting mis-staging. After partial adjustment, a lower VAT (< 122 cm2, P < 0.001) and proximal location of tumor (P = 0.004) were independent factors associated with higher probability of mis-staging. Compared to VAT ≥ 122 cm2 as the reference, VAT < 122 cm2 exhibited an odds ratio of 2.701 (95% confidence intervals [CI], 1.618-3.907) for the probability of mis-staging. CONCLUSION: A lower-VAT is associated with an increased probability of inaccurate clinical T-staging in colon cancer.

Imaging Strategies for Rectal Cancer Initial Staging: Does Pelvic Computed Tomography Provide Significantly Additional Findings when High-resolution Magnetic Resonance Imaging has Been Performed?

BACKGROUND: Initial staging of rectal cancer is done by high-resolution magnetic resonance imaging (MRI), however, pelvic computed tomography (CT) is also frequently used. The aim of this study was to evaluate the added clinical benefit of pelvic CT or whether it can alter the initial staging or not. METHODS: The study was composed of 187 patients with rectal cancer. Firstly, imaging except pelvic CT was evaluated. Secondly, the pelvic CT was evaluated and the staging was adjusted according to the new findings. Subsequently, the two staging results were compared to investigate the added clinical benefit of pelvic CT. RESULTS: Compared with the imaging data except pelvic CT, new findings revealed by the pelvic CT included metastases of the pelvic bone (n = 1) and pelvic peritoneum (n = 3). However, the new findings did not change the primary staging. Of the three patients with pelvic peritoneal metastasis, two were already determined with peritoneal involvement and ascites by abdominal CT, and the third patient was observed with liver and distant lymph node metastasis. Thus, none of their initial stagings needed to be changed. CONCLUSION: The addition of pelvic CT to the pre-treatment imaging strategy cannot provide added clinical benefit for the primary evaluation of rectal cancer.

Pre-treatment ADC image-based random forest classifier for identifying resistant rectal adenocarcinoma to neoadjuvant chemoradiotherapy.

OBJECTIVE: To develop a predicting model for tumor resistance to neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC) by using pre-treatment apparent diffusion coefficient (ADC) image-derived radiomics features. METHOD: A total of 89 patients with LARC were randomly assigned into training (N = 66) and testing cohorts (N = 23) at the ratio of 3:1. Radiomics features were derived from manually determined tumor region of pre-treatment ADC images. Random forest algorithm was used to determine the most relevant features and then to construct a predicting model for identifying resistant tumor. Stability and diagnostic performance of the random forest model was evaluated with the testing cohort. RESULTS: The top 10 most relevant features (entropymean, inverse variance, energymean, small area emphasis, ADCmin, ADCmean, sdGa02, small gradient emphasis, age, and size) were determined from clinical characteristics and 133 radiomics features. In the prediction of resistant tumor of the testing cohort, the random forest model constructed based on these most relevant features achieved an area under the receiver operating characteristic curve of 0.83, with the highest accuracy of 91.3%, a sensitivity of 88.9%, and a specificity of 92.8%. CONCLUSION: The random forest classifier based on radiomics features derived from pre-treatment ADC images have the potential to predict tumor resistance to NCRT in patients with LARC, and the use of predicting model may facilitate individualized management of rectal cancer.

Performance comparison between MRI and CT for local staging of sigmoid and descending colon cancer.

PURPOSE: To compare the diagnostic performance of MRI and CT for local staging of sigmoid and descending colon cancer, with pathological results as the reference standard. METHOD: This retrospective study included 116 patients with sigmoid or descending colon cancer who underwent both MRI and CT before surgery. MRI and CT images were separately reviewed by two independent and blinded radiologists to assess the following features: T-stage, presence of extramural extension (T3-4 disease), lymph node metastases (N+), and extramural vascular invasion (EMVI+). Diagnostic performance with sensitivity and specificity for detecting positive status (T3-4, N+ or EMVI+) were assessed using receiver-operating-characteristic (ROC) curve, and compared between MRI and CT. RESULTS: MRI achieved correct T-stage in 81 of 116 patients (69.8 %) while CT in 66 (56.9 %). For detecting T3-4 disease, MRI showed better performance than CT with area under the curve (AUC) of 0.888 versus 0.712 (P =  0.002) and specificity of 81.82 % versus 54.6 % (P =  0.011). No significance was found in sensitivity between two modalities (89.2 % versus 83.1 %, P =  0.302). For detecting N+ disease, performance of MRI and CT were similar (AUC, 0.670 versus 0.650, P =  0.412). For detecting EMVI+, MRI showed better performance than CT (AUC, 0.780 versus 0.575, P =  0.012) with significantly higher sensitivity (68.6 % versus 40.0 %, P =  0.031) and similar specificity (both are 84.3 %). CONCLUSIONS: MRI may offer more superior diagnostic performance than CT for detecting T3-4 disease and EMVI, thereby supporting its alternative application to CT in local staging of colon cancer.

Silencing Stem Cell Factor Gene in Fibroblasts to Regulate Paracrine Factor Productions and Enhance c-Kit Expression in Melanocytes on Melanogenesis.

Melanogenesis is a complex physiological mechanism involving various paracrine factors. Skin cells such as keratinocytes, fibroblasts, and melanocytes communicate with one another through secreted regulators, thereby regulating the melanocytes' bio-functions. The stem cell factor (SCF) is a paracrine factor produced by fibroblasts, and its receptor, c-kit, is expressed on melanocytes. Binding of SCF to c-kit activates autophosphorylation and tyrosine kinase to switch on its signal transmission. SCF inhibition does not suppress fibroblast proliferation in MTT assay, and SCF silencing induced mRNA expressions of paracrine factor genes, HGF, NRG-1, and CRH in qPCR results. Following UVB stimulation, gene expressions of HGF, NRG, and CRH were higher than homeostasis; in particular, HGF exhibited the highest correlation with SCF variations. We detected fibroblasts regulated SCF in an autocrine-dependent manner, and the conditioned medium obtained from fibroblast culture was applied to treat melanocytes. Melanogenesis-related genes, tyrosinase and pmel17, were upregulated under conditioned mediums with SCF silencing and exposed to UVB treatments. Melanin quantities in the melanocytes had clearly increased in the pigment content assay. In conclusion, SCF silencing causes variations in both fibroblast paracrine factors and melanocyte melanogenesis, and the differences in gene expressions were observed following UVB exposure.

Locally advanced rectal cancer: predicting non-responders to neoadjuvant chemoradiotherapy using apparent diffusion coefficient textures.

PURPOSE: The purpose of the study is to evaluate whether apparent diffusion coefficient (ADC) textures could identify patient with locally advanced rectal cancer (LARC) who would not respond to neoadjuvant chemoradiotherapy (NCRT). METHOD: Twenty-six patients who underwent MRI including diffusion-weighted imaging at a 3.0 T system before NCRT were enrolled. Texture analysis of pre-therapy ADC mapping was carried out, and a total of 133 ADC textures as well as routine mean ADC value of the primary tumor were extracted for each patient. Texture parameters and mean ADC were compared between responsive group and non-responsive group. Logistic regression was used to determine the independent predictors for non-responders. Receiver operating characteristic curve (ROC) was performed to evaluate the predictive performance of the significant parameters. RESULTS: Eighteen of the 133 texture parameters significantly differed between responsive and non-responsive groups (p < 0.05). Further, energy variance and SdGa47 were identified as independent predictors for non-responders to NCRT; this logistic model achieved an area under the curve (AUC) of 0.908. CONCLUSION: Texture analysis based on pre-therapy ADC mapping could potentially be helpful to identify patients with LARC who would not respond to NCRT.

CT findings of persistent pure ground glass opacity: can we predict the invasiveness?

BACKGROUND: To investigate whether CT findings can predict the invasiveness of persistent cancerous pure ground glass opacity (pGGO) by correlating the CT imaging features of persistent pGGO with pathological changes. MATERIALS AND METHODS: Ninety five patients with persistent pGGOs were included. Three radiologists evaluated the morphologic features of these pGGOs at high resolution CT (HRCT). Binary logistic regression was used to assess the association between CT findings and histopathological classification (pre-invasive and invasive groups). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of diameters. RESULTS: A total of 105 pGGOs were identified. Between pre-invasive (atypical adenomatous hyperplasia, AAH, and adenocarcinoma in situ, AIS) and invasive group (minimally invasive adenocarcinoma, MIA and invasive lung adenocarcinomas, ILA), there were significant differences in diameter, spiculation and vessel dilatation (p<0.05). No difference was found in air-bronchogram, bubble- lucency, lobulated-margin, pleural indentation or vascular convergence (p>0.05). The optimal threshold value of the diameters to predict the invasiveness of pGGO was 12.50mm. CONCLUSIONS: HRCT features can predict the invasiveness of persistent pGGO. The pGGO with a diameter more than 12.50mm, presences of spiculation and vessel dilatation are important factors to differentiate invasive adenocarcinoma from pre-invasive cancerous lesions.