Design and practice of blended teaching of internal medicine nursing based on O-AMAS effective teaching model.

BACKGROUND: Self-directed learning (SDL) ability is the basis for cultivating nursing students' ability to find and solve problems, lifelong learning, and providing high-quality nursing talents for healthcare. The O-AMAS (Objective, Activation, Multi-learning, Assessment, Summary) model adheres to the teaching philosophy of student-centered, result-oriented, combines the advantages of online and offline teaching, enriching teaching resources and learning channels, diversifying teaching and evaluation methods, and emphasizing integrating and applying knowledge conducive to improving students' SDL ability and achieving teaching objectives. This study explored the course design, practical, and application effects under the O-AMAS effective teaching model in internal medicine nursing to provide a basis and reference for combining effective teaching models with blended teaching in future nursing courses. METHODS: This study is a self-controlled before-after trial. The participants were 76 nursing undergraduates from Hunan Normal University. This study utilizes the O-AMAS effective teaching model to design internal medicine nursing courses and implement blended online and offline teaching. Main links: The overall course design and application are student-centered, after clarifying macro and micro multi-dimensional learning objectives, with online and offline blended teaching environments activated students' learning behavior and diversified teachers' teaching activities, then based on instant and dynamic provide effective feedback; finally, students take the initiate to make a brief and potent summary under the teacher guidance. After the course, a unified assessment of the learning effect of nursing students was conducted, including the evaluation of the SDL ability of nursing students, a final comprehensive evaluation grade, and a teaching satisfaction survey. RESULTS: The nursing students' SDL ability scores are higher than before teaching, and the results were statistically significant (P < 0.05). The final average comprehensive evaluation grade of nursing students was 78.38 ± 7.12. More than 96% of the students are satisfied with this course. CONCLUSION: Applying for internal medicine nursing blended teaching integrated with the O-AMAS effective teaching model is conducive to improving nursing students' SDL ability, academic grades, and teaching satisfaction.

Predictive role of red blood cell distribution width to platelet ratio combined mean platelet volume in patients with microscopic polyangiitis.

BACKGROUND: We aimed to investigate the role of red blood cell distribution width (RDW)-to-platelet ratio (RPR) and mean platelet volume (MPV) in evaluating the disease activity of microscopic polyangiitis (MPA). MATERIALS AND METHODS: A total of 73 newly diagnosed MPA patients and 57 healthy controls were enrolled in this study. The hematologic and biochemical indexes of two groups were assessed. The RPR was calculated as the ratio of RDW and platelet counts, and Birmingham Vasculitis Activity Score (BVAS) was used to evaluate the disease activity. RESULTS: Compared with the healthy controls, RPR and RDW were significantly increased, and MPV was significantly decreased in MPA patients. In the MPA group, RPR was positively correlated with BVAS (p = 0.032), but negatively correlated with lymphocyte, hemoglobin, and complement 3 (all p < 0.05). MPV was negatively correlated with white blood cell (p = 0.045). Patients with BVAS > 15 had significantly higher RPR than patients with BVAS ≤ 15 (p = 0.011). A cut-off level of 0.066 for RPR had 47.9% sensitivity and 90.4% specificity in predicting MPA, and the combination of RPR and MPV had 75.3% sensitivity and 78.9% specificity in differentiating MPA patients from healthy controls. CONCLUSION: The study suggests that RPR may be a potential marker of diagnosis and disease activity in newly diagnosed MPA patients. Additionally, a higher predictive value in monitoring and evaluation of MPA was found when RPR and MPV were combined.

A Rare Case of Abnormal Hemoglobin Variant Hb Mizuho: [HBB: c.206T > C ß 68(E12) Leu-Pro]: A First Report in the Chinese Population.

A 6-month-old female infant presented with unexplained hemolytic anemia, showing no abnormalities by capillary electrophoresis and genetic testing for α- and ß-thalassemia mutations that are commonly seen in the Chinese population. A rare Hb Mizuho: [HBB: c.206T > C ß 68(E12) Leu- Pro] variant was identified by next-generation sequencing (NGS) and verified by Sanger sequencing. Hb Mizuho: [HBB: c.206T > C ß 68(E12) Leu- Pro] is not easily detectable because it is extremely unstable, and the correct diagnosis is usually made via DNA sequencing. This is the first report of this variant in the Chinese population.

The clinical relevance of epithelial-mesenchymal transition and its correlations with tumorigenic immune infiltrates in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a cancer with extremely high mortality. Epithelial-mesenchymal transition (EMT) may play an important role in the occurrence, invasion and prognosis of HCC; however, its relationship with immunity in HCC has not yet been studied. Therefore, we investigated the diagnostic and prognostic values of EMT and explored its potential connections with tumorigenic immune infiltrates in HCC. We first proposed a quantitative metric of EMT activity, the EMT score. After applying this metric to 20 datasets from the Integrative Molecular Database of Hepatocellular Carcinoma, the Cancer Genome Atlas, and the Gene Expression Omnibus, we explored the ability of the EMT score to stratify across sample types. We then applied the EMT score for survival analysis and to differentiate patients with/without vascular invasion to test its prognostic value. We also collected and calculated data on the abundance of immune cells and immune cell markers in HCC and investigated their correlations with EMT scores. Finally, we synthesized and analyzed 20 datasets and constructed an EMT-gene-immune linkage network. The results showed higher EMT scores in HCC samples than in cirrhotic and normal livers. The cases with higher EMT scores also showed poorer performance in terms of prognostic factors such as vascular invasion and overall survival time. Our research demonstrated a broad correlation between EMT and the tumor immune microenvironment, and we uncovered multiple potential linkers associated with both EMT and immunity. Studying EMT has clinical relevance and high diagnostic and prognostic value for HCC.

Association between loneliness and its components and cognitive function among older Chinese adults living in nursing homes: A mediation of depressive symptoms, anxiety symptoms, and sleep disturbances.

OBJECTIVE: This study aimed to investigate the associations between loneliness and its components and cognitive function among older Chinese adults living in nursing homes and to test whether depressive symptoms, anxiety symptoms, and sleep disturbances mediate these associations. METHODS: The sample comprised 228 Chinese individuals aged ≥ 65 years living in nursing homes who were free of dementia and psychiatric or serious somatic diseases. Loneliness was evaluated using the UCLA Loneliness Scale. Global cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment. Multivariable linear regression analyses were performed to examine the associations between loneliness and its components and global cognitive function. A mediation analysis was used to test the potential mediating effects of depressive symptoms, anxiety symptoms, and sleep disturbances. RESULTS: The mean (SD) age of the participants was 80.8 (6.3) years, and 58.3% were women. Compared with the lowest quartile of loneliness degree, the multivariable-adjusted beta coefficient (95% confidence interval [95% CI]) for the highest quartile was -1.32 (-2.61 to -0.02) (P for trend = 0.03). Loneliness components, personal feelings of isolation and the lack of relational connectedness but not the lack of collective connectedness, were also inversely associated with cognitive function. Significant indirect effects on cognitive function were observed for loneliness and its two components (personal feelings of isolation and the lack of relational connectedness) in mediating pathways via depressive symptoms, anxiety symptoms, and sleep disturbances (all p < 0.05). CONCLUSIONS: A higher degree of loneliness and its two components, personal feelings of isolation and the lack of relational connectedness, are associated with worse cognitive function among Chinese residents in nursing homes. Depressive symptoms, anxiety symptoms, and sleep disturbances may at least partially mediate these associations.

The Role of the Monocyte-to-Lymphocyte Ratio in Acute Ischemic Stroke Patients with Acute Kidney Injury.

Objective: The objective of the study was to determine if acute kidney injury (AKI) in patients with acute ischemic stroke was associated with the monocyte-to-lymphocyte ratio (MLR) assessed upon admission to the neurology intensive care unit (NICU) (AIS). We also looked into the MLR's function in predicting hospital mortality in AIS patients. Methods: This retrospective analysis included 595 adult patients with AIS who were hospitalized to the NICU of the First Affiliated Hospital of South China between January 2017 and December 2019. Clinical signs and imaging studies were used to diagnose AIS. KDIGO criteria were used to define AKI. The ratio of monocytes to lymphocytes was used to compute MLR, the ratio of neutrophils to lymphocytes was used to calculate NLR, and the ratio of platelets to lymphocytes was used to calculate PLR. Result: 361 males and 234 women between the ages of 66.27 ± 12.05 years took part in the study. The individuals' MLR was 0.4729 ± 0.3461 and their neutrophil-to-lymphocyte ratio (NLR) was 8.18 ± 5.45. There were notable disparities in MLR and NLR between the AKI and non-AKI groups (p < 0.001). The link between MLR and AKI development risk was enhanced after adjustment, with respective cutoff values of 0.4581 and 9.26. For the MLR-based prediction of AKI incidence, the areas under the receiver-operating characteristic curves (AUCs) were 0.711 (95% CI: 0.663-0.758). And NLR-based prediction of AKI incidence the AUCs was (95% CI: 0.742-0826). Additionally, MLR was associated with a higher rate of in-hospital mortality (2.825, 95% confidence interval: 1.058, 7.545), whereas NLR was associated with a risk of in-hospital mortality of 1.085. (95 percent CI: 1.022, 1.151). An AUC of 0.745 (95% CI: 0.601-0.889, p = 0.026) was obtained for in-hospital mortality based on the MLR, whereas an AUC of 0.724 (95% CI: 0.531-0.916, p = 0.042) was obtained for in-hospital mortality based on the NLR. Conclusion: MLR and neutrophil-to-lymphocyte ratio (NLR) were associated with a higher risk of AKI and in-hospital death in AIS patients.

Monocyte-to-lymphocyte ratio: a potential novel predictor for acute kidney injury in the intensive care unit.

Monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) are considered as surrogate inflammatory indexes. Previous studies indicated that NLR was associated with the development of septic acute kidney injury (AKI). The objective of the present study was to explore the value of MLR and NLR in the occurrence of AKI in intensive care unit (ICU) patients. The clinical details of adult patients (n = 1500) who were admitted to the ICU from January 2016 to December 2019 were retrospectively examined. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. The development of AKI was the main outcome, and the secondary outcome was in-hospital mortality. Overall, 615 (41%) patients were diagnosed with AKI. Both MLR and NLR were positively correlated with AKI incidence (p < 0.001). Multivariate logistic regression analysis suggested that the risk value of MLR for the occurrence of AKI was nearly three-fold higher than NLR (OR = 3.904, 95% CI: 1.623‒9.391 vs. OR = 1.161, 95% CI: 1.135‒1.187, p < 0.001). The areas under the receiver operating characteristic curve (AUC) for MLR and NLR in the prediction of AKI incidence were 0.899 (95% CI: 0.881‒0.917) and 0.780 (95% CI: 0.755‒0.804) (all p < 0.001), with cutoff values of 0.693 and 12.4. However, the AUC of MLR and NLR in the prediction of in-hospital mortality was 0.583 (95% CI: 0.546‒0.620, p < 0.001) and 0.564 (95% CI: 0.528‒0.601, p = 0.001). MLR, an inexpensive and widely available parameter, is a reliable biomarker in predicting the occurrence of AKI in ICU patients.

PAUF Induces Migration of Human Pancreatic Cancer Cells Exclusively via the TLR4/MyD88/NF-κB Signaling Pathway.

PAUF, a tumor-promoting protein secreted by cancer cells, exerts paracrine effects on immune cells through TLR4 receptors expressed on immune cell surfaces. This study aimed to investigate if PAUF elicits autocrine effects on pancreatic cancer (PC) cells through TLR4, a receptor that is overexpressed on PC cells. In this study, TLR4 expression was detected in PC cells only, but not normal pancreatic cells. The migration of TLR4 high-expressing PC cells (i.e., BxPC-3) was reduced by a selective TLR4 inhibitor, in a dose-dependent manner. Using TLR4 overexpressed and knockout PC cell lines, we observed direct PAUF-TLR4 binding on the PC cell surfaces, and that PAUF-induced cancer migration may be mediated exclusively through the TLR4 receptor. Further experiments showed that PAUF signaling was passed down through the TLR4/MyD88 pathway without the involvement of the TLR4/TRIF pathway. TLR4 knockout also downregulated PC membrane PD-L1 expression, which was not influenced by PAUF. To the best of our knowledge, TLR4 is the first receptor identified on cancer cells that mediates PAUF's migration-promoting effect. The results of this study enhanced our understanding of the mechanism of PAUF-induced tumor-promoting effects and suggests that TLR4 expression on cancer cells may be an important biomarker for anti-PAUF treatment.

MiR-133b regulates the proliferation, colony formation, and invasion of bladder cancer cells via inhibiting SOX4. / MiR-133b通过抑制SOX4è°ƒèŠ‚è†€èƒ±ç™Œç»†èƒžçš„å¢žæ®–ã€å ‹éš†å½¢æˆå’Œä¾µè¢­èƒ½åŠ›.

OBJECTIVES: Bladder cancer is one of the most common urothelial tumors with high incidence and mortality rates. Although it has been reported that microRNA (miR)-133b can regulate tumorigenesis of bladder cancer, the mechanism remains unclear. Sex-determining region Y-box transcription factor 4 (SOX4) exhibits an important role in tumorigenesis, but it is unclear whether SOX4 and miR-133b are associated with regulation of pathogenesis of bladder cancer. This study aims to determine the expressions of SOX4 and miR-133b in bladder cancer tissues and cells, investigate their effects on the proliferation, colony formation, and invasion of bladder cancer cells, and to explore the association between miR-133b and SOX4 in regulating biological featurss of bladder cancer cells. METHODS: The bladder cancer and adjacent tissue samples of 10 patients who underwent surgical resection in the Second Xiangya Hospital of Central South Universty from Januray to June 2015 were obtained. The levels of miR-133b were tested by real-time PCR, and the protein levels of SOX4 were evaluated using Western blotting in bladder cancer tissues, matched adjacent tissues, and cell lines. The correlation between miR-133b expression and SOX4 expression in bladder cancer tissues was analyzed. Using the online database TargetScan, the relationship between SOX4 and miR-133b was predicted. MiR-133b mimics, miR-133b inhibitor, and short hairpin RNA (shRNA)-SOX4 were transfected into T24 cells by Lipofectamine 2000. The relationship between miR-133b and SOX4 was also verified by a dual-luciferase reporter assay. The proliferation of T24 cells cultured for 0, 12, 48, 72, and 96 h was evaluated by cell counting kit-8 (CCK-8) assay. The colony formation capacity of bladder cancer cells was tested after 14-day culture, and cell invasion capacity was evaluated with Transwell invasion assay. RESULTS: Bladder cancer tissue and bladder cancer cells had low level of miR-133b but high level of SOX4, compared with matched adjacent tissues and normal bladder epithelial cells. A negative correlation between miR-133b mRNA and SOX4 protein levels in bladder cancer tissues was also found (r=-0.84). The results of online database TargetScan showed that miR-133b targets at SOX4, and overexpression of miR-133b significantly attenuated the expression of SOX4 in T24 cells. Both overexpression of miR-133b and knockdown of SOX4 significantly inhibited the proliferation, colony formation, and invasion capacity of bladder cancer cells in vitro. SOX4 down-regulation restored the effects of miR-133b inhibitor on the proliferation, colony formation, and invasion capacity of T24 cells. CONCLUSIONS: The up-regulation of SOX4 contributes to the progression of bladder cancer, and miR-133b can regulate the proliferation, colony formation, and invasion of bladder cancer cells via inhibiting SOX4.

Distribution and prognostic impact of M1 macrophage on esophageal squamous cell carcinoma.

Macrophages are a double-edged sword with potential cancer-promoting and anticancer effects. Controversy remains regarding the effect of macrophages, especially M1 macrophages, on tumor promotion and suppression. We aimed to investigate the role of M1 macrophages in the occurrence and progression of esophageal squamous cell carcinoma (ESCC). Analyzing the data in Gene Expression Omnibus database by the CIBERSORT algorithm found that M1 macrophages were one of the important components of many immune cells in ESCCs, and the increase in their number was obviously negatively correlated with tumor T staging. This result was verified by our experimental data: the density of CD68/HLA-DR double-stained M1 macrophages in ESCC tumor nest and tumor stroma was significantly higher than that in cancer-adjacent normal (CAN) tissues. The density of M1 macrophages in ESCC tumor nest was negatively correlated with the patient's lymph node metastasis and clinical stage (P < 0.05), and the negative tendency was more obvious for M1 macrophages in ESCC tumor stroma (P < 0.001). Exposure to M1 macrophage-conditioned medium inhibited ESCC cell migration and invasion ability significantly (P < 0.05). Moreover, the increased M1 macrophage density in ESCC tumor stroma correlated positively with good prognosis of ESCC. M1 macrophages were involved in inhibiting ESCC cell migration and invasion, which could serve as a good prognostic factor in patients with ESCC.

Bioinformatic analysis and validation of microRNA-508-3p as a protective predictor by targeting NR4A3/MEK axis in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) featured a debilitating progressive disorder. Here, we intend to determine diagnosis-valuable biomarkers for PAH and decode the fundamental mechanisms of the biological function of these markers. Two mRNA microarray profiles (GSE70456 and GSE117261) and two microRNA microarray profiles (GSE55427 and GSE67597) were mined from the Gene Expression Omnibus platform. Then, we identified the differentially expressed genes (DEGs) and differentially expressed miRNAs (DEMs), respectively. Besides, we investigated online miRNA prediction tools to screen the target gene of DEMs. In this study, 185 DEGs and three common DEMs were screened as well as 1266 target genes of the three DEMs were identified. Next, 16 overlapping dysregulated genes from 185 DEGs and 1266 target gene were obtained. Meanwhile, we constructed the miRNA gene regulatory network and determined miRNA-508-3p-NR4A3 pair for deeper exploring. Experiment methods verified the functional expression of miR-508-3p in PAH and its signalling cascade. We observed that ectopic miR-508-3p expression promotes proliferation and migration of pulmonary artery smooth muscle cell (PASMC). Bioinformatic, dual-luciferase assay showed NR4A3 represents directly targeted gene of miR-508-3p. Mechanistically, we demonstrated that down-regulation of miR-508-3p advances PASMC proliferation and migration via inducing NR4A3 to activate MAPK/ERK kinase signalling pathway. Altogether, our research provides a promising diagnosis of predictor and therapeutic avenues for patients in PAH.

Bioinformatics-based screening of key genes for transformation of liver cirrhosis to hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of liver tumour, and is closely related to liver cirrhosis. Previous studies have focussed on the pathogenesis of liver cirrhosis developing into HCC, but the molecular mechanism remains unclear. The aims of the present study were to identify key genes related to the transformation of cirrhosis into HCC, and explore the associated molecular mechanisms. METHODS: GSE89377, GSE17548, GSE63898 and GSE54236 mRNA microarray datasets from Gene Expression Omnibus (GEO) were analysed to obtain differentially expressed genes (DEGs) between HCC and liver cirrhosis tissues, and network analysis of protein-protein interactions (PPIs) was carried out. String and Cytoscape were used to analyse modules and identify hub genes, Kaplan-Meier Plotter and Oncomine databases were used to explore relationships between hub genes and disease occurrence, development and prognosis of HCC, and the molecular mechanism of the main hub gene was probed using Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway analysis. RESULTS: In total, 58 DEGs were obtained, of which 12 and 46 were up- and down-regulated, respectively. Three hub genes (CDKN3, CYP2C9 and LCAT) were identified and associated prognostic information was obtained. CDKN3 may be correlated with the occurrence, invasion, and recurrence of HCC. Genes closely related to changes in the CDKN3 hub gene were screened, and Kyoto Encyclopedia of Genes and Genomes (KEGGs) pathway analysis identified numerous cell cycle-related genes. CONCLUSION: CDKN3 may affect the transformation of liver cirrhosis into HCC, and represents a new candidate molecular marker of the occurrence and progression of HCC.

Physical frailty and its associated factors among elderly nursing home residents in China.

BACKGROUND: Evidence is scarce on the trend in prevalence of physical frailty in China; the primary purpose of this study was to identify the prevalence and correlates of physical frailty among older nursing home residents in China. METHODS: Cross-sectional study in 20 nursing homes in Changsha, China. Physical frailty was defined based on the frailty phenotype including weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Participants with at least three affected criteria were defined as being frail. Participants with one or two affected criteria were considered as pre-frail, and those with no affected criteria were considered as robust. A total of 1004 nursing home residents aged 60 and over were included in this study. A multinomial logistic regression model was used to analyze the associations of physical frailty with its potential risk factors, including age, sex, education levels, marital status, type of institution, living status, current drinking, current smoking, regular exercise, and self-reported health. RESULTS: The overall prevalence of physical frailty and prefrailty was 55.6, and 38.5%, respectively. The rate of physical frailty substantially increased with age, and was higher in women than in men (69.5% vs. 30.5%). The multinomial logistic regression analysis showed that older age, being women, living in a private institution, living alone or with unknown person, having no regular exercise (≤ 2 times/week), and poor self-reported health were significantly associated with increased odds of being physically frail. CONCLUSION: We demonstrated physical frailty is highly prevalent among older residents in nursing homes in China, especially in women. The potential role of those associated factors of physical frailty warrant further investigations to explore their clinical application among elderly nursing home residents.

Effects of lincomycin hydrochloride on the neurotoxicity of zebrafish.

Lincomycin hydrochloride is one of the commonly used drugs in clinic. However, it has many side effects on patients, and its mechanism is still poorly understood. In this study, 6 h post-fertilization (6 hpf) zebrafish embryos were exposed to several concentrations of lincomycin hydrochloride (15, 30, 60 µg/mL) for up to 24 or 96 hpf to detect their developmental toxicity and neurotoxicity, and to 6 days post-fertilization (6 dpf) to detect their behavioral toxicity. Our results showed that lincomycin hydrochloride could lead to embryonic head deformities (unclear ventricles, smaller ventricles, fewer new neurons). The studies showed that the frequency of spontaneous tail flick of zebrafish embryo increased at 24 hpf, and the lincomycin hydrochloride exposed zebrafish embryos showed increased heart rate, shorter body length, and yolk sac edema with severe pericardial edema at 96 hpf. The studies also showed that lincomycin hydrochloride increased oxidative stress level, Acetylcholinesterase (AChE) activity, ATPase activity and apoptosis in zebrafish larvae. In addition, the swimming behavior of zebrafish larvae decreased with the increase of lincomycin hydrochloride concentration, but the angular velocity and meandering degree increased, which might be due to the decreased activity of AChE and ATPase, as well as the decreased expression of genes related to neurodevelopment and neurotransmitter system, leading to the change of their motor behaviors. In summary, we found that lincomycin hydrochloride induced developmental toxicity and neurotoxicity in zebrafish larvae, contributing to a more comprehensive evaluation of the safety of the drug.

Response to neoadjuvant chemoradiotherapy for locally advanced rectum cancer: Texture analysis of dynamic contrast-enhanced MRI.

BACKGROUND: Tumor heterogeneity can be assessed by texture analysis (TA). TA has been applied using diffusion-weighted imaging and apparent diffusion coefficient maps to predict pathological responses to preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC). PURPOSE: To evaluate the texture parameters obtained from K trans maps derived from dynamic contrast-enhanced (DCE)-MRI for predicting pathological responses to preoperative CRT for LARCs. STUDY TYPE: Retrospective. POPULATION: Altogether, 83 patients (26 women, 57 men) with rectal cancer met the inclusion criteria. FIELD STRENGTH/SEQUENCE: 3.0T/T1 -weighted DCE-MRI sequence. ASSESSMENT: After CRT, each tumor was assessed by a pathologist who assigned a tumor regression grade (TRG), thereby identifying pathologically complete responders (pCR; TRG 1) and good responders (GR; TRG1 + TRG2). TA was then applied to the DCE-MRI K trans maps. The K trans value, several TA parameters, and tumor volumes were calculated. STATISTICAL TESTS: The Shapiro-Wilk test was used to verify that the data had normal distribution. Results of parameters measured before and after CRT were compared using paired-sample t-tests. Value changes of each parameter in the combined pCR/GR group were compared using independent sample t-tests. Receiver operating characteristic curves and areas under the curve (AUC) were calculated to assess the diagnostic performance of each parameter related to CRT effectiveness. RESULTS: There were 15 pCR (16.9%) and 21 GR (25.3%) patients. Tumor volume, mean K trans , entropy, and correlation decreased and energy values increased significantly in these groups compared with those of the non-PCR and non-GR groups. ΔCorrelation (Δcorrelation = postcorrelation - precorrelation) was found to be a valuable parameter for identifying pCR/GR patients (AUC 0.895, sensitivity 86.7%, specificity 81.8%). DATA CONCLUSION: TA parameters from the DCE-MRI K trans map can predict the efficacy of CRT for treating LARCs. Also, Δcorrelation may be useful for identifying patients who will be responsive to CRT. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:885-893.

Differentiating Transition Zone Cancers From Benign Prostatic Hyperplasia by Histogram Analysis of Apparent Diffusion Coefficient Maps With Standard and Ultrahigh b-value Diffusion-weighted MR Imaging.

OBJECTIVE: To compare the diagnostic performance of standard and ultrahigh b-value Diffusion-weighted Imaging (DWI) using volumetric histogram analysis in differentiating transition zone (TZ) cancer from benign prostatic hyperplasia (BPH). METHODS: 57 TZ cancer and 61 BPH patients received standard (1000 s/mm) and ultrahigh b-value (2000 s/mm) DWI. The diagnostic ability of ADC histogram parameters derived from two DWI for differentiating TZ cancer from BPH was determined by receiver operating characteristic curve. RESULTS: Median, minimum, the 10th, 25th percentile ADC in both ADC1000 and ADC2000 and skewness in ADC2000 had significant differences between TZ cancer and BPH (for all, P < 0.05).The 10th percentile ADC showed highest area under the ROC curve (AUC) in both ADC1000 and ADC2000.The 10th percentile ADC of ADC2000 showed significantly higher AUC than did ADC1000 (P = 0.0385). CONCLUSIONS: The 10th percentile ADC obtained from ultrahigh b-value DWI performed better for differentiating TZ cancer from BPH.

Dynamic contrast-enhanced MRI in orbital lymphoproliferative disorders: Effects of region of interest selection methods on time efficiency, measurement reproducibility, and diagnostic ability.

BACKGROUND: Previous studies indicated that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could serve as a useful biomarker for differentiating malignant from benign orbital lymphoproliferative disorders (OLPDs). PURPOSE: To investigate the influence of different region of interest (ROI) selection methods on the measurements of DCE-MRI parameters, and their diagnostic ability in discriminating malignant from benign OLPDs. STUDY TYPE: Retrospective study. POPULATION: In all, 46 patients with OLPDs (22 benign and 24 malignant). FIELD STRENGTH/SEQUENCE: 3.T DCE-MRI using a 2D turbo fast low angle shot sequence postcontrast. ASSESSMENT: DCE-MRI data were analyzed using three different ROI selection methods, including whole-tumor ROI (ROIWT ), single-slice ROI (ROISS ) and hot-spot ROI (ROIHS ). Quantitative parameters (Ktrans , Kep , Ve ) were calculated based on a modified Tofts model. STATISTICAL TESTING: Analysis of variance test, intraclass correlation coefficient (ICC), Bland-Altman plots, independent t-test, and receiver operating characteristic curve analyses were used for statistical analyses. RESULTS: The time required for outlining ROIWT was significantly longer than ROISS and ROIHS (P < 0.001). The measurements of DCE-MRI-derived parameters based on ROIHS demonstrated lowest ICC, followed by ROISS and ROIWT . Malignant OLPDs showed significantly higher Kep than benign mimics (P < 0.001), while no significant differences were found on Ktrans (ROIWT , P = 0.535; ROISS , P = 0.557; ROIHS , P = 0.400) and Ve (ROIWT , P = 0.071; ROISS , P = 0.079; ROIHS , P = 0.057). Kep -ROIWT showed the highest area under curve for differentiating malignant from benign OLPDs, followed by Kep -ROISS , and Kep-ROIHS ; however, the differences were not significant (ROIWT vs. ROISS , P = 0.407; ROIWT vs. ROIHS , P = 0.363; ROISS vs. ROIHS , P = 0.887). DATA CONCLUSION: ROI selection methods could have an influence on the measurements of DCE-MRI parameters. Taking measurement time, reproducibility, and diagnostic ability into account, we suggest single-slice ROI to be used for differentiating malignant from benign OLPDs in clinical practice. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1298-1305.

HLA-DQB1*03 and DRB1*07 alleles increase the risk of cervical cancer among Uighur and Han women in Xinjiang, China.

AIM: To explore the association between the determinant factors including HLA-DQB1*03, DRB1-*07, -*13 and high-risk HPV infection, the cervical squamous cell carcinoma (CSCC) pathogenesis among Chinese Uighur and Han population. MATERIALS & METHODS: HLA alleles were genotyped by PCR sequence-specific primers. RESULTS: HPV16 infection rate was significantly higher among the Uighurs and Hans with CSCC as compared with healthy controls, respectively. HLA-DQB1*03 significantly increased among Uighurs with CSCC, while HLA-DRB1*07 significantly increased among Hans with CSCC. Similar tendencies were observed for DQB1*03 with HPV16-positive Uighurs CSCC and DRB1*07 with HPV16-positive Hans CSCC. CONCLUSION: This study suggests that HLA-DQB1*03 and DRB1*07 alleles may influence the immune response to HPV16 infection and increase the risk of CSCC among the Uighurs and Hans in China.

Benign and malignant orbital lymphoproliferative disorders: Differentiating using multiparametric MRI at 3.0T.

PURPOSE: To determine the optimal combination of parameters derived from 3T multiparametric (conventional magnetic resonance imaging [MRI], diffusion-weighted [DW] and dynamic contrast-enhanced [DCE]) MRI for differentiating malignant from benign orbital lymphoproliferative disorders (OLPDs). MATERIALS AND METHODS: Forty patients with OLPDs (18 benign and 22 malignant) underwent conventional 3.0T MR, DW, and DCE-MRI examination for presurgery evaluation. Conventional MRI features (including tumor laterality, shape, number of involved quadrants, signal intensity on T1 -weighted imaging (WI) and T2 WI, flow void sign on T2 WI, and findings suggestive of sinusitis) were reviewed, and multivariate logistic regression analysis was used to identify the most significant conventional MRI features. Apparent diffusion coefficient (ADC) and DCE-MRI derived parameters (area under curve [AUC], time to peak [TTP], maximum rise slope [Slopemax ]) were measured and compared between two groups. Receiver operating characteristic (ROC) curve analyses were used to determine the diagnostic ability of each combination that was established based on identified qualitative and quantitative parameters. RESULTS: Multivariate logistic regression analysis showed that the presence of flow void sign on T2 WI significantly associated with benign OLPDs (P = 0.034). Malignant OLPDs demonstrated significantly lower ADC (P = 0.001) and AUC (P = 0.002) than benign mimics. ROC analyses indicted that, ADC alone showed the optimal sensitivity (threshold value, 0.886 × 10-3 mm2 /s; sensitivity, 90.9%), while a combination of no presence of flow void sign on T2 WI + ADC ≤ 0.886 × 10-3 mm2 /s + AUC ≤ 7.366 showed optimal specificity (88.9%) in differentiating benign from malignant OLPDs. CONCLUSION: Multiparametric MRI can help to differentiate malignant from benign OLPDs. DWI offers optimal sensitivity, while the combination of conventional MRI, DWI, and DCE-MRI offers optimal specificity. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:167-176.

Lung adenocarcinoma: Assessment of epidermal growth factor receptor mutation status based on extended models of diffusion-weighted image.

PURPOSE: To evaluate the diagnostic performance of extended models of diffusion-weighted (DW) imaging to help differentiate the epidermal growth factor receptor (EGFR) mutation status in stage IIIA-IV lung adenocarcinoma. MATERIALS AND METHODS: This retrospective study had institutional research board approval and was HIPAA compliant. Preoperative extended DW imaging including intravoxel incoherent motion (IVIM) and diffusional kurtosis imaging (DKI) 3 Tesla MRI were retrospectively evaluated in 53 patients with pathologically confirmed non-early stage (IIIA-IV) lung adenocarcinoma. EGFR mutationsat exons 18-21 were determined by using polymerase chain reaction-based ARMS. Quantitative parameters (mean, kurtosis, skewness, 10th and 90th percentiles) of IVIM (true-diffusion coefficient D, pseudo-diffusion coefficient D*, and perfusion fraction f) and DKI (kurtosis value Kapp, kurtosis corrected diffusion coefficient Dapp) were calculated by outlining entire-volume histogram analysis. Receiver operating characteristic analysis was constructed to determine the diagnostic performance of each parameter. Multivariate logistic regression was used to differentiate the probability of EGFR mutation status. RESULTS: Twenty-four of 53 patients with lung adenocarcinoma were EGFR mutations, which occurred most often in acinar (10 of 13 [76.9%]) and papillary predominant tumors (9 of 13 [69.2%]). Patients with EGFR mutation showed significant higher 10th percentile of D, lower D* value in terms of kurtosis, and lower Kapp value in terms of mean, skewness, 10th and 90th percentiles (all P values < 0.05). The 90th Kapp showed significantly higher sensitivity (97%; P < 0.05) and Az (0.817; P < 0.05) value. Multivariate logistic regression showed 90th Kapp was a independent factor for determining EGFR mutation with odds ratio -1.657. CONCLUSION: Multiple IVIM and DKI parameters, especially the histogram 90th Kapp value, helped differentiate EGFR mutation status in stage IIIA-IV lung adenocarcinoma. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:281-289.