Diagnostic error and bias in the department of radiology: a pictorial essay.

Diagnostic imaging is an essential and indispensable part of medical diagnosis and treatment, and diagnostic errors or biases are also common in the department of radiology, sometimes even having a severe impact on the diagnosis and treatment of patients. There are various reasons for diagnostic errors or biases in imaging. In this review, we analyze and summarize the causes of diagnostic imaging errors and biases based on practical cases. We propose solutions for dealing with diagnostic imaging errors and reducing their probability, thereby helping radiologists in their clinical practice.Critical relevance statement Diagnostic errors or bias contribute to most medical errors in the radiology department. Solutions for dealing with diagnostic imaging errors are pivotal for patients.Key points• Diagnostic errors or bias contribute to most medical errors in radiology department.• Solutions for dealing with diagnostic imaging errors are pivotal for patients.• This review summarizes the causes of diagnostic errors and offers solutions to them.

Impacts of Mercury Exposure Levels and Sources on the Demethylation of Methylmercury Through Human Gut Microbiota.

This study aims to investigate methylmercury (MeHg) demethylation processes in human gut. Here, we determined the compositions and MeHg demethylation rates of gut microbiota in residents from different Hg exposure levels (Wanshan (WS) town and Yangtou (YT) town) and different Hg exposure sources (Zhuchang (ZC) town and YT town) regions. MeHg and inorganic Hg exposure levels in residents of WS town were significantly higher than those of YT and ZC town. Desulfovibrio and Methanogens, which related to Hg methylation/demethylation, showed significantly higher abundance in WS and ZC, comparing with YT. In vitro experiments demonstrated that human intestinal microbiota could degrade MeHg directly. Besides, gut microbiota in WS and ZC exhibited significantly higher demethylation rates than YT, suggesting Desulfovibrio and Methanogens may play important roles in intestinal MeHg demethylation. This study highlights Hg exposure levels and sources may affect demethylation efficiency of gut microbiota, which provides new insights for MeHg demethylation processes in human body.

Confined Heteropoly Blues in Defected Zr-MOF (Bottle Around Ship) for High-Efficiency Oxidative Desulfurization.

The Keggin-type polyoxometalates (POMs) are effective catalysts for oxidative desulfurization (ODS) and confining these POMs in metal-organic frameworks (MOFs) is a promising strategy to improve their performances. Herein, postsynthetic modification of POMs confined in MOFs by adding thiourea creates more unsaturated metal sites as defects, promoting ODS catalytic activity. Additional modification by confining 1-butyl-3-methyl imidazolium POMs in MOFs is performed to obtain higher ODS activity, owing to the affinity between electron-rich thiophene-based compounds and electrophilic imidazolium compounds. The ODS catalytic activities of four Zr-MOF-based composites (bottle around ship) including phosphomolybdate acid (PMA)/UiO-66, [Bmim]3 PMo12 O40 /UiO-66, PMA/Thiourea/UiO-66, and [Bmim]3 PMo12 O40 /Thiourea/UiO-66 are therefore investigated in detail. In order to explore the catalytic mechanism of these MOF composites, their microstructures and electronic structures are probed by various techniques such as X-ray diffraction, thermogravimetric analysis, Fourier transform infrared, Raman, scanning electron microscope, transmission electron microscope, BET, X-ray photoelectron spectroscopy, EPR, UV-vis, NMR spectra, and H2 -temperature-programmed reduction. The results reveal that phosphomolybdate blues and imidazolium phosphomolybdate blues with different Mo5+ /Mo6+ ratios with the Keggin structure are confined in defected UiO-66 for all four composites. This approach can be applied to design and synthesize other POMs/MOFs composites as efficient catalysts.

[Expression of CLAUDIN-11 in the testicular tissue of the patient with non-obstructive azoospermia and its clinical significance].

OBJECTIVE: To study the expression of CLAUDIN-11 in the testis tissue of non-obstructive azoospermia (NOA) patients with different severities and investigate its clinical significance. METHODS: Sixty-two NOA patients were divided into a hypospermatogenesis (HS) group (n = 30) and a Sertoli cell only syndrome (SCO) group (n =32). The expression of CLAUDIN-11 in the testicular tissue of the patients was detected by immunohistochemistry, that of CLAUDIN-11 mRNA determined by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and the levels of serum reproductive hormones measured by chemiluminescent immunoassay. RESULTS: Immunohistochemistry showed that the expression of CLAUDIN-11 was mainly in the cytoplasm of the Sertoli cells around the seminiferous tubule wall in the HS group, but diffusely distributed in the membrane of the Sertoli cells in the SCO group. RT-qPCR revealed a significantly lower expression of CLAUDIN-11 mRNA in the HS than in the SCO group (0.008 ± 0.001 vs 0.013 ± 0.002, t = 10.616, P<0.01). The level of serum luteotropic hormone (LH) was also markedly lower in the HS than in the SCO group (ï¼»3.62 ± 1.34ï¼½ vs ï¼»4.96 ± 3.10ï¼½ IU/L, P<0.05) and so was that of follicle-stimulating hormone (FSH) (ï¼»5.36 ± 2.80ï¼½ vs ï¼»10.65 ± 9.18ï¼½ IU/L, P<0.05). CONCLUSIONS: The up-regulated expression of CLAUDIN-11 in Sertoli cells may play an important role in the development and progression of spermatogenic dysfunction in NOA patients.

Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain.

PURPOSE: To investigate the prevalence of lumbosacral transitional vertebra (LSTV) within the Chinese Han population, and to determine whether LSTV correlates with low back pain (LBP) and gluteal pain. MATERIALS AND METHODS: Typical standing pelvic radiographs were obtained for 5860 volunteers between 18 to 60 years of age. The lumbosacral region of each spine was evaluated to identify LSTV, which was classified into types I, II, III, and IV based on Castellvi's method. Histories of low back symptoms were obtained using a questionnaire. The association of different subtypes of LSTV with LBP and gluteal pain was explored. RESULTS: LSTV was found in 15.8% (928 of 5860) of our study population. Of the 928 individuals with LSTV, 44.8% were type I (dysplastic transverse process with height >19mm), 43.2% were type II (pseudoarticulation), 7.2% were type III (fusion), and 4.8% were type IV (a unilateral type II transition with a type III fusion on the contralateral side). Type II LSTV were closely associated with LBP and gluteal pain, with respective odds ratios (ORs) of 2.56 (95% CI: 2.17-3.89) and 5.38 (95% CI: 4.29-8.43). Similarly, types IV LSTV also demonstrated a significant correlation with LBP and gluteal pain, with respective ORs of 4.28 (95% CI: 3.21-6.35) and 6.82 (95% CI: 5.17-16.59). CONCLUSIONS: In this population-based study, the prevalence of LSTV was 15.8%, with type I being the most common. Importantly, LSTV types II and IV were significantly associated with LBP and gluteal pain.

Hollow melon-seed-shaped lithium iron phosphate micro- and sub-micrometer plates for lithium-ion batteries.

Melon-seed-shaped LiFePO4 hollow micro- and sub-micrometer plates have been synthesized via a polyol-assisted hydrothermal method. The as-prepared LiFePO4 hollow materials were new with regard to their single-crystalline shells with large ac surfaces. Based on the detailed analysis of time-dependent studies, a possible growth mechanism was proposed involving nucleation, anisotropic growth, selective etching, and reversed recrystallization. The effects of polyol concentration, reaction temperature, and feeding sequence of precursors on the growth of LiFePO4 materials were investigated. The electrochemical properties of as-prepared LiFePO4 hollow materials were examined as cathode materials.

Gene order rearrangement of the M gene in the rabies virus leads to slower replication.

The matrix protein (M) is one of only five genes in the RV genome and is an important multifunctional protein. Besides to allow for the release of newly replicated virions pairing with G, the M protein also functions in virus replication, pathogenicity, and host cell apoptosis. The goal of present study is to generate recombinant viruses with M gene rearranged, thus laying the foundation for further exploring what will happen when the gene for M is relocated on the RV single-strand RNA. We used rHEP-Flury, an attenuated virus that remains virulent for less than 3 days in sucking mice, to reshuffle the M gene, using an approach that leaves the other viral nucleotide sequence intact. Two viruses with translocated M genes (N1M2 and N1M4) were recovered from each of the rearranged cDNAs, whose gene order is 3'-N-M-P-G-L-5' and 3'-N-P-G-M-L-5' respectively. The growth dynamics of these viruses showed slower replication than the wild-type virus in multiple-step growth curves, but they can grow to a comparable titer in tests of single-step growth curves. Further experimentation with these rearranged viruses will provide insights into the relationships between genome structure and virus phenotypes.

[Expression of TEKT4 protein decreases in the ejaculated spermatozoa of idiopathic asthenozoospermic men].

OBJECTIVE: To investigate the role of the TEKT4 protein in the pathogenesis of idiopathic asthenozoospermia. METHODS: We separated and purified the ejaculated sperm from idiopathic asthenozoospermia patients and normozoospermic men by Percoll discontinuous density gradients, and detected the distribution and the expressions of TEKT4 mRNA and TEKT4 protein by RT-PCR and Western blot. RESULTS: RT-PCR revealed that the expression of TEKT4 mRNA was significantly lower in the sperm of the idiopathic asthenozoospermia patients than in those of the normozoospermic men (0.59 +/- 0.13 vs 0.75 +/- 0.15, t = 4.325, P < 0.05), and Western blot confirmed the results of RT-PCR (0.48 +/- 0.14 vs 0.69 +/- 0.13, t = 5.939, P < 0.05). CONCLUSION: The expression of TEKT4 is significantly decreased in the ejaculated sperm of idiopathic asthenozoospermia patients, which might be one of the causes of idiopathic asthenozoospermia.

[Shengjing tablets for semen non-liquefaction: a clinical study of 100 cases].

OBJECTIVE: To investigate the efficacy and action mechanism of Shengjing Tablets in the treatment liquefaction. METHODS: We randomly assigned 150 patients with semen non-liquefaction to receive Shengjing Tablets group, n = 100) and vitamin E capsules (control group, n = 50) for 2 courses of 45 days each, followed by observation liquefaction time and other semen parameters. RESULTS: After the first course, 68 of the patients in the treatment group 20 responded and 12 failed to respond; and after the second course, 84 were cured, 9 responded and 7 failed to respond, effective rate of 93.0%. In comparison, only 8 of the controls were cured, 8 responded and 34 failed to respond after medication. There were statistically significant differences between the two groups (P < 0.01). Meanwhile, the treatment showed obvious improvement in sperm motility and concentration. CONCLUSION: Shengjing Tablets may shorten the time liquefaction, and can be used as a safe and effective therapy for semen non-liquefaction.

[Concentration of polybrominated diphenyl ethers in umbilical cord serum and the influence on newborns birth outcomes in Shanghai].

OBJECTIVE: To explore the concentration of polybrominated diphenyl ethers (PBDEs) in umbilical cord serum and analyze the influence of exposure to PBDEs during fetal stage on newborn birth outcomes in Shanghai. METHODS: Fifty delivery women in a Shanghai hospital were surveyed by questionnaire, and the umbilical cord serum were collected from September 2006 to April 2007. All the delivery women were singleton pregnancies, excluding high blood pressure, diabetes, HIV infection and adverse medical history. Seven congeners (BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154 and BDE-183) were measured by gas chromatography-negative chemical ionization-mass spectrometry and the influencing factors were analyzed. RESULTS: Newborns' length, weight, chest circumference, head circumference and body mass index (BMI) were (50.15 ± 0.75) cm, (3.49 ± 0.42) kg, (34.76 ± 1.51) cm, (35.03 ± 1.40) cm, (13.76 ± 1.36) kg/m(2), respectively. The median of Σ(7PBDEs) concentration in umbilical cord serum was 14.06 (1.03 - 379.73) ng/g lipid weight (lw). The detection rate of BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154 and BDE-183 were 22% (11/50), 22% (11/50), 98% (49/50), 72% (36/50), 76% (38/50), 90% (45/50) and 14% (7/50), respectively. The median (range) of PBDEs (BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183) congeners were < LOD (< LOD-137.20 ng/g lw), < LOD (< LOD-33.17 ng/g lw), 7.54 ng/g lw (< LOD-94.01 ng/g lw), 1.57 ng/g lw (< LOD-46.95 ng/g lw), 0.63 ng/g lw (< LOD-79.08 ng/g lw), 0.63 ng/g lw (< LOD-22.30 ng/g lw) and < LOD (< LOD-21.63 ng/g lw), respectively. The newborns' BMI showed a negative correlation with BDE-99 (r = -0.347, P < 0.05) and BDE-154 (r = -0.292, P < 0.05). BDE-99 in low-length group (≤ 50 cm, 10.59 ng/g lw) was significantly higher (t = 2.32, P = 0.03) than that in high-length group (> 50 cm, 3.60 ng/g lw). CONCLUSION: PBDEs were commonly detected in newborns' umbilical cord serum in this study. Our findings indicated that exposure to PBDEs adversely affected the development of the newborns.

[Expression of SEPT4 protein in the ejaculated sperm of idiopathic asthenozoospermic men].

OBJECTIVE: To investigate the role of the SEPT4 protein in the pathogenesis of idiopathic asthenozoospermia. METHODS: Samples of ejaculated sperm from idiopathic asthenozoospermia patients and normozoospermic men were separated and purified by Percoll discontinuous density gradients, the distribution and expression of SEPT4 in the sperm samples were determined by immunocytochemistry, and the expressions of SEPT4 mRNA and SEPT4 protein were detected by RT-PCR and Western blot. RESULTS: Immunocytochemistry showed that the expression of SEPT4, located in the annulus, was significantly reduced in the sperm of the idiopathic asthenozoospermia patients (t = 3.452, P < 0.01). RT-PCR revealed that the expression of SEPT4 mRNA was significantly lower in the sperm of the idiopathic asthenozoospermia patients than in those of the normozoospermic men (t = 3.521, P < 0.05). Western blot confirmed the results of RT-PCR (t = 5.872, P < 0.05). CONCLUSION: The expression of SEPT4 is significantly decreased in the ejaculated sperm of idiopathic asthenozoospermia patients, which might be one of the causes of idiopathic asthenozoospermia.

[CatSper1 protein and idiopathic asthenozoospermia].

OBJECTIVE: To investigate the role of the cation channel of sperm 1 (CatSper1) protein in the pathogenesis of idiopathic asthenozoospermia. METHODS: Sperm samples from patients with idiopathic asthenozoospermia were separated by Percoll discontinuous density gradients, and the distribution and expression of the CatSper1 protein were determined by immunocytochemistry. Western blotting was used to detect the different expressions of CatSper1 in the ejaculated sperm from the normal control, mild asthenozoospermia, moderate asthenozoospermia and severe asthenozoospermia groups, followed by statistical analyses. RESULTS: The expression of CatSper1, located in the principle piece of the sperm tail, was reduced significantly in the samples from the idiopathic asthenozoospermia patients as compared with the normal controls (t = 2.188, P = 0.042). The relative contents of the CatSper1 protein in the sperm of the control, mild asthenozoospermia, moderate asthenozoospermia and severe asthenozoospermia groups were 0.806 +/- 0.266, 0.669 +/- 0.207, 0.505 +/- 0.214 and 0.295 +/- 0.162, respectively, significantly decreased in the asthenozoospermia patients in comparison with the normal controls (P <0.05). There was a positive correlation between the percentage of progressively motile sperm and the relative content of the CatSper1 protein (r = 0.633, P = 0.000). CONCLUSION: The decreased or abnormal expression of the CatSper1 protein may be a factor involved in the pathogenesis of idiopathic asthenozoospermia.

[Correlations between PBDEs and thyroid hormone concentrations in adults from production source area].

Polybrominated diphenyl ethers (PBDEs) concentrations in 36 resident serum samples from PBDEs production source area were analyzed by gas chromatography/negative chemical ionization/mass spectrometry(GC-NCI-MS) method, and the concentrations of thyroid hormones were determined as well. The sigma5PBDEs (BDE-28, -47, -153, -183, -209) concentrations(lipid weight) in serum ranged from 130.3 to 4 478.4 ng x g(-1), with an average value of 529.9 ng x g(-1). BDE-209 was a dominant PBDE congener, on average accounting for 69.8% of the total PBDEs concentrations. Spearman rank correlation coefficient was calculated between PBDEs and thyroid hormone, it showed that there were high significant negative correlation between BDE-28, -47, -153, -183 and thyroid-stimulating hormone (TSH), and significant negative correlation was also found between BDE-183 and free thyroxine (fT4). Additionally, there were significant positive correlation between BDE-28, -47 and triiodothyronine (T3), as well as between BDE-28, -153, -183 and free triiodothyronine(fT3). In summary, the concentrations of PBDEs in serum in this study were at a high level, and BDE-209 was the predominant congener. The exposure to the PBDEs may affect thyroid hormone levels, and the further research should focus on the relationship between PBDEs and thyroid hormone concentrations.

[Reviews on antiviral activity of chemical constituents from plants].

This paper reviewed the progress in researches on antiviral activity of chemical constituents from plants in recent years, the antiviral activity and mechanism of action of flavonoids, alkaloids, terpenoids, coumarins and polysaccharoses were sammarszed, provided new leading compound for antivirus new drugs from the plares in prospect.

[Continuous inhalation of allergen induces immunotolerance in a mouse asthma model].

OBJECTIVE: To investigate the mechanism of immunotolerance caused by allergen immunotherapy in allergen-induced asthmatic airway inflammation. METHODS: Sixty ovalbumin (OVA)-sensitized BALB/c mice were randomly divided into two groups, 50 in the experimental group and 10 in the control group. The mice in the experimental group were treated with 3 injections of ovalbumin intraperitoneally (1 mg for each separated for two weeks) and challenged by ovalbumin inhalation 1 h/day for 10 successive days. Then the mice were divided further into group A, group B, group C, group D and E with 10 mice in each group. The mice in group A were sacrificed after 10 day challenge. The mice in group B and D were continuously exposed to inhaled OVA for 4 and 8 weeks (1 h/day, 5 days a week), respectively, then to inhaled OVA 1 h/day for 10 successive days. The inhalation was interrupted for 4 weeks in group C after initial challenge and restarted for another 10 days (1 h/day) afterwards. The mice in group E were exposed continuously to inhaled OVA for 4 weeks (1 h/day, 5 days a week) after initial challenge, which was interrupted for 4 weeks, and restarted for 10 days (1 h/day). Bronchoalveolar lavage (BAL) was performed, and total cells, eosinophils, lymphocytes were assessed; CD4+, CD8+, CD4+ IL-10+ cells were determined using flow cytometry, and IL-4, IFN-gamma and IL-10 in the BAL fluid were measured by ELISA. Serum ovalbumin-specific IgE, IL-4, IFN-gamma and IL-10 were also determined. Pathologic manifestation of the lung was analyzed. RESULTS: The percentage of EOS, B lymphocytes, CD4+ IL-10+ cells in BAL were 0.010 +/- 0.000, 2.1 +/- 1.9 and 4.9 +/- 1.5, respectively in the control group; 0.480 +/- 0.110, 5.1 +/- 2.6 and 5.1 +/- 2.3, respectively, in group A; 0.120 +/- 0.020, 8.9 +/- 3.6, and 10.4 +/- 3.6, respective, in group B; 0.560 +/- 0.050, 4.7 +/- 1.7 and 6.3 +/- 3.1, respectively, in group C; 0.070 +/- 0.030, 10.1 +/- 2.9 and 12.7 +/- 4.5, respectively, in group D; 0.680 +/- 0.030, 5.6 +/- 3.2 and 6.1 +/- 3.4, respectively, in group E. The difference was significant among different groups (F = 36.46, 31.89, 167.89 respectively; all P < 0.01). The percentage of CD4+ IL-10+ cells in BAL was increased in group B and group D, which were significantly higher than those in group A (q = 5.8, 6.4, P < 0.05). The levels of IL-4 and IL-10 in BAL fluid were (21 +/- 3) pg/ml and (44 +/- 12) pg/ml, respectively, in the control group; (128 +/- 23) pg/ml and (68 +/- 18) pg/ml, respectively, in group A; (54 +/- 12) pg/ml and (127 +/- 27) pg/ml, respectively, in group B; (133 +/- 21) pg/ml and (78 +/- 17) pg/ml, respectively, in group C; (8 +/- 18) pg/ml and (135 +/- 34) pg/ml, respectively, in group D; (143 +/- 26) pg/ml and (76 +/- 15) pg/ml, respectively, in group E. The difference was statistically significant among different groups (F = 37.20, 143.78 respectively; all P < 0.01). The levels of IL-10 in BAL fluid were increased in group B and group D, which were significantly higher than that in group A (q = 7.8, 9.6, all P < 0.05). CONCLUSION: The results show that continuous allergen inhalation suppresses allergen-induced airway inflammation and produces immunotolerance, in which IL-10 may play an important role.