Research progress of acupuncture and moxibustion for the enhanced synergism of chemotherapy. / é’ˆç¸ååŒåŒ–ç–—å®žçŽ°å¢žæ•ˆçš„ç ”ç©¶è¿›å±•.

The application of acupuncture and moxibustion in alleviating the adverse effects of chemotherapy drugs has been widely recognized at home and abroad, but the studies have been rarely summarized for the enhanced anti-tumor effect and its mechanism of acupuncture and moxibustion to synergize the chemotherapy drugs. This paper reviewed the clinical and basic studies on the synergism of chemotherapy with acupuncture and moxibustion in recent years. It was found that chemotherapy synergized with acupuncture and moxibustion can suppress cancer to a certain extent and improve the quality of life in patients. The effect mechanism of acupuncture and moxibustion combined with chemotherapy drugs is related to promoting tumor cell apoptosis, improving the immune and vascular microenvironment, and advancing chemotherapy drug enrichment on the affected area. It provides the evidences and ideas for enhancing the effect of chemotherapy by delivering acupuncture and moxibustion as an adjuvant therapy.

Coronary artery calcification and plaque stability： an optical coherence tomography study.

Background: Coronary artery calcification (CAC), a surrogate of atherosclerosis, is related to stent underexpansion and adverse cardiac events. However, the effect of CAC on plaque stability is still controversial and the morphological significance of CAC has yet to be elucidated. Methods: A retrospective series of 419 patients with acute coronary syndrome (ACS) who underwent optical coherence tomography (OCT) were enrolled. Patients were classified into three groups based on the calcification size in culprit plaques and the features of the culprit and non-culprit plaques among these groups were compared. Logistic regression was used to analyze independent risk factors for culprit plaque rupture and the nonlinear relationship between calcification parameters and culprit plaque rupture. Furthermore, we compared the detailed calcification parameters of different kinds of plaques. Results: A total of 419 culprit plaques and 364 non-culprit plaques were identified. The incidence of calcification was 53.9 % in culprit plaques and 50.3 % in non-culprit plaques. Compared with culprit plaques without calcification, plaque rupture, macrophages and cholesterol crystals were more frequently observed in the spotty calcification group, and the lipid length was longer; the incidence of macrophages and cholesterol crystals was higher in the macrocalcification group. Calcification tended to be smaller in ruptured plaques than in non-ruptured plaques. Moreover, the arc and length of calcification were greater in culprit plaques than in non-culprit plaques. Conclusions: Vulnerable features were more frequently observed in culprit plaques with spotty calcification, whereas the presence of macrocalcification calcifications did not significantly increase plaque vulnerability. Calcification tends to be larger in culprit plaques than in non-culprit plaques.

Moxibustion for the Treatment of Cancer and its Complications: Efficacies and Mechanisms.

Cancer treatment remains a significant challenge for the medical community, and improved therapies are necessary to treat cancer and its associated complications. Current anticancer therapies often have significant side effects, underscoring the need for new treatment options. Moxibustion is a representative external therapy used in traditional Chinese medicine. This review examines clinical studies demonstrating moxibustion's ability to improve the efficacy of radiotherapy and chemotherapy and control tumor progression. Moxibustion can prevent and treat various complications of cancer, including cancer-related or therapy-induced gastrointestinal symptoms, myelosuppression, fatigue, pain, and postoperative lymphedema. has also been shown to enhance the quality of life for cancer patients. However, very few studies have investigated the underlying mechanisms for these effects, a topic that requires systematic elucidation. Evidence has shown that moxibustion alone or combined with chemotherapy can improve survival and inhibit tumor growth in cancer-bearing animal models. The anticancer effect of moxibustion is associated with alleviating the tumor immunosuppressive and vascular microenvironments. Additionally, the therapeutic effects of moxibustion may originate from the heat and radiation produced during the combustion process on acupoints or lesions. This evidence provides a scientific basis for the clinical application of moxibustion in anticancer treatment and reducing the side effects of cancer therapies and helps promote the precise application of moxibustion in cancer treatment.

Dynamic contrast-enhanced magnetic resonance imaging features and apparent diffusion coefficient value of HER2-positive/HR-negative breast carcinoma.

Background: According to hormone receptor (HR) status, human epidermal growth factor 2 positive (HER2+) breast carcinoma can be divided into HR- and HR+, with different treatment and prognosis. We analyzed the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings, apparent diffusion coefficient (ADC) value and the combination of DCE-MRI and ADC value of HER2+/HR- breast carcinoma. Methods: Totally 259 cases (96 HR-, 163 HR+) of pathologically verified HER2+ breast carcinoma were collected. Patients underwent DCE-MRI and diffusion weighted imaging (DWI). The morphological characteristics, internal enhancement characteristics, early enhancement rate (EER), and time-signal intensity curves (TIC) were recorded, and ADC values were measured. The relationship between each feature and HER2+/HR- breast cancer was analyzed. Area under the cures (AUC) was used to compare diagnostic performance of DCE-MRI, ADC value and the combination of DCE-MRI and ADC value. Results: HER2+/HR- breast cancer presented as non-mass enhancement (NME), mass with NME, whereas HER2+/HR+ breast cancer presented as mass (P<0.001). HR- cases showed a round or oval shape with circumscribed margins, whereas HR+ cases showed an irregular mass with irregular or spiculated margins (P=0.001, P=0.028). The size of the mass, the internal enhancement characteristics, EER, and TIC did not differ significantly between the two HER2+ breast carcinomas. The ADC values for HR- and HR+ breast cancers were [1.2 (1.14, 1.33)] ×10-3 mm2/s and [1.0 (0.89, 1.11)] ×10-3 mm2/s, respectively, which were statistically significant (Z=-9.119, P<0.001). The ADC value can be used for diagnosing HER2+/HR- breast carcinoma, with the threshold value of 1.095×10-3 mm2/s [negative predictive value (NPV) of 89.8%, sensitivity of 86.5% and specificity of 70.6%]. The AUCs of ADC value, DCE-MRI, and DCE-MRI combined with ADC value were 0.839, 0.689 and 0.860, respectively. AUC of the DCE-MRI combined with ADC value was significantly higher than DCE-MRI alone (P<0.0001). Conclusions: The diagnostic performance of the DCE-MRI combined with ADC value was good in diagnosing HER2+/HR- breast cancers. MRI is an effective tool in diagnosing HER2+/HR- breast carcinoma, which will help select the clinical treatment plan and determine the prognosis.

Prognostic value of gut microbiota-derived metabolites in patients with ST-segment elevation myocardial infarction.

BACKGROUND: Studies about the prognostic role of gut microbiota-derived metabolites including phenylacetyl glutamine (PAGln), indoxyl sulfate (IS), lithocholic acid (LCA), deoxycholic acid (DCA), trimethylamine (TMA), trimethylamine N-oxide (TMAO), and its precursor trimethyllysine (TML) are limited in patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: To examine the relationship between plasma metabolite levels and major adverse cardiovascular events (MACEs), including nonfatal MI, nonfatal stroke, all-cause mortality, and heart failure in patients with STEMI. METHODS: We enrolled 1004 patients with STEMI undergoing percutaneous coronary intervention (PCI). Plasma levels of these metabolites were determined by targeted liquid chromatography/mass spectrometry. The associations of metabolite levels with MACEs were assessed with the Cox regression model and quantile g-computation. RESULTS: During a median follow-up of 360 d, 102 patients experienced MACEs. Higher plasma PAGln (hazard ratio [HR], 3.17 [95% CI: 2.05, 4.89]; P < 0.001), IS (2.67 [1.68, 4.24], P < 0.001), DCA (2.36 [1.40, 4.00], P = 0.001), TML (2.66 [1.77,3.99], P < 0.001), and TMAO (2.61 [1.70, 4.00], P < 0.001) levels were significantly associated with MACEs independent of traditional risk factors. According to quantile g-computation, the joint effect of all these metabolites was 1.86 (95% CI: 1.46, 2.27). PAGln, IS and TML had the greatest proportional positive contributions to the mixture effect. Additionally, plasma PAGln and TML combined with coronary angiography scores including the Synergy between PCI with Taxus and cardiac surgery (SYNTAX) score (area under the curve [AUC]: 0.792 vs. 0.673), Gensini score (0.794 vs. 0.647) and Balloon pump-assisted Coronary Intervention Study (BCIS-1) jeopardy score (0.774 vs. 0.573) showed better prediction performance for MACEs. CONCLUSIONS: Higher plasma PAGln, IS, DCA, TML, and TMAO levels are independently associated with MACEs suggesting that these metabolites may be useful markers for prognosis in patients with STEMI.

Significance of Gut Microbiota and Short-Chain Fatty Acids in Heart Failure.

Heart failure (HF), as the terminal stage of various heart diseases, seriously threatens an individual's life, health, and quality of life. Emerging evidence has shown that the gut microbiota comprises an important component of human physiology and metabolic homeostasis, and can directly or indirectly affect the metabolic health of the host through metabolites. Upon in-depth study of intestinal microecology, the "gut-heart axis" appears to provide a novel direction for HF research. Thus, this review primarily focuses on the relationship between the gut microbiota and its major metabolites-i.e., short-chain fatty acids (SCFAs)-and HF. It explores the mechanisms underlying HF and its effective treatment by targeting SCFAs to optimize current HF treatment and thus improve the quality of patients' lives.

Performance of abbreviated protocols versus unenhanced MRI in detecting occult breast lesions of mammography in patients with dense breasts.

To assess the diagnostic ability of abbreviated protocols of MRI (AP-MRI) compared with unenhanced MRI (UE-MRI) in mammographically occult cancers in patients with dense breast tissue. The retrospective analysis consisted of 102 patients without positive findings on mammography who received preoperative MRI full diagnostic protocols (FDP) between January 2015 and December 2018. Two breast radiologists read the UE, AP, and FDP. The interpretation times were recorded. The comparisons of the sensitivity, specificity and area under the curve of each MRI protocol, and the sensitivity of these protocols in each subgroup of different size tumors used the Chi-square test. The paired sample t-test was used for evaluating the difference of reading time of the three protocols. Among 102 women, there were 68 cancers and two benign lesions in 64 patients and 38 patients had benign or negative findings. Both readers found the sensitivity and specificity of AP and UE-MRI were similar (p > 0.05), whereas compared with FDP, UE had lower sensitivity (Reader 1/Reader 2: p = 0.023, 0.004). For different lesion size groups, one of the readers found that AP and FDP had higher sensitivities than UE-MRI for detecting the lesions ≤ 10 mm in diameter (p = 0.041, p = 0.023). Compared with FDP, the average reading time of UE-MRI and AP was remarkably reduced (p < 0.001). AP-MRI had more advantages than UE-MRI to detect mammographically occult cancers, especially for breast tumors ≤ 10 mm in diameter.

Cholesterol crystals in non-culprit plaques of STEMI patients: A 3-vessel OCT study.

BACKGROUND: Cholesterol crystals (CCs) are regular microstructures found within the necrotic core of atherosclerotic plaques and have been hypothesized to be related to plaque destabilization. We attempted to investigate the potential association between CCs and non-culprit plaque vulnerability in patients with ST-segment elevated myocardial infarction (STEMI) and study morphological features of CCs in ruptured non-culprit plaques. METHODS: A total of 261 patients with ST-segment elevation myocardial infarction who underwent 3-vessel optical coherence tomography (OCT) imaging were included. Non-culprit plaques were divided into two groups according to the presence or absence of CCs in the plaque to compare the morphological characteristics of the plaques. The differences in parameters of the non-culprit plaque CCs were explored between ruptured plaques and unruptured plaques. RESULTS: Totally, 530 non-culprit plaques (29 ruptured plaques and 501 unruptured plaques) were identified by OCT. The incidence of CCs was 21.1%. Compared with non-culprit plaques without CCs, those with CCs had a larger lipid burden. Macrophages (p < 0.001) and spotty calcification (p = 0.002) were more frequently observed in non-culprit plaques with CCs. The frequency of CCs was significantly higher (p = 0.001) and the CCs were larger (p = 0.046) and more superficial (p = 0.005) in ruptured non-culprit plaques than in unruptured non-culprit plaques. The maximum lipid arc and fibrous cap thickness were independent predictors of plaque rupture, but the presence of CCs was not. CONCLUSIONS: Non-culprit plaques with CCs have more vulnerable features. CCs are more frequently found in ruptured non-culprit plaques and larger and more superficial CCs are associated with plaque rupture.

Clinical Efficacy and Potential Mechanisms of Acupoint Stimulation Combined With Chemotherapy in Combating Cancer: A Review and Prospects.

Although chemotherapy is the first-line treatment strategy for a variety of tumors, its side effects have limited its efficacy. This review summarizes the progress on the use of acupoint stimulation to combat chemotherapy-associated side effects, including chemotherapy-induced peripheral neuropathy (CIPN), cognitive impairment (CICI), and gastrointestinal toxicity (GI), as well as myelosuppression and immunosuppression. It was found that acupoint stimulation attenuated CIPN and GI by modulating the 5-hydroxytryptamine system in dorsal root ganglia, the dorsal horn of the spinal cord, and the duodenum by reducing oxidative stress and neuroinflammation. Acupoint stimulation also alleviated GI by activating vagal activity in the nucleus tractus solitarius and promoting the secretion of gastrointestinal neuropeptide hormones. Acupoint stimulation restored both bone marrow hematopoiesis and immune function to combat cancer. In addition, the combination of acupoint stimulation and chemotherapy could inhibit tumor growth by promoting tumor cell apoptosis and the enrichment of chemotherapeutic agents in tumor tissue and by modulating the tumor immune microenvironment and normalizing the vasculature. Multiple evidence also indicates that neuroimmune regulation may be involved in the effects of acupoint stimulation. In conclusion, the evidence suggests that acupoint stimulation can alleviate the side effects of chemotherapy and can also assist chemotherapeutic agents in inhibiting tumor growth, which expands the clinical application of acupoint stimulation in cancer treatment. However, more high-quality clinical studies are needed to confirm the clinical value of acupoint stimulation.

A Concomitant Cancer Diagnosis Is Associated With Poor Cardiovascular Outcomes Among Acute Myocardial Infarction Patients.

BACKGROUND AND AIMS: With the increasing coexistence of cardiovascular disease and cancer in contemporary clinical practice, studies on the outcomes in acute myocardial infarction (AMI) patients with cancer has not been systematically investigated. This study sought to investigated the effect of coexisting cancer on the treatment and clinical outcomes among AMI patients. METHODS: We retrospectively integrated and analyzed cardiovascular data of 6,607 AMI patients between June 2016 and December 2019. Patients with cancer were compared with pair-matched cancer-naive patients. Cox proportional hazards models were constructed to compare the differences in outcomes. RESULTS: Of 6,607 patients, 2.3% (n = 150) had been diagnosed with cancer. Patients with cancer were older (70.3 ± 10.0 vs. 63.9 ± 11.5 years, P < 0.001) and had a higher burden of comorbidities. Moreover, patients with cancer tended to receive clopidogrel (52.0 vs. 40.0%, P = 0.004) rather than ticagrelor (45.6 vs. 58.2%, P = 0.003) than those without cancer. After pairwise matching, patients with cancer were less likely to undergo in-hospital percutaneous coronary intervention (61.3 vs. 70.0%, P = 0.055). And after 3-year follow-up, the cumulative incidence of cardiovascular death (14.0 vs. 8.3%; adjusted HR, 1.93; 95% CI, 1.11-3.39; P = 0.021) among patients with cancer was significantly higher than that among the matched controls, a similar pattern was observed for the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (16.0 vs. 10.3%; adjusted HR, 1.98; 95% CI, 1.21-3.26; P = 0.007). Moreover, patients with a historical cancer diagnosis within 5 years had a higher risk of cardiovascular ischemic events. CONCLUSIONS: AMI patients with a concomitant diagnosis of cancer tended to be treated with conservative therapies and were at substantially higher risk for adverse cardiovascular outcomes.

PAC1 Receptor Mediates Electroacupuncture-Induced Neuro and Immune Protection During Cisplatin Chemotherapy.

Platinum-based chemotherapy is an effective treatment used in multiple tumor treatments, but produces severe side effects including neurotoxicity, anemia, and immunosuppression, which limits its anti-tumor efficacy and increases the risk of infections. Electroacupuncture (EA) is often used to ameliorate these side effects, but its mechanism is unknown. Here, we report that EA on ST36 and SP6 prevents cisplatin-induced neurotoxicity and immunosuppression. EA induces neuroprotection, prevents pain-related neurotoxicity, preserves bone marrow (BM) hematopoiesis, and peripheral levels of leukocytes. EA activates sympathetic BM terminals to release pituitary adenylate cyclase activating polypeptide (PACAP). PACAP-receptor PAC1-antagonists abrogate the effects of EA, whereas PAC1-agonists mimic EA, prevent neurotoxicity, immunosuppression, and preserve BM hematopoiesis during cisplatin chemotherapy. Our results indicate that PAC1-agonists may provide therapeutic advantages during chemotherapy to treat patients with advanced neurotoxicity or neuropathies limiting EA efficacy.

Generation and identification of a conditional knockout allele for the PSMD11 gene in mice.

BACKGROUND: Our previous study have shown that the PSMD11 protein was an important survival factor for cancer cells except for its key role in regulation of assembly and activity of the 26S proteasome. To further investigate the role of PSMD11 in carcinogenesis, we constructed a conditional exon 5 floxed allele of PSMD11 (PSMD11flx) in mice. RESULTS: It was found that homozygous PSMD11 flx/flx mice showed normal and exhibited a normal life span and fertility, and showed roughly equivalent expression of PSMD11 in various tissues, suggesting that the floxed allele maintained the wild-type function. Cre recombinase could induce efficient knockout of the floxed PSMD11 allele both in vitro and in vivo. Mice with constitutive single allele deletion of PSMD11 derived from intercrossing between PSMD11flx/flx and CMV-Cre mice were all viable and fertile, and showed apparent growth retardation, suggesting that PSMD11 played a significant role in the development of mice pre- or postnatally. No whole-body PSMD11 deficient embryos (PSMD11-/-) were identified in E7.5-8.5 embryos in uteros, indicating that double allele knockout of PSMD11 leads to early embryonic lethality. To avoid embryonic lethality produced by whole-body PSMD11 deletion, we further developed conditional PSMD11 global knockout mice with genotype Flp;FSF-R26CAG - CreERT2/+; PSMD11 flx/flx, and demonstrated that PSMD11 could be depleted in a temporal and tissue-specific manner. Meanwhile, it was found that depletion of PSMD11 could induce massive apoptosis in MEFs. CONCLUSIONS: In summary, our data demonstrated that we have successfully generated a conditional knockout allele of PSMD11 in mice, and found that PSMD11 played a key role in early and postnatal development in mice, the PSMD11 flx/flx mice will be an invaluable tool to explore the functions of PSMD11 in development and diseases.

Diagnostic performance of minimum apparent diffusion coefficient value in differentiating the invasive breast cancer and ductal carcinoma in situ.

BACKGROUND: This study is to explore the role of the minimum apparent diffusion coefficient (ADC-min) value in the diagnosis of invasive breast cancer and ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: A total of 196 breast cancer patients with pathologically verified lesions were included. They received diffusion-weighted imaging and dynamic breast magnetic resonance imaging before the pathological confirmation. The ADC-min value and its relationship with invasive ductal carcinoma (IDC), IDC-DCIS, and DCIS were analyzed. RESULTS: Of the 196 breast cancer patients, there were 115 (58.67%) cases of IDC, 53 (27.04%) cases of IDC-DCIS, and 28 (14.29%) cases of DCIS. The mean ADC-min values for IDC, IDC-DCIS, and DCIS were (0.96 ± 0.16) × 10-3, (1.10 ± 0.13) × 10-3, and (1.24 ± 0.17) × 10-3 mm 2/s, respectively. The mean ADC-min value of IDC was significantly lower than that of IDC-DCIS and that of IDC-DCIS was significantly lower than that of DCIS (P < 0.01). The mean ADC-min value was also significantly different between invasive cancer and DCIS (P < 0.01). The mean ADC-min value can be used in the differential diagnosis of DCIS, with a cutoff point of 1.02 × 10-3 mm 2/s (sensitivity of 92.9% and specificity of 57.7%). CONCLUSIONS: The ADC-min values are significantly different among IDC, IDC-DCIS, and DCIS, with the lowest ADC-min values in IDC, followed by IDC-DCIS and DCIS. The ADC-min maybe used as a promising parameter to differentiate DCIS and invasive cancer.

Correlation between minimum apparent diffusion coefficient values and the histological grade of breast invasive ductal carcinoma.

The present study aimed to investigate the correlation between the minimum apparent diffusion coefficient (ADCmin) value and the histological grade of breast invasive ductal carcinoma (IDC). In total, 129 pathologically verified lesions that were subjected to dynamic breast magnetic resonance imaging and diffusion weighted imaging prior to biopsy were included. The ADCmin value was calculated and its correlation with the tumor histological grade was investigated. Tumors of lower grades demonstrated significantly higher ADCmin values as compared with tumors of higher grades (F=33.49; P<0.01). The mean ADCmin values for IDC of grades I, II and III were (1.14±0.11)×10-3, (0.99±0.12)×10-3 and (0.86±0.13)×10-3 mm2/sec, respectively. Statistically significant differences were detected in the mean ADCmin value between tumors of grades II and III (P<0.01), as well as between tumors of grades I and II (P<0.01). In addition, the mean ADCmin values for the less aggressive (grades I and II) and more aggressive (grade III) groups were (1.01±0.13)×10-3 and (0.86±0.13)×10-3 mm2/sec, respectively (t=5.76, P<0.01). In conclusion, these data indicated that the ADCmin value was correlated with the IDC histological grade, and lower ADCmin values were associated with a higher histological grade and more aggressiveness. Thus, the ADCmin value may be considered as a promising prognostic parameter in identifying tumor aggressiveness.

HOTAIR Is a Potential Novel Biomarker in Patients with Congenital Heart Diseases.

OBJECTIVE: To investigate the expression of HOX transcript antisense RNA (HOTAIR) in cardiac tissues and plasma of patients with congenital heart diseases (CHDs). METHODS: qRT-PCR was used to detect the expression of HOTAIR in right atrial appendage tissues of 16 patients with CHDs and 14 patients with rheumatic valvular heart diseases (RVHDs), as well as in plasma of 36 normal people and 90 patients with CHDs including 36 cases of ASD, 23 cases of VSD, and 31 cases of PDA. Besides, the proteins interacting with HOTAIR were obtained from databases. RESULTS: The HOTAIR expression in cardiac tissues of CHDs group was significantly higher than that of the RVHDs group (P < 0.01). Compared with the control group, the expression of plasma HOTAIR in the ASD group, the VSD group, and the PDA group was all remarkably upregulated (P < 0.01), whereas there was no relationship between HOTAIR and pulmonary arterial hypertension and defects size. Databases show that HOTAIR is associated with polycomb repressive complex 2 (PRC2) which contributes to heart development. CONCLUSION: The levels of HOTAIR were increased in cardiac tissues and plasma of patients with CHDs. HOTAIR is a potential novel diagnostic biomarker in patients with CHDs.

PPARα activation alleviates damage to the cytoskeleton during acute myocardial ischemia/reperfusion in rats.

The cytoskeleton serves an important role in maintaining cellular morphology and function, and it is a substrate of calpain during myocardial ischemia/reperfusion (I/R) injury (MIRI). Calpain may be activated by endoplasmic reticulum (ER) stress during MIRI. The activation of peroxisome proliferator­activated receptor α (PPARα) may inhibit ischemia/reperfusion damage by regulating stress reactions. The present study aimed to determine whether the activation of PPARα protects against MIRI­induced cytoskeletal degradation, and investigated the underlying mechanism involved. Wistar rats were pretreated with or without fenofibrate and subjected to left anterior descending coronary artery ligation for 45 min, followed by 120 min of reperfusion. Calpain activity and the expression of PPARα, desmin and ER stress parameters were evaluated. Electrocardiography was performed and cardiac function was evaluated. The ultrastructure was observed under transmission electron microscopy. I/R significantly induced damage to the cytoskeleton in cardiomyocytes and cardiac dysfunction, all of which were improved by PPARα activation. In addition, I/R increased ER stress and calpain activity, which were significantly decreased in fenofibrate­pretreated rat heart tissue. The results suggested that PPARα activation may exert a protective effect against I/R in the myocardium, at least in part via ER stress inhibition. Suppression of ER stress may be an effective therapeutic target for protecting the I/R myocardium.

Heart combined with adrenal multiple pheochromocytomas.

Pheochromocytoma is a kind of rare tumor, occurring at any site in the sympathoadrenal system. Main lesions occur within the adrenal gland; only 1%-2% occur within the chest, and most of these are located in the posterior mediastinum. Intrapericardial pheochromocytoma is extremely rare in clinic, only about 100 cases have been reported in total in both the domestic and foreignliterature since Besterman et al. first reported in 1974. It is often difficult to diagnose and locate these tumors. Hence, we present here a case of adrenal combined with heart multiple pheochromocytomas and discuss about techniques contributed to diagnosis and localization.

Histological grade of hepatocellular carcinoma predicted by quantitative diffusion-weighted imaging.

OBJECTIVE: This study is to evaluate the application of diffusion-weighted imaging (DWI) in determining the histological grade of hepatocellular carcinoma (HCC). METHODS: Totally, 27 HCC patients who received DWI examination before surgical resection were included in this study. Relationships of apparent diffusion coefficient (ADC) and signal intensity (SI) with the histological grade of HCC were analyzed. RESULTS: These 27 HCC patients could be classified into 6 well, 10 moderately, and 11 poorly differentiated HCCs. The overall ADC value for all HCC cases was (1.28 ± 0.19) × 10(-3) mm(2)/s. The ADC value for poorly differentiated HCCs was (1.16 ± 0.16) × 10(-3) mm(2)/s, significantly lower than the well [(1.43 ± 0.09) × 10(-3) mm(2)/s] and moderately [(1.34 ± 0.19) × 10(-3) mm(2)/s] differentiated HCCs. There was no significant difference in ADC between the well and moderately differentiated HCCs. The overall SI value for all the HCC cases was 75.66 ± 32.94. The mean SI value for the moderately differentiated HCC cases was 54.37 ± 28.37, significantly lower than the well (90.78 ± 27.49) and poorly (86.77 ± 31.51) differentiated HCCs. No significant difference in SI was observed between the well and poorly differentiated HCCs. Additionally, there was a significant negative correlation between the ADC value and the histological grade of HCC. CONCLUSION: The ADC value based on DWI is useful in determining the histological grade of HCC, while the SI value provides limited contribution to HCC histological grade evaluation.

Intracranial pure yolk sac tumor in the anterior third ventricle of an adult: A case report.

A 45-year-old female patient presented with symptoms of polydipsia and polyuria, menopause, headache, gait disturbance and deteriorated mental state. Brain magnetic resonance imaging (MRI) showed an irregular mass in the anterior third ventricle. The tumor was excised using a transfrontal approach from the anterior section of the third ventricle. The histological diagnosis was of an intracranial pure yolk sac tumor. The patient underwent radiotherapy and suffered no tumor recurrence one year after the surgery. Overall, when heterogeneous enhancement and an irregular mass with surrounding invasion and ventricular dilation are observed in the anterior third ventricle of an adult, a yolk sac tumor should be considered, and MRI may aid the differential diagnosis. A combination of surgical resection and radiotherapy is recommended for the yolk sac tumor.

Adjacent vessel sign and breast imaging reporting and data system are valuable for diagnosis of benign and malignant breast lesions.

The purpose of this study is to investigate whether an adjacent vessel sign (AVS) observed on the maximum intensity projections (MIPs) from the subtracted images can help distinguish between malignant and benign breast lesions and to test whether the combination of breast imaging reporting and data system (BI-RADS) category and AVS can increase the specificity and diagnostic accuracy of breast magnetic resonance imaging (MRI). The study included 63 histologically verified lesions which underwent dynamic breast MRI before biopsy. All magnetic resonance (MR) images were evaluated by two radiologists in consensus, who were unaware of the histopathological outcome. The MR images of all cases were analyzed according to BI-RADS-MRI assessment category. Levels of suspicion were reported as categories of I-V. The presence of vessels either entering the enhancing lesion or in contact with the lesion edge on MIP images was considered as the presence of AVS. Final analysis of 63 masses revealed 41 malignant lesions (65.1%) and 22 benign lesions (34.9%). Thirty seven out of 41 malignant lesions and 3 out of 22 benign lesions were associated with adjacent vessel, with highly significant difference between benign and malignant lesions (P < 0.001), especially for lesions smaller than 2.0 cm. The corresponding specificity, sensitivity and accuracy of contrast-enhanced 3.0-T breast were 86.4%, 82.9% and 84.1%, respectively. Based on BI-RADS-MRI category, the specificity, sensitivity and accuracy of breast MRI were 54.5%, 100% and 84.1%, respectively. After combining BI-RADS category and AVS, the specificity, sensitivity and accuracy of breast MRI were 90.9%, 82.9% and 85.7%, respectively. AVS can help differentiate malignant from benign breast lesions, especially for the lesions smaller than 2.0 cm. The combination of BI-RADS category and AVS can increase the specificity and the diagnostic accuracy of breast MRI.