Application of Contrast-enhanced Ultrasound and Bosniak Classification to the Diagnosis of Cystic Renal Masses.

BACKGROUND: The Bosniak classification system based on contrast-enhanced computed tomography (CECT) is commonly used for the differential diagnosis of cystic renal masses. Contrastenhanced ultrasound (CEUS) is a relatively novel technique, which has gradually played an important role in the diagnosis of cystic renal cell carcinoma (CRCC) due to its safety and lowest price. OBJECTIVE: The aim of the study is to investigate the application value of CEUS and Bosniak classification into the diagnosis of cystic renal masses. METHODS: 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional ultrasound (US), CEUS and CECT from subjects confirmed by surgical pathology were retrospectively analyzed. The Bosniak classification system of cystic renal masses was implemented using CEUS and CECT, and the diagnostic ability was compared. RESULTS: For the 32 cystic masses, postoperative pathology confirmed 11 cases of multilocular CRCC, 15 cases of clear cell carcinoma with hemorrhage, necrosis and cystic degeneration, 5 cases of renal cysts, and 1 case of renal tuberculosis. The Bosniak classification based on CEUS was higher than that based on CECT, and the difference was statistically significant (P = .024). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were comparable to CECT. There was no significant difference observed in the diagnosis of CRCC (P >.05). CONCLUSION: CEUS combined with Bosniak classification greatly improves the diagnosis of CRCC. CEUS shows a comparable diagnostic ability to CECT. In daily clinical routine, patients who require multiple examinations and present contraindications for CECT can particularly benefit from CEUS.

Contrast-enhanced Ultrasound for Diagnosis of Renal Cystic Mass.

BACKGROUND: Cystic Renal Cell Carcinoma (CRCC) is often difficult to differentiate from complex cysts with sonographic manifestations of renal carcinoma. Contrast-Enhanced Ultrasound (CEUS) is a new technology, and its clinical utility in the diagnosis of renal cystic mass has not been established. OBJECTIVE: The objective of this study is to analyze the characteristics of CEUS of renal cystic masses and to explore the clinical significance and value of CEUS in the diagnosis of CRCC. METHODS: This study was a retrospective study. A total of 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional Ultrasound (US) and CEUS were confirmed via surgical pathology. Routine US was used to observe the location, shape, size, boundary, cyst wall, internal echo, and blood supply of each cystic mass. CEUS observed contrast enhancement of the cyst wall, cystic septa, and solid nodules of cystic masses. RESULTS: There were 26 cases of CRCC, 5 cases of renal cysts, and 1 case of renal tuberculosis. The enhancement pattern, degree of enhancement, and pseudocapsular sign by CEUS in benign and malignant masses had statistically significant differences (P<.05). In the diagnosis of CRCC, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 92.3%, 83.3%, 90.6%, 96.0%, and 71.4% for CEUS; 57.6%, 66.7%, 59.3%, 88.2%, and 26.7% for conventional US, respectively. CEUS had a higher sensitivity and accuracy than the conventional US (P<.05), although the diagnostic specificity, positive predictive value and negative predictive value of the two methods were not significantly different (P>.05). CONCLUSION: CEUS is more accurate in the diagnosis of renal cystic masses, and it can be used as an effective imaging method.

SPARC promotes insulin secretion through down-regulation of RGS4 protein in pancreatic ß cells.

SPARC-deficient mice have been shown to exhibit impaired glucose tolerance and insulin secretion, but the underlying mechanism remains unknown. Here, we showed that SPARC enhanced the promoting effect of Muscarinic receptor agonist oxotremorine-M on insulin secretion in cultured mouse islets. Overexpression of SPARC down-regulated RGS4, a negative regulator of ß-cell M3 muscarinic receptors. Conversely, knockdown of SPARC up-regulated RGS4 in Min6 cells. RGS4 was up-regulated in islets from sparc -/- mice, which correlated with decreased glucose-stimulated insulin secretion (GSIS). Furthermore, inhibition of RGS4 restored GSIS in the islets from sparc -/- mice, and knockdown of RGS4 partially decreased the promoting effect of SPARC on oxotremorine-M-stimulated insulin secretion. Phosphoinositide 3-kinase (PI3K) inhibitor LY-294002 abolished SPARC-induced down-regulation of RGS4. Taken together, our data revealed that SPARC promoted GSIS by inhibiting RGS4 in pancreatic ß cells.

Mental health status after living donor hepatectomy.

Donor safety and preservation of donor health after living liver donation are of paramount importance. In addition, the preoperative mental state of a donor is an important factor in determining the psychological impact of donor hepatectomy. Thus, we aimed to explore the mental health status of living liver donors after hepatectomy. We enrolled 60 donors who were scheduled to undergo living donor hepatectomy during the period January 2014 to March 2015 at a single medical center. Mental health status was measured before and 3 months after surgery using 3 self-report questionnaires, namely the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms, the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to measure quality of life, and the Chinese Health Questionnaire (CHQ) to screen for minor psychiatric disorders. A comparison of the pre- and postdonation CES-D scores revealed a significant reduction in depressive symptoms after surgery (P = .031). There were significant improvements in the physical health domain (P = .031), the psychological health domain (P = .005), the social relationships domain (P = .005), and the environmental health domain (P = .010) of the WHOQOL-BREF. There were no significant changes in CHQ scores after donor hepatectomy (P = .136). All donors reported that they would donate again if required. Approximately one-third (33.3%) of donors experienced more pain than they had anticipated in the immediate postoperative period, and 20.0% of donors had complications after donor hepatectomy. Donor mental health status tended to improve as donors regained physical function during the 1st 3 months of recovery. Long-term monitoring of living donors' mental health is needed to minimize the adverse psychological outcomes of living liver donation.

Development and validation of a new performance-based measurement of instrumental activities of daily living in Taiwan.

BACKGROUND: The performance-based instrumental activities of daily living (IADL) measurement is thought to improve the validity and reliability of conventional tools that rely on proxy reports. The aims of this study were to develop and validate a performance-based measurement of IADL for use in elderly patients with cognitive impairment in Taiwan and other Chinese-speaking communities. METHODS: Referring to current versions of performance-based IADL, we developed the new Taiwan Performance-Based IADL (TPIADL) measurement to minimize literacy dependency and render it compatible with local culture. Participants performed tasks, including finding a telephone number, calculating the correct amount of change, reading the ingredients on a tin of food, finding food items on a shelf, and reading instructions on a medicine container. The internal consistency and convergent and criteria validity of the TPIADL were examined. RESULTS: Altogether, 117 elderly subjects were invited to participate in this study, including 39 patients with dementia due to Alzheimer's disease, 29 with amnestic mild cognitive impairment, and 49 without cognitive impairment. The internal consistency of the TPIADL was 0.82. The TPIADL scores were significantly correlated with the Lawton Instrumental Activities of Daily Living Scale (r = 0.76, P < 0.001). The area under the relative operating characteristic curve was 0.90 (95% confidence interval = 0.84-0.97) to differentiate dementia due to Alzheimer's disease and others. The optimal cut-off point for the TPIADL was 6/7, which gives a sensitivity of 84.6% and a specificity of 75.6%. CONCLUSIONS: The TPIADL is a validated instrument for the measurement of IADL in elderly subjects. It might replace conventional assessment as a valid and easily administered measurement.

Association of Gly972Arg variant of insulin receptor subtrate-1 and Gly1057Asp variant of insulin receptor subtrate-2 with polycystic ovary syndrome in the Chinese population.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrinologic disease in women. In the present study, we examined the relationship of the IRS-1 Gly972Arg and IRS-2 Gly1057Asp polymorphisms to PCOS and phenotypic features of PCOS in a Chinese population from Taiwan. MATERIALS AND METHODS: A total of three hundred and forty genetically unrelated women with age from 18 to 45 years, including two hundred and forty-eight PCOS patients and ninety-two control subjects, were recruited. The hormone and biochemical measurements were evaluated for each woman. Genotyping of the IRS-1 gene Gly972Arg variant and IRS-2 gene Gly1057Asp variant were performed by using direct sequencing. RESULTS: We found significant difference in the genotypic distribution of IRS-2 gene Gly1057Asp between the PCOS group and the control group (p = 0.004). The carriers of homozygous IRS-2 Asp had an increased risk of PCOS compared with the carriers of Gly/Gly (OR 4.08, 95% C.I. 1.60-10.41, p = 0.003). No significant difference in genotype frequencies of IRS-1 Gly972Arg was observed between two groups. We further investigated the effect of interaction of IRS-1 Gly972Arg and IRS-2 Gly1057Asp on the risk of PCOS and found that women carried IRS-1 Gly/Arg or IRS-2 Asp/Asp or carried both IRS-1 Gly/Arg and IRS-2 Asp/Asp had a much higher risk of PCOS compared with their counterpart, respectively (OR 2.49, 95% C.I. 1.16-5.37, p = 0.019; OR 11.87, 95% C.I. 1.21-116.84, p = 0.034). We further found, the non-obese PCOS patients carried significantly higher frequency of IRS-2 Asp/Asp as compared with the control group (p = 0.004). A significant effect of interaction of carrying both IRS-1 Gly/Arg and IRS-2 Asp/Asp was also observed in the non-obese PCOS patients (p = 0.003), but not in the obese PCOS patients. CONCLUSIONS: In this study, we found significant association of the variant of IRS-2 gene as well as the interaction of IRS-1 and IRS-2 genes with PCOS, especially in non-obese women. Women with IRS-2 homozygous Asp variant may be considered as a risk factor for PCOS that needs early detection to prevent further complication in the Chinese population from Taiwan.

Transcription factor Ets1 regulates expression of thioredoxin-interacting protein and inhibits insulin secretion in pancreatic ß-cells.

Long-term activation of extracellular-regulated kinase (ERK1/2) pathway has been shown to cause glucotoxicity and inhibit insulin gene expression in ß-cells. Transcription factor Ets1 is activated by ERK1/2-mediated phosphorylation at the Thr38 residue. We hypothesize that Ets1 plays an important role in mediating ERK1/2 induced glucotoxicity in ß-cells. We determined the role of Ets1 in Min6 cells and isolated mouse islets using overexpression and siRNA mediated knockdown of Ets1. The results show that Ets1 was localized in insulin-staining positive cells but not in glucagon-staining positive cells. Overexpression of Ets1 reduced glucose-stimulated insulin secretion in primary mouse islets. Overexpression of Ets1 in Min6 ß-cells and mouse islets increased expression of thioredoxin-interacting protein (TXNIP). Conversely, knockdown of Ets1 by siRNA reduced expression of TXNIP in Min6 cells. Ets1 was associated with the txnip promoter in min6 cells and transfection of 293 cells with Ets1 and p300 synergistically increased txnip promoter reporter activity. Moreover, overexpression of Ets1 inhibited Min6 cell proliferation. Our results suggest that Ets1, by promoting TXNIP expression, negatively regulates ß-cell function. Thus, over-activation of Ets1 may contribute to diet-induced ß-cell dysfunction.

Vitamin D receptor 1a promotor -1521 G/C and -1012 A/G polymorphisms in polycystic ovary syndrome.

OBJECTIVE: The aim of this case-control study was to investigate whether the vitamin D receptor (VDR) 1a promoter gene polymorphisms are associated with susceptibility to polycystic ovary syndrome (PCOS). METHODS: Women with PCOS and a control group, all aged 18-45 years, were enrolled. Genotypes of two functional single nucleotide polymorphisms (SNPs), the 1521 bp (G/C) and 1012 bp (A/G), located on the 1a promoter of the VDR gene were determined by using direct sequencing. Serum 25-hydroxyvitamin D levels were measured by ELISA. RESULTS: Two functional SNPs in the 1a promoter region of the VDR gene were in complete linkage disequilibrium. The genotype distributions of these two polymorphisms in the PCOS group were not significantly different from those of the control group. Further subgroup analyses according to body mass index also revealed no significant differences in the genotype distribution in the PCOS group. Significantly lower serum 25-hydroxyvitamin D levels were observed in the heterozygous 1521CG/1012GA haplotype of both groups. Metformin treatment was only effective to increase serum 25-hydroxyvitamin D levels in PCOS patients carrying the homozygous 1521G/1012A haplotype. CONCLUSION: These results suggest that the VDR 1a promoter polymorphisms may not be associated with the risk for PCOS, but are associated with serum 25-hydroxyvitamin D levels. Metformin treatment will be beneficial to PCOS patients without the VDR 1a promoter variant in Taiwanese population.

Interleukin-6 as an early chronic inflammatory marker in polycystic ovary syndrome with insulin receptor substrate-2 polymorphism.

PROBLEM: Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder. This study was to evaluate whether insulin receptor substrate (IRS)-2 Gly1057Asp polymorphism influences chronic inflammatory parameters in Taiwanese patients with PCOS. METHOD OF STUDY: DNA was extracted from whole blood samples for genotyping and detection of IRS-2 Gly1057Asp polymorphism in 129 PCOS women and 109 control women. Ninety-seven PCOS women accepted metformin treatment for 3 months, and low-grade chronic inflammatory markers were assessed. RESULTS: The levels of IL-6 were significantly elevated in PCOS women compared with normal women. Among allelic variant of IRS-2, concentrations of IL-6 were greater in IRS-2 homozygous Asp population. Treatment with metformin significantly reduced IL-6, especially in PCOS patients with IRS-2 homozygous Asp variant. CONCLUSION: The results showed that IL-6 may be an early low-grade chronic inflammatory marker among PCOS patients with IRS-2 polymorphism in Taiwanese population. This pharmacologic study in IRS-2 polymorphism may provide more information for preventing long-term complications in PCOS.

Defining hirsutism in Chinese women: a cross-sectional study.

OBJECTIVE: To determine the normative cut-off score that defines hirsutism among Chinese women, and the effect of age, menstrual irregularities, and polycystic ovaries on the same. DESIGN: Cross-sectional, population-based study. SETTING: A multistage systematic cluster random sampling among 16 communities from two rural and two city regions. PATIENT(S): A representative sample of 2,988 women aged 20-45 years from the general population of Southern China. INTERVENTION(S): Subjects underwent physical and ultrasound evaluations. MAIN OUTCOME MEASURE(S): Terminal hair growth was assessed using the modified Ferriman-Gallwey (mFG) scoring system. RESULT(S): An mFG score ≥5 was observed in 10% and a score of ≥2 in 25% of the subjects. Cluster analysis identified an mFG score of 5 as the cut-off value that defines abnormal terminal facial and body hair growth in a male pattern (i.e., hirsutism) in the total population; scores of 6, 5, and 4 for women aged 20-25, 26-30, and >30 years, respectively. Defined by these cut-off values, the prevalence of hirsutism in our total population was 10.5%; and decreased with increasing age: 14.4%, 10.7%, 7.9%, 3.6%, and 1.5%, respectively, in women aged 20-25, 26-30, 31-35, 36-40, and 41-45 years. Furthermore, the incidence of acne, menses irregularities, polycystic ovaries, and acanthosis nigricans were significantly increased among the hirsute women. CONCLUSION(S): An mFG score of 5 or greater indicates hair growth above the norm among women in the general Southern Chinese population, a cut-off value that decreases with increasing age.

Associations between substance use and body mass index: moderating effects of sociodemographic characteristics among Taiwanese adolescents.

The aim of this study was to analyze the association between substance use and body mass index (BMI) among adolescents in Southern Taiwan. A total of 10,259 adolescent students aged 11-19 years were selected by stratified random sampling for proportional representation of districts, schools and grades in Southern Taiwan, and completed the questionnaires. The body weight, body height, experience of substance use and sociodemographic characteristics including sex, age, residential background and paternal/maternal educational levels were collected. The association between substance use and BMI, and the moderating effects of sociodemographic characteristics were examined. After adjusting for sociodemographic characteristics, BMI was higher for adolescents who smoke cigarettes or drink alcohol than for those who do not regularly smoke or drink. Chewing betel nuts and using illicit drugs were not significantly associated with BMI. Paternal education level had a moderating effect on the association between smoking and BMI. Smoking, alcohol drinking, and low paternal education level were associated with higher BMI among adolescents. Thus, healthcare professionals should pay more attention to the weight-related problems among these adolescents.

Synthesis of a novel glycoconjugated chitosan and preparation of its derived nanoparticles for targeting HepG2 cells.

In the study, a novel chitosan (CS) derivative conjugated with multiple galactose residues in an antennary fashion (Gal-m-CS) was synthesized. A galactosylated CS (Gal-CS) was also prepared by directly coupling lactobionic acid on CS. Using an iontropic gelation method, CS and the synthesized Gal-CS and Gal-m-CS were used to prepare nanoparticles (CS, Gal-CS, and Gal-m-CS NPs) for targeting hepatoma cells. TEM examinations showed that the morphology of all three types of NPs was spherical in shape. No aggregation or precipitation of NPs in an aqueous environment was observed during storage for all studied groups, as a result of the electrostatic repulsion between the positively charged NPs. Little fluorescence was observed in HepG2 cells after incubation with the FITC-labeled CS NPs. The intensity of fluorescence observed in HepG2 cells incubated with the Gal-m-CS NPs was stronger than that incubated with the Gal-CS NPs. These results indicated that the prepared Gal-m-CS NPs had the highest specific interaction with HepG2 cells among all studied groups, via the ligand-receptor-mediated recognition.

Effects of laparoscopic ovarian drilling on young adult women with polycystic ovarian syndrome.

STUDY OBJECTIVE: To assess changes in serum hormone levels and ovarian stromal blood flow after laparoscopic ovarian drilling (LOD) in young adult women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, nonrandomized study (Canadian Task Force classification II-1). SETTING: Tertiary care, major teaching hospitals. PATIENTS: Anovulatory young women with PCOS who were resistant to clomiphene citrate. INTERVENTION: Laparoscopic ovarian drilling. MEASUREMENTS AND MAIN RESULTS: To evaluate the endocrinological effects of LOD, serum leptin, insulin-like growth factor-1, estrone (E1), and estradiol were measured before and after ovarian drilling in the early follicular phase. Three-dimensional transabdominal power Doppler examinations were performed to determine the effects of LOD. Serum leptin was correlated with body mass index (BMI) before LOD. Levels of BMI, fasting blood sugar, and leptin were higher and LH, LH/FSH, and the sugar/insulin ratio were lower in the obese group. There were significant decreases in the free androgen index, and total testosterone, luteinizing hormone (LH), and LH/follicle-stimulating hormone (FSH) levels, and a significant increase in sex hormonebinding globulin (SHBG) concentration in the 3 months after the operation. The vascularization index and vascularization flow index of the intraovarian stroma significantly decreased after treatment. Reversed correlations between leptin and LH, LH/FSH, E1, thyroid-stimulating hormone, and SHBG were noted 3 months after the operation compared with levels obtained before the operation. CONCLUSIONS: Treatment of young adult women with PCOS using LOD did not influence leptin levels but changed the ovarian stromal blood flow dynamics during short-term follow-up. The surgical procedure may be beneficial both to endocrine profiles and to intraovarian stromal flow in patients with PCOS.