Electrochemical Sensor for the Detection and Accurate Early Diagnosis of Ovarian Cancer.

Ovarian cancer (OC) has the highest mortality rate among malignant tumors, primarily because it is difficult to diagnose early. Exosomes, a type of extracellular vesicle rich in parental information, have garnered significant attention in the field of cancer diagnosis and treatment. They play an important regulatory role in the occurrence, development, and metastasis of OC. Consequently, exosomes have emerged as noninvasive biomarkers for early cancer detection. Therefore, identifying cancer-derived exosomes may offer a novel biomarker for the early detection of OC. In this study, we developed a metal-organic frameworks assembled "double hook"-type aptamer electrochemical sensor, which enables accurate early diagnosis of OC. Under optimal experimental conditions, electrochemical impedance spectroscopy technology demonstrated a good linear relationship within the concentration range of 31-3.1 × 106 particles per microliter, with a detection limit as low as 12 particles per microliter. The universal exosome detection platform is constructed, and this platform can not only differentiate between high-grade serous ovarian cancer (HGSOC) patients and healthy individuals but also distinguish between HGSOC patients and nonhigh-grade serous OC (non-HGSOC). Consequently, it provides a novel strategy for the early diagnosis of OC and holds great significance in clinical differential diagnosis.

Activated allograft combined with induced menbrane technique for the reconstruction of infected segmental bone defects.

This study was desinged to evaluate the efficacy and safety of activated allograft combined with the induced membrane technique for reconstruction of infected segment bone defects of lower limbs. A retrospective analysis was conducted on 19 patients from May 2015 to February 2017. After debridements, the bone defects were filled with antibiotic bone cement to form the induced membrane. Autologous mesenchymal stem cells were seeded onto allografts to construct activated allograft, which was implanted into the induced membrane after infection was controlled. The clinical efficacy and complications were observed. 19 patients with 20 infected segment bone defect were evaluated. The average deficit size was 11.08 (4-17) cm in length. After a mean follow-up of 71.84 (61-82) months, bone union was achieved in 16 patients (17 sites), resulting in a final union rate of 84.21% (16/19 patients). The average bone union time was 10.18 (5-28) months. There were 2 patients with recurrence of infection, 3 patients with graft absorption, and 1 patient with malunion due to implant breakage. There were no graft-related complications. This study provides clinical significance for the treatment of patients with insufficient autologous bone.

Continuous and low-carbon production of biomass flash graphene.

Flash Joule heating (FJH) is an emerging and profitable technology for converting inexhaustible biomass into flash graphene (FG). However, it is challenging to produce biomass FG continuously due to the lack of an integrated device. Furthermore, the high-carbon footprint induced by both excessive energy allocation for massive pyrolytic volatiles release and carbon black utilization in alternating current-FJH (AC-FJH) reaction exacerbates this challenge. Here, we create an integrated automatic system with energy requirement-oriented allocation to achieve continuous biomass FG production with a much lower carbon footprint. The programmable logic controller flexibly coordinated the FJH modular components to realize the turnover of biomass FG production. Furthermore, we propose pyrolysis-FJH nexus to achieve biomass FG production. Initially, we utilize pyrolysis to release biomass pyrolytic volatiles, and subsequently carry out the FJH reaction to focus on optimizing the FG structure. Importantly, biochar with appropriate resistance is self-sufficient to initiate the FJH reaction. Accordingly, the medium-temperature biochar-based FG production without carbon black utilization exhibited low carbon emission (1.9 g CO2-eq g-1 graphene), equivalent to a reduction of up to ~86.1% compared to biomass-based FG production. Undoubtedly, this integrated automatic system assisted by pyrolysis-FJH nexus can facilitate biomass FG into a broad spectrum of applications.

Development of a Multi-Parametric ultrasonography nomogram for prediction of invasiveness in ductal carcinoma in situ.

OBJECTIVE: To investigate the independent risk variables associated with the potential invasiveness of ductal carcinoma in situ (DCIS) on multi-parametric ultrasonography, and further construct a nomogram for risk assessment. METHODS: Consecutive patients from January 2017 to December 2022 who were suspected of having ductal carcinoma in situ (DCIS) based on magnetic resonance imaging or mammography were prospectively enrolled. Histopathological findings after surgical resection served as the gold standard. Grayscale ultrasound, Doppler ultrasound, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) examinations were preoperative performed. Binary logistic regression was used for multifactorial analysis to identify independent risk factors from multi-parametric ultrasonography. The correlation between independent risk factors and pathological prognostic markers was analyzed. The predictive efficacy of DCIS associated with invasiveness was assessed by logistic analysis, and a nomogram was established. RESULTS: A total of 250 DCIS lesions were enrolled from 249 patients, comprising 85 pure DCIS and 165 DCIS with invasion (DCIS-IDC), of which 41 exhibited micro-invasion. The multivariate analysis identified independent risk factors for DCIS with invasion on multi-parametric ultrasonography, including image size (>2cm), Doppler ultrasound RI (≥0.72), SWE's Emax (≥66.4 kPa), hyper-enhancement, centripetal enhancement, increased surrounding vessel, and no contrast agent retention on CEUS. These factors correlated with histological grade, Ki-67, and human epidermal growth factor receptor 2 (HER2) (P < 0.1). The multi-parametric ultrasound approach demonstrated good predictive performance (sensitivity 89.7 %, specificity 73.8 %, AUC 0.903), surpassing single US modality or combinations with SWE or CEUS modalities. Utilizing these factors, a predictive nomogram achieved a respectable performance (AUC of 0.889) for predicting DCIS with invasion. Additionally, a separate nomogram for predicting DCIS with micro-invasion, incorporating independent risk factors such as RI (≥0.72), SWE's Emax (≥65.2 kPa), and centripetal enhancement, demonstrated an AUC of 0.867. CONCLUSION: Multi-parametric ultrasonography demonstrates good discriminatory ability in predicting both DCIS with invasion and micro-invasion through the analysis of lesion morphology, stiffness, neovascular architecture, and perfusion. The use of a nomogram based on ultrasonographic images offers an intuitive and effective method for assessing the risk of invasion in DCIS. Although the nomogram is not currently considered a clinically applicable diagnostic tool due to its AUC being below the threshold of 0.9, further research and development are anticipated to yield positive outcomes and enhance its viability for clinical utilization.

Groundwater pollution risk, health effects and sustainable management of halocarbons in typical industrial parks.

As important chemical raw materials and organic solvents, halogenated hydrocarbons not only play an important role in economic development, but are also the main source of environmental pollution. This study proposed an improved groundwater risk assessment model system, aimed at identifying and treating contaminants at leak sites. Groundwater ubiquity score (GUS) was used to evaluate the leachability of organic pollutants. The entropy-weighted water quality index (EWQI) method was used to assess the comprehensive quality of groundwater at the site. An improved groundwater health risk assessment model was constructed to analyze the health risks of groundwater. The sources of organic pollutants were identified based on the positive matrix factorization (PMF) model. Self-organizing mapping (SOM) and the K-means algorithm were integrated to classify and manage pollution source areas. The results showed that groundwater in the study area was strongly affected by human activities. The pollution source was located in a factory near S05. Different organic pollutants were highly leachable and had high potential to contaminate surrounding groundwater. 1,2-dichloropropane and 1,2,3-trichloropropane caused the largest range of contamination. The groundwater pollution index in the study area was high, and 72% of the monitoring points were non-drinkable. Both the carcinogenic and non-carcinogenic indexes of groundwater far exceeded the international standard limits and had a great impact on human health. 1,2,3-trichloropropane and 1,2-dichloropropane were major non-carcinogenic risk factors. The leakage of pollutants and pesticide solvents were the main causes of groundwater pollution. Cluster areas III and II were areas with significant pollution impacts and needed to be monitored intensively. Most areas were cluster I, with relatively low risk. This study can provide technical support for groundwater pollution risk assessment and management in similar industrial parks.

Predictive value of contrast-enhanced ultrasonography and ultrasound elastography for management of BI-RADS category 4 nonpalpable breast masses.

PURPOSE: The objective of this study was to investigate the independent risk factors and associated predictive values of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and strain elastography (SE) for high-risk lesions (HRL) and malignant tumors (MT) among nonpalpable breast masses classified as BI-RADS category 4 on conventional ultrasound. METHODS: This prospective study involved consecutively admitted patients with breast tumors from January 2018, aiming to explore the management of BI-RADS category 4 breast tumors using CEUS and elastography. We conducted a retrospective review of patient data, focusing on those with a history of a nonpalpable mass as the primary complaint. Pathologic findings after surgical resection served as the gold standard. The CEUS arterial-phase indices were analyzed using contrast agent arrival-time parametric imaging processing mode, while quantitative and qualitative indices were examined on ES images. Independent risk factors were identified through binary logistic regression multifactorial analysis. The predictive efficacy of different modalities was compared using a receiver operating characteristics curve. Subsequently, a nomogram for predicting the risk of HRL/MT was established based on a multifactorial logistic regression model. RESULTS: A total of 146 breast masses from 146 patients were included, comprising 80 benign tumors, 12 HRLs, and 54 MTs based on the final pathology. There was no significant difference in pathologic size between the benign and HRL/MT groups [8.00(6.25,10.00) vs. 9.00(6.00,10.00), P = 0.506]. The diagnostic efficacy of US plus CEUS exceeded that of US plus SWE/SE for BI-RADS 4 nonpalpable masses, with an AUC of 0.954 compared to 0.798/0.741 (P ï¼œ 0.001). Further stratified analysis revealed a more pronounced improvement for reclassification of BI-RADS 4a masses (AUC: 0.943 vs. 0.762/0.675, P ï¼œ 0.001) than BI-RADS 4b (AUC:0.950 vs. 0.885/0.796, P＞0.05) with the assistance of CEUS than SWE/SE. Employing downgrade CEUS strategies resulted in negative predictive values ranging from 95.2 % to 100.0 % for BI-RADS 4a and 4b masses. Conversely, using upgrade nomogram strategies, which included the independent predictive risk factors of irregular enhanced shape, poor defined enhanced margin, earlier enhanced time, increased surrounding vessels, and presence of contrast agent retention, the diagnostic performance achieved an AUC of 0.947 with good calibration. CONCLUSION: After investigating the potential of CEUS and ES in improving risk assessment and diagnostic accuracy for nonpalpable BI-RADS category 4 breast masses, it is evident that CEUS has a more significant impact on enhancing classification compared to ES, particularly for BI-RADS 4a subgroup masses. This finding suggests that CEUS may offer greater benefits in improving risk assessment and diagnostic accuracy for this specific subgroup of breast masses.

The correlation between tumor radiological features and spread through air spaces in peripheral stage IA lung adenocarcinoma: a propensity score-matched analysis.

BACKGROUND: The consolidation tumor ratio (CTR) is a predictor of invasiveness in peripheral T1N0M0 lung adenocarcinoma. However, its association with spread through air spaces (STAS) remains largely unexplored. We aimed to explore the correlation between the CTR of primary tumors and STAS in peripheral T1N0M0 lung adenocarcinoma. METHODS: We collected data from patients who underwent surgery for malignant lung neoplasms between January and November 2022. Univariate and multivariate analyses following propensity-score matching with sex, age, BMI, were performed to identify the independent risk factors for STAS. The incidence of STAS was compared based on pulmonary nodule type. A smooth fitting curve between CTR and STAS was produced by the generalized additive model (GAM) and a multiple regression model was established using CTR and STAS to determine the dose-response relationship and calculate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: 17 (14.5%) were diagnosed with STAS. The univariate analysis demonstrated that the history of the diabetes, size of solid components, spiculation, pleural indentation, pulmonary nodule type, consolidation/tumor ratio of the primary tumor were statistically significant between the STAS-positive and STAS-negative groups following propensity-score matching(p = 0.047, 0.049, 0.030, 0.006, 0.026, and < 0.001, respectively), and multivariate analysis showed that the pleural indentation was independent risk factors for STAS (with p-value and 95% CI of 0.043, (8.543-68.222)). Moreover, the incidence of STAS in the partially solid nodule was significantly different from that in the solid nodule and ground-glass nodule (Pearson Chi-Square = 7.49, p = 0.024). Finally, the smooth fitting curve showed that CTR tended to be linearly associated with STAS by GAM, and the multivariate regression model based on CTR showed an OR value of 1.24 and a p-value of 0.015. CONCLUSIONS: In peripheral stage IA lung adenocarcinoma, the risk of STAS was increased with the solid component of the primary tumor. The pleural indentation of the primary tumor could be used as a predictor in evaluating the risk of the STAS.

Impact of bronchoscopic thermal vapor ablation on lung volume reduction in patients with emphysema: a meta-analysis.

BACKGROUND: Bronchoscopic lung volume reduction (LVR) could significantly improve pulmonary function and quality of life in patients with emphysema. We aimed to assess the efficacy and safety of bronchoscopic thermal vapor ablation (BTVA) on LVR in patients with emphysema at different stage. METHODS: A systematic search of database including PubMed, Embase and Cochrane library was conducted to determine all the studies about bronchoscopic thermal vapor ablation published through Dec 1, 2022. Related searching terms were "lung volume reduction", "bronchoscopic thermal vapor ablation", "bronchial thermal vapor ablation" "BTVA" and "emphysema", "efficacy" and"safety". We used standardized mean difference (SMD) to analyze the summary estimates for BTVA therapy. RESULTS: We retrieved 30 records through database search, and 4 trials were selected for meta-analysis, including 112 patients with emphysema. Meta-analysis of the pooled effect showed that levels of forced expiratory volume in 1 s (FEV1), residual volume (RV), total lung capacity (TLC), 6-min walk distance (6MWD) and St George's Respiratory Questionnaire (SGRQ) were significantly improved in patients with emphysema following BTVA treatment between 6 months vs. baseline. Additionally, no significant changes in FEV1, RV, TLC and SGRQ occurred from 3 to 6 months of follow-up except for 6MWD. The magnitude of benefit was higher at 3 months compared to 6 months. The most common complications at 6 months were treatment-related chronic obstructive pulmonary disease (COPD) exacerbations (RR: 12.49; 95% CI: 3.06 to 50.99; p < 0.001) and pneumonia (RR: 9.49; 95% CI: 2.27 to 39.69; p < 0.001). CONCLUSIONS: Our meta-analysis provided clinically relevant information about the impact and safety of BTVA on predominantly upper lobe emphysema. Particularly, short-term significant improvement of lung function and quality of life occurred especially within the initial 3 months. Further large-scale, well-designed long-term interventional investigations are needed to clarify this issue.

[Mechanism of Proliferation and Apoptosis of Acute Promyelocytic Leukemia Cell Line NB4 Induced by TPA].

OBJECTIVE: To investigate the effect of phorbol-12-myristate-13-ace-tate (TPA) on the proliferation and apoptosis of acute promyelocytic leukemia cell line NB4 and its molecular mechanism. METHODS: The effect of different concentrations of TPA on the proliferation of NB4 cells at different time points was detected by CCK-8 assay. The morphological changes of NB4 cells were observed by Wright-Giemsa staining. The cell cycle and apoptosis of NB4 cells after TPA treatment were detected by flow cytometry. The mRNA expressions of NB4 cells after TPA treatment were analyzed by high-throughput microarray analysis and real-time quantitative PCR. Western blot was used to detect the protein expression of CDKN1A, CDKN1B, CCND1, MYC, Bax, Bcl-2, c-Caspase 3, c-Caspase 9, PIK3R6, AKT and p-AKT. RESULTS: Compared with the control group, TPA could inhibit the proliferation of NB4 cells, induce the cells to become mature granulocyte-monocyte differentiation, and also induce cell G1 phase arrest and apoptosis. Differentially expressed mRNAs were significantly enriched in PI3K/AKT pathway. TPA treatment could increase the mRNA levels of CCND1, CCNA1, and CDKN1A, while decrease the mRNA level of MYC. It could also up-regulate the protein levels of CDKN1A, CDKN1B, CCND1, Bax, c-Caspase 3, c-Caspase 9, and PIK3R6, while down-regulate MYC, Bcl-2, and p-AKT in NB4 cells. CONCLUSION: TPA induces NB4 cell cycle arrest in G1 phase and promotes its apoptosis by regulating PIK3/AKT signaling pathway.

Astragaloside IV protects against lung injury and pulmonary fibrosis in COPD by targeting GTP-GDP domain of RAS and downregulating the RAS/RAF/FoxO signaling pathway.

BACKGROUND: Pulmonary fibrosis is a chronic progressive interstitial lung disease characterized by the replacement of lung parenchyma with fibrous scar tissue, usually as the final stage of lung injury like COPD. Astragaloside IV (AST), a bioactive compound found in the Astragalus membranaceus (Fisch.) used in traditional Chinese medicine, has been shown to improve pulmonary function and exhibit anti-pulmonary fibrosis effects. However, the exact molecular mechanisms through which it combats pulmonary fibrosis, especially in COPD, remain unclear. PURPOSE: This study aimed to identify the potential therapeutic target and molecular mechanisms for AST in improving lung injury especially treating COPD type pulmonary fibrosis both in vivo and in vitro. METHODS: Multi lung injury models were established in mice using lipopolysaccharide (LPS), cigarette smoke (CS), or LPS plus CS to simulate the processes of pulmonary fibrosis in COPD. The effect of AST on lung function protection was evaluated, and proteomic and metabolomic analysis were applied to identify the signaling pathway affected by AST and to find potential targets of AST. The interaction between AST and wild-type and mutant RAS proteins was studied. The RAS/RAF/FoxO signaling pathway was stimulated in BEAS-2B cells and in mice lung tissues by LPS plus CS to investigate the anti-pulmonary fibrosis mechanism of AST analyzed by western blotting. The regulatory effects of AST on the RAS/RAF/FoxO pathway dependent on RAS were further confirmed using RAS siRNA. RESULTS: RAS was predicted and identified as the target protein of AST in anti-pulmonary fibrosis in COPD and improving lung function. The administration of AST was observed to impede the conversion of fibroblasts into myofibroblasts, reduce the manifestation of inflammatory factors and extracellular matrix, and hinder the activation of epithelial mesenchymal transition (EMT). Furthermore, AST significantly suppressed the RAS/RAF/FoxO signaling pathway in both in vitro and in vivo settings. CONCLUSION: AST exhibited lung function protection and anti-pulmonary fibrosis effect by inhibiting the GTP-GDP domain of RAS, which downregulated the RAS/RAF/FoxO signaling pathway. This study revealed AST as a natural candidate molecule for the protection of pulmonary fibrosis in COPD.

Translational practice of fluorescence in situ hybridisation to identify neuroblastic tumours with TERT rearrangements.

Recently, telomerase reverse transcriptase (TERT) gene rearrangements have been identified in neuroblastoma (NB), the typical pathological type of neuroblastic tumours (NTs); however, the prevalence of TERT rearrangements in other types of NT remains unknown. This study aimed to develop a practical method for detecting TERT defects and to evaluate the clinical relevance of TERT rearrangements as a biomarker for NT prognosis. A TERT break-apart probe for fluorescence in situ hybridisation (FISH) was designed, optimised, and applied to assess the genomic status of TERT in Chinese children with NTs at the Beijing Children's Hospital from 2016 to 2019. Clinical, histological, and genetic characteristics of TERT-rearranged NTs were further addressed. Genomic TERT rearrangements could be effectively detected by FISH and were mutually exclusive with MYCN amplification. TERT rearrangements were identified in 6.0% (38/633) of NTs overall, but 12.4% (31/250) in high-risk patients. TERT rearrangements identified a subtype of aggressive NTs with the characteristics of Stage 3/4, high-risk category, over 18 months old, and presenting all histological subtypes of NB and ganglioneuroblastoma nodular. Moreover, TERT rearrangements were significantly associated with elevated TERT expression levels and decreased survival chances. Multivariable analysis confirmed that it was an independent prognostic marker for NTs. FISH is an easily applicable method for evaluating TERT defects, which define a subgroup of NTs with unfavourable prognosis. TERT rearrangements would contribute to characterising NT molecular signatures in clinical practice.

Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic-loaded cement spacer for definitive bone defect treatment.

Aims: This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis. Methods: We included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients' demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed. Results: In total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months' (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment. Conclusion: Permanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence.

The predictive models based on multimodality ultrasonography for the differential diagnosis of thyroid nodules smaller than 10 mm.

OBJECTIVE: The objective of this study was to establish a multimodality ultrasound prediction model based on conventional ultrasound (Con-US), shear wave elastography (SWE), and strain elastography (SE) and contrast-enhanced ultrasound (CEUS) and to explore their diagnostic values for thyroid nodules ≤ 10 mm. METHODS: This retrospective study included 198 thyroid nodules (maximum diameter≤10 mm) in 198 thyroid surgery patients who were examined preoperatively with above-mentioned methods. The pathological findings of the thyroid nodules were used as the gold standard, and there were 72 benign nodules and 126 malignant nodules. The multimodal ultrasound prediction models were developed by logistic regression analysis based on the ultrasound image appearances. The diagnostic efficacy of these prediction models was then compared and internally cross-validated in a fivefold manner. RESULTS: The specific features on CEUS (enhancement boundary, enhancement direction and decreased nodule area) and the parenchyma-to-nodule strain ratio (PNSR) on SE and SWE ratio were included in the prediction model. The Model one combining American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR TI-RADS) score with PNSR and SWE ratio had the highest sensitivity (92.8%), while the Model three combining TI-RADS score with PNSR, SWE ratio and specific CEUS indicators had the highest specificity, accuracy, and AUC (90.2%,91.4%, and 0.958, respectively). CONCLUSION: The multimodality ultrasound predictive models effectively improved the differential diagnosis of thyroid nodules smaller than 10 mm. ADVANCES IN KNOWLEDGE: For the differential diagnosis of thyroid nodules ≤ 10 mm, both ultrasound elastography and CEUS could be effective complements to ACR TI-RADS.

Comparison of the diagnostic value of contrast-enhanced ultrasound combined with conventional ultrasound versus magnetic resonance imaging in malignant non-mass breast lesions.

OBJECTIVE: To compare the diagnostic value of contrast-enhanced ultrasound (CEUS)+conventional ultrasound vs MRI for malignant non-mass breast lesions (NMLs). METHODS: A total of 109 NMLs detected by conventional ultrasound and examined by both CEUS and MRI were retrospectively analysed. The characteristics of NMLs in CEUS and MRI were noted, and agreement between the two modalities was analysed. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and area under the curve (AUC) of the two methods for diagnosing malignant NMLs were calculated in the overall sample and subgroups of different sizes(<10 mm, 10-20 mm, >20 mm). RESULTS: A total of 66 NMLs detected by conventional ultrasound showed non-mass enhancement in MRI. Agreement between ultrasound and MRI was 60.6%. Probability of malignancy was higher when there was agreement between the two modalities. In the overall group, the sensitivity, specificity, PPV, and NPV of the two methods were 91.3%, 71.4%, 60%, 93.4% and 100%, 50.4%, 59.7%, 100%, respectively. The diagnostic performance of CEUS+conventional ultrasound was better than that of MRI (AUC: 0.825 vs 0.762, p = 0.043). The specificity of both methods decreased as lesion size increased, but sensitivity did not change. There was no significant difference between the AUCs of the two methods in the size subgroups (p > 0.05). CONCLUSION: The diagnostic performance of CEUS+conventional ultrasound may be better than that of MRI for NMLs detected by conventional ultrasound. However, the specificity of both methods decrease significantly as lesion size increases. ADVANCES IN KNOWLEDGE: This is the first study to compare the diagnostic performance of CEUS+conventional ultrasound vs that of MRI for malignant NMLs detected by conventional ultrasound. While CEUS+conventional ultrasound appears to be superior to MRI, subgroup analysis suggests that diagnostic performance is poorer for larger NMLs.

Value of an expanded range of lesions on contrast-enhanced ultrasound for the diagnosis of hypervascular breast masses.

Background: Breast cancer lesions show an expanded range on contrast-enhanced ultrasound (CEUS). Here, we quantitatively analyze this index to explore its effective cutoff value for distinguishing benign and malignant lesions and the corresponding diagnostic performance and investigate its role in prognostic assessment of malignant lesions. Methods: Consecutive patients who underwent CEUS for breast lesions during the period from September 2017 to June 2019 were included. Original CEUS images were selected, displayed in dual-frame mode, and measured when enhancement of the lesion reached its peak. The longitudinal diameter, transverse diameter, and area of the lesion on the two-dimensional images and the corresponding postenhancement images were measured to calculate six indicators: longitudinal diameter increment, transverse diameter increment, area increment, percent increase in longitudinal diameter, percent increase in transverse diameter, and percent increase in area increment. With postoperative pathology as the gold standard, the cutoff values for distinguishing benign and malignant lesions and the correlations of these indicators with pathological subtypes and pathological grades were evaluated. Results: Malignant lesions showed a more significantly expanded range after enhancement compared to benign lesions, especially in terms of area increase. When the cutoff value of the area increment was set at 0.47 cm2 for distinguishing between benign and malignant lesions, the area under the curve (AUC) was 0.945, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.1%, 91.5%, 90.9%, 87.2%, and 93.5%, respectively. The pathologically measured maximum diameter of malignant masses correlated with the percent increase in transverse diameter, area increment, and percent increase in area increment. The longitudinal diameter increment in the luminal A group was significantly smaller than that in the human epidermal growth factor receptor 2 (HER2)+ group. The percent increase in transverse diameter was helpful for predicting the pathological grade of malignant masses. When the cutoff value of the percent increase in transverse diameter was set at 10.84% for pathological grading, the AUC was 0.623, and the sensitivity was 90.8%. Conclusions: Indicators related to the expanded lesion range on CEUS are helpful in differential diagnosis of benign and malignant lesions and in prognostic assessment of pathological grades.

Contrast-Enhanced Ultrasonography for Transabdominal and Transrectal Ultrasound in Staging Cervical Cancer: A Reliability Study.

OBJECTIVE: This retrospective study aimed to evaluate the consistency of transrectal contrast-enhanced ultrasonography (TR-CEUS) with post-operative pathology and the value of contrast-enhanced ultrasonography (CEUS) in staging surgically treated cervical cancer when combined with conventional ultrasonography (US). METHODS: From October 2020 to March 2023, hospitalized patients with stage IB and II cervical cancer confirmed by total hysterectomy were consecutively enrolled. The standard images of US and CEUS by transabdominal (TA-US/CEUS) and transrectal (TR-US/CEUS) approaches and magnetic resonance imaging (MRI) were acquired, on which the size and stage of the tumors were evaluated, and the consistency of results with the pathological specimen was analyzed. RESULTS: Thirty-nine patients with cervical cancer were finally enrolled in this study. The results showed that CEUS significantly improved the reliability of TA-US in evaluating tumor diameter; the intraclass correlation coefficient (ICC) was from 0.672 to 0.735. TR-US indicated good reliability with or without the addition of CEUS (ICC = 0.796 and 0.780). In terms of tumor staging, CEUS improved the consistency of transabdominal (weighted κ values from 0.689 to 0.731) and transrectal staging of tumors (κ from 0.758 to 0.785), and the staging of TR-US combined with TR-CEUS had the highest consistency with post-operative results, similar to MRI (κ, respectively 0.785 and 0.789). CEUS can reflect the heterogeneity of the tumor. Heterogeneous enhancement and perfusion defects were more common in >2 cm cervical cancer (50%, 20/40 and 52.5%, 21/40), respectively, and perfusion defects were more common in moderately to poorly differentiated tumors (66.67%, 20/30). CONCLUSION: For stage IB and IIA cervical cancer, CEUS can aid in assessing the International Federation for Gynecology and Obstetrics staging of tumors alongside TA-US and TR-US. The combination of TR-US and TR-CEUS has shown good consistency with pathology in the staging of cervical cancer, comparable to that of MRI.

Spatio-temporal variation of groundwater pollution in urban wetlands and management strategies for zoning.

Groundwater is an important resource to maintain the sustainable development of urban wetlands. The Jixi National Wetland Park (JNWP) was studied to realize the refined prevention and control of groundwater. The self-organizing map-K-means algorithm (SOM-KM), improved water quality index (IWQI), health risk assessment model and forward model were used comprehensively to evaluate the groundwater status and solute sources in different periods. The results showed that the groundwater chemical type in most areas was the HCO3-Ca type. Groundwater chemistry data from different periods were clustered into five groups. Groups 1 and 5 are affected by agricultural and industrial activities, respectively. The IWQI value in the normal period was higher in most areas due to the influence of spring ploughing. The east side of the JNWP was disturbed by human activities, and the quality of drinking water continued to deteriorate from the wet period to the dry period. 64.29% of the monitoring points showed good irrigation suitability. The health risk assessment model showed that the health risk was the largest in the dry period and the smallest in the wet period. The main factors causing health risks in the wet period and other periods were NO3- and F-, respectively. The overall cancer risk was within acceptable limits. The forward model and ion ratio analysis showed that the weathering of carbonate rocks was the main factor affecting the evolution of groundwater chemistry, accounting for 67.16%. The high-risk areas of pollution were mainly concentrated in the east of the JNWP. K+ and Cl- were the key monitoring ions in the risk-free zone and potential risk zone, respectively. The research can be used to help decision-makers carry out fine zoning control of groundwater.

Clinical efficacy of belimumab in central nervous system demyelinating syndromes with systemic lupus erythematosus: A case series.

RATIONALE: Systemic lupus erythematosus (SLE) is a complex autoimmune disease involving multiple systems. Central nervous system (CNS) demyelinating syndromes are one of the rare neurological manifestations of SLE, whose diagnosis, treatment, and prognosis are rarely reported. Belimumab, an anti-BAFF monoclonal antibody, has been approved by the FDA for the treatment of SLE. We aimed to assess the effects of belimumab on demyelinating syndromes in patients with SLE. PATIENT CONCERNS: Six patients with demyelination in SLE who were managed at Traditional Chinese and Western Medicine Hospital of Wuhan from March 2021 to March 2023, who received belimumab ≥ 5 times, were enrolled. Ten age- and sex-matched SLE patients with noutneuropsychiatric systemic lupus erythematosus (NPSLE) and normal controls were recruited to analyze potential biomarkers. DIAGNOSES: All patients were diagnosed with SLE based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria or the 2019 EULAR/ACR classification criteria. All SLE patients with CNS demyelinating syndromes were diagnosed by rheumatologists, neurologists, and radiologists. INTERVENTIONS: These patients were administered belimumab combined with standard treatment (glucocorticoids and/or antimalarials and/or immunosuppressants [cyclophosphamide, mycophenolate, methotrexate, etc.]). OUTCOMES: Six patients were included in the study (100% female, mean [range] age at first demyelinating episode 42.8 [24-66] years). The most common extra-CNS features in these patients were rash, arthritis, alopecia, leukopenia, and hypocomplementemia. After Belimumab treatment, 3 of 6 (50%) patients achieved complete remission with decreased prednisone, 2 improvements, and 1 relapsed with uterine surgery. Compared with the baseline, 3.5 months post belimumab treatment, the disease activity score SLEDAI (21.5-5.5, P < .001), C3 and C4 increased, and extra-CNS symptoms improved rapidly. Moreover, The expression of lupus susceptibility gene PBX1 in CD19+ B cells was lowest in demyelinating syndromes with lupus patients compared with healthy volunteers and lupus patients without demyelination, and its relative expression negatively correlated with SLE disease activity. CONCLUSION: Belimumab could be an effective and safe option for the treatment of SLE demyelination. In addition, PBX1 might be a potential biomarker for the clinical diagnosis of lupus in patients with demyelinating syndrome.

Preoperative strain ultrasound elastography can predict occult central cervical lymph node metastasis in papillary thyroid cancer: a single-center retrospective study.

Objective: To determine whether preoperative ultrasound elastography can predict occult central cervical lymph node metastasis (CCLNM) in patients with papillary thyroid cancer. Methods: This retrospective study included 541 papillary thyroid cancer patients with clinically negative lymph nodes prior to surgery between July 2019 and December 2021. Based on whether CCLNM was present on postoperative pathology, patients were categorized as CCLNM (+) or CCLNM (-). Preoperative clinical data, conventional ultrasound features, and ultrasound elastography indices were compared between the groups. Univariate and multivariate logistic regression analysis were performed to identify the independent predictors of occult CCLNM. Results: A total of 36.60% (198/541) patients had confirmed CCLNM, while 63.40% (343/541) did not. Tumor location, bilaterality, multifocality, echogenicity, margin, shape, vascularity, capsule contact, extrathyroidal extension, aspect ratio, and shear wave elasticity parameters were comparable between the groups (all P > 0.05). Univariate analysis showed statistically significant differences between the two groups in age, sex, tumor size, calcification, capsule invasion, and strain rates ratio in strain ultrasound elastography (all P < 0.05). In multivariate logistic regression analysis, the independent predictors of occult CCLNM were age (OR = 0.975, 95% CI = 0.959-0.991, P = 0.002), sex (OR = 1.886, 95% CI = 1.220-2.915, P = 0.004), tumor size (OR = 1.054, 95% CI = 1.014-1.097, P = 0.008), and strain rates ratio (OR = 1.178, 95% CI = 1.065-1.304, P = 0.002). Conclusion: Preoperative strain ultrasound elastography can predict presence of occult CCLNM in papillary thyroid cancer patients and help clinicians select the appropriate treatment strategy.

Can pre-operative ultrasound elastography predict aggressive features of solitary papillary thyroid carcinoma?

OBJECTIVE: To investigate whether pre-operative ultrasound elastography (USE) can be used to predict aggressive features of solitary papillary thyroid carcinomas (PTCs). METHODS: Clinical and USE indices were retrospectively analyzed in 487 patients with surgically confirmed solitary PTCs. The patients were grouped per aggressive features on pathologic testing. Univariate and binary logistic regression analyses were performed to explore independent risk factors of aggressive features. RESULTS: Univariate analysis revealed standard deviation (SD) values of the tumor shear-wave velocity (SWV) were associated with capsular invasion (p < 0.05). Further, shear-wave elasticity and SWV ratios correlated with extrathyroidal extension (all p < 0.05). The tumor shear-wave elasticity and SWV SD values were associated with cervical lymph node metastasis (CLNM) (all p < 0.05). Binary logistic regression analysis identified location and capsule contact as independent predictive risk factors for capsular invasion (all p < 0.05); size for extrathyroidal extension (all p < 0.05); and sex, age, margin, and suspected CLNM for CLNM (all p < 0.05). However, pre-operational USE indexes were not independent predictors of aggressive features (all p > 0.05). CONCLUSION: Pre-operative USE indices were not independent risk factors of aggressive features of solitary PTCs. Thus, USE may have a limited value for predicting the aggressive features of PTC. ADVANCES IN KNOWLEDGE: Pre-operative USE indices may have a limited value for predicting the aggressive features of PTC.