Cascaded Inner-Outer Clip Retformer for Ultrasound Video Object Segmentation.

Computer-aided ultrasound (US) imaging is an important prerequisite for early clinical diagnosis and treatment. Due to the harsh ultrasound (US) image quality and the blurry tumor area, recent memory-based video object segmentation models (VOS) achieve frame-level segmentation by performing intensive similarity matching among the past frames which could inevitably result in computational redundancy. Furthermore, the current attention mechanism utilized in recent models only allocates the same attention level among whole spatial-temporal memory features without making distinctions, which may result in accuracy degradation. In this paper, we first build a larger annotated benchmark dataset for breast lesion segmentation in ultrasound videos, then we propose a lightweight clip-level VOS framework for achieving higher segmentation accuracy while maintaining the speed. The Inner-Outer Clip Retformer is proposed to extract spatialtemporal tumor features in parallel. Specifically, the proposed Outer Clip Retformer extracts the tumor movement feature from past video clips to locate the current clip tumor position, while the Inner Clip Retformer detailedly extracts current tumor features that can produce more accurate segmentation results. Then a Clip Contrastive loss function is further proposed to align the extracted tumor features along both the spatial-temporal dimensions to improve the segmentation accuracy. In addition, the Global Retentive Memory is proposed to maintain the complementary tumor features with lower computing resources which can generate coherent temporal movement features. In this way, our model can significantly improve the spatial-temporal perception ability without increasing a large number of parameters, achieving more accurate segmentation results while maintaining a faster segmentation speed. Finally, we conduct extensive experiments to evaluate our proposed model on several video object segmentation datasets, the results show that our framework outperforms state-of-theart segmentation methods.

Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study.

Background and Objectives: Housing is one of the main places where falls occur; however, few studies have examined housing environmental factors driving fall risk. This study aimed to explore the associations between housing environmental factors and falls in China. Research Design and Methods: The study included data of middle-aged and older adults aged ≥45 years from 4 waves of the China Health and Retirement Longitudinal Study. We assessed 7 housing environmental factors: building materials, toilet types, household tidiness, household cooking fuels, and access to electricity, running water, and bathing facilities. Based on these, we divided housing environments into 3 types: good (0-2 poor factors), moderate (3-5 poor factors), and poor (6-7 poor factors). Falls incidence (yes or no) was self-reported during the survey period. We applied the Cox proportional hazard model to estimate the associations, adjusting for a set of covariates such as sociodemographic characteristics, lifestyles, and disease status. Results: A total of 12,382 participants were analyzed, and the incidence of falls was 31.7%. According to the fully adjusted model, having a squatting toilet (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.03-1.26), household untidiness (HR = 1.09, 95% CI = 1.01-1.18), and solid fuel use for cooking (HR = 1.10, 95% CI = 1.02-1.18) were associated with a higher risk of falls (ps < .05), compared to their counterparts. We found a linear relationship between housing environments and falls (p for trend = .001). Specifically, moderate (HR = 1.16, 95% CI = 1.06-1.27) and poor housing environments (HR = 1.21, 95% CI = 1.08-1.34) were associated with a higher risk of falls compared to a good housing environment. Discussion and Implications: Among middle-aged and older Chinese adults, a better household environment, including sitting toilets, tidy living conditions, and clean fuel use for cooking, may reduce the risk of falls. The evidence from our study suggests the need to implement age-friendly housing environments to prevent falls and disability in an aging society.

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy.

BACKGROUND: Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. METHODS: Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. RESULTS: The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. CONCLUSION: The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.

Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty.

BACKGROUND: To explore the risk factors involved in the induction of thoracolumbar fascia (TLF) injury by osteoporotic vertebral compression fracture (OVCF), and the association between the residual pain after percutaneous vertebroplasty (PVP) and fascial injury. METHODS: A total of 81 patients with single-segment OVCF, treated between January 2018 and January 2020 were included. The patients were grouped according to the existence of TLF injury. The patients' general, clinical, and imaging data were accessed. RESULTS: There were 47 patients in the TLF group and 34 in the non-injury group (NTLF group). In the TLF group, BMI (Body mass index) was significantly lower, while the prevalence of hypertension and sarcopenia were significantly higher (P < 0.05). The vertebral compression degree was higher, and the kyphosis angle of the injured vertebra was greater in the TLF group (P < 0.05). Cobb's angle was not significantly different between groups. At 3-d after the operation, the VAS (Visual analogue scale) was 4.64 ± 1.78 and 3.00 ± 1.71, and the ODI (Oswestry disability index) was 67.44 ± 11.37% and 56.73 ± 10.59% in TLF and NTLF group, respectively (P < 0.05). However, at 3-m after the operation, the differences in the VAS score and the ODI between groups were not statistically significant. The area of fascial edema was not significantly associated with the pre- and post-operative VAS or ODI, but was positively correlated with the vertebral body compression degree (R = 0.582, P = 0. 029). CONCLUSION: Residual back pain after PVP is associated with TLF injury. Low BMI, hypertension and sarcopenia are risk factors of TLF injury, and sarcopenia may be the major factor.

The effectiveness of portable ultrasound-guided resuscitative endovascular balloon occlusion of the aorta for stopping iliac artery hemorrhage during first aid pre-hospital: a randomized control animal trial.

PURPOSE: This study aimed at to comparing the effectiveness of portable ultrasound guided REBOA vs. traditional manual extracorporeal compression in stopping iliac artery hemostasis. METHODS: Twelve swine were included in this study (treatment group vs. control group, 6:6). A biopsy device was used to create an iliac artery rupture and hemorrhage in each swine. After 30 s of bleeding, the treatment group received REBOA under the guidance of ultrasound, whereas the control group received traditional manual extracorporeal compression. General physiological conditions were recorded at 0 s (baseline, T1), 30 s (initiation of therapies to stop bleeding, T2), 10 min (T3) and 30 min (T4) after bleeding. Intraperitoneal and retroperitoneal hemorrhage and specimens of iliac artery were collected after all swine were euthanized. RESULTS: One swine was excluded because of accidental death not related to the experiment; thus, 11 swine were analyzed in this study. The general physiological characteristics of the two groups showed no difference at T1. Hemorrhagic shock occurred in both groups. After the hemostatic procedure was performed, systolic pressure, diastolic pressure and heart rate first increased significantly between T2 and T3, and then became stable between T3 and T4; these indicators in the control group deteriorated over time. The total blood loss in the treatment group (1245.23 ± 190.07 g) was much significantly less than that in the control group (2605.63 ± 291.67 g) with p < 0.001. CONCLUSIONS: Performing REBOA under the guidance of portable ultrasound is an effective way to stop bleeding. It suggests a potential alternative method for iliac artery hemostasis in the pre-hospital setting.

Thyroid nodules and its association with vitamin D in centenarians.

OBJECTIVES: Thyroid Nodules (TNs) and hypovitaminosis D are common conditions in old people. Our objective was to determine the prevalence of benign and malignant thyroid nodules in centenarians and to examine their associations with serum vitamin D levels. METHODS: A population-based survey of 875 centenarians in Hainan, China was conducted. The thyroid glands and neck areas were scanned by board-certified sonographers using standard procedures. RESULTS: The prevalence of thyroid nodules (TN) was 74.2%, with 58.9% in group of possibly benign thyroid nodules (TIRADS 2, 3) and 15.5% in group of possibly malignant thyroid nodules (TIRADS 4A, 4B, 4C, 5). An analysis of logistic regression revealed that serum vitamin D levels were independently associated with increased thyroid nodule prevalence. We observed an inverse dose-effect relationship between TNs and serum vitamin D status with full adjustments (P for trend = 0.025%). For the severely vitamin D deficient group, the deficient group, and the insufficient group, respectively, odds ratios and 95% confidence intervals (OR: CI) for possibly malignant TNs were 3.46 (1.26-9.51), 2.15 (1.08-4.28), and 1.41 (0.72-2.75), compared to the optimal vitamin D status group. The multivariable OR with a 5 ng/mL decrease in serum vitamin D levels was 1.16 (95% CI: 1.01-1.33), for possibly malignant TNs in centenarians. CONCLUSIONS: Nearly three-quarters of centenarians were found to have thyroid nodules. Most of these nodules were benign and did not possess any suspicious ultrasound findings. Vitamin D deficiency was associated with thyroid nodules as suggestive characteristics of malignancy in this population.

Establishment and evaluation of a Beagle model of grade III pancreatic trauma.

Pancreatic trauma (PT) is a severe abdominal injury that is often combined with multiple organ injury. It is a severe disease that is difficult to diagnose and has a high mortality rate, particularly for grade III PT. The pathogenesis, disease progress and complications have not been fully investigated due to the lack of a reliable animal model. To address this, a Beagle model of grade III PT was established in the present study using a procedure involving rupture of the main pancreatic duct. Peripancreatic effusions and the degree of pancreatic damage were examined by routine ultrasound and contrast-enhanced ultrasound (CEUS). Also, ascites were collected for the examination of amylase and lipase levels, and whole blood samples were collected for the analysis of amylase, lipase, C-reactive protein (CRP), interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels in the serum. Urine samples were also collected for the examination of trypsinogen activation peptide (TAP). In addition, the pancreas was sectioned and stained with hematoxylin and eosin. In comparison with routine ultrasound, CEUS showed a large area of focal trauma, with a depth greater than half of the anteroposterior diameter of the pancreas, with a clear boundary, clear capsular rupture and trauma induced by active bleeding. The volume of ascites peaked at 48 h post-trauma and decreased thereafter. Amylase and lipase levels in the ascites were elevated at 24 h post-trauma and significantly decreased at 48 and 72 h post-trauma (P<0.01). In addition, serum amylase and lipase levels increased to peak levels at 48 h post-trauma and then decreased (P<0.05), while serum CRP, IL-6 and TNF-α levels peaked at 24 h post-trauma and then decreased (P<0.05). Urinary TAP levels also peaked at 24 h post-trauma and subsequently decreased (P<0.05). At 72 h post-trauma, the pancreatic cells were loosely distributed, with damaged acini, hyperchromatic nuclei and severe inflammatory cell invasion. These results indicated that the Beagle model of grade III PT was satisfactorily established, and that CEUS is potentially useful as an auxiliary diagnosis method for PT. This animal model may be useful for studying the pathogenesis, disease progress and complications of PT.

Thyroid nodules in centenarians: prevalence and relationship to lifestyle characteristics and dietary habits.

BACKGROUND: Thyroid nodules (TNs) are common thyroid lesions in older population. Few studies have focused on the prevalence of TNs and their relationship to lifestyle characteristics and dietary habits in centenarians. The current study aimed at determining the prevalence of TNs in Chinese centenarians by using high-resolution ultrasound (US) equipment and at investigating its relationship to lifestyle characteristics and dietary habits. PARTICIPANTS AND METHODS: The current study was part of the China Hainan Centenarian Cohort Study that was conducted in Hainan, an iodine-sufficient region in People's Republic of China. A total of 874 permanent residents aged ≥100 years (mean age =102.8±2.8 years) without any missing data were included in the analysis. RESULTS: Among the participants, 649 of them were detected at least one TN under the US examinations. The overall prevalence rate of TNs was 74.3%. The prevalence of TNs was higher in participants who were women, had hypertension, had diabetes, and were underweight compared with their counterparts. Multivariate logistic regression analyses showed that being female, hypertensive, and diabetic; betel quid consumption; and red meat consumption were independent risk factors, while being underweight and nut consumption were independent protective factors for TNs. CONCLUSION: Our findings indicate that the presence of TNs was highly prevalent in Chinese centenarians, particularly in women. In addition to gender, having hypertension, having diabetes, and being underweight, the presence of TNs was independently associated with betel quid, red meat, and nut consumption. Further prospective studies are warranted to verify these associations in populations from different age strata, races, cultures, and iodine supplementation.

Identification of miRNA biomarkers of pneumonia using RNA-sequencing and bioinformatics analysis.

Pneumonia is a lower respiratory tract infection that causes dramatic mortality worldwide. The present study aimed to investigate the pathogenesis of pneumonia and identify microRNA (miRNA) biomarkers as candidates for targeted therapy. RNA from the peripheral blood plasma of participants with pneumonia (severe, n=9; non-severe, n=9) and controls (n=9) was isolated and paired-end sequencing was performed on an Illumina HiSeq4000 system. Following the processing of raw reads, the sequences were aligned against the Genome Reference Consortium human genome assembly 38 reference genome using Bowtie2 software. Reads per kilobase of transcript per million mapped read values were obtained and the limma software package was used to identify differentially expressed miRNAs (DE-miRs). Then, DE-miR targets were predicted and subjected to enrichment analysis. In addition, a protein-protein interaction (PPI) network of the predicted targets was constructed. This analysis identified 11 key DE-miRs in pneumonia samples, including 6 upregulated miRNAs (including hsa-miR-34a and hsa-miR-455) and 5 downregulated miRNAs (including hsa-let-7f-1). All DE-miRs kept their upregulation/downregulation pattern in the control, non-severe pneumonia and severe pneumonia samples. Predicted target genes of DE-miRs in the subjects with non-severe pneumonia vs. the control and the subjects with severe pneumonia vs. the non-severe pneumonia group were markedly enriched in the adherens junction and Wnt signaling pathways. KALRN, Ras homolog family member A (RHOA), ß-catenin (CTNNB1), RNA polymerase II subunit K (POLR2K) and amyloid precursor protein (APP) were determined to encode crucial proteins in the PPI network constructed. KALRN was predicted to be a target of hsa-mir-200b, while RHOA, CTNNB1, POLR2K and APP were predicted targets of hsa-let-7f-1. The results of the present study demonstrated that hsa-let-7f-1 may serve a role in the development of cancer and the Notch signaling pathway. Conversely, hsa-miR-455 may be an inhibitor of pneumonia pathogenesis. Furthermore, hsa-miR-200b might promote pneumonia via targeting KALRN.

Molecular Mechanisms of Mild and Severe Pneumonia: Insights from RNA Sequencing.

BACKGROUND This study aimed to uncover the molecular mechanisms underlying mild and severe pneumonia by use of mRNA sequencing (RNA-seq). MATERIAL AND METHODS RNA was extracted from the peripheral blood of patients with mild pneumonia, severe pneumonia, and healthy controls. Sequencing was performed on the HiSeq4000 platform. After filtering, clean reads were mapped to the human reference genome hg19. Differentially expressed genes (DEGs) were identified between the control group and the mild or severe group. A transcription factor-gene network was constructed for each group. Biological process (BP) terms enriched by DEGs in the network were analyzed and these genes were also mapped to the Connectivity map to search for small-molecule drugs. RESULTS A total of 199 and 560 DEGs were identified from the mild group and severe group, respectively. A transcription factor-gene network consisting of 215 nodes and another network consisting of 451 nodes were constructed in the mild group and severe group, respectively, and 54 DEGs (e.g., S100A9 and S100A12) were found to be common, with consistent differential expression changes in the 2 groups. Genes in the transcription factor-gene network for the mild group were mainly enriched in 13 BP terms, especially defense and inflammatory response (e.g., S100A8) and spermatogenesis, while the top BP terms enriched by genes in the severe group include response to oxidative stress (CCL5), wound healing, and regulation of cell differentiation (CCL5), and of the cellular protein metabolic process. CONCLUSIONS S100A9 and S100A12 may have a role in the pathogenesis of pneumonia: S100A9 and CXCL1 may contribute solely in mild pneumonia, and CCL5 and CXCL11 may contribute in severe pneumonia.

Protection Provided by a Gabexate Mesylate Thermo-Sensitive In Situ Gel for Rats with Grade III Pancreatic Trauma.

BACKGROUND/AIMS: This study investigated the protection provided by gabexate mesylate thermo-sensitive in-situ gel (GMTI) against grade III pancreatic trauma in rats. METHODS: A grade III pancreatic trauma model with main pancreatic duct dividing was established, and the pancreas anatomical diagram, ascites, and serum biochemical indices, including amylase, lipase, C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α), were examined. The pancreas was sliced and stained with hematoxylin eosin and subjected to terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. RESULTS: Ascites, serum amylase, lipase, CRP, IL-6, and TNF-α levels were significantly increased in the pancreas trauma (PT) groups with prolonged trauma time and were significantly decreased after GMTI treatment. The morphological structure of the pancreas was loose, the acinus was significantly damaged, the nuclei were irregular and hyperchromatic, and there was inflammatory cell invasion in the PT group compared to the control. After GMTI treatment, the morphological structure of the pancreas was restored, and the damaged acinus and inflammatory cell invasion were decreased compared to the PT group. Moreover, the cell apoptosis index was significantly increased in the PT group and restored to the same levels as the control group after GMTI treatment. CONCLUSIONS: GMTI, a novel formulation and drug delivery method, exhibited specific effective protection against PT with acute pancreatitis therapy and has potential value as a minimally invasive adjuvant therapy for PT with acute pancreatitis.

Suppression of MicroRNA-219-5p Activates Keratinocyte Growth Factor to Mitigate Severity of Experimental Cirrhosis.

BACKGROUND/AIMS: Keratinocyte growth factor (KGF) plays a critical role in prevention of cirrhosis and enhancement of liver regeneration. However, the molecular regulation of KGF in liver is unknown. MicroRNAs (miRNAs) control the pathogenesis of cirrhosis, whereas the exact involved miRNAs and molecular signaling pathways remain ill-defined. Here we addressed these questions. METHODS: We examined the correlation of the levels of miR-219-5p and KGF in the liver biopsies from patients with liver diseases. The effects of overexpression or suppression of miR-219-5p on KGF were examined in both human and mouse hepatic stellate cells (HSCs). Bioinformatics analysis was applied to examine the binding of human/mouse miR-219-5p to the 3'-UTR of human/mouse KGF mRNA, respectively. Finally, adeno-associated viruses carrying antisense of miR-219-5p were infused into the liver from the mice that had developed cirrhosis by carbon tetrachloride (CCl4), and the effects on KGF levels and liver damage and function were examined. RESULTS: The levels of miR-219-5p and KGF in the liver biopsies were inversely correlated. MiR-219-5p inhibited KGF expression in both human and mouse HSCs, through directly binding the 3'-UTR of KGF mRNA. Expression of antisense of miR-219-5p significantly attenuated the levels of liver fibrosis, portal hypertension and sodium retention caused by CCl4. CONCLUSIONS: Suppression of miR-219-5p may benefit the liver regeneration and prevent cirrhosis through increasing KGF.

Effect of peritoneal lavage with ulinastatin on the expression of NF-κB and TNF-α in multiple organs of rats with severe acute pancreatitis.

The aim of the present study was to investigate the effect of peritoneal lavage with ulinastatin on the expression levels of nuclear factor κB (NF-κB) and tumor necrosis factor (TNF)-α in multiple organs of rats with severe acute pancreatitis (SAP). Male Wistar rats were randomly divided into the following groups: Sham-operated (C), SAP model (SAP), saline lavage (SL), intravenous ulinastatin (IU) and peritoneal lavage with ulinastatin (UL). The SAP model was induced by the retrograde infusion of 5% sodium taurocholate into the biliopancreatic ducts of the rats. Intraperitoneal lavage or injection was performed immediately following the establishment of the SAP model in groups SL, IU and UL. Intraperitoneal lavage with or without ulinastatin was performed for 3 h. The survival time of half of the rats in each group was recorded over a 12-h period. At 3 h after the induction of SAP, inflammatory mediators and the expression levels of NF-κB and TNF-α in multiple organs of the rats in each group were also detected. The survival rates of the rats in group UL at 6 h and 9 h were increased compared with those in group SAP, and were also higher than that in groups SL and IU. The levels of serum inflammatory mediators were effectively reduced in groups SL, IU and UL, the greatest effects were observed in group UL. The expression levels of NF-κB and TNF-α in multiple organs were significantly lower in group UL compared with other groups. Intraperitoneal lavage with ulinastatin significantly ameliorated the inflammatory reaction and inhibited NF-κB and TNF-α expression in multiple organs of SAP model rats.

Effectiveness of contrast-enhanced ultrasound in the classification and emergency management of abdominal trauma.

OBJECTIVE: To analyse the correlation between contrast-enhanced ultrasound (CEUS)-based classification of the severity of abdominal parenchymal organ trauma and clinical outcomes, and to explore CEUS in classifying patients with such trauma, expecting that the use of CEUS will potentially enhance the quality and speed of the emergency management of abdominal trauma. METHODS: Three hundred six consecutive patients with blunt abdominal parenchymal organ trauma who received CEUS examination were retrospectively analysed. Two CEUS radiologists (identified as Reader A and Reader B in this study) who were not involved in the CEUS examinations of the patients were then asked to classify the patients independently according to their CEUS results. The classification results were later compared with patients' clinical outcomes using Spearman's rank correlation. RESULTS: The final clinical outcomes showed that 25.5 % (78/306) of patients received conservative treatment, 52.0 % (159/306) received minimally invasive treatment, and 22.5 % (69/306) received surgery. Spearman's rank correlation coefficients between the CEUS-based classification and clinical outcome were 0.952 from Reader A and 0.960 from Reader B. CONCLUSIONS: CEUS can play an important role in the emergency management of abdominal trauma through the classification of patients for different treatment methods. KEY POINTS: • The severity of abdominal trauma was classified by contrast-enhanced ultrasound (CEUS) • There was a high correlation between CEUS-based classification and clinical outcomes • CEUS-based classification is helpful for surgeons in the emergency management of abdominal trauma.

Development of a logistic regression formula for evaluation of subcentimeter thyroid nodules.

OBJECTIVES: The purpose of this study was to build a logistic regression formula for ameliorating the diagnosis of subcentimeter thyroid nodules. METHODS: The sonographic features of 889 subcentimeter nodules were reviewed retrospectively with reference of histologic results. The diagnostic performance of each feature was evaluated. Multivariate binary logistic regression was used to develop the formula for evaluation of subcentimeter nodules, and the cutoff value was decided for recommending biopsy. RESULTS: The logistic regression formula was -0.029age - 2.063US1 - 0.812US2 + 1.781US3 + 1.627height-to-width ratio - 0.333 (for nonhypoechogenicity, US1 = 1; for hypoechogenicity, US1 = 0; for a well-circumscribed margin, US2 = 1 and US3 = 0; for a microlobulated margin, US2 = 0 and US3 = 1; and for an irregular margin, US2 = 0 and US3 = 0). The area under the receiver operating characteristic curve for the formula was 0.860. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the formula under the cutoff value of 0.284 were 90.9%, 54.0%, 66.4%, 85.6%, and 72.5%, respectively. With the use of the formula, 229 of 830 nodules could avoid surgery. CONCLUSIONS: A logistic regression formula with a cutoff value could provide an objective and easy tool with effective diagnostic performance, which could improve diagnosis of subcentimeter thyroid nodules and reduce unnecessary biopsy, decreasing costs and patient discomfort.

Thyroid nodules with suspicious ultrasound findings: the role of ultrasound-guided core needle biopsy.

The aim of this study was to evaluate the value of core needle biopsy (CNB) in the diagnosis of sonographically suspicious thyroid nodules. We retrospectively reviewed 997 patients with sonographically suspicious thyroid nodules who underwent CNB using pathological results as gold standard. In our result, the accuracy of CNB was 98.0%, and its area under the receiver operating characteristic curve was 0.981. The inconclusive result was in 22 (6.0%) of CNBs. Therefore, CNB demonstrates high rates of conclusive and accurate diagnosis in sonographically suspicious thyroid nodules, which may reduce repeat fine needle aspiration, diagnostic surgery, and unnecessary follow-up.

Transrectal real-time tissue elastography - an effective way to distinguish benign and malignant prostate tumors.

BACKGROUND: To investigate the relationship between extracellular matrix parameters and texture of prostatic lesions evaluated by transrectal real-time tissue elastography (TRTE). METHODS: 120 patients suspicious for prostate cancer underwent TRTE. Targeted biopsies were carried out after 12-core systematic biopsy. Epithelia were stained with hematoxylin-eosin, and Victoria blue and Ponceau S were used to stain elastic-collagen fibers, and picric acid-sirius red for visualization of collagen type I (Col1) and III (Col3). Smooth muscles were visualized by immunohistochemistry. All image analyses were performed in a blind manner using Image Pro Plus 6.0, and the area ratios of epithelium, elastic fibers, collagen fibers and Col1/Col3 were determined. RESULTS: 42 patients with typical elastograms were included in the final data analysis. Significant differences were detected between the benign and malignant groups in the area ratios of epithelium (P = 0.01), smooth muscles and Col1/Col3 (P = 0.04, P = 0.02, respectively). There were no significant differences in the area ratios of epithelium, smooth muscle and elastic fibers between the stiff and soft lesion groups. The area ratio of Col1 was (0.05 ± 0.03) in the stiff group, and (0.02 ± 0.01) in the soft group (P= 0.00). However, the area ratio of Col3 was (0.03 ± 0.02) in the stiff group, and (0.05 ± 0.04) in the soft group (P = 0.16). Col1/Col3 in the stiff group (1.99 ± 1.59) was greater than in the soft group (0.71 ± 0.64) (P = 0.01). CONCLUSIONS: Tissue hardness of prostatic tumors was mainly dependent on the Col1 content, Col1/Col3 being higher in malignant than in benign lesions, so the prostate tissue texture can be used as a target for distinguishing between the two with TRTE.

[A multiple regression formula for the prediction of thyroid microcarcinoma].

OBJECTIVE: To establish a quantitative analysis formula for the prediction of thyroid microcarcinoma and decide the cut-off values for the recommendation of ultrasound-guided biopsy. METHODS: The ultrasound characteristics of 830 subcentimeter thyroid nodules were retrospectively analyzed based on pathological results in this study. A diagnostic formula was developed using multivariate binary Logistic regression with the cut-off values for the recommendation of biopsy. The diagnostic values of each feature and the formula were evaluated. RESULTS: The most suspicious ultrasound characteristics for subcentimeter thyroid nodules were solid echostructure (OR=41.97), microlobulated margin (OR=25.89), hypoechoic echogenicity(OR=10.36), no halo (OR=8.38), irregular margin (OR=4.26), taller than wide (OR=2.71), microcalcification (OR=1.92), and macrocalcification (OR=1.28). The sensitivity, specificity, and accuracy of the formula were 90.9%, 54.0%, and 72.5%, respectively. CONCLUSION: This multiple regression formula is an objective tool for the evaluation of thyroid microcarcinoma, which can provide the cutoff values for the ultrasound guided biopsy.

Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions.

BACKGROUND: To assess the accuracy of ultrasound-guided 16G or 18G core needle biopsy (CNB) for ultrasound-visible breast lesions, and to analyze the effects of lesion features. METHODS: Between July 2005 and July 2012, 4,453 ultrasound-detected breast lesions underwent ultrasound-guided CNB and were retrospectively reviewed. Surgical excision was performed for 955 lesions (566 with 16G CNB and 389 with 18G CNB) which constitute the basis of the study. Histological findings were compared between the ultrasound-guided CNB and the surgical excision to determine sensitivity, false-negative rate, agreement rate, and underestimation rate, according to different lesion features. RESULTS: Final pathological results were malignant in 84.1% (invasive carcinoma, ductal carcinoma in situ, lymphoma, and metastases), high-risk in 8.4% (atypical lesions, papillary lesions, and phyllodes tumors), and benign in 7.5%. False-negative rates were 1.4% for 16G and 18G CNB. Agreement rates between histological findings of CNB and surgery were 92.4% for 16G and 92.8% for 18G CNB. Overall underestimate rates (high-risk CNB becoming malignant on surgery and ductal carcinoma in situ becoming invasive carcinoma) were 47.4% for 16G and 48.9% for 18G CNB. Agreements were better for mass lesions (16G: 92.7%; 18G: 93.7%) than for non-mass lesions (16G, 85.7%; 18G, 78.3%) (P <0.01). For mass lesions with a diameter ≤10 mm, the agreement rates (16G, 83.3%; 18G, 86.7%) were lower (P <0.01). CONCLUSIONS: Ultrasound-guided 16G and 18G CNB are accurate for evaluating ultrasound-visible breast mass lesions with a diameter >10 mm.

[Impact of needle size and sonographic feature on accuracy of ultrasound-guided breast biopsy].

OBJECTIVE: To assess the accuracy of ultrasound-guided 16G and 18G core needle biopsy for detecting ultrasound visible breast lesions with different sonographic features. METHODS: A total of 955 sonographically detected breast lesions examined with ultrasound-guided core needle biopsy (US-CNB) and subsequently surgically excised from July 2005 to July 2012 were retrospectively reviewed. Histological findings of US-CNB and the surgical specimens were analyzed for agreements, sensitivities, false negative rates, and underestimate rates according to different sonographic features. RESULTS: The pathological results of the US-CNB showed malignant lesions in 84.1%, high-risk lesions in 8.4%, and benign lesions in 7.5% of the samples. The overall agreement rates were 92.4% for 16G CNB and 92.8% for 18G CNB; their complete sensitivities and false negative rates were both 98.6% and 1.4%, respectively; the high-risk underestimate rates and DCIS underestimate rates were 48.0% and 46.2% for 16G CNB vs 53.3% and 41.2% for 18G CNB, showing no significant difference between the two groups (P>0.01). For both 16G and 18G CNB, the agreements were better for mass lesions than for non-mass lesions (P<0.01). For the mass lesions with a diameter no greater than 10 mm, the agreement rates were lower than the overall data (P<0.01). Calcification in the lesions did not affect the agreement rates (P>0.01). CONCLUSION: Ultrasound-guided 16G and 18G CNB are both accurate methods for evaluating ultrasound visible breast mass lesions with a diameter larger than 10 mm.