Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules.

OBJECTIVES: To explore the value of applying contrast-enhanced ultrasound (CEUS) in adjusting the classification of category 4 nodules in the Chinese-Thyroid Imaging Report and Data System (C-TIRADS). METHODS: The data of preoperative conventional ultrasound and CEUS examinations of 125 C-TIRADS 4 nodules in 109 patients were retrospectively analyzed. We divided the thyroid nodules into two groups based on whether recommend by the guide fine-needle aspiration (FNA). Group I included C-TIRADS 4A nodules with a maximum diameter ≤15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter ≤10 mm, and Group II included C-TIRADS 4A nodules with a maximum diameter >15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter >10 mm. In CEUS, thyroid nodules showing suspicious malignant features such as hypoenhancement or early washout were adjusted to a level higher in the C-TIRADS classification; thyroid nodules showing possible benign features such as iso- or hyperenhancement were adjusted to a level lower; and thyroid nodules showing no enhancement were adjusted to C-TIRADS 3. Taking the pathological results as the gold standard, the receiver operating characteristic (ROC) curves of the C-TIRADS classification before and after the adjustment based on CEUS were plotted, and the diagnostic efficiency was compared. RESULTS: The sensitivity, specificity, accuracy, and positive and negative predictive values of the C-TIRADS classification for the diagnosis of thyroid nodule malignancy before the adjustment based on the CEUS results were 83.6%, 63.8%, 74.4%, 72.7%, and 77.1%, respectively, and these values were 91.0%, 82.8%, 87.2%, 85.9%, and 88.9%, respectively, after the adjustment. The area under the ROC curve (AUC) was 0.737 and 0.869, respectively, showing a significant difference (Z = 3.288, P=0.001). The diagnostic efficiency of C-TIRADS classification after the adjustment based on the CEUS results in both groups was improved compared with the result before the adjustment, and the difference in Group II was significant (Z = 2.931, P=0.003). CONCLUSIONS: CEUS significantly improved the diagnostic performance in the adjustment of C-TIRADS 4 nodule classification, especially for the nodules which needs FNA recommended by the C-TIRADS.

CD44v6 in peripheral blood and bone marrow of patients with gastric cancer as micro-metastasis.

AIM: To detect the expression of CD44 correlated with the ability of micro-metastasis in peripheral blood and bone marrow of patients with gastric cancer and to deduce its clinical significance. METHODS: Preoperative peripheral blood and bone marrow specimens from 46 patients with gastric cancer and 6 controls were studied by semi-quantitative RT-PCR amplification of CD44v6mRNA. Preoperative and postoperative peripheral blood specimens from 40 patients with gastric cancer and 14 controls were studied by quantitative RT-PCR amplification of CD44v6mRNA in the corresponding period. RESULTS: Semi-quantitative RT-PCR amplification showed that CD44v6mRNA expression of peripheral blood and bone marrow was positive in 39 (84.8%) and 40 (86.9%) of 46 patients with gastric cancer, respectively. In peripheral blood, CD44v6mRNA expression was positive for diffuse type in 30 (93.8%) of 32 patients and for intestinal type in 9 (64.3%) of 14 patients. On the other hand, in bone marrow, CD44v6mRNA expression was positive for diffuse type in 31 (96.9%) of 32 patients and for intestinal type in 10 (71.4%) of 14 patients. There was a significant difference between the diffuse type and intestinal type. Quantitative RT-PCR amplification demonstrated that CD44v6mRNA was not expressed in the peripheral blood of controls and CD44v6mRNA expression was positive for preoperative peripheral blood in 40 patients with gastric cancer, the expression levels being from 4.9 x 10(8) - 3.2 x 10(11) copies/g RNA. The average expression level of CD44v6mRNA in peripheral blood was 3.9 x 10(10) copies/g RNA. The expression levels of CD44v6mRNA in peripheral blood in gastric cancer patients after curative operation increased from 5.5 x 10(6) to 7.6 x 10(9) copies/g RNA and the average level was 2.4 x 10(8) copies/g RNA (Figure 3B) (P = 0.00496). After curative operation, the expression level decreased markedly. CONCLUSION: Semi-quantitative and quantitative RT-PCR amplification for CD44v6mRNA is a sensitive and specific method for the detection of micro-metastasis in peripheral blood and bone marrow, which might be used as an indicator of tumor burden and therapeutic effect.

[Effects of environmental stress on seedlings root growth and nodulation of leguminous shrubs in the dry valley of Minjiang River].

A field investigation was made to understand the seedlings root nodulation, biomass accumulation, root length, and fine root percentage of Sophora davidii, Indigofera lenticellata and Campylotropis polyantha along an altitudinal gradient on two contrasting sloped hills (north Zongqu and south Jingzhoushan) in the dry valley of Minjiang River. In the meantime, a greenhouse experiment was conducted to study the adaptation responses of 2 month-old S. davidii and C. polyantha seedlings root nodulation to different soil moisture regimes (80%, 60%, 40%, and 20% WHC). For the three test shrub species, fewer nodules were observed at lower altitude (1600-1950 m) areas, the nodule number per plant of S. davidii, I. lenticellata, and C. polyantha being 0.1 +/- 0.1, 0.9 +/- 0.5, and 5.7 +/- 1.9, and the non-nodulation plant accounting for 65.1%, 12.3% and 17.6%, respectively. The nodule number of the three species increased with increasing altitude, and correlated positively with root length and fine root percentage. However, there were no significant differences in the plant growth and biomass at different altitudes. When the soil moisture content was lower than 60% WHC, the nodule number and the fresh and dry mass of both S. davidii and C. polyantha decreased markedly, and at 20% WHC, no nodule and only 9.8 +/- 3.6 nodules were observed for S. davidii and C. polyantha, respectively, indicating that in this dry valley, the root nodulation capability of endemic leguminous shrubs was very low. Comparing with S. davidii, C. polyantha had higher root nodulation capability and drought-resistance. Prior to introducing these shrub species in forestation practices, to keep the soil moisture content higher than 40% WHC was recommended for relatively efficient biological nitrogen fixation.

[Effect of Shark Chondroitin on T Lymphocyte Subsets of Cancer Patients]

The objective of the study is to find out the effect of shark chondroitin on T lymphocyte subsets in cancer patients. Patients were divided into two groups. One group was treated with chemotherapy alone, and the other group was treated with chemotherapy plus shark chondroitin. Using immunofluorescence technique, T lymphocyte subsets in the peripheral blood were determined in two groups before and after chemotherapy. The results showed that CD4(+)/CD8(+) ratio increased in the patients received shark chondroitin. In the chemotherapy group, CD3(+) had no change, but CD4(+) decreased while CD8(+) increased significantly. The results suggest that shark chondroitin could enhance immune function in cancer patients, especially during chemotherapy.