The diagnostic accuracy of dermoscopy and reflectance confocal microscopy for amelanotic/hypomelanotic melanoma: a systematic review and meta-analysis.

BACKGROUND: Dermoscopy and reflectance confocal microscopy (RCM) are noninvasive techniques for the diagnosis of skin lesions. Their accuracy for amelanotic/hypomelanotic melanoma (AHM) has not been systematically studied. OBJECTIVES: We aimed to investigate systematically the accuracy of dermoscopy and RCM and to compare the accuracy between them for diagnosing AHM. METHODS: We searched the PubMed, Web of Science, Embase and Cochrane Library databases for eligible studies about dermoscopy, RCM and AHM from inception to 31 June 2019. The quality of the studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. The pooled results were calculated using a random effects model in Stata 14, Meta-DiSc, RevMan 5·3 and SAS 9·4. We also explored the sources of heterogeneity by sensitivity analysis. RESULTS: Seven studies with a total of 1111 lesions were included. The pooled sensitivity and specificity of dermoscopy for the diagnosis of AHM were 61% [95% confidence interval (CI) 0·37-0·81] and 90% (95% CI 0·74-0·97), respectively. The corresponding respective values of RCM for the diagnosis of AHM were 67% (95% CI 0·51-0·81) and 89% (95% CI 0·86-0·92). In three studies including the performance of both RCM and dermoscopy, the relative diagnostic odds ratio of RCM over dermoscopy was 4·69 (95% CI 0·81-27·3) (P = 0·068). CONCLUSIONS: Our study demonstrates that both dermoscopy and RCM offer good diagnostic accuracy with high specificity and moderate sensitivity in the diagnosis of AHM. RCM is more accurate than dermoscopy in diagnosing AHM but the comparison needs to be confirmed. What's already known about this topic? Amelanotic/hypomelanotic melanoma (AHM) is the most lethal skin cancer. The diagnosis of AHM is a great challenge because of its nonspecific clinical manifestation. Early diagnosis can improve the prognosis. Dermoscopy and reflectance confocal microscopy (RCM) have high diagnostic accuracy for pigmented melanoma. What does this study add? Both dermoscopy and RCM offer good diagnostic accuracy with high specificity and moderate sensitivity for AHM. RCM might be more accurate than dermoscopy for diagnosis of AHM. More research on the diagnostic accuracy of dermoscopy and RCM for AHM is required in support of these findings.

Correlation between the hemoporfin-mediated photodynamic treatment response and the dermoscopy vascular pattern in patients with a port-wine stain: a prospective study.

BACKGROUND: Vascular targeted photodynamic therapy (PDT) is a novel and promising therapy for the treatment of port-wine stains (PWS). There has been little prior exploration to our knowledge of how the dermatological vascular pattern may predict the response to PDT. OBJECTIVES: To analyse whether the vascular pattern classifications of PWS by dermoscopy can predict the efficacy of PDT. METHODS: This prospective cohort study included 163 patients with a clinical diagnosis of PWS who were treated twice with hemoporfin-mediated photodynamic therapy (HMME-PDT) at two-month intervals and followed up for 6 months. The vascular manifestations of dermoscopy with PWS were independently classified into 8 categories by 3 dermatologists. Images of the lesions were taken using VISIA, and the vascular patterns were imaged by dermoscopy by the same investigator. Images were captured before and after each treatment. The efficacy was evaluated with pre- and post-treatment VISIA images, and correlations between efficacy and vascular patterns were analysed by four dermatologists in a blinded and independent manner, between 10 January 2019 and 11 December 2019. RESULTS: In the dermoscopy images for the whole cohort, dotted and globular vessels (15.3%), short clubbed vessels (18.4%) and curved vessels (12.9%) were highly associated with cure and beneficial treatment effects. Pale halos surrounding brown dots (8.0%) and arborizing vessels (9.8%) were mainly correlated with skin lesion alleviation. Mixed vessels (12.9%), a grey-whitish veil (11.7%) and reticular patterns (11.0%) were mainly associated with no effect. The differences between each subgroup were statistically significant (P = 0.000). CONCLUSIONS: There is a clear correlation between the efficacy of PDT and the dermoscopy pattern in patients with PWS. Dermoscopy may therefore provide very useful clinical information prior to treatment in these cases. In addition, the vascular manifestations of PWS determined by dermoscopy help to predict response to PDT and manage patient expectations.

[Quantitative study of T1 weighted imaging labyrinthine high signal ratio based on magnetic resonance imaging in patients with unilateral sudden deafness accompanied by vertigo and tinnitus].

Objective: To explore the value of speculating etiology of the magnetic resonance imaging (MRI) T1 weighted imaging (T1WI) labyrinthine high signal ratio in patients with unilateral sudden deafness accompanied by vertigo and tinnitus and its relationship with hearing prognosis. Methods: Fifty-two patients with unilateral sudden deafness accompanied by vertigo and tinnitus who were admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from January 2016 to July 2019 were collected, including 27 males and 25 females, aged (47.7±15.1) years. The inner ear MRI data of 52 patients (17 plain scan, 35 enhanced scan) with unilateral sudden deafness were retrospectively analyzed. Two radiologists independently measured the labyrinthine high signal intensity of the affected side and the contralateral normal side on T1WI and enhanced T1WI and calculated the signal ratio (the normal labyrinth signal was subtracted from the affected signal and then divided by the normal signal). The etiology of the enhanced group was judged based on two methods, including whether the abnormal high signal was enhanced or not (unenhancement indicated hemorrhage and enhancement indicated inflammation), and the locations of labyrinthine involvement on enhanced three-dimensional fluid attenuated inversion recovery (3D-FLAIR) (inflammation usually involved the perilymph spaces, while hemorrhage involved the perilymph and endolymph spaces). In the plain group, the locations of labyrinthine involvement on 3D-FLAIR was applied to infer the potential etiology. Results: The two methods presumed that 8 cases might be hemorrhage (22.9%, 8/35) and 27 be inflammation (77.1%, 27/35) in the enhanced group, which had a high consistency, while it was speculated that 7 patients might be hemorrhage (7/17) and 10 patients be inflammation (10/17) in the plain group. The measurement results of the two radiologists were highly consistent within and between the groups [the intraclass correlation coefficient (ICC) values were greater than 0.800]. The area under the receiver operating characteristic (ROC) curve (AUC) of the T1WI high signal ratio in the enhanced group for speculating etiology was 0.949 (P<0.01), when the predictive threshold value was 0.467, with a sensitivity of 96.3% and a specificity of 87.5%. It might be hemorrhage when the ratio was higher than the threshold value, otherwise it was inflammation. The T1WI labyrinthine high signal ratio was higher in the hemorrhage group than that of the inflammation group, and the hearing prognosis was worse (all P<0.05). The T1WI labyrinthine high signal ratio of the unrecovered group was higher than that of the recovered group (P=0.034). Conclusions: The etiology of labyrinthine high signal formation can be inferred by quantitative values combined with the involved sites. The high signal in the labyrinth indicates poor hearing prognosis, the higher the signal intensity, the greater the possibility of hemorrhage and the worse the hearing prognosis.

[Preliminary study of sequential multi-modality adjuvant chemotherapy and radiation for advanced endometrial cancer].

Objective: To evaluate the clinical outcomes and feasibility of multi-modality adjuvant chemotherapy and radiation, which was conducted as postoperative chemotherapy, radiation, and consolidation chemotherapy (CRC) mode for the treatment of advanced endometrial cancer. Methods: A retrospective analysis of 124 patients with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅲ and Ⅳ endometrial cancer from Jan. 2004 to Oct. 2012 was conducted in Peking University People's Hospital and Beijing Obstetrics and Gynecology Hospital. Inclusion criteria were comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, and (or) selective pelvic aortic lymphadenectomy, and treatment with adjuvant chemotherapy and (or) radiation. The average age of these patients was (55.9±8.4) years old (range from 23 to 79 years old). According to different postoperative adjuvant treatment modes, the patients were divided into CRC group, chemotherapy-radiotherapy (CR) group and single chemotherapy (C) group. The survival and side effects of the three groups were compared. Results: (1) One hundred and twenty-four patients with advanced stage endometrial cancer were identified and received postoperative adjuvant therapies.Sixty-one (49.2%, 61/124) cases of them received postoperative CRC fashion, 19 (15.3%, 19/124) received postoperative CR and 44 (35.5%, 44/124) cases received C. The age, stage, grade and type of surgery of the three groups were not significantly different (all P>0.05); while, the pathology, chemotherapy cycles and chemotherapy regimens differed significantly (all P<0.05). (2) The progression-free survivals (PFS) of the patients with CRC, CR, and C group were (121±7), (68±15), and (100±11) months, respectively. The 3-year PFS rates were 87.9%, 43.7%, and 61.4%, respectively. The 5-year PFS rates were 82.2%, 36.4%, and 61.4%, respectively. The above indicators were significantly higher in the CRC group than in the CR group (all P<0.01), and there was no difference between the CRC group and the C group (P=0.037). The overall survival (OS) of patients with CRC, CR, and C group were (128±6), (80±12), and (99±10) months, respectively. The 3-year OS rates were 87.8%, 72.4%, and 67.1%, the 5-year OS rate were 84.2%, 54.3%, and 64.1%, respectively. The above indicators were significantly higher in the CRC group than those in the CR group and C group (all P<0.01). (3) There was no difference in the frequency of adverse effects either chemotherapy, such as severe bone suppression or radiotherapy; hepatotoxicity,blood transfusion, dose modifications; or cycle delays between the CRC, CR and C group (all P>0.05). (4) In the univariate analysis shown that, stage, the fashion of postoperative adjuvant therapy and type of surgery were risk factors for tumor progression in patients with advanced endometrial cancer (P<0.05). After adjusted for FIGO stage and type of surgery, the tumor progression hazard ratio (HR) was 3.931 (95%CI: 1.734-8.914, P=0.001) for the CR group and 2.188 (95%CI: 1.010-4.741, P=0.047) for the C group, compared to the CRC group. Conclusion: Sequential CRC delivered in a "sandwich" fashion for the treatment in advanced endometrial cancer could significantly improve the 3-year and 5-year OS rates and have a similar adverse effect profile compared with other sequencing modalities.

Scaling Behavior of Quasi-One-Dimensional Vortex Avalanches in Superconducting Films.

Scaling behaviour of dynamically driven vortex avalanches in superconducting YBa2Cu3O7-δ films deposited on tilted crystalline substrates has been observed using quantitative magneto-optical imaging. Two films with different tilt angles are characterized by the probability distributions of avalanche size in terms of the number of moving vortices. It is found in both samples that these distributions follow power-laws over up to three decades, and have exponents ranging between 1.0 and 1.4. The distributions also show clear finite-size scaling, when the system size is defined by the depth of the flux penetration front - a signature of self-organized criticality. A scaling relation between the avalanche size exponent and the fractal dimension, previously derived theoretically from conservation of the number of magnetic vortices in the stationary state and shown in numerical simulations, is here shown to be satisfied also experimentally.

MiR-200a promotes cell invasion and migration of ovarian carcinoma by targeting PTEN.

OBJECTIVE: To explore the role of miR-200a combined with PTEN in the progression of ovarian carcinoma. PATIENTS AND METHODS: The human ovarian cancer tissues and normal adjacent tissues (n = 57) were obtained from our hospital. The human ovarian cancer cell lines OVCAR3 and A2780, the human ovarian surface epithelial cell line (HOSEpiC), and HEK293T cells were used in this study. Cell migration assay and invasion assay were used to detect the ability of cell migratory. Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Western blotting were used to detect the expression of miRNA and proteins. RESULTS: The clinic pathological analysis suggested a significant correlation with lymph node metastasis and tumor-lymph node metastasis (TNM) stage. Moreover, miR-200a was identified as aberrantly up-regulated in ovarian carcinoma tissues and cell lines. Through transwell analysis, the miR-200a overexpression significantly enhanced the cell migratory and invasive abilities. Luciferase assay validated phosphatase and tensin homolog (PTEN) was a miR-200a's direct and functional target gene. The miR-200a overexpression reduced the PTEN expression in OVCAR3 cells while the expression of PTEN was increased via miR-200a inhibitor as confirmed by Western blot. Furthermore, over-expression of PTEN was found reversing the inhibition of cell migration and invasion caused by miR-200a. CONCLUSIONS: MiR-200a has a carcinogenic effect on ovarian cancer through regulating PTEN.

Effects of sodium, 1,25-dihydroxyvitamin D3 and parathyroid hormone fragment on inorganic P absorption and Type IIb sodium-phosphate cotransporter expression in ligated duodenal loops of broilers.

Three experiments were conducted with 22-day-old Arbor Acres male broilers to study the effects of Na+, 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] and parathyroid hormone fragment [PTH (1-34)] on inorganic P absorption and Type IIb sodium-phosphate cotransporter (NaP-IIb) mRNA and protein expression levels in ligated duodenal loops. The duodenal loops were perfused with solutions (pH = 6) containing zero, 50, or 150 mmol/L of Na+ as NaCl in Exp. 1, containing zero, 30, or 300 pmol/L of 1,25-(OH)2D3 in Exp. 2, or containing zero, 65, or 650 pmol/L of PTH (1-34) in Exp. 3, respectively. Compared with the control, additions of 50 and 150 mmol/L of Na+, 30 and 300 pmol/L of 1,25-(OH)2D3, or 65 and 650 pmol/L of PTH (1-34) to the perfusates promoted (P < 0.02) the P absorption percentages and rates, respectively. Additions of the above-mentioned concentrations of Na+ or 1,25-(OH)2D3 to the perfusates increased (P < 0.003) NaP-IIb mRNA level in the duodenum of broilers, and a similar trend (P = 0.08) was observed for PTH (1-34). The Na+, 1,25-(OH)2D3, and PTH (1-34) had no effects (P > 0.15) on NaP-IIb protein level in the duodenum of broilers. The results indicate that increased P absorption due to perfusions of Na+, 1,25-(OH)2D3 or PTH (1-34) might be attributed to enhanced NaP-IIb expression in the duodenum of broilers.

Growth of anisotropic gold nanoparticles in photoresponsive fluid for UV sensing and erythema prediction.

AIM: To develop a novel plasmonic nanosensing technique to monitor the exposure levels of UV light for sunlight disease prevention. METHODS: Anisotropic gold nanoparticles were grown inside a UV photoresponsive fluid, which was previously exposed to UV radiation from different sources. The morphology and optical properties of the obtained nanoparticles were monitored by spectroscopy and microscopy. RESULTS: The morphological and optical properties of the nanoparticles were dependent on the UV dose. The UV exposure levels were accurately correlated to the UV minimal doses to produce erythema to different skin types. CONCLUSION: This plasmonic nanosensing technique can be employed as novel sunlight-indexing tool for monitoring the dangerous level of skin exposure.

Kinetics of phosphorus absorption in ligated small intestinal segments of broilers.

Two experiments were conducted using 22-d-old Arbor Acres male broilers to study the kinetics of inorganic P absorption and the effect of P treatment on Type IIb sodium-phosphate cotransporter (NaP-IIb) mRNA and protein levels in ligated segments from different intestinal regions. In Exp. 1, the P absorption in different small intestinal segments at different postperfusion times (0, 2.5, 5, 10, 20, or 40 min) were compared. In Exp. 2, different small intestinal loops were perfused with solutions containing 0, 1.5, 3, 6, 12, 24, or 48 mmol P/L as KHPO, and P concentrations in perfusates were determined at 20 min after perfusion. The mRNA levels of NaP-IIb in different small intestinal loops and protein expression levels in the duodenums from the control group and the 6 or 48 mmol P/L group were analyzed. The results from Exp. 1 showed that P absorption increased in an asymptotic response to postperfusion time within 40 min in all the intestinal segments and P absorption was greater ( < 0.04) in the duodenum than in the other 2 segments at 20 min after perfusion, indicating that the duodenum is the main site of P absorption in the small intestine of chicks. In Exp. 2, the kinetic curves showed that P absorption in the duodenum was a saturated carrier mediated process and in the jejunum or ileum occurred with a nonsaturated diffusion process. In addition, the b mRNA levels were greater ( < 0.0001) in the duodenum than in the other 2 segments in the 3 groups (0, 6, or 48 mmol P/L), further indicating that P absorption in the duodenum occurred mainly by a saturated carrier mediated process. However, no significant differences ( = 0.20) in the NaP-IIb protein levels of the duodenum were observed among the 0, 6, and 48 mmol P/L groups. In conclusion, this study suggests by our criteria in ligated intestinal loops that the duodenum is the main site of P absorption and that P absorption may be a saturated carrier mediated process in the duodenum but a nonsaturated diffusion process in the jejunum or ileum of broilers.

Increased survival rate in patients with massive burns.

A review of 113 patients with massive burns treated in our centre from 1970 to 1989 is presented. There were 57 adults patients with massive burns (> or = 50 per cent TBSA) in 1980-89 who were compared with 56 patients with similar massive burns in the period between 1970 and 1979. The results show a significant improvement (P < 0.01) in survival rate of the more recent patients. The increased survival rate is attributed to improvements in the early treatment of inhalation injury, sepsis and multiorgan failure.

[A case of adult onset phosphoglucomutase deficiency].

A case of 38-year-old male with adult onset phosphoglucomutase (PGM) deficiency was reported. The patient was admitted at Kawamura Hospital (Gifu City) for evaluation of easy fatiguability and exercise-induced weakness of the extremities since he was 20 years old. Physical examination revealed moderate muscle weakness, wasting of extremities, bilateral clubbed fingers and hypoesthesia of distal portion of extremities. Fasting plasma glucose was low (58 mg/dl). Venous concentration of lactate failed to rise after an ischemic forearm exercise test. An epinephrine tolerance test revealed hyperglycemic response. Studies of anaerobic glycolysis in vitro using muscle homogenates with the substrate between glucose-1-phosphate and glucose-6-phosphate showed decreased lactate production. Direct assay of individual muscle glycolytic enzymes demonstrated reduction of PGM activity (15% of normal, n = 12). Biopsy study with PAS staining of quadriceps femoris muscle demonstrated small amount of deeply staining glycogen in subsarcolemmal area. Electron microscopic examination revealed muscle destruction with small amount of glycogen in subsarcolemmal and intermyofibrillar spaces. Sural nerve biopsy showed degeneration of myelinated and unmyelinated fibers but there was no apparent accumulation of glycogen. From the clinical, biochemical and histopathological evidences, the patient might be a rare case of adult onset PGM deficiency.

Ethanol-induced neurodegeneration in NRSF/REST neuronal conditional knockout mice.

The transcription regulator, neuron-restrictive silencer factor (NRSF), also known as repressor element-1 silencing transcription factor (REST), plays an important role in neurogenesis and various neuronal diseases such as ischaemia, epilepsy, and Huntington's disease. In these disease processes, neuronal loss is associated with abnormal expression and/or localization of NRSF. Previous studies have demonstrated that NRSF regulates the effect of ethanol on neuronal cells in vitro, however, the role of NRSF in ethanol-induced neuronal cell death remains unclear. We generated nrsf conditional knockout mice using the Cre-loxP system to disrupt neuronal expression of nrsf and its truncated forms. At postnatal day 6, ethanol significantly increased the expression of REST4, a neuron-specific truncated form of NRSF, in the brains of wild type mice, and this effect was diminished in nrsf conditional knockout mice. The apoptotic effect of ethanol was pronounced in multiple brain regions of nrsf conditional mutant mice. These results indicate that NRSF, specifically REST4, may protect the developing brain from ethanol, and provide new evidence that NRSF can be a therapeutic target in foetal alcohol syndrome (FAS).