Postsurgical Management of Dilated Biliary Tract in Children: Ultrasound-Guided Percutaneous Transhepatic Cholangial Drainage and Subsequent Percutaneous Ultrasound Cholangiography.

OBJECTIVE. The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous transhepatic cholangial drainage (PTCD) and consequent percutaneous US cholangiography in managing the dilated biliary tracts of children who have undergone hepatobiliary surgery. SUBJECTS AND METHODS. Sixteen children (11 boys, five girls; age range, 3-144 months) who underwent hepatobiliary surgery from December 2016 to October 2018 and had US evidence of biliary dilatation were included. All patients had undergone US-guided PTCD because of elevated postoperative serum bilirubin levels or bile duct infection. Immediately after the PTCD procedure, diluted sulphur hexafluoride microbubbles dispersion was injected through the PTCD tube to evaluate the anastomosis and the intrahepatic bile duct tree. Laboratory results, including those of serum bilirubin measurement, liver function tests, and routine blood tests, were evaluated before and after PTCD. Nine of 16 patients also underwent percutaneous transhepatic cholangiography (PTC). The percutaneous US cholangiography findings were evaluated and compared with the PTC findings. RESULTS. Liver enzyme levels decreased after PTCD with a statistically significant difference from the values before PTCD. Percutaneous US cholangiography showed that the anastomosis in 6 of the 16 patients (37.5%) was patent and depicted the morphologic featuresof intrahepatic bile duct tree in five of these patients. In the other 10 patients, the anastomosis was completely obstructed, and percutaneous US cholangiography depicted the morphologic features of intrahepatic bile duct tree in eight patients. In the nine patients who underwent PTC, the percutaneous US cholangiographic findings were the same as the PTC findings. CONCLUSION. US-guided PTCD is helpful in relieving jaundice and inflammation in children who have undergone hepatobiliary surgery and have biliary dilatation. Findings at consequent percutaneous US cholangiography are comparable to those of PTC in depicting the anastomosis in these patients.

Identification of cis-regulatory regions responsible for developmental and hormonal regulation of HbHMGS1 in transgenic Arabidopsis thaliana.

OBJECTIVES: 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) synthase (HMGS) is an important enzyme in mevalonate (MVA) pathway of isoprenoid biosynthesis, which regulates the rubber biosynthetic pathway in rubber tree (Hevea brasiliensis) in coordination with HMG-CoA reductase (HMGR). However, little information is available about the regulation of HMGS gene expression. To understand the mechanism controlling the HbHMGS1 gene expression, we characterized the HbHMGS1 promoter sequence in transgenic plants with the ß-glucuronidase (GUS) reporter gene. RESULTS: GUS activity analysis of the transgenic plants showed that the HbHMGS1 promoter is active in all organs of the transgenic Arabidopsis plants during various developmental stages (from 6 to 45-day-old). Deletion of different portions of the upstream HbHMGS1 promoter identified sequences responsible for either positive or negative regulation of the GUS expression. Particularly, the - 454 bp HbHMGS1 promoter resulted in a 2.19-fold increase in promoter activity compared with the CaMV 35S promoter, suggesting that the - 454 bp HbHMGS1 promoter is a super-strong near-constitutive promoter. In addition, a number of promoter regions important for the responsiveness to ethylene, methyl jasmonate (MeJA) and gibberellic acid (GA) were identified. CONCLUSION: The - 454 bp HbHMGS1 promoter has great application potential in plant transformation studies as an alternative to the CaMV 35S promoter. The HbHMGS1 promoter may play important roles in regulating ethylene-, MeJA- and GA-mediated gene expression. The functional complexity of cis-elements revealed by this study remains to be elucidated.

Percutaneous US-guided Cholecystocholangiography with Microbubbles for Assessment of Infants with US Findings Equivocal for Biliary Atresia and Gallbladder Longer than 1.5 cm: A Pilot Study.

Purpose To evaluate the feasibility of ultrasonographically (US) guided percutaneous cholecystocholangiography (PCC) for early exclusion of biliary atresia (BA) in infants suspected of having BA with equivocal US findings or indeterminate type of BA and a gallbladder longer than 1.5 cm at US. Materials and Methods This study was approved by the ethics committee; written informed parental consent was obtained. From February 2016 to December 2016, nine infants (four boys, five girls; mean age, 60.2 days; median age, 57 days; age range, 23-117 days) with conjugated hyperbilirubinemia and gallbladder longer than 1.5 cm at US were referred for US-guided PCC after US findings were equivocal for BA (n = 7) or the type of BA was unclear (n = 2). PCC was performed with a US machine with incorporated contrast pulse sequencing, contrast-specific software, and a linear transducer by injecting diluted contrast material via an 18-gauge needle. Images from US and US-guided PCC were evaluated in consensus by two radiologists. US criteria for BA were fibrotic cord sign (>2 mm) and gallbladder length-to-width ratio greater than 5.2. BA was excluded at PCC when contrast material was visualized in the gallbladder, common hepatic ducts, and common bile duct and during passage to the duodenum. Patients in whom BA was diagnosed after PCC underwent surgery or liver biopsy as the reference standard. Nonparametric and Fisher exact tests were used. Results US-guided PCC was successful in all patients. There were no procedural-related complications. BA was excluded in five of the nine patients. The median serum direct bilirubin level in these patients slightly decreased 1 week after PCC, from 91.1 µmol/L (interquartile range [IQR], 81.6-113.8 µmol/L) to 65.3 µmol/L (IQR, 57.8-74.7 µmol/L); however, this difference was not statistically significant (P = .062). BA was diagnosed in four patients, with the diagnosis confirmed at surgery (n = 2) or liver biopsy (n = 2). BA in two patients with unclear type of BA was defined as type III without patency of the common bile duct in one patient and as type III with patency of the common bile duct in the other. Conclusion In this highly selected group of infants with indeterminate type of BA or inconclusive US findings, US-guided PCC enabled the diagnosis of BA in four infants and the exclusion of BA in five. US-guided PCC may be a safe and effective tool to exclude BA early in infants with equivocal US findings. © RSNA, 2017.

IL-33/ST2 signaling contributes to radicular pain by modulating MAPK and NF-κB activation and inflammatory mediator expression in the spinal cord in rat models of noncompressive lumber disk herniation.

BACKGROUND: Immune and inflammatory responses occurring in the spinal cord play a pivotal role in the progression of radicular pain caused by intervertebral disk herniation. Interleukin-33 (IL-33) orchestrates inflammatory responses in a wide range of inflammatory and autoimmune disorders of the nervous system. Thus, the purpose of this study is to investigate the expression of IL-33 and its receptor ST2 in the dorsal spinal cord and to elucidate whether the inhibition of spinal IL-33 expression significantly attenuates pain-related behaviors in rat models of noncompressive lumbar disc herniation. METHODS: Lentiviral vectors encoding short hairpin RNAs that target IL-33 (LV-shIL-33) were constructed for gene silencing. Rat models of noncompressive lumber disk herniation were established, and the spines of rats were injected with LV-shIL-33 (5 or 10 µl) on the first day after the operation. Mechanical thresholds were evaluated during an observation period of 21 days. Moreover, the expression levels of spinal tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and cyclooxygenase 2 (COX-2) and the activation of the mitogen-activated protein kinases (MAPK) and nuclear factor-κB (NF-κB) pathways were evaluated to gain insight into the mechanisms related to the contribution of IL-33/ST2 signaling to radicular pain. RESULTS: The application of nucleus pulposus (NP) to the dorsal root ganglion (DRG) induced an increase in IL-33 and ST2 expression in the spinal cord, mainly in the dorsal horn neurons, astrocytes, and oligodendrocytes. Spinally delivered LV-shIL-33 knocked down the expression of IL-33 and markedly attenuated mechanical allodynia. In addition, spinal administration of LV-shIL-33 reduced the overexpression of spinal IL-1ß, TNF-α, and COX-2 and attenuated the activation of C-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase (ERK), and NF-κB/p65 but not p38. CONCLUSIONS: This study indicates that spinal IL-33/ST2 signaling plays an important role in the development and progression of radicular pain in rat models of noncompressive lumber disk herniation. Thus, the inhibition of spinal IL-33 expression may provide a potential treatment to manage radicular pain caused by intervertebral disk herniation.

Value of flaccid penile ultrasound in screening for arteriogenic impotence: a preliminary prospective study.

BACKGROUND: This prospective study is to evaluate the potential value of sonographic measurements in the flaccid penis for the screening of arteriogenic impotence. METHODS: A consecutive series of 260 Chinese males consulting for sexual dysfunction and 54 controls underwent sonographic examination. The sonographic parameters were correlated with the clinical gold standards, including the international index of erectile function (IIEF) and penile erectile hardness grading scale (EHGS). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUROC) of flaccid peak systolic velocity (PSV) in predicting patients with normal function were analyzed. RESULTS: The mean cavernous PSV of both sides in the patients with sexual dysfunction ranged from 7.76 to 11.12 cm/sec with a stepwise increase in IIEF and EHGS grading scale (P < .05). The cutoff value of flaccid PSV for the differential diagnosis of grade 4 of IIEF-5 or EHGS was 8.20-8.90 cm/sec, with an AUROC of 0.657-0.724, specificity of 82.96-86.84% and PPV of 95.20-96.60%, respectively. CONCLUSIONS: This simple flaccid PSV measurement is a specific tool for screening arteriogenic impotence.

Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a comparative study with grey-scale US.

OBJECTIVES: To prospectively assess the diagnostic performance of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) among infants with conjugated hyperbilirubinaemia by comparing this approach with grey-scale ultrasonography (US). METHODS: Forty infants were analysed as the control group to determine normal liver stiffness values. The use of SSWE values for identifying BA was investigated in 172 infants suspected of having BA, and results were compared with the results obtained by grey-scale US. The Mann-Whitney U test, unpaired t-test, Spearman correlation and linear regression were also performed. RESULTS: The success rates of SSWE measurements in the control and study group were 100% (40/40) and 96.4% (244/253), respectively. Age, direct bilirubin, and indirect bilirubin all significantly correlated with SSWE in the liver (all P < 0.001). Linear regression showed that age had a greater effect on SSWE values than direct or indirect bilirubin. The diagnostic performance of liver stiffness values in identifying BA was lower than that of grey-scale US (area under the receiver operating characteristic curve [AUC], 0.790 vs 0.893, P < 0.001). CONCLUSIONS: SSWE is feasible and valuable in differentiating BA from non-BA. However, its diagnostic performance does not exceed that of grey-scale US. KEY POINTS: • SSWE could be successfully performed in an infant population. • For infants, the liver stiffness will increase as age increases. • SSWE is potentially useful in assessing infants suspected of biliary atresia. • SSWE is inferior to grey-scale US in identifying biliary atresia.

Assessment of liver fibrosis in chronic hepatitis B using acoustic structure quantification: quantitative morphological ultrasound.

OBJECTIVES: To prospectively investigate the usefulness of acoustic structure quantification (ASQ) for noninvasive assessment of liver fibrosis in patients with chronic hepatitis B (CHB). METHODS: Consecutive patients with CHB scheduled for liver biopsy or partial liver resection underwent standardized ASQ examinations. The ASQ parameter, named focal disturbance (FD) ratio, were compared with METAVIR scores. The analysis was based on receiver operating characteristic (ROC) curves and multiple regression analysis. RESULTS: A total of 114 patients were enrolled in the final analysis. The area under the ROC curve for the FD ratio was 0.84 for significant fibrosis (≥ F2), 0.86 for severe fibrosis (≥ F3), and 0.83 for cirrhosis (= F4). The optimal cutoff values for the FD ratio were 0.25, 0.30 and 0.50 for fibrosis stages ≥ F2, ≥ F3 and = F4, respectively. The prevalence of a difference of at least two stages between the FD ratio and the histological stage was 12.3 % (14 of 114). The fibrosis stage (P < 0.001), degree of steatosis (P < 0.001) were independent factors associated with the FD ratio. CONCLUSIONS: FD ratio should be an effective noninvasive imaging biomarker for the assessment of liver fibrosis in patients with CHB. KEY POINTS: • Focal disturbance (FD) ratio increased with the increasing histological fibrosis stages. • FD ratio showed promising diagnostic accuracy in assessing liver fibrosis. • Degree of fibrosis and steatosis were independent factors associated with FD ratio.

Elastography of shear wave speed imaging for the evaluation of liver fibrosis: A meta-analysis.

AIM: A meta-analysis was carried out to assess the accuracies of shear wave speed imaging (SWSI) in predicting significant fibrosis (stages F2-4) and cirrhosis (stage F4). METHODS: A review was performed of relevant studies published until October 2015. A bivariate binomial model was used to combine the sensitivity, specificity, and the area under the summary receiver operating characteristic (AUC), and 95% confidence intervals were derived to indicate the diagnostic accuracy of imaging modalities. RESULTS: In total, 10 studies with 2182 patients were included in the analysis. The sensitivity, specificity, and AUC (with 95% confidence intervals) of SWSI were: 0.84 (0.81-0.87), 0.83 (0.77-0.88), and 0.88 (0.85-0.90) for significant fibrosis, respectively; and 0.80 (0.66-0.89), 0.93 (0.88-0.96), and 0.95 (0.92-0.96) for cirrhosis, respectively. When SWSI was compared with well-evaluated transient elastography, the AUCs for the prediction of significant fibrosis were 0.93 and 0.86, respectively. The AUCs for the prediction of cirrhosis were both 0.94. CONCLUSION: Shear wave speed imaging is a trustworthy tool for staging hepatic fibrosis, with a high combination of sensitivity and specificity. Compared with transient elastography, SWSI showed better diagnostic performance for the prediction of significant fibrosis.

Optimizing the US Diagnosis of Biliary Atresia with a Modified Triangular Cord Thickness and Gallbladder Classification.

Purpose To evaluate the diagnostic performance of ultrasonography (US) in the identification and exclusion of biliary atresia with a modified triangular cord thickness metric together with a gallbladder classification scheme, as well as hepatic artery (HA) diameter and liver and spleen size, in a large sample of jaundiced infants. Materials and Methods The ethics committee approved this study, and written informed parental consent was obtained. In 273 infants with conjugated hyperbilirubinemia (total bilirubin level ≥ 31.2 µmol/L, with direct bilirubin level > indirect bilirubin level), detailed abdominal US was performed to exclude biliary atresia. Biliary atresia was found in 129 infants and ruled out in 144. A modified triangular cord thickness was measured at the anterior branch of the right portal vein, and a gallbladder classification scheme was identified that incorporated the appearance of the gallbladder and a gallbladder length-to-width ratio of up to 5.2 when the lumen was visualized, as well as HA diameter and liver and spleen size. Reference standard diagnosis was based on results of one or more of the following: surgery, liver biopsy, cholangiography, and clinical follow-up. Area under the receiver operating characteristic curve (AUC) analysis, binary logistic regression analysis, Fisher exact test, and unpaired t test were performed. Results Triangular cord thickness, HA diameter, ratio of gallbladder length to gallbladder width, liver size, and spleen size exhibited statistically significant differences (all P < .05) between the group with biliary atresia and the group without. AUCs of triangular cord thickness, ratio of gallbladder length to width, and HA diameter were 0.952, 0.844, and 0.838, respectively. Logistic regression analysis demonstrated that these three US parameters were significantly associated (all P < .05) with biliary atresia. The combination of triangular cord thickness and gallbladder classification could yield comparable AUCs (0.915 vs 0.933, P = .400) and a higher sensitivity (96.9% vs 92.2%), compared with triangular cord thickness alone. Conclusion By using the combination of modified triangular cord thickness and gallbladder classification scheme, most infants with biliary atresia could be identified. (©) RSNA, 2015.

Usefulness of Sonography in Evaluating Children Suspected of Malrotation: Comparison With an Upper Gastrointestinal Contrast Study.

OBJECTIVES: The purpose of this study was to prospectively evaluate the value of sonography in working up or ruling out malrotation by 3 sonographic features (inversion of the superior mesenteric artery and superior mesenteric vein, the whirlpool sign, and an intraperitoneal transverse duodenum) and comparing it with an upper gastrointestinal (GI) contrast study. METHODS: A total of 70 pediatric patients who underwent detailed abdominal sonography to rule out intestinal malrotation were included. Twenty-three of them also underwent an upper GI contrast study. Surgery or clinical follow-up was taken as the reference standard. Statistical analysis was performed with the χ(2) test. RESULTS: Twenty-three patients had a diagnosis of malrotation by surgical findings. With the combination of all 3 sonographic features, the sensitivity, specificity, and accuracy of sonography for determining malrotation were 100% (23 of 23), 97.8% (46 of 47), and 98.6% (69 of 70), respectively, whereas the sensitivity, specificity, and accuracy of the upper GI study were 40% (4 of 10), 64.3% (9 of 14), and 56.5% (13 of 23; P < .001). Combined anomalies in 2 patients and complications in 2 patients were also detected by sonography. CONCLUSIONS: By combining inversion of the superior mesenteric artery and superior mesenteric vein, the whirlpool sign, and an intraperitoneal transverse duodenum, sonography might be more valuable for accurately working up or ruling out pediatric malrotation than an upper GI contrast study. In addition, sonography could provide extra information, such as combined anomalies and intestinal necrosis, to help management.

Preliminary experience of a new perspective view technology for the detection of portal vein thrombus in hepatocellular carcinoma patients.

OBJECTIVE: To assess the feasibility and efficiency of a perspective view technology (Fly Thru) for the detection of portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients. METHODS: Fly Thru was performed in 79 HCC patients. The images were reviewed off-site for evaluation of the imaging quality and diagnosis. Pathology and/or contrast-enhanced CT was used as the reference standard for PVTT. The diagnostic quality of the images, presences of PVTT, and patency of the target vessels were recorded by two-dimensional ultrasound (2DUS) and Fly Thru image. The diagnostic performances of resident and staff radiologists were compared between 2DUS with or without off-line Fly Thru. RESULTS: Fly Thru was performed successfully in 43 of 79 patients (54.4%). The Fly Thru Imaging quality was good in 30/43 patients (69.8%), suboptimal but diagnostic in 10/43 (23.2%), and non-diagnostic in the remaining 3/43 (7.0%). PVTTs were detected in 31 patients according to the reference standard, with 8 in the main portal vein, 15 in the first branch, and 8 in the second branch of the portal vein. The agreement was good between conventional 2DUS and Fly Thru (κ = 0.783, p = 0.000). There was a significant association between the quality and the ability of Fly Thru in the detection of PVTTs (p = 0.001). The diagnostic performance for both readers between 2DUS with or without Fly Thru showed no statistically significant differences, except for the sensitivity for resident radiologist. The sensitivity of 2DUS (71.0%, 22/31) for resident radiologists was lower than that of Fly Thru as an adjunctive diagnostic tool (90.3%, 28/31) (p = 0.041). CONCLUSION: Fly Thru is of diagnostic quality and can provide useful information for the detection of PVTT in HCC patients.

Contrast-enhanced ultrasound features of histologically proven focal nodular hyperplasia: diagnostic performance compared with contrast-enhanced CT.

OBJECTIVES: To investigate and compare contrast-enhanced ultrasound (CEUS) in the characterisation of histologically proven focal nodular hyperplasia (FNH) with contrast-enhanced computed tomography (CECT). METHODS: CEUS was performed in 85 patients with 85 histologically proven FNHs. Enhancement, centrifugal filling, spoke-wheel arteries, feeding artery and central scarring were reviewed and correlated with lesion size or liver background. Independent factors for predicting FNH from other focal liver lesions (FLLs) were evaluated. Forty-seven FLLs with CECT were randomly selected for comparison of diagnostic performance with CEUS. RESULTS: Centrifugal filling was more common (P = 0.002) and the significant predictor (P = 0.003) in FNHs ≤3 cm. Lesion size or liver background has no significant influence on the detection rate of the spoke-wheel arteries and feeding artery (P > 0.05). Central scarring was found in 42.6 % of FNHs ≥3 cm (P = 0.000). The area under the ROC curve, sensitivity and specificity showed no significant differences between CEUS and CECT (P > 0.05), except that the sensitivity of CEUS was better for reader 1 (P = 0.041). CONCLUSION: CEUS is valuable in characterising centrifugal filling signs or spoke wheels in small FNHs and should be employed as the first-line imaging technique for diagnosis of FNH. KEY POINTS: • The confident diagnosis of focal nodular hyperplasia is important in liver imaging. • The centrifugal filling sign is useful for diagnosis of FNHs ≤3 cm. • Contrast-enhanced ultrasound and contrast-enhanced CT have similar diagnostic performance for FNH. • CEUS should be the first-line imaging technique for the diagnosis of FNH.

Objective differential characteristics of cystic biliary atresia and choledochal cysts in neonates and young infants: sonographic findings.

OBJECTIVES: To prospectively evaluate the objective differential characteristics between cystic biliary atresia and choledochal cysts on sonography among neonates and young infants. METHODS: Twenty-three patients who had sonographic findings of a portal cyst and a final diagnosis were included. Their final diagnoses were cystic biliary atresia in 12 patients and choledochal cysts in 11. All of them underwent detailed sonographic scanning. Data for cystic biliary atresia and choledochal cyst groups were compared by the χ(2) test for categorical variables and an unpaired t test for continuous variables. RESULTS: The triangular cord sign was detected in 11 patients in the atresia group but in none in the cyst group (P < .001). Nine of 11 patients in the cyst group had dilatation of intrahepatic bile ducts, whereas none in the atresia group had that feature (P < .001). Sonography also showed sludge deposits in the cysts in 6 of 11 patients in the cyst group, whereas none in the atresia group had sludge deposits (P = .005). The mean width and length of the cysts in the cyst group were significantly larger than those in the atresia group (P< .05 for both). The mean hepatic artery diameter was significantly larger in the atresia group than in the cyst group (P < .001). The difference in gallbladder abnormalities between the atresia (n = 11) and cyst (n = 0) groups was also significant (P < .001). When all specific sonographic features were used, all patients were correctly classified into the atresia and cyst groups. CONCLUSIONS: The triangular cord sign, intrahepatic bile duct dilatation, and echoic cysts might be regarded as objective sonographic features for differentiating cystic biliary atresia and choledochal cysts. Other sonographic features might be very supportive.

Development and evaluation of lipid microbubbles targeted to alpha(v)beta(3)-integrin via biotin-avidin bridge.

This work was to report preparation and quality control of targeted microbubbles (MB(t)) via biotin-avidin bridge, specifically verification of the "biotin-avidin-biotin" sandwich structure. (1) Lipid microbubbles filled with sulphur hexafluoride were produced by sonication and compared with commercially available microbubbles. (2) MB(t) were produced via biotin-avidin bridge. Specifically, the "biotin-avidin-biotin" sandwich structure on the surface of MB(t) was verified in vitro using fluorescence. (3) Adhesion of alpha(v)beta(3)-integrin targeted MB(t) (MB(αvß3)) to human umbilical vein endothelial cells (HUVECs) was tested using the parallel plate flow chamber (PPFC). "Biotin-avidin" is a reliable method to attach molecular probe onto the surface of microbubbles.

Inhibition of Spinal Interleukin-33 Attenuates Peripheral Inflammation and Hyperalgesia in Experimental Arthritis.

Accumulating evidence indicates that the continuous and intense nociceptive from inflamed tissue may increase the excitability of spinal dorsal horn neurons, which can signal back and modulate peripheral inflammation. Previous studies have demonstrated that spinal interleukin (IL)-33 contributes to the hyperexcitability of spinal dorsal horn neurons. This study was undertaken to investigate whether spinal IL-33 can also influence a peripheral inflammatory response in a rat model of arthritis. Lentivirus-delivered short hairpin RNA targeting IL-33 (LV-shIL-33) was constructed for gene silencing. Rats with adjuvant-induced arthritis (AIA) were injected intrathecally with LV-shIL-33 3 days before the complete Freund's adjuvant (CFA) injection. During an observation period of 21 days, pain-related behavior and inflammation were assessed. In addition, the expression of spinal proinflammatory cytokines and the activation of spinal extracellular signal-regulated kinase (ERK) and nuclear factor-κB (NF-κB) pathways were evaluated on 9 days after CFA treatment. The existence of tissue injury or inflammation in rats with AIA resulted in the upregulation of spinal IL-33, which is predominantly expressed in neurons, astrocytes, and oligodendrocytes. Intrathecal administration of LV-shIL-33 significantly alleviated hyperalgesia, paw swelling, and joint destruction, and attenuated the expression of proinflammatory cytokines [IL-6, IL-1ß, and tumor necrosis factor-α (TNF-α)], as well as the activation of ERK and NF-κB/p65 in the spinal cord. Our data suggest that spinal IL-33 contributes to the development of both peripheral inflammation and hyperalgesia. Thus, interference with IL-33 at the spinal level might represent a novel therapeutic target for painful inflammatory disorders.

Effects of different fertilization rates on growth, yield, quality and partial factor productivity of tomato under non-pressure gravity irrigation.

To select the optimum fertilizer application under specific irrigation levels and to provide a reliable fertigation system for tomato plants, an experiment was conducted by using a microporous membrane for water-fertilizer integration under non-pressure gravity. A compound fertilizer (N:P2O5:K2O, 18:7:20) was adopted for topdressing at four levels, 1290 kg/ha, 1140 kg/ha, 990 kg/ha, and 840 kg/ha, and the locally recommended level of 1875 kg/ha was used as the control to explore the effects of different fertilizer application rates on growth, nutrient distribution, quality, yield, and partial factor of productivity (PFP) in tomato. The new regime of microporous membrane water-fertilizer integration under non-pressure gravity irrigation reduced the fertilizer application rate while promoting plant growth in the early and intermediate stages. Except for the 990 kg/ha fertilizer treatment, yields per plant and per plot for each fertilizer application rate were higher than or equal to those of the control. The new regime could effectively improve PFP and reduce soil nutrient enrichment. Fertilizer at 840 kg/ha showed the optimum results by increasing PFP by 75.72% as compared to control. In conclusion, the fertilizer rate at 840 kg/ha has not only maintained the productivity of soil but also tomato growth and quality of fruit which makes the non-pressure gravity irrigation a potential and cost-effective way for fertilizer application.

The Prognosis of Type III Biliary Atresia with Hilar Cyst.

OBJECTIVE: To compare the outcome of biliary atresia (BA) patients with and without hilar cyst on preoperative ultrasound. METHODS: A single center retrospective review of patients of BA with (n = 27) and without hilar cyst (n = 27) over a 5 y period was done. The patients were analyzed using propensity score matching to reduce selection bias. All patients were diagnosed as type III BA by histologic examination and cholangiograms. Clinicopathological characteristics and survival outcomes were compared between the two groups. RESULTS: There were no significant intergroup differences between baseline characteristics and outcomes after Kasai portoenterostomy surgery in two groups. BA with hilar cyst group showed comparable survival outcomes to the BA without cyst group (cumulative 1-y, 2-y and 5-y overall survival rates with native liver 61.4% vs. 65.8%, P = 0.041; 45.0% vs. 49.0%, P = 0.57; 45.0% vs. 49.0%, P = 0.57). And the Kaplan-Meier survival curves showed no significant difference in cumulative survival with native liver between the two groups (P = 0.58). CONCLUSIONS: Type III BA with hilar cyst had no better prognosis compared with Type III BA without cyst.

[The clinical value of high frequency ultrasound in diagnosis of peripheral nerve diseases].

OBJECTIVE: To evaluate the clinical value of high frequency ultrasound in diagnosing peripheral nerve diseases (PNDs). METHODS: From January 2003 to December 2006, 64 cases of PNDs were analyzed retrospectively. The ultrasound diagnosis was compared with the operative and pathological diagnosis. RESULTS: Based on the operative and histopathological results, in 38 patients with trauma or entrapment, 38 among 45 traumatic nerves were rightly diagnosed by ultrasound. The coincidence rate was 84.4%. In 26 patients with original peripheral nerve tumors (PNTs), including 20 neurilemmomas, 4 neurofibromas and 2 malignant neurilemmomas, 16 cases were diagnosed by ultrasound with a coincidence rate of 61.5%. The coincidence rates in limbs and trunk were 86.7% (13/15) and 27.3% (3/11) respectively. CONCLUSIONS: The study suggests that high frequency ultrasound can locate peripheral nerve trauma precisely, assess the impair degree correctly and provide useful information for clinic diagnosis. The high frequency ultrasound brings better diagnosis outcome in limbs nerve tumors than in trunk.

Effects of PEMFs on Osx, Ocn, TRAP, and CTSK gene expression in postmenopausal osteoporosis model mice.

Objective: Ovariectomized mice were used to simulate the symptoms of postmenopausal women with osteoporosis, and observe the effects of PEMF treatment on expression of Osx, Ocn, TRAP, and CTSK in ovariectomized mice. Methods: Thirty-week-old wild-type C57BL/6 mice were randomly divided into three groups (n=10, each group): sham operation group, ovariectomy (OVX) group, and PEMF group. Mice in the sham group underwent sham ovariectomy, while mice in the remaining two groups were ovariectomized. On postoperative day two, mice in the PEMF treatment group received PEMF treatment at a frequency of 8 Hz and an intensity of 3.8 mT for one hour daily for four weeks. At the same time, mice in the remaining two groups were placed in the PEMF treatment area under power-down state daily, similar to that in the PEMF group. After four weeks, all relevant indicators were tested. Results: (1) Compared with mice in the sham group, the number of trabecular bones significantly decreased, the thickness of the trabecular bone became thinner, the number of osteoclasts significantly increased, the gene expression of Osx and Ocn significantly decreased, and the gene expression of TRAP and CTSK significantly increased in the OVX group (P<0.01). (2) Compared with the blank controls without operation, the number of osteoblasts increased in the PEMF group. (3) Compared with the OVX group, the number of osteoclasts significantly decreased, the expression of Osx and Ocn significantly increased, and the gene expression of TRAP and CTSK significantly decreased in the PEMF group (P<0.01). Conclusion: PEMF treatment can significantly promote bone formation, which may be realized through inhibition of osteoclast formation, achieving bone morphological protection. PEMFs can significantly upregulate Osx and Ocn osteogenesis-related genes, which affect bone formation, and downregulate TRAP and CTSK osteoclast-related genes, which affect bone resorption. PEMFs may be used to treat postmenopausal osteoporosis by regulating Osx, Ocn, TRAP, and CTSK gene expression.

The value of clinical and ultrasound features for the diagnosis of infantile hepatic hemangioma: Comparison with contrast-enhanced CT/MRI.

OBJECTIVES: To investigate the combined use of ultrasound together with clinical features to differentiate infantile hepatic hemangioma (IHH) from other focal liver lesions (FLLs) in children and to compare the efficacy of the combined method to that of CECT/MRI. METHODS: The location, number, size and appearance of the tumors were evaluated in 45 children with IHH. Another 45 children with FLL were randomly selected as a control group. Independent factors for predicting IHH versus FLLs were evaluated. The diagnostic performance of the clinical and ultrasound features was compared with CECT/MRI. RESULTS: Compared with the control FLL group, the IHH group had a younger age at diagnosis (P = 0.008), lower alpha-fetoprotein (AFP) levels (P = 0.000), smaller lesion sizes (P = 0.000), and a higher tumor proportion with a resistance index (RI) of <0.7. Multiple logistic regression analysis showed that age, size, RI and AFP were independent factors for predicting IHH. Receiver operating characteristic (ROC) curve analysis showed that the AUC (area under the curve) of the four combined independent factors was 0.881 (95% CI: 0.744-0.960), while the AUC for the CECT/MRI method was 0.905 (95% CI: 0.774-0.973), and the combined AUC for the independent factors and CECT/MRI was 0.929 (95% CI: 0.805-0.985). There were not statistically significant among the three AUCs (P > 0.05). CONCLUSIONS: CECT/MRI was the effective diagnostic indicator for IHH. However, the combined clinical and ultrasound diagnoses, including age at diagnosis, lesion size, RI and AFP, can achieve the same effectiveness as CECT/MRI.