The value of multimodal ultrasound in diagnosis of cervical lymphadenopathy: can real-time elastography help identify benign and malignant lymph nodes?

Aim: To investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes. Methods: A retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS. Results: Of the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p< 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p< 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p<0.001). Conclusion: In this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.

Extramammary Paget's Disease in the Genital Area of a Male: A Case Report and Review of the Literature.

Extramammary Paget's disease (EMPD) is an uncommon intraepithelial malignancy that is rarely found in the male. Currently, there is very little knowledge pertaining to EMPD imaging, particularly in cases that involve the scrotum. Here, a 67-year-old man with lichenification on his left scrotum confirmed to be EMPD was reviewed. Bloodwork did not return a positive result, but syphilis-specific antibodies were found. Conventional high-frequency ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging were utilized to determine the lesion size and blood perfusion. In the present case, the lesion's size and involvement were vividly depicted by CEUS, while results obtained by conventional US were grossly underestimated. Consequently, multimodal imaging assessment is likely to provide more accurate diagnoses for uncommon diseases, such as EMPD, and to aid in clinical decision-making.

miR-573 regulates cell proliferation and apoptosis by targeting Bax in nucleus pulposus cells.

BACKGROUND: MicroRNA (miRNA) plays a vital role in the pathogenesis of intervertebral disc degeneration (IDD). The expression and potential mechanism of miR-573 in human nucleus pulposus (NP) remains to be elucidated. In this study, we aimed to investigate the role of miR-573 in IDD. METHODS: Quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis was applied to examine the expression of miR-573 and Bax in idiopathic scoliosis tissues and IDD tissues. Human NP cells were employed for analysis. Moreover, the proliferation and apoptosis of NP cells were detected using MTT and flow cytometry assay respectively. The expression levels of Bcl-2, cleaved caspase-3, cleaved caspase-9, caspase-3 and caspase-9 in degenerative NP cells were measured by Western blotting assay. Furthermore, a luciferase reporter assay was used to verify the relationship between miR-573 and Bax. RESULTS: The results revealed that the mRNA expression level of miR-573 was down-regulated whereas Bax was up-regulated notably in degenerative NP cells. In addition, overexpression of miR-573 increased cell viability remarkably, coupled with inhibition of cell apoptosis. The expression level of Bcl-2 was increased while cleaved caspase-3 and cleaved caspase-9 expression levels were decreased in miR-573 overexpression NP cells. Additionally, the bioinformatics analysis underscored that Bax was a direct target gene of miR-573. CONCLUSION: These results suggest that overexpression of miR-573 inhibited NP cell apoptosis by down-regulating Bax, which proved to be a novel effective strategy for IDD therapies.

[Frequency distribution and antibiotic resistance of pathogens from the cerebrospinal fluid of 116 children with bacterial meningitis].

OBJECTIVE: To determine the frequency distribution and antibiotic resistance of pathogens isolated from the cerebrospinal fluid samples of children with bacterial meningitis (BM) and to provide a basis for the timely and effective treatment of childhood BM. METHODS: Retrospective analysis was performed on pathogens isolated from 5097 cerebrospinal fluid samples collected from children in Kunming Children's Hospital between January 2008 and June 2012, as well as drug sensitivity test results. Kirby-Bauer antibiotic testing was used to analyze the sensitivity of these pathogens to commonly used antibiotics. RESULTS: A total of 116 pathogen strains were detected from the 5097 cerebrospinal fluid samples, including 77 (66.4%) Gram-positive strains, 30 (25.9%) Gram-negative strains, and 9 (7.8%) fungal strains, with a positive rate of 2.28%. The six most frequently isolated pathogens were Staphylococcus epidermidis (32 strains, 27.6%), Streptococcus pneumoniae (15 strains, 12.9%), Escherichia coli (15 strains, 12.9%), Staphylococcus haemolyticus (9 strains, 7.8%), Cryptococcus neoformans (8 strains, 6.9%) and Staphylococcus aureus (6 strains, 5.2%). Coagulase-negative staphylococci was the predominant pathogen in neonates and young infants with BM, and its sensitivity rates to penicillin, erythromycin and clindamycin were lower than 40%. Streptococcus pneumoniae had a penicillin sensitivity rate of 13.4%, while sensitivity rates to erythromycin and clindamycin reached 60.0%. No Staphylococcus and Streptococcus pneumoniae pathogens resistant to vancomycin were found. Gram-negative bacilli had relatively high sensitivity rates to imipenem, meropenem, cefoperazone/sulbactam and cefepime. CONCLUSIONS: Gram-positive cocci are the predominant pathogens for childhood BM over the past five years. The detected pathogens develop high resistance to commonly used antibiotics. To prevent misdiagnosis, careful attention should be paid to BM caused by Cryptococcus neoformans.