CT-based radiomics combined with clinical features for invasiveness prediction and pathological subtypes classification of subsolid pulmonary nodules.

Purpose: To construct optimal models for predicting the invasiveness and pathological subtypes of subsolid nodules (SSNs) based on CT radiomics and clinical features. Materials and Methods: This study was a retrospective study involving two centers. A total of 316 patients with 353 SSNs confirmed as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) were included from January 2019 to February 2023. Models based on CT radiomics and clinical features were constructed for classification of AAH/AIS and MIA, MIA and IAC, as well as lepidic-predominant adenocarcinoma (LPA) and acinar-predominant adenocarcinoma (APA). Receiver operating characteristic (ROC) curve was used to evaluate the model performance. Finally, the nomograms based on the optimal models were established. Results: The nomogram based on the combined model (AAH/AIS versus MIA) consisting of lobulation, the GGN-vessel relationship, diameter, CT value, consolidation tumor ratio (CTR) and rad-score performed the best (AUC=0.841), while age, CT value, CTR and rad-score were the significant features for distinguishing MIA from IAC, the nomogram based on these features performed the best (AUC=0.878). There were no significant differences in clinical features between LPA and APA, while the radiomics model based on rad-score showed good performance for distinguishing LPA from APA (AUC=0.926). Conclusions: The nomograms based on radiomics and clinical features could predict the invasiveness of SSNs accurately. Moreover, radiomics models showed good performance in distinguishing LPA from APA.

Atractylenolide II regulates the proliferation, ferroptosis, and immune escape of hepatocellular carcinoma cells by inactivating the TRAF6/NF-κB pathway.

Hepatocellular carcinoma (HCC) is a common and lethal tumor worldwide. Atractylenolide II (AT-II) is a natural sesquiterpenoid monomer, with anti-tumor effect. To address the effect and mechanisms of AT-II on HCC. The role and mechanisms of AT-II were assessed through cell counting kit-8, flow cytometry, enzyme-linked immunosorbent assay, immunofluorescence, and western blot experiments in Hep3B and Huh7 cells. In vivo experiments were conducted in BALB/c nude mice using immunohistochemistry and western blot assays. AT-II decreased the cell viability of Hep3B and Huh7 cells with a IC50 of 96.43 µM and 118.38 µM, respectively. AT-II increased relative Fe2+ level, which was further promoted with the incubation of erastin and declined with the ferrostatin-1 in Hep3B and Huh7 cells. AT-II enhanced the level of ROS and MDA, but reduced the GSH level, and the expression of xCT and GPX4. AT-II elevated the percent of CD8+ T cells and the IFN-γ contents, and declined the IL-10 concentrations and the expression of PD-L1 in Hep3B and Huh7 cells. AT-II downregulated the relative protein level of TRAF6, p-p65/p-65, and p-IkBα/IkBα, which was rescued with overexpression of TRAF6. Upregulation of TRAF6 also reversed the effect of AT-II on proliferation, ferroptosis, and immune escape in Hep3B cells. In vivo, AT-II reduced tumor volume and weight, the level of GPX4, xCT, and PD-L1, and the expression of TRAF6, p-p65/p-65, and p-IkBα/IkBα, with the increased expression of CD8. AT-II modulated the proliferation, ferroptosis, and immune escape of HCC cells by downregulating the TRAF6/NF-κB pathway.

Development and validation of a nomogram based on CT texture analysis for discriminating minimally invasive adenocarcinoma from glandular precursor lesions in sub­centimeter pulmonary ground glass nodules.

In a recent reclassification, adenocarcinoma in situ has been redefined as a glandular precursor lesion (GPL), alongside adenomatous hyperplasia. This updated classification necessitates corresponding adaptations in clinical diagnostic and therapeutic protocols. Consequently, the present study aimed to construct and validate a nomogram utilizing computed tomography (CT) texture features to effectively discriminate between minimally invasive adenocarcinoma (MIA) and GPL within sub-centimeter pulmonary ground glass nodules (GGNs). To achieve this objective, the present study employed rigorous statistical methodologies, including the Mann-Whitney U test and binary logistic regression analysis, to identify distinguishing features and establish predictive models. Subsequently, the diagnostic performance of these models underwent evaluation through receiver operating characteristic (ROC) curves. The area under the curve (AUC) in ROC curves was compared using DeLong's test. Additionally, the nomogram was constructed using R software and its diagnostic performance was validated through calibration curves. Within both the training and validation datasets, the AUCs were observed to be 0.992 [95% confidence interval (CI): 0.980-1.000] and 0.975 (95% CI: 0.935-1.000), respectively. DeLong's test revealed significant disparities in the AUCs between the nomogram and single-parameter models (P<0.001). Furthermore, calibration curves demonstrated concordance between the training and validation datasets. In conclusion, the application of a CT texture-based nomogram model has demonstrated aptitude in differentiating between MIA and GPL within sub-centimeter GGNs. This model streamlines the identification of optimal surgical interventions and enhances the sphere of clinical decision-making and management.

Identifying Depression in Parkinson's Disease by Using Combined Diffusion Tensor Imaging and Support Vector Machine.

Objective: To investigate white matter microstructural alterations in Parkinson's disease (PD) patients with depression using the whole-brain diffusion tensor imaging (DTI) method and to explore the DTI-based machine learning model in identifying depressed PD (dPD). Methods: The DTI data were collected from 37 patients with dPD and 35 patients with non-depressed PD (ndPD), and 25 healthy control (HC) subjects were collected as the reference. An atlas-based analysis method was used to compare fractional anisotropy (FA) and mean diffusivity (MD) among the three groups. A support vector machine (SVM) was trained to examine the probability of discriminating between dPD and ndPD. Results: As compared with ndPD, dPD group exhibited significantly decreased FA in the bilateral corticospinal tract, right cingulum (cingulate gyrus), left cingulum hippocampus, bilateral inferior longitudinal fasciculus, and bilateral superior longitudinal fasciculus, and increased MD in the right cingulum (cingulate gyrus) and left superior longitudinal fasciculus-temporal part. For discriminating between dPD and ndPD, the SVM model with DTI features exhibited an accuracy of 0.70 in the training set [area under the receiver operating characteristic curve (ROC) was 0.78] and an accuracy of 0.73 in the test set (area under the ROC was 0.71). Conclusion: Depression in PD is associated with white matter microstructural alterations. The SVM machine learning model based on DTI parameters could be valuable for the individualized diagnosis of dPD.

TiaochangXiaoliu decoction inhibits azomethane (AOM)/dextran sulfate sodium (DSS)-induced colorectal cancer by regulating immune response.

BACKGROUND: TiaochangXiaoliu decoction (TXD) has an anti-tumor effect in clinical practice. We further investigated the role of TXD in colorectal cancer (CRC). METHODS: Mouse models of CRC were induced by azomethane (AOM)/dextran sulfate sodium (DSS), with sixty male C57BL/6 mice randomly divided into six groups (10 mice/group): a control group, AOM/DSS group, TXD at low dose (L-dose) group, middle dose (M-dose) group, high dose (H-dose) group, and Celecoxib (Cel) group. The colorectum, serum, and plasma of mice in each group was collected following sacrifice to record the number of tumors. HE staining was utilized for observing pathological damage to colorectal tissues, ELISA used for detecting INF-γ, IL-2, and TNF-α expression in serum, and flow cytometry used for measuring the proportion of CD4+, CD8+, CD4+/CD8+, and NK cells in plasma. RESULTS: Compared with the control group, the AOM/DSS group showed tumor masses in the colorectum and different degrees of pathological damage in the intestine. AOM/DSS induction also resulted in an increase in INF-γ, IL-2, and TNF-α expression in serum, and a decrease in the percentages of CD4+, CD8+, CD4+/CD8+, and NK cells(P<0.05). In comparison with the AOM/DSS group, with the increase of TXD dose, the number of tumors decreased significantly, and intestinal structure and mucosal inflammatory cell infiltration also improved. Further, in comparison with the AOM/DSS group, all three doses of TXD and celecoxib caused an increase in the contents of CD4+, CD8+, CD4+/CD8+, and NK cells in plasma. In addition, in the M-dose, H-dose, and Cel groups, INF-γ, IL-2, and TNF-α expression showed a marked decrease, and the reduction in these two groups treated with TXD was dose-dependent. CONCLUSIONS: TXD leads to a marked reduction in the number of tumors and inflammatory cell infiltration in CRC mice. This decoction significantly decreased the levels of INF-γ, IL-2, and TNF-α in serum, and increased the contents of CD4+, CD8+, CD4+/CD8+, and NK cell in the plasma of mice with AOM/DSS-induced CRC.

Machine learning-based multiparametric traditional multislice computed tomography radiomics for improving the discrimination of parotid neoplasms.

Characterization of parotid tumors is important for treatment planning and prognosis, and parotid tumor discrimination has recently been developed at the molecular level. The aim of the present study was to establish a machine learning (ML) predictive model based on multiparametric traditional multislice CT (MSCT) radiomic and clinical data analysis to improve the accuracy of differentiation among pleomorphic adenoma (PA), Warthin tumor (WT) and parotid carcinoma (PCa). A total of 345 patients (200 with WT, 91 with PA and 54 with PCa) with pathologically confirmed parotid tumors were retrospectively enrolled from five independent institutions between January 2010 and May 2019. A total of 273 patients recruited from institutions 1, 2 and 3 were randomly assigned to the training model; the independent validation set consisted of 72 patients treated at institutions 1, 4 and 5. Data were investigated using a linear discriminant analysis-based ML classifier. Feature selection and dimension reduction were conducted using reproducibility testing and a wrapper method. The diagnostic accuracy of the predictive model was compared with histopathological findings as reference results. This classifier achieved a satisfactory performance for the discrimination of PA, WT and PCa, with a total accuracy of 82.1% in the training cohort and 80.5% in the validation cohort. In conclusion, ML-based multiparametric traditional MSCT radiomics can improve the accuracy of differentiation among PA, WT and PCa. The findings of the present study should be validated by multicenter prospective studies using completely independent external data.

Three-dimensional pulsed continuous arterial spin labeling and intravoxel incoherent motion imaging of nasopharyngeal carcinoma: correlations with Ki-67 proliferation status.

BACKGROUND: Recurrence and distant metastasis are still the main problems affecting the long-term prognosis of nasopharyngeal carcinoma (NPC) patients, and may be related to the Ki-67 proliferation status. We therefore explored the potential correlation between Ki-67 proliferation status in NPC with the parameters derived from two imaging techniques: three-dimensional pulsed continuous arterial spin labeling (3D pCASL) and intravoxel incoherent motion (IVIM). METHODS: Thirty-six patients with pathologically confirmed NPC were included, and the Ki-67 labeling index (LI) was measured by immunohistochemistry. All patients underwent plain and contrast-enhanced magnetic resonance imaging (MRI), IVIM, and 3D pCASL examination. The mean, maximum, and minimum of blood flow (BF), minimum of apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) parameters were all measured, and Spearman's correlation analysis was performed to evaluate the relationships between these parameters and the Ki-67 LI. According to the Ki-67 values, the patients were divided into two groups: high (>50%) and low (≤50%). The rank-sum test (Mann-Whitney U test) was then used to compare the differences in quantitative parameters between the high and low Ki-67 groups. RESULTS: Ki-67 LI was positively correlated with BFmean and BFmax (r=0.415 and 0.425). D*mean and D*min did have positive correlation with Ki-67, but this was not significant (P=0.082 and 0.072). BFmax was significantly different between the high and low Ki-67 groups (P=0.028). CONCLUSIONS: 3D pCASL and IVIM are noninvasive functional MR perfusion imaging techniques that can evaluate perfusion information and perfusion parameters. Our study suggests that 3D pCASL is more effective than IVIM for assessing the proliferation status of NPC, which is beneficial for evaluating the prognosis of patients. Furthermore, BFmax is the best biomarker for distinguishing high from low Ki-67 levels.

Effects of Cangfu Daotan Decoction on obese polycystic ovary syndrome and its mechanism.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. Cangfu Daotan Decoction (CFDTT) is one of the prescriptions in the stagnation of obesity-type PCOS. Our previous study showed that CFDTT treatment of obese PCOS was correlated with organic anion transporting polypeptides (OATPs). METHODS: Here, we studied the effects of CFDTT on obese PCOS and its underlying mechanism. We built an obese PCOS rat model and treated the rats with CFDTT. Then, we detected the serum levels of TCHO, TG, LDL-c, HDL-c, luteinizing hormone (LH), follicle stimulating growth hormone (FSH), testosterone (T), estradiol (E2), IL-1ß, IL-6, and TNF-α in each group and adopted RT-PCR, western blotting and immunohistochemical staining to investigate the effects of CFDTT treatment on the expression of OATP2B1 and OATP3A1 in ovarian and uterine tissues. In addition, we compared the pregnancy outcomes of each group. RESULTS: We found that CFDTT decreased the serum levels of TCHO, TG, LDL-c, LH, T, IL-1ß, IL-6, and TNF-α and increased the levels of HDL-c, FSH and E2 in a dose-dependent manner. CFDTT could induce the expression of OATP2B1 and OATP3A1 in ovarian and uterine tissues. Moreover, CFDTT could improve pregnancy outcomes. CONCLUSION: These data suggested that the therapeutic mechanism of Cangfu Daotan Decoction on PCOS may be correlated with regulating lipid metabolism, sex hormone secretion and the inflammatory response and increasing OATP2B1 and OATP3A1 expression. Cangfu Daotan Decoction can be developed as a PCOS treatment drug.

Effect of rNA interference on Oatp3a1 gene expression on biological characteristics and immune factors of ovarian granulosa cells in rats with PCOS.

Polycystic ovary syndrome (PCOS) is a common endocrinal metabolic disease, and its pathogenesis has not yet been thoroughly studied. The purpose of this experiment was to investigate the effect of RNA interference on Oatp3a1 gene expression on the biological viability and immune factors of ovarian granulosa cells in rats with PCOS. First, rats were intragastrically administered 1 mg/kg letrozole to successfully construct PCOS model. Western blot, qRT-PCR, CCK8 and flow cytometry were used to detect the gene expression, immune factor protein expression, cell proliferation and apoptosis in ovarian granulosa cells transfected with siRNA Oatp3a1 in rats with PCOS, respectively. The results showed that follicle stimulating hormone receptor (FSHR) was located on the cell membrane of rat ovarian granulosa cells, and letrozole successfully induced PCOS rat model. In PCOS rat ovarian granulosa cells, the mRNA expression level of Oapta1 was higher than that in normal rat ovarian granulosa cells. At the same time, compared with the sham group, the protein expression of NF-κB, TGF-ß1 and VEGF in si-Oatp3a1 group was significantly down-regulated (P < 0.05), and the cell proliferation rate was significantly decreased in si-Oatp3a1 group (P < 0.05) in comparison with the sham group. The apoptotic rate was increased obviously (P < 0.05), which was about 2.5 times that of the sham group. This indicates that in the ovarian granulosa cells of rats with PCOS, the interference of Oatp3a1 gene expression can significantly inhibit cell proliferation and promote apoptosis, while inhibiting the expression of immune factors TGF-ß1 and VEGF can reduce the expression of NF-κB protein, thereby suppressing the activation of the NF-κB signaling pathway.

Longitudinal Analysis of Prevalence and Risk Factors of Rifampicin-Resistant Tuberculosis in Zhejiang, China.

OBJECTIVES: To investigate the factors associated with rifampicin-resistant tuberculosis among drug resistant tuberculosis patients and to determine the correlation of rifampicin-resistant TB with MDR-TB in a high MDR-TB burden province of china. METHODS: A retrospective longitudinal analysis on four surveys of anti-TB drug resistance done in 1998, 2003, 2008, and 2013 in Zhejiang province, China. 4289 sputum-smear microscopy positive suspected tuberculosis patients were eligible at 30 investigation points, chosen by stratified random sampling at survey sites from all over the province. Culturing samples in L-J medium and the drug-susceptibility testing for the 4 first-line anti-TB drugs were performed to all patients. Multivariate logistic regression was carried out to determine the factors associated with the rifampicin-resistance in the study population. RESULTS: Overall, there were 3832 patients with positive mycobacterial cultures, and 2813 of the isolates (73.4%) were susceptible to all 4 first-line drugs. Analysis of rifampin monoresistant (RMR) TB indicated the prevalence was 1.1% in new cases and 3.4% in previously treated cases. Among the 359 rifampicin resistant TB (RR-TB) cases, 279 (77.7%) were also resistant to isoniazid, indicating MDR-TB. From 1998 to 2013, the proportion of MDR-TB among rifampicin-resistant TB cases varied between 80.0% and 87.5% (P for trend: 0.768) among previously treated cases and varied from 68.6% to 79.5% (P for trend: 0.403) among new cases. Among previously treated patients, those who received treatment for less than 6 months were less likely to have drug resistant TB (OR: 0.40, 95% CI: 0.16-0.97) or MDR-TB (OR: 0.24, 95% CI: 0.07-0.81). Patients who received anti-TB treatment in a general hospital were less likely to develop MDR-TB than those treated in a TB clinic (OR: 0.08, 95% CI: 0.01-0.72). CONCLUSION: This study highlights a high proportion of RMR-TB among new RR-TB cases in Zhejiang, China. The management of treatment with rapid and accurate diagnosis of MDR-TB other than only relying on RIF susceptibility testing is crucial for improving adherence and outcomes in patients with drug-resistant TB.

Correction to: A multiparametric analysis based on DCE-MRI to improve the accuracy of parotid tumor discrimination.

Figure captions of Figures 2, 3, and 4 were incorrect in the original version of this article.

A SWOT analysis of vaccine management in Zhejiang Province / 预防医学

Objective @# To learn the situation of vaccine management in Zhejiang Province by SWOT analysis,so as to provide basis for normalization and standardization of vaccine management. @*Methods@#Through supervision and investigation,the data of vaccine management related human resources and information construction of the CDCs in Zhejiang Province were collected. The comprehensive evaluation of vaccine management in Zhejiang Province was carried out by SWOT analysis,and the SWOT matrix was established for suggestions.@*Results@#The advantages of vaccine management in Zhejiang Province lay in the standardized management of purchase and supply,the construction of vaccine management information system and the guarantee of cold chain system;the disadvantages lay in the insufficient allocation of human resources,new problems of cold chain management,the lack of standardized vaccine management mode and the incomplete coverage of vaccine and vaccination information system;the opportunities lay in the legalization of vaccine management,“Healthy Zhejiang”initiative and the “one run at most”reform in healthcare services;the threats lay in the shortage of vaccine,the gap between the expectation of the public on vaccine management and the current situation,and the reduced capacity of vaccine deployment in the provincial CDC. We should constantly improve the construction of vaccine management system,strengthen the standardized administration,regularly carry out risk assessment on vaccine management,accelerate the full coverage of vaccine and vaccination management information system,and explore the standard operation procedure of vaccine management in Zhejiang Province. @*Conclusions @#Although some achievements have been made in vaccine management in Zhejiang Province,there is still a gap from the goals of high-efficiency,high-level,normalization and standardization. The standardization and full coverage of the information system of vaccine management should be strengthen in the next stage.

A multiparametric analysis based on DCE-MRI to improve the accuracy of parotid tumor discrimination.

BACKGROUND: Recently, semiquantitative time-intensity curve (TIC) analysis based on DCE-MRI and apparent diffusion coefficient (ADC) value-based diffusion-weighted imaging (DWI) were used to improve the diagnostic efficiency when diagnosing parotid tumors (PTs). However, quantitative DCE-MRI biomarkers have not been emphasized previously. PURPOSE: To explore the diagnostic efficiency of perfusion parameters alone or in combination based on quantitative DCE-MRI and DWI in the differential diagnosis of PTs. METHODS: In total, 112 patients with parotid masses were prospectively recruited in our hospital from August 2013 to March 2017. All patients were evaluated with DCE-MRI and DWI before surgery. TIC and quantitative parameters based on DCE MRI and ADCs were analyzed. Receiver operating characteristic analysis and linear discriminant analysis (LDA) was used to determine their diagnostic performance. RESULTS: In total, 87% (27/31) of pleomorphic adenoma (PA) showed type A TIC, 74% (65/88) of Warthin's tumors showed type B TIC, and 95% (19/20) of malignant tumors showed TIC type C. Pearson X2 test showed a significant difference between TIC patterns in benign and malignant tumors (X2 = 38.78, p < 0.001). ROC analysis revealed that ADC achieved the best diagnostic performance for distinguishing PA and Warthin's tumor from others, with area under the curve (AUC) values of 0.945 and 0.925 (p < 0.01), respectively. Furthermore, the TIC type was the only useful biomarker for distinguishing malignant from benign PTs, with an AUC of 0.846 (p < 0.01). Concerning the accuracy of the combined application of multiple parameters of DCE-MRI and ADC values, a combination of TIC pattern and extracellular volume ratio (Ve) provided the best results among five protocols, producing the highest accuracy of 0.75, followed by the combined use of the TIC pattern and ADC (accuracy was 0.70). CONCLUSION: TIC pattern in combination with the Ve biomarker based on DCE-MRI could achieve optimal diagnostic accuracy in the differential diagnosis of PTs.

Feasibility of a new model for early detection of patients with multidrug-resistant tuberculosis in a developed setting of eastern China.

OBJECTIVES: The poor detection rate of multidrug-resistant tuberculosis (MDR-TB) highlights the urgent need to explore new case finding model to improve the detection of MDR-TB in China. The aim of this study was to evaluate the feasibility of a new model that combines molecular diagnostics and sputum transportation for early detection of patients with MDR-TB in Zhejiang. METHODS: From May 2014 to January 2015, TB suspects were continuously enrolled at six county-level designated TB hospitals in Zhejiang. Each patient gave three sputum samples, which were submitted to laboratory for smear microscopy, solid culture and GeneXpert. The specimens from rifampin (RIF)-resistant cases detected by GeneXpert, and positive cultures were transported from county-level to prefecture-level laboratories for line probe analysis (LPA) and drug susceptibility testing (DST). The performance and interval of MDR-TB detection of the new model were compared with those of conventional model. RESULTS: A total of 3151 sputum specimens were collected from TB suspects. The sensitivity of GeneXpert for detecting culture-positive cases was 92.7% (405/437), and its specificity was 91.3% (2428/2659). Of 16 RIF-resistant cases detected by DST, GeneXpert could correctly identify 15 cases, yielding a sensitivity of 93.8% (15/16). The specificity of GeneXpert for detecting RIF susceptibility was 100.0% (383/383). The average interval to diagnosis of the conventional DST model was 56.5 days, ranging from 43 to 71 days, which was significantly longer than that of GeneXpert plus LPA (22.2 days, P < 0.01). CONCLUSION: Our data demonstrate that the combination of improved molecular TB tests and sputum transportation could significantly shorten the time required for detection of MDR-TB, which will bring benefits for preventing an epidemic of MDR-TB in this high-prevalence setting.

Drug-resistant tuberculosis in Zhejiang Province, China: an updated analysis of time trends, 1999-2013.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) hinder the progress of TB control. OBJECTIVE: To track the trend of drug-resistant tuberculosis (DR-TB) prevalence in Zhejiang Province from 1999 to 2013, and identify risk factors of resistance to second-line drugs among MDR-TB patients. DESIGN: Four DR-TB surveys had been done in Zhejiang Province in 1999, 2004, 2008 and 2013 through questionnaires, in which demographic and epidemiological items were included. After questionnaires, drug susceptibility testing (DST) targeted at four first-line drugs was done for all TB patients and DST targeted at six second-line drugs (only in 2008 and 2013) for MDR-TB patients. The drug resistance trend over time was analyzed using the Cochran-Armitage test. The factors associated with resistance to second-line drugs among MDR-TB patients were examined by a multivariate logistic regression model. RESULTS: Of 936 patients enrolled, 27 (3.21%) and 20 (21.28%) MDR-TB cases were registered as new and previously treated cases, respectively. MDR-TB showed a decreasing trend (Z = -3.31, p < 0.01) while resistance to any first-line drugs showed an increasing trend (Z = 5.22, p < 0.001), from 1999 to 2013. The highest resistance rate was shown to ofloxacin among MDR-TB patients both in 2008 (28.8%) and in 2013 (27.7%), while resistance to para-aminosalicylate decreased significantly (Z = -2.06, p = 0.04) between 2008 and 2013. MDR-TB patients aged 45-65 years (OR = 5.00, p = 0.02) were more likely to be resistant to any second-line drugs. CONCLUSIONS: DR-TB including MDR-TB remains a major public health problem in Zhejiang Province. Further efforts on MDR-TB control should be conducted to hinder drug resistance, including critical clinical use of anti-TB antibiotics and preventing transmission.

A First Insight into the Genetic Diversity and Drug Susceptibility Pattern of Mycobacterium tuberculosis Complex in Zhejiang, China.

In this study, our aim was to determine the predominant genotypes among the Mycobacterium tuberculosis (MTB) strains circulating in Zhejiang Province. In addition, we also sought to determine the potential associations between MTB genotypes and susceptibility to first-line drugs. Out of these isolates, 673 (71.6%) were classified into the Beijing genotype, while the other 267 (28.4%) were from non-Beijing families. The highest proportion of Beijing genotype was found in Huzhou (80.0%) and the lowest in Lishui (48.3%). Statistical analysis revealed that there was a significant difference in the prevalence of Beijing genotype among different regions (χ2 = 17.57, P = 0.04). In addition, the overall proportions of drug resistance to INH, RIF, SM, and EMB were 13.2% (124/940), 21.8% (75/940), 3.4% (32/940), and 5.9% (55/940) in Zhejiang, respectively. Further comparison revealed that there was no significant difference in drug susceptibility profiles between Beijing and non-Beijing strains (P > 0.05). In conclusion, we describe the genetic diversity and drug susceptibility pattern of MTB in Zhejiang for the first time. Our data demonstrate that Beijing genotype is the predominant lineage in Zhejiang, while the distribution of Beijing-genotype strains shows geographic diversity. In addition, no correlation is observed between Beijing genotype and anti-TB drug resistance.

Noninvasive assessment of liver stiffness by transient elastography (FibroScan) in liver fluke disease.

AIM: Transient elastography is a noninvasive and reliable method for the assessment of liver stiffness. This study aimed to assess liver stiffness of asymptomatic liver fluke disease patients by FibroScan and evaluate the factors influencing liver stiffness. METHODS: Overall, 65 patients were prospectively recruited from The First People's Hospital of Foshan, Guangdong, China. All patients were diagnosed with liver fluke disease; their durations of ingested freshwater raw fish or shrimp were more than 10 years, and none of them had abnormal liver function and hepatitis B virus or hepatitis C virus infection, or clinical symptoms. All patients underwent FibroScan, blood biochemical examination, and BMI measurement on the same day. Liver stiffness measurement (LSM) values, sex, age, durations of ingested freshwater raw fish or shrimp, and BMI were recorded. LSM value greater than 7.4 kPa was defined as abnormal. RESULTS: A total of 27 patients (41.5%) had abnormal LSM values. On partial correlation analysis, duration of ingested freshwater raw fish or shrimp was the independent factor that showed a positive correlation with abnormal LSM values (r=0.502, P=0.012). An independent-samples t-test showed that the durations of patients with abnormal LSM values were significantly longer than the durations of patients with normal LSM values (P<0.001). Sex, age, and BMI were not significantly correlated with LSM values (P>0.05). CONCLUSION: A high proportion of asymptomatic liver fluke disease patients had abnormal LSM values. The durations of patients with abnormal LSM values were significantly longer than the durations of patients with normal LSM values and the durations of patients with abnormal LSM values were an independent factor that showed a positive correlation with abnormal LSM values.

Phenotypic and genotypic characterization of pyrazinamide resistance among multidrug-resistant Mycobacterium tuberculosis isolates in Zhejiang, China.

To explore the phenotypic and genotypic characterization of pyrazinamide (PZA) resistance among multidrug-resistant Mycobacterium tuberculosis (MDR-TB) isolates in Zhejiang province, a total of 274 MDR-TB isolates were collected. Drug susceptibility testing and spoligotyping were performed on all clinical isolates. In addition, the mutated features of PZA-resistant loci, including pncA and rpsA, were also analyzed by DNA sequencing. Our results showed that the prevalence of PZA resistance among MDR-TB strains in Zhejiang province was 43.07% and that PZA resistance was associated with concomitant resistance to streptomycin. The majority of PZA-resistant MDR-TB isolates belonged to the Beijing family. Mutations within pncA, not rpsA, constituted the primary mechanism of PZA resistance. Among 118 PZA-resistant isolates, 53 different mutations were observed in pncA, and most of them were point mutations. Compared with the phenotypic data, DNA sequencing of pncA has sensitivity and specificity of 77.97% and 96.79%, respectively. Analysis of pncA provided a robust tool for rapid detection of PZA drug resistance.

Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy.

AIM: To present computed tomography (CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy. METHODS: From January 2009 to November 2011, 56 patients were collected through the histopathology and Picture Archiving and Communication Systems records, which revealed 5 basal cell adenoma (BCA), 16 pleomorphic adenoma (PA), 25 Warthin's tumor (War-T), 3 Kimura's disease (KD) and 7 parotid carcinoma (PCa) cases. All the CT images were retrospectively analyzed by two radiologists in consensus, based on their description of morphology (location, number, size, margin and fibrous capsule) and enhancement patterns of masses. In addition, the diagnostic efficiency of diagnostic strategy is tested. RESULTS: War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years; the significant difference was seen in War-T vs PA and BCA vs PA. About 40% of War-Ts presented with bilateral multifocal lesions, a higher ratio than others. Seventy two percent of War-Ts were limited to the superficial lobe, followed by BCA 60% and PA 40%. Vessel facing sign and enlarged lymph nodes were both frequent in War-T, which respectively accounts for 84% and 76% of cases. Rapid contrast enhancement and decreases were unique for War-T. BCA and PA showed obvious delayed enhancement. The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency, with high accuracy, sensitivity and specificity. CONCLUSION: Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data. A diagnostic strategy with high diagnostic efficiency was established.