Validity evidence for simulator-based obstetric ultrasound competency assessment tool: a multi-center study.

PURPOSE: To collect validity evidence for a simulator-based obstetric ultrasound competency assessment tool (OUCAT). METHODS: 89 sonographers from three centers (XY, MC, DT), including novices (n=21), experienced trainees (n=44), and experts (n=24), participated in the competency assessment. Validity evidence of OUCAT was collected according to Standards for Educational and Psychological Testing. Content validity was ensured by reviewing guidelines and reaching expert consensus. The response process was ensured via training raters. Internal structure was explored through internal consistency, inter-rater reliability, and test-retest reliability. Relations to other variables were explored by comparing OUCAT scores of sonographers with different experience. Evidence for consequences was collected by determining the pass/fail level. RESULTS: OUCAT included 123 items, of which 117 items could effectively distinguish novices from experts (P<0.05). The internal consistency was represented by the Cronbach's α coefficient (0.978). The inter-rater reliability was high, with XY being 0.868, MC being 0.877, and DT being 0.937 (P<0.001). Test-retest reliability was 0.732 (P=0.001). The performance of experts was significantly better than experienced trainees, and the performance of experienced trainees was significantly better than novices (70.3±10.7 vs. 39.8±15.0 vs. 20.5±10.6, P<0.001). The pass/fail level determined by contrast group method was 45 points. The passing rate of novices, experienced trainees and experts was 0% (0/21), 31.8% (14/44), and 100% (24/24), respectively. CONCLUSION: Simulator-based OUCAT exhibits good reliability and validity in assessing obstetric ultrasound skills.

Application of S-detect combined with virtual touch imaging quantification in ultrasound for diagnosis of breast mass. / S-detectè”åˆå£°è§¦è¯Šç»„ç»‡æˆåƒå®šé‡åœ¨ä¹³è ºè‚¿å—è¶ å£°è¯Šæ–­ä¸­çš„åº”ç”¨.

OBJECTIVES: Ultrasound is a safe and timely diagnosis method commonly used for breast lesion, however it depends on the operator to a certain degree. As an emerging technology, artificial intelligence can be combined with ultrasound in depth to improve the intelligence and precision of ultrasound diagnosis and avoid diagnostic errors caused by subjectivity of radiologists. This paper aims to investigate the value of artificial intelligence S-detect system combined with virtual touch imaging quantification (VTIQ) technique in the differential diagnosis of benign and malignant breast masses by conventional ultrasound (CUS). respectively, and AUCs for them were 0.74, 0.86, 0.79, and 0.94, respectively. The diagnostic accuracy of CUS+S-detect was higher than that of CUS (P<0.05). The diagnostic accuracy of CUS+S-detect was higher than that of CUS (P<0.05). The diagnostic specificity of CUS+VTIQ was higher than that of CUS (P<0.05). The diagnostic accuracy and AUC of CUS+S-detect+VTIQ were higher than those of S-detect or VTIQ applied to CUS alone (P<0.05). The sensitivities of CUS for senior radiologists, CUS for junior radiologists, CUS+S-detect+VTIQ for senior radiologists, and CUS+S-detect+VTIQ for junior radiologists were 60.00%, 80.00%, 72.73%, and 90.00%, respectively, when diagnosing benign and malignant breast masses in 50 randomly selected cases. The specificities for them was 66.67%, 76.67%, 80.00%, and 81.25%, respectively. The accuracies for them was 64.00%, 78.00%, 80.00%, and 88.00%, respectively. The AUCs for them were 0.63, 0.78, 0.88, and 0.80, respectively. Compared with the CUS for junior radiologists, the CUS+S-detect+VTIQ for junior radiologists had higher sensitivity, specificity, and accuracy (all P<0.05). The consistency of the combined application of S-detect and VTIQ for diagnosing breast masses at 2 different times was good among junior radiologists (Kappa=0.800). METHODS: CUS, S-detects, and VTIQ were used to differentially diagnose benign and malignant breast masses in 108 cases, and the final pathological results were referred to as the gold standard for classifying breast masses. The diagnostic efficacy were evaluated and compared, among the 3 methods and among S-detect applied to CUS (CUS+S-detect), VTIQ applied to CUS (CUS+VTIQ), and S-detect combined with VTIQ applied to CUS (CUS+S-detect+VTIQ). Fifty cases were acquired randomly from the collected breast masses, and 2 radiologists with different years of experience (2 and 8 years) used S-detect combined with VTIQ for the ultrasonic differential diagnosis of benign and malignant breast masses. RESULTS: The differences in sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC) of the 3 diagnostic methods of CUS, S-detect, and VTIQ were not statistically significant (all P>0.05). The sensitivities of CUS, CUS+Sdetect, CUS+VTIQ, and CUS+S-detect+VTIQ were 78.57%, 92.86%, 69.05%, and 95.24%, respectively, the specificities for them were 69.70%, 78.79%, 87.88%, and 92.42%, respectively, the accuracies for them were 73.15%, 84.26%, 80.56%, and 93.52%. CONCLUSIONS: S-detect combined with VTIQ when applied to CUS can overcome the shortcomings of separate applications and complement each other, especially for junior radiologists, and can more effectively improve the diagnostic efficacy of ultrasound for benign and malignant breast masses.

Identification of the lymph node metastasis-related automated breast volume scanning features for predicting axillary lymph node tumor burden of invasive breast cancer via a clinical prediction model.

Breast cancer has become the malignant tumor with the highest incidence in women. Axillary lymph node dissection (ALND) is an effective method of maintaining regional control; however, it is associated with a significant risk of complications. Meanwhile, whether the patients need ALND or not is according to sentinel lymph node biopsy (SLNB). However, the false-negative results of SLNB had been reported. Automated breast volume scanning (ABVS) is a routine examination in breast cancer. A real-world cohort consisting of 245 breast cancer patients who underwent ABVS examination were enrolled, including 251 tumor lesions. The ABVS manifestations were analyzed with the SLNB results, and the ALND results for selecting the lymph node metastasis were related to ABVS features. Finally, a nomogram was used to construct a breast cancer axillary lymph node tumor burden prediction model. Breast cancer patients with a molecular subtype of luminal B type, a maximum lesion diameter of ≥5 cm, tumor invasion of the Cooper's ligament, and tumor invasion of the nipple had heavy lymph node tumor burden. Molecular classification, tumor size, and Cooper's ligament status were used to construct a clinical prediction model of axillary lymph node tumor burden. The consistency indexes (or AUC) of the training cohort and the validation cohort were 0.743 and 0.711, respectively, which was close to SLNB (0.768). The best cutoff value of the ABVS nomogram was 81.146 points. After combination with ABVS features and SLNB, the AUC of the prediction model was 0.889, and the best cutoff value was 178.965 points. The calibration curve showed that the constructed nomogram clinical prediction model and the real results were highly consistent. The clinical prediction model constructed using molecular classification, tumor size, and Cooper's ligament status can effectively predict the probability of heavy axillary lymph node tumor burden, which can be the significant supplement to the SLNB. Therefore, this model may be used for individual decision-making in the diagnosis and treatments of breast cancer.

BRD7 Stabilizes P53 via Dephosphorylation of MDM2 to Inhibit Tumor Growth in Breast Cancer Harboring Wild-type P53.

Bromodomain-containing protein 7 (BRD7) was found to be down-expressed in nasopharyngeal carcinoma as well as breast cancer and to function as a potential tumor suppressor. BRD7 interacts with p53 and is required for p53-dependent oncogene-induced senescence. However, the mechanism how BRD7 functions as tumor suppressor roles in breast cancer remains unclear. MTT, colony formation assay, cell cycle, cell apoptosis, and tumorigenicity assays were performed to evaluate the biological functions of BRD7 in breast cancer cells in vitro and in vivo. Real-time PCR, western blot, luciferase reporter gene assays, and co-immunoprecipitation were used to examine the gene expression, transcription activation and protein-protein interaction. We reported that BRD7 effectively suppressed cell proliferation and tumor growth in vitro and in vivo. In addition, BRD7 increased p53 protein stability through ubiquitin-dependent proteasome pathway and regulated the expression of p53 downstream target genes by activating its transcriptional activity in breast cancers harboring wild-type p53. Mechanistically, BRD7 decreased phosphorylation and activation of MDM2 via inactivating its upstream kinase AKT depending on the bromodomain of BRD7, therefore BRD7 significantly reduced the amounts of phosphorylated MDM2 binding with p53 eventually decreasing ubiquitination level of p53. Furthermore, silencing the expression of p53 at least partly reversed the inhibition effect of BRD7 on cell proliferation and tumor growth in vitro and in vivo. Our studies identify that BRD7 stabilizes p53 by inhibiting the phosphorylation of MDM2 via AKT pathway dependent on its bromodomain to function as a tumor suppressor in breast cancer harboring wild-type p53.

Effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting: A retrospective study.

OBJECTIVE: To investigate the effect of perioperative blood pressure variability on cerebral hyperperfusion syndrome after carotid artery stenting. METHODS: A retrospective analysis was conducted of data collected from 418 patients who underwent carotid artery stenting in Guangxi Zhuang Autonomous Region People's Hospital in China. The blood pressure data were collected during operation (after balloon dilation, before stent release, after stent release) and within 3 days after the operation. The blood pressure variability was evaluated by measuring the mean, maximum, minimum, max-min, standard deviation (SD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). The correlation between blood pressure variability and cerebral hyperperfusion syndrome was analysed. RESULTS: Blood pressure data from 418 patients were analysed. Twenty patients (4.8%) developed cerebral hyperperfusion syndrome. The parameters of blood pressure variability were divided into four groups according to quartile. After adjusting for age, symptomatic carotid stenosis, unilateral carotid stenosis, bilateral carotid stenosis, collateral circulation, diabetes mellitus and chronic kidney disease, multivariate analysis showed that SBPMax, SBPMin, SBPMax-Min, SBPCV, DBPSD, DBPMax, DBPMin, DBPMax-Min and DBPCV were associated with the occurrence of cerebral hyperperfusion syndrome (P < 0.05), respectively. CONCLUSION: This study suggests that blood pressure variability during the perioperative period may increase the risk of cerebral hyperperfusion syndrome.

[Application of automated breast volume scanner and mammography in differentiation of small breast lesions with BI-RADS-US 4].

OBJECTIVE: To evaluate the value of automatic breast volume scanner (ABVS) and mammography (MG) in differential diagnosis for small breast lesions with breast imaging reporting and data system ultrasound (BI-RADS-US) 4.
 Methods: ABVS and MG were performed for 103 patients with 109 breast lesions, which were classified as BI-RADS-US 4 by conventional ultrasound (US). Postoperative pathological diagnosis served as gold standard. The diagnostic efficacy for US, US combined with MG, US combined with ABVS and the combination of three methods were compared.
 Results: The sensitivity of US, US combined with MG, US combined with ABVS and the combination of three methods were 85.5%, 86.8%, 94.7% and 96.0%, respectively. The specificity for them were 66.7%, 69.7%, 81.8% and 84.9%, respectively. The accuracy for them were 79.8%, 81.6%, 90.8% and 92.7%, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) for them were 0.76, 0.78, 0.88 and 0.90, respectively. The accuracy and AUC for US combined with ABVS in differential diagnosis of BI-RADS-US 4 small breast lesions were significantly higher than those of US and US combined with MG (P<0.05). There was no significant difference in sensitivity and specificity among these 3 groups (P>0.05). No significant difference was found in sensitivity, specificity, accuracy, and AUC between US combined with ABVS and the combination of three methods (P>0.05).
 Conclusion: Combination of US with ABVS can improve the diagnostic efficacy of conventional US in differential diagnosis for BI-RADS-US 4 small breast lesions, and it is superior to US combined with MG.

[Effect of LY249002 on myocardial structure and cardiac function in rats with dilated cardiomyopathy].

OBJECTIVE: To examine the role of LY294002 in cardiac function and myocardial structure in dilated cardiomyopathy (DCM) rats.
 Methods: Fifty-two male SD rats were randomly assigned to a control group (n=16) and a DCM group (n=36). The DCM rats were induced by intraperitoneal injection of adriamycin, and the control rats were given normal saline. After observation for 2 weeks, 6 rats from each group were killed randomly. In the end of the 8th week, the 24 DCM rats were randomly assigned to a DCM group (n=12) and a LY294002 group (n=12), which were given normal saline and LY294002, respectively. In the end of the 8th week and 16th week, the cardiac function was analyzed by ultrasonic cardiogram (UCG) and the plasma was collected to test the level of N-terminal pro-brain natriuretic peptide (NT-pro BNP). HE and Van Gieson (VG) staining were performed to calculate the collagen volume fraction (CVF).
 Results: Compared with the control group, the left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) and NT-proBNP level of in the DCM rats were increased obviously, while the left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) in the DCM rats were decreased obviously (P<0.01). These changes were consistent with DCM characteristics. Compared with the DCM group, the LVEDD, LVESD and NT-proBNP levels in the LY294002 group were decreased, while the LVEF and LVFS were increased (P<0.05). Histopathology showed that the myocardium in the DCM rats was fibrotic and the CVF was increased compared with the control rats (P<0.01). The myocardial structure was improved in the LY294002 group compared to the DCM group.
 Conclusion: LY294002 can reduce the myocardial fibrosis in the DCM rats and improve the cardiac function.

Deficient arginase II expression without alteration in arginase I expression attenuated experimental autoimmune encephalomyelitis in mice.

In the past there have been a multitude of studies that ardently support the role of arginase II (Arg II) in vascular and endothelial disorders; however, the regulation and function of Arg II in autoimmune diseases has thus far remained unclear. Here we report that a global Arg II null mutation in mice suppressed experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis. During EAE, both Arg I and Arg II were induced in spinal cords, but only Arg II was induced in spleens and splenic dendritic cells (DCs). DC activation by lipopolysaccharide (LPS), CD40L or TLR8 agonist significantly enhanced Arg II expression without affecting Arg I expression. Conversely, DC differentiating cytokines [IL-4 and granulocyte macrophage-colony-stimulating factor (GM-CSF)] yielded opposite effects. In addition, Arg I and Arg II were regulated differentially during Th1 and Th17 cell polarization. Arg II deficiency in mice delayed EAE onset, ameliorated clinical symptoms and reduced myelin loss, accompanied by a remarkable reduction in the EAE-induced spinal cord expression of Th17 cell markers (IL-17 and RORγt). The abundance of Th17 cells and IL-23+ cells in relevant draining lymph nodes was significantly reduced in Arg II knockout mice. In activated DCs, Arg II deficiency significantly suppressed the expression of Th17-differentiating cytokines IL-23 and IL-6. Interestingly, Arg II deficiency did not lead to any compensatory increase in Arg I expression in vivo and in vitro. In conclusion, Arg II was identified as a factor promoting EAE likely via an Arg I-independent mechanism. Arg II may promote EAE by enhancing DC production of Th17-differentiating cytokines. Specific inhibition of Arg II could be a potential therapy for multiple sclerosis.

[Evaluation of three-dimensional speckle tracking echocardiography to left ventricular rotation and twist in patients with silent myocardial ischemia].

OBJECTIVE: To analyze the characteristics of left ventricular rotation and twist in patients with silent myocardial ischemia (SMI) by three-dimensional speckle tracking echocardiography (3D-STE), and to explore the diagnostic value of this method for SMI.
 METHODS: According to Gensini score, 66 patients with SMI were divided into 3 subgroups: a mild lesion group (n=16), a moderate lesion group (n=26) and a severe lesion group (n=24). Thirty patients with negative results in selective coronary angiography served as a control group. The parameters of wall motion score index (WMSI), left ventricular ejection fraction (LVEF), peak basal rotation (Ptw-B), peak apical rotation (Prot-A), left ventricular peak apical rotation (LVrot), left ventricular peak apical twist (LVtw) were measured.
 RESULTS: In the SMI group, with an increase in severity of myocardial ischemia, LVEF, Prot-A, Prot-B, LVrot, LVtw showed a decrease trend while WMSI exhibited an opposite phenomenon (P<0.05), and all of them displayed a significant corelation with Gensini score (P<0.05). In the diagnosis of SMI, all of the above-mentioned parameters were highly sensitive and specific. 3D-STE showed the highest diagnostic value for LVtw.
 CONCLUSION: Left ventricular rotation and twisting motion monitered by 3D-STE can evaluate the severity of myocardial ischemia in patients with SMI.

MicroRNA223 promotes pathogenic T-cell development and autoimmune inflammation in central nervous system in mice.

Multiple sclerosis (MS) is an incurable central nervous system autoimmune disease. Understanding MS pathogenesis is essential for the development of new MS therapies. In the present study, we identified a novel microRNA (miR) that regulates experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Expression of miR223 was up-regulated specifically in spinal cords and lymphoid organs but not in other examined tissues. A global miR223 knockout (miR223(-/-) ) in mice led to a significant delay in EAE onset, reduction in spinal cord lesion, and lessening of neurological symptoms. These protective effects could be reproduced in bone marrow chimeras reconstituted with miR223(-/-) haematopoietic stem cells. We also found that miR223 deficiency reduced T helper type 1 (Th1) and Th17 infiltration into spinal cords. To address underlying mechanisms, we investigated the role of miR223 in regulating the function, development and interaction of the major immune cells. Expression of the genes associated with dendritic cell (DC) activation (CD86 and MHC II) and Th1 and Th17 differentiation [interleukin-12 (IL-12) and IL-23, respectively] was significantly decreased in the spleens of miR223(-/-) mice bearing EAE. The miR223(-/-) DCs expressed significantly lower levels of basal and lipopolysaccharide-induced IL-12 and IL-23 compared with the wild-type DCs. These data are consistent with the observed lower efficiency of miR223(-/-) DCs to support Th1 and Th17 differentiation from naive T cells over-expressing an EAE antigen-specific T-cell receptor. Our data suggest that miR223 promotes EAE, probably through enhancing DC activation and subsequently the differentiation of naive T cells toward Th1 and Th17 effector cells.

Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report.

OBJECTIVE: The aim of this study is to evaluate the efficacy and feasibility of three-dimensional printing (3D printing) assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach. METHODS: A total of 38 patients with unstable pelvic fractures were analyzed retrospectively from August 2012 to February 2014. All cases were treated operatively with internal fixation assisted by three-dimensional printing from minimal invasive para-rectus abdominis approach. Both preoperative CT and three-dimensional reconstruction were performed. Pelvic model was created by 3D printing. Data including the best entry points, plate position and direction and length of screw were obtained from simulated operation based on 3D printing pelvic model. The diaplasis and internal fixation were performed by minimal invasive para-rectus abdominis approach according to the optimized dada in real surgical procedure. Matta and Majeed score were used to evaluate currative effects after operation. RESULTS: According to the Matta standard, the outcome of the diaplasis achieved 97.37% with excellent and good. Majeed assessment showed 94.4% with excellent and good. The imageological examination showed consistency of internal fixation and simulated operation. The mean operation time was 110 minutes, mean intraoperative blood loss 320 ml, and mean incision length 6.5 cm. All patients have achieved clinical healing, with mean healing time of 8 weeks. CONCLUSION: Three-dimensional printing assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach is feasible and effective. This method has the advantages of trauma minimally, bleeding less, healing rapidly and satisfactory reduction, and worthwhile for spreading in clinical practice.

Correlation of NGX6 expression with clinicopathologic features and prognosis in colon cancer.

OBJECTIVE: The aim was to explore the correlation of NGX6 expression with clinicopathological features and prognosis in colon cancer. METHODS: Clinicopathological feature of 145 patients with colon cancer were analyzed.NGX6 expression was measured using immunohistochemistry methods. The correlation of NGX6 expression with clinicopathological features and prognosis were assessed. RESULTS: Among 145 cases of colon cancer, NGX6 positive expression were found in 76 (52.4%) cases and NGX6 negative expression were found in 69 (47.6%) cases. The expression of NGX6 was closely associated with size tumor, lymph node metastasis and TNM stage (P=0.002, 0.012, and 0.039, respectively). Kaplan-Meier analysis showed that NGX6 negative expression was associated with shorter disease-free survival (DFS) (P=0.029) and overall survival (OS) (P=0.015). Multivariate survival analysis demonstrated that NGX6 expression was the important independent prognostic factor for colon cancer (P=0.022). CONCLUSION: NGX6 is involved in the invasion and metastasis activity of colon cancer. NGX6 could may be applied as a novel and promising prognostic marker for colon cancer.

Association of ultrasonographic features with NGX6 expression and prognosis in invasive ductal breast carcinoma.

INTRODUCTION: Nasopharyngeal carcinoma-associated gene 6 (NGX6) is a newly discovered tumor suppressor gene. It contains one epidermal growth factor (EGF)-like domain. Many studies have shown that proteins contain (EGF)-like domain structure affect a variety of biological actions. However, little is known about the relationships between NGX6 expression and biological behaviors in invasive ductal breast carcinoma (IDBC). The study discussed the association of ultrasonographic features with NGX6 expression and prognosis in IDBC. METHODS: Ultrasonographic feature and clinical data in 122 patients with IDBC were retrospectively analyzed. NGX6 expression of IDBC was measured using immunohistochemistry methods. RESULTS: The incidence of the burr sign, lymph node metastasis and abundance blood flow in NGX6 expression negative groups were higher than those in positive groups. Kaplan-Meier analysis showed that the association between NGX6 positive expression and higher disease-free survival (DFS) or higher overall survival (OS); Lymph node metastasis is associated with lower DFS or lower OS; Lower blood flow grade is associated with higher DFS. In univariate and multivariate survival analysis, NGX6 expression, lymph node metastasis, TNM and the blood flow grade were the independent prognostic factors for DFS and OS of IDBC. CONCLUSIONS: ultrasonographic features are associated with NGX6 expression in IDBC. NGX6 is involved in the invasion and metastasis activity of IDBC. Our results suggest that NGX6 may be employed as a promising prognostic factor and useful therapeutic target for IDBC. Combination of ultrasonic findings and NGX6 detection may yield clinically useful information for IDBC prognosis.

Down-regulated Na(+)/K(+)-ATPase activity in ischemic penumbra after focal cerebral ischemia/reperfusion in rats.

This study was aimed to examine whether the Na(+)/K(+) adenosine triphosphatase (Na(+)/K(+)-ATPase) activity in ischemic penumbra is associated with the pathogenesis of ischemia/reperfusion-induced brain injury. An experimental model of cerebral ischemia/reperfusion was made by transient middle cerebral artery occlusion (tMCAO) in rats and the changes of Na(+)/K(+)-ATPase activity in the ischemic penumbra was examined by Enzyme Assay Kit. Extensive infarction was observed in the frontal and parietal cortical and subcortical areas at 6 h, 24 h, 48 h, 3 d and 7 d after tMCAO. Enzyme Assay analyses revealed the activity of Na(+)/K(+)-ATPase was decreased in the ischemic penumbra of model rats after focal cerebral ischemia/reperfusion compared with sham-operated rats, and reduced to its minimum at 48 h, while the infarct volume was enlarged gradually. In addition, accompanied by increased brain water content, apoptosis-related bcl-2 and Bax proteins, apoptotic index and neurologic deficits Longa scores, but fluctuated the ratio of bcl-2/Bax. Correlation analysis showed that the infarct volume, apoptotic index, neurologic deficits Longa scores and brain water content were negatively related with Na(+)/K(+)-ATPase activity, while the ratio of bcl-2/Bax was positively related with Na(+)/K(+)-ATPase activity. Our results suggest that down-regulated Na(+)/K(+)-ATPase activity in ischemic penumbra might be involved in the pathogenesis of cerebral ischemia/reperfusion injury presumably through the imbalance ratio of bcl-2/Bax and neuronal apoptosis, and identify novel target for neuroprotective therapeutic intervention in cerebral ischemic disease.

Clinicopathological significance of NGX6 expression in breast cancer and its relationship to angiogenesis.

OBJECTIVE: The aim was to explore clinicopathological significance of Nasopharyngeal carcinoma-associated gene 6 (NGX6) expression in breast cancer and its relationship to angiogenesis. METHODS: Clinicopathological feature of 168 patients with breast cancer were analyzed. NGX6 expression and microvessel density (MVD) in tumor tissue were measured using immunohistochemistry methods. The association of NGX6 expression with MVD and clinicopathological features was assessed. RESULTS: Among 168 cases of breast cancer, NGX6 positive expression were found in 92 (54.8%) cases and NGX6 negative expression were found in 76 (45.2%) cases. Incidence rate of large size tumor, high tumor node metastasis (TNM) stage and lymph node metastasis in NGX6 negative expression group were higher than NGX6 positive expression group in breast cancer (P=0.003, 0.007, and 0.003, respectively). MVD in NGX6 negative expression group is 22.5±4.8, MVD in NGX6 positive expression group is 15.2±4.2. MVD in the NGX6 negative expression group was significantly higher than the NGX6 positive expression group (P<0.05). CONCLUSION: The expression of NGX6 was closely associated with tumor size, TNM stage, lymph node metastasis and MVD. NGX6 is involved in metastasis and angiogenesis activity of breast cancer. The study may provide a theoretical basis for anti-angiogenic therapy of breast cancer.

Three-dimensional speckle tracking echocardiography for the evaluation of the infarct size and segmental transmural involvement in patients with acute myocardial infarction.

PURPOSE: To compare parameters between three-dimensional speckle tracking echocardiography (3DSTE) and delayed enhancement magnetic resonance imaging (DE-MRI) for estimating myocardial infarct size, peak systolic strain, and transmural involvement of infarct segments in patients with acute myocardial infarction (AMI). METHODS: Delayed enhancement MRI was conducted to determine myocardial infarction (MI) position, size, and transmural involvement in 26 patients with AMI. 3DSTE was conducted to measure global peak systolic strain in the left ventricle and to estimate longitudinal, circumferential, and radial peak systolic strain in papillary muscle segments. Conventional echocardiography was used to calculate the wall-motion score index (WMSI) and left ventricular ejection fraction (LVEF). RESULTS: Left ventricular strain parameters and LVEF were statistically significantly lower in patients with large-size MI than in those with small-size MI. Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly lower in patients with moderate-size MIs than in those with small-size MIs. All parameters except ejection fraction (EF) were lower in patients with large-size MI compared with those with moderate-size MI (P < 0.05). Pearson analysis revealed that left ventricular GCS, GLS, GRS, WMSI, and LVEF of AMI patients correlated with the myocardial infarct area (MIA) measured by MRI (r = 0.86, 0.81, -0.71, 0.64, and -0.66, respectively; all P-values <0.01). Transmural infarct segments exhibited significantly lower longitudinal, circumferential, and radial strains than normal segments (P < 0.05). CONCLUSIONS: These findings indicate that 3DSTE can distinguish between MIs of different infarct sizes, and may provide an indirect means for the accurate determination of transmural involvement in infarct segments.

[Clinical application of the 3-dimensional speckle tracking imaging in coronary artery disease].

OBJECTIVE: To observe the 3-dimensional speckle tracking imaging (3D-STI) in clinical diagnosis of coronary artery disease by quantitatively evaluating left ventricular segmental and global systolic function. METHODS: According to the selective coronary artery angiography, 150 inpatients suspected of coronary artery disease were divided into 5 groups according to the distribution of the affected coronary arteries: a left anterior descending coronary artery group (LAD, n=46), a left circumflex coronary artery group (LCX, n=25), a right coronary artery group (RCA, n=23), a multivessel group (n=26), and a normal group (n=30). Gensini score was calculated according to coronary artery angiography. Conventional echocardiography was applied in each patient and wall motion score index (WMSI) was calculated. 3D-STI was applied in each patient to evaluate the segmental and global systolic function in the left ventricle. RESULTS: Compared with the normal group, ejection fraction was decreased in the multi-vessel group alone (P<0.05). Peak systolic 3D strains in all segments were decreased in the multi-vessel group (P<0.01), while peak systolic 3D strains in the main blood-supply segments were decreased significantly in the rest of the groups (P<0.05). Global 3-dimensional strain (G3DS) was negatively correlated with Gensini score in patients with coronary artery disease (r= -0.76, P<0.01). Receiver operating characteristic curve analysis demonstrated that G3DS was more sensitive and accurate in clinical diagnosis of coronary artery disease. CONCLUSION: 3D-STI can quantitatively evaluate the segmental and global systolic function of the left ventricle, and reflect the extent of coronary artery stenosis in patients with coronary artery disease.

Evaluation of hepatocellular carcinoma using contrast-enhanced ultrasonography: correlation with microvessel morphology.

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is an important technique for depiction and assessment of tumor vascularity. This study aimed to explore the relationship between the morphological characteristics of tumor microvessels and enhancement patterns on CEUS in hepatocellular carcinoma (HCC). METHODS: Eighty patients with HCC underwent CEUS using SonoVue before hepatectomy. Contrast-enhanced ultrasonographic enhancement patterns and quantitative parameters were recorded. The tumor tissue sections were immunostained with human CD34 monoclonal antibody. The patients were classified into a point-line type group (n = 36) and a loop-strip type group (n = 44) according to microvessel morphology. The microvascular density (MVD) in the different types of microvessels was calculated. The relationship between enhancement patterns of HCC lesions and morphological characteristics of tumor microvessels was analyzed. RESULTS: The mean MVD in HCC was 22.4+/-3.5 per 0.2 mm2 in the point-line group, and 19.6+/-6.7 per 0.2 mm2 in the loop-strip group, and there was no significant difference between them (t = 0.948, P = 0.354). In the portal vein phase, hypoenhancement was significantly more frequent in HCC (X2 = 4.789, P = 0.029) in the loop-strip group (40/44, 90.9%) than in the point-line group (26/36, 72.2%). The time to hypo-enhancement in the loop-strip group (mean 64.84+/-26.16 seconds) was shorter than that in the point-line group (mean 78.39+/-28.72 seconds) (t = 2.247, P = 0.022). The time to hypo-enhancement was correlated with MVD in the loop-strip group (r = -0.648, P = 0.001). CONCLUSIONS: The enhancement patterns on CEUS are related to tumor microvascular morphology, and the type of microvascular morphology influences CEUS characterization. CEUS, an important noninvasive imaging technique, is used to evaluate microvascular morphology and angiogenesis, providing valuable information for antiangiogenic therapy in HCC.

[Flow imaging of residual neck lymph nodes in nasopharyngeal carcinoma by contrast-enhanced ultrasonography after radiotherapy].

OBJECTIVE: To explore the value of flow imaging with contrast-enhanced ultrasound for residual neck lymph nodes in nasopharyngeal carcinoma after radiotherapy. METHODS: Blood flow imaging of 50 residual cervical lymph nodes in 36 patients with nasopharyngeal carcinoma after radiotherapy was observed and compared by color doppler ultrasound and contrast-enhanced ultrasonography. RESULTS: In the 50 remaining lymph nodes in the neck, 40 blood flow signals were increased, 10 did not significant change by contrast-enhanced ultrasonography. The blood flow in residual lymph nodes by contrast-enhanced ultrasonography was richer than that by color doppler ultrasound. There was a significant difference in the blood flow signals between contrast-enhanced ultrasonography and color doppler ultrasound (chi(2)=49.172, P<0.01). CONCLUSION: Contrast-enhanced ultrasonography can help blood flow imaging of the residual lymph nodes in nasopharyngeal carcinoma after radiotherapy, which may provide the imaging basis for clinical diagnosis and treatment.

Radiotherapy efficacy of E-Flow imaging on cervical lymph nodes metastasized from nasopharyngeal carcinoma.

OBJECTIVE: To explore the effect of E-Flow imaging on the radiotherapy of cervical lymph nodes metastasized from nasopharyngeal carcinoma. METHODS: A total of 52 nasopharyngeal carcinoma patients with 94 invasion neck lymph nodes were treated with conventional radiotherapy. Lymph node size, hemodynamic parameters, and blood supply were detected by E-Flow imaging and two-dimensional ultrasound before and after the radiotherapy. The relationship between those examinations and radiotherapy effect was analyzed. RESULTS: Of the 94 metastatic cervical lymph nodes from nasopharyngeal carcinoma before the radiotherapy, 40 disappeared, 52 reduced, and 2 maintained the original size after the radiotherapy. Blood flow in all residual lymph nodes decreased or disappeared. Artery flow spectrum in the lymph node was changed from the high-speed high impedance to low-speed low resistance. The size of cervical lymph node and blood flow before the radiotherapy were associated with clinical efficacy (P < 0.05). CONCLUSION: E-Flow imaging plays an important role in assessing the efficacy of radiation therapy by changing the blood supply of cervical lymph node and its size before and after the radiotherapy.