Chinese Ultrasound Doctors Association Guideline on Operational Standards for 2-D Shear Wave Elastography Examination of Musculoskeletal Tissues.

The Ultrasound Physician Branch of the Chinese Medical Doctor Association sought to develop evidence-based recommendations on the operational standards for 2-D shear wave elastography examination of musculoskeletal tissues. A consensus panel of 22 Chinese musculoskeletal ultrasound experts reviewed current scientific evidence and proposed a set of 12 recommendations for 13 key issues, including instruments, operating methods, influencing factors and image interpretation. A final consensus was reached through discussion and voting. On the basis of research evidence and expert opinions, the strength of recommendation for each proposition was assessed using a visual analog scale, while further emphasizing the best available evidence during the question-and-answer session. These expert consensus guidelines encourage facilitation of the standardization of clinical practices for collecting and reporting shear wave elastography data.

Diagnostic value of ultrasound evaluation of major salivary glands for Sjögren's syndrome based on the novel OMERACT scoring system.

OBJECTIVE: The novel Outcome Measures in Rheumatology Clinical Trials (OMERACT) scoring system was used to evaluate the diagnostic effectiveness of major salivary gland ultrasonography (SGUS) for Sjögren's syndrome (SS). MATERIALS AND METHODS: SGUS was performed on the parotid glands (PGs) and submandibular glands of 242 patients (145 patients with SS and 97 patients without SS) using the OMERACT scoring system (grade 0-3). We also evaluated the association of SGUS scores with unstimulated whole salivary flow rate (UWSF), stimulated whole salivary flow rate (SWSF), and labial salivary gland biopsy (LSGB) results. RESULTS: The SGUS scores were significantly higher for the SS group than for the non-SS group (p < 0.001). Using a cutoff value of 8 for the total score yielded the highest sensitivity (76%), specificity (90%), and area under the receiver operating characteristic curve (AUC, 0.828). The correlation between SGUS scores and salivary gland function was moderate to good. A cutoff value of 10 for the total score was more effective in predicting SWSF outcomes than UWSF outcomes (sensitivity: 73% > 58%, specificity: 98% > 87%, and AUC: 0.856 > 0.723). The association of OMERACT scores with LSGB results was fair to moderate. Among 61 anti-SSA-negative patients, 17 had positive PG scores (including ten SS and seven non-SS patients), and 44 had negative PG scores (including 37 non-SS and seven SS patients). CONCLUSION: The OMERACT scoring system had good sensitivity and excellent specificity, demonstrating excellent diagnostic potential for SS and efficacy in assessing salivary gland function. Negative SGUS results may help reduce unnecessary biopsies in anti-SSA-negative patients.

Degradation of pyrene in contaminated soil by the dielectric barrier discharge combined with the MnFe2O4 catalyst.

In this work, a spinel oxide of MnFe2O4 was used as the dielectric barrier discharge (DBD) catalyst for the remediation of pyrene-contaminated soil. The performances were investigated through tuning voltage, frequency, catalyst dosage, and soil moisture. Under the optimal conditions, such as the voltage of 10.0 kV, the discharge frequency of 1.0 kHz, MnFe2O4 dosage of 0.3 g, air flow rate of 2.0 L min-1, soil humidity of 5.3%, and degradation efficiency of DBD/MnFe2O4 for pyrene could reach 79.26% after 10 min treatment, which was much higher than that of DBD for pyrene of 42.56%. The DBD/MnFe2O4 system also showed the high degradation efficiency of other pollutants including phenanthrene, p-nitrophenol, and p-nitrophenol in contaminated soil. The enhancing mechanism of the DBD/MnFe2O4 system was discussed.

Efficacy and Safety of Ablative Fractional Laser-Assisted Delivery of Methotrexate in Adults with Localized Scleroderma: A Randomized and Controlled Clinical Trial.

Localized scleroderma (LS) is an autoimmune disease with sclerosis of the skin as the main manifestation. Currently, there is no specific treatment for LS. The effectiveness of ablative fractional laser (AFL) therapy for LS has been demonstrated in several studies. Combining ablative fractional Er:YAG laser therapy with topical methotrexate may yield therapeutic benefits for patients with LS. To compare the efficacy and safety of AFL-assisted delivery of methotrexate in adults with LS, we randomly divided patients into an AFL therapy group and an ablative fractional laser-assisted delivery of methotrexate (AFL+MTX) therapy group. Laser and assisted drug delivery treatment were given every four weeks for four months, and 22 patients completed the trial. Ultrasound measurements of dermal thickness and histological fibrosis degree and the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) score were used to assess therapeutic effects. Treatment results showed that both AFL and AFL-assisted methotrexate delivery were effective in treating LS, and the laser combined with methotrexate therapy was more effective in improving clinical appearance (p value = 0.042) and dermal thickness (p value = 0.016). No serious adverse reaction occurred in either group. In conclusion, AFL and assisted delivery of methotrexate are effective and safe treatments for LS.

Interface engineering of hierarchical NiCoP/NiCoSx heterostructure arrays for efficient alkaline hydrogen evolution at large current density.

The development of non-noble metal electrocatalysts with high activity and long-term stability for the hydrogen evolution reaction (HER), especially at large current density, is of great significance for industrial hydrogen production from water using renewable electricity. Constructing heterostructures with interfacial interactions is an effective strategy to improve the catalytic performance for large-current-density HER. Herein, we innovatively present a facile two-step electrodeposition method to immobilize a hierarchical NiCoP/NiCoSx heterostructure on Ni foam (NF) for alkaline HER. The strong interfacial coupling effect between NiCoP and NiCoSx not only offers abundant active sites for fast electrochemical reaction, but also enhances the charge transfer ability accompanied by high electrical conductivity. Consequently, the obtained self-supporting NiCoP/NiCoSx/NF exhibits an excellent catalytic performance with low overpotentials of 68, 144 and 222 mV to deliver current densities of 10, 100 and 500 mA cm-2 in 1 M KOH, along with good stability for more than 110 h, outperforming most of the reported non-noble metal based HER catalysts. Density functional theory (DFT) results further confirm that this bimetal phosphide/sulfide heterostructure can synergistically optimize the Gibbs free energy of H* during the HER process, thus accelerating the HER reaction kinetics. This work provides a new strategy toward the rational design of large-current-density electrocatalysts, which have great potential in practical large-scale hydrogen production.

ACR TI-RADS classification combined with number of nodules, halo features optimizes diagnosis and prediction of follicular thyroid cancer.

OBJECTIVES: To investigate the application value of The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) category combined with other ultrasound features of nodules in distinguishing follicular thyroid carcinoma (FTC) from thyroid follicular adenoma (FTA). METHODS: We collected and retrospectively analyzed clinical and ultrasound data for 118 and 459 patients with FTCs and FTAs, respectively, at our hospital. Next, we used ACR TI-RADS classification combined with other ultrasound features of nodules to distinguish FTC from FTA. Multivariate Logistic regression was used to screen independent risk factors for FTC, which were subsequently used to construct a nomogram for predicting FTC. RESULTS: ACR TI-RADS categories 4 and 5, unilateral multiple nodules, and halo thickness≥2 mm were independent risk factors for FTC. ACR TI-RADS category combined with number of nodules, halo features of the nodule was a significantly better prediction model for FTC diagnosis (AUC = 0.869) than that of ACR TI-RADS classification alone (AUC = 0.756). CONCLUTIONS: Clinicians need to pay attention to the halo of nodules when distinguishing FTA from FTC. Notably, ACR TI-RADS combined with other nodule ultrasound features has superior predictive performance in diagnosis of FTC compared to ACR TI-RADS classification alone, thus can provide an important reference value for preoperative diagnosis of FTC.

Torsion strained iridium oxide for efficient acidic water oxidation in proton exchange membrane electrolyzers.

Acidic oxygen evolution reaction is crucial for practical proton exchange membrane water splitting electrolysers, which have been hindered by the high catalytic overpotential and high loading of noble metal catalysts. Here we present a torsion-strained Ta0.1Tm0.1Ir0.8O2-δ nanocatalyst with numerous grain boundaries that exhibit a low overpotential of 198 mV at 10 mA cm-2 towards oxygen evolution reaction in 0.5 M H2SO4. Microstructural analyses, X-ray absorption spectroscopy and theoretical calculations reveal that the synergistic effects between grain boundaries that result in torsion-strained Ir-O bonds and the doping induced ligand effect collectively tune the adsorption energy of oxygen intermediates, thus enhancing the catalytic activity. A proton exchange membrane electrolyser using a Ta0.1Tm0.1Ir0.8O2-δ nanocatalyst with a low mass loading of 0.2 mg cm-2 can operate stably at 1.5 A cm-2 for 500 hours with an estimated cost of US$1 per kilogram of H2, which is much lower than the target (US$2 per kg of H2) set by the US Department of Energy.

Ultrasonography predicts the results of labial salivary gland biopsy in patients with suspected Sjögren's syndrome: a matrix risk model.

OBJECTIVE: Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren's syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren's syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results. METHODS: A derivation cohort and later a validation cohort of patients with suspected Sjögren's syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm2 of glandular tissue. RESULTS: In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both p < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation. CONCLUSION: A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren's syndrome patients on whether the invasive procedure of LSGB should be performed.

Dopants fixation of Ruthenium for boosting acidic oxygen evolution stability and activity.

Designing highly durable and active electrocatalysts applied in polymer electrolyte membrane (PEM) electrolyzer for the oxygen evolution reaction remains a grand challenge due to the high dissolution of catalysts in acidic electrolyte. Hindering formation of oxygen vacancies by tuning the electronic structure of catalysts to improve the durability and activity in acidic electrolyte was theoretically effective but rarely reported. Herein we demonstrated rationally tuning electronic structure of RuO2 with introducing W and Er, which significantly increased oxygen vacancy formation energy. The representative W0.2Er0.1Ru0.7O2-δ required a super-low overpotential of 168 mV (10 mA cm-2) accompanied with a record stability of 500 h in acidic electrolyte. More remarkably, it could operate steadily for 120 h (100 mA cm-2) in PEM device. Density functional theory calculations revealed co-doping of W and Er tuned electronic structure of RuO2 by charge redistribution, which significantly prohibited formation of soluble Rux>4 and lowered adsorption energies for oxygen intermediates.

Ce-Doped IrO2 Electrocatalysts with Enhanced Performance for Water Oxidation in Acidic Media.

Electrocatalytic water splitting in acidic media based on a proton-exchange membrane (PEM) is a promising technique for the large-scale production of hydrogen. However, developing electrocatalysts with high activity and excellent stability for an oxygen evolution reaction (OER) in acidic media is still a big challenge. Herein, a Cex-IrO2 catalyst supported on N-doped porous carbon (NPC) was developed via doping Ce into IrO2 nanoparticles. The Cex-IrO2 nanoparticles were uniformly distributed on NPC due to the high surface area. The optimized Ce0.2-IrO2@NPC delivers a low overpotential of 224 mV and excellent stability of 100 h in 0.5 M H2SO4 at 10 mA cm-2. Density functional theory (DFT) calculations indicated that the introduction of Ce could modify the electronic structure of IrO2, decreasing the energy barrier of the rate-determining step for OER and enhancing the electrochemical OER performance. Our work opens up a new way of developing anodic electrocatalysts, which can be stably applied in acidic media.

A measurement method of knee joint space width by ultrasound: a large multicenter study.

BACKGROUND: Although plain radiology is the primary method for assessing joint space width (JSW), it has poor sensitivity to change over time in regards to determining longitudinal progression. We, therefore, developed a new ultrasound (US) measurement method of knee JSW and aimed to provide a monitoring method for the change of JSW in the future. METHODS: A multicenter study was promoted by the Professional Committee of Musculoskeletal Ultrasound, the Ultrasound Society, and the Chinese Medical Doctor Association. US study of knee specimens determined the landmarks for ultrasonic measurement of knee JSW. The US of 1,272 participants from 27 centers was performed to discuss the feasibility and possible influencing factors of knee JSW. The landmarks for US measurement of knee JS, the inflection point of medial femoral epicondyle and the proximal end of the tibia, were determined. RESULTS: The mean knee JSW1 (medial knee JSW) was 8.57±1.95 mm in females and 9.52±2.31 mm in males. The mean knee JSW2 (the near medial knee JSW) was 9.07±2.24 mm in females and 10.17±2.35 mm in males. The JSW values of males were significantly higher than those of females, with a statistical difference. JSW values were negatively correlated with age and body mass index (BMI) to different degrees and positively correlated with height. CONCLUSIONS: The novel US measurement method can be used to measure knee JSW.

Synthesis of high-entropy alloy nanoparticles on supports by the fast moving bed pyrolysis.

High-entropy alloy nanoparticles (HEA-NPs) are important class of materials with significant technological potential. However, the strategies for synthesizing uniformly dispersed HEA-NPs on granular supports such as carbon materials, γ-Al2O3, and zeolite, which is vital to their practical applications, are largely unexplored. Herein, we present a fast moving bed pyrolysis strategy to immobilize HEA-NPs on granular supports with a narrow size distribution of 2 nm up to denary (MnCoNiCuRhPdSnIrPtAu) HEA-NPs at 923 K. Fast moving bed pyrolysis strategy ensures the mixed metal precursors rapidly and simultaneously pyrolyzed at high temperatures, resulting in nuclei with a small size. The representative quinary (FeCoPdIrPt) HEA-NPs exhibit high stability (150 h) toward hydrogen evolution reaction with high mass activity, which is 26 times higher than the commercial Pt/C at an overpotential of 100 mV. Our strategy provides an improved methodology for synthesizing HEA-NPs on various supports.

Multifactor Analysis of Thyroid Stiffness in Graves Disease: A Preliminary Study.

OBJECTIVE. The aim of this study was to evaluate the value of shear wave elastography (SWE) in Graves disease (GD) and to identify the potential factors influencing thyroid stiffness. MATERIALS AND METHODS. A total of 207 subjects were enrolled and underwent SWE examination in the study, including 162 patients with GD and 45 healthy volunteers with normal thyroids, matched for age and sex. For all subjects, five measurements of elastic modulus values (SWE mean, SWE minimum, and SWE maximum of a 9-mm ROI) were performed on each thyroid lobe, and a mean value was calculated. The indicators including free three-triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid size, isthmus thickness, anti-thyroid peroxidase (TPO) antibodies (Abs), and antithyroglobulin (TG) Abs were detected in the 162 patients with GD, among whom 88 patients underwent initial TSH receptor (TR) Ab examination. RESULTS. The elastic modulus values for patient with GD were significantly higher than those for healthy control subjects. The ROC AUC values for GD by SWE mean was 0.656, and the cutoff value was 15.45 kPa. The sensitivity and specificity were 56.8% and 71.1%, respectively. The duration of disease, thyroid size, isthmus thickness, and levels of TPO Ab, TG Ab, and TR Ab were positively correlated with SWE mean in GD. However, there was no correlation between age, FT3, FT4, TSH, and SWE mean. CONCLUSION. Quantitative SWE helps in the diagnosis of GD. The duration of disease, thyroid size, isthmus thickness, and levels of thyroid autoantibodies (TPO Ab, TG Ab, and TR Ab) could influence thyroid stiffness of GD.

Strain Elastography: A Valuable Additional Method to BI-RADS?

BACKGROUND: Breast lesions classified as BI-RADS-US 3 are probably benign and observation was recommended, while a considerable number of BI-RADS-US 4 lesions were benign, resulting in excessive biopsies. We focus exclusively on BI-RADS-US 3 and 4 lesions and hypothesize that improved diagnostic performance can be achieved by integrating real-time elastography (strain ratio) into the BI-RADS-US classification system. METHOD: From April 2010 to September 2015, 1071 lesions were included in the final analysis. After the conventional ultrasound examination, the BI-RADS-US (2013) classification was used to evaluate the lesions. Then the strain ratios were calculated, and the final diagnosis was made on the basis of histological results. The sensitivity, specificity, accuracy, PPV and NPV were calculated and the AUCs were compared. Additionally, an analysis of the diagnostic performance expressed by the pretest and posttest probability of disease (POD) was performed in BI-RADS-US 3 and 4A lesions. RESULTS: With the cutoff point of 2.98, the sensitivity, specificity and accuracy of the strain ratio method were 86.9 %, 86.6 % and 82.6 %, respectively. In BI-RADS-US 3 lesions, a suspicious strain ratio significantly modified the POD from 1.3 % to a posttest POD of 29.8 %. In BI-RADS-US 4A lesions, a suspicious strain ratio significantly modified the POD from 8.5 % to a posttest POD of 48.7 %. CONCLUSION: Ultrasonographic elastography (strain ratio) yields additional diagnostic information in the evaluation of BI-RADS-US 3 and 4 breast lesions. The strain ratios should be integrated into the BI-RADS-US classification system and into daily practice.

B-Mode Ultrasound Combined with Color Doppler and Strain Elastography in the Diagnosis of Non-mass Breast Lesions: A Prospective Study.

Non-mass breast lesions on ultrasound (US) are areas without an associated mass. The purpose of this study was to evaluate whether combining B-mode US with color Doppler US and strain elastography (SE) improves US differentiation between benign and malignant non-mass breast lesions and the decision for biopsy. In this prospective study, three different radiologists analyzed the US images of 77 non-mass lesions independently and recorded Breast Imaging Reporting and Data System (BI-RADS) categories for four data sets. The image characteristics and BI-RADS categories of the four data sets were analyzed by another radiologist. The final diagnosis was made on the basis of pathologic findings. Values for area under the receiver operating curve (AUC), sensitivity, specificity and accuracy were compared among the data sets. The AUC of B-mode US combined with both color Doppler US and SE was greater than that of B-mode US alone (0.666 vs. 0.828) (p = 0.011). The specificity of making the decision for biopsy increased from 6.5% to 38.7% when B-mode US was combined with color Doppler and SE, without a statistically significant change in sensitivity (p < 0.001). Combined use of color Doppler and SE could improve the diagnostic value of B-mode US in distinguishing benign from malignant non-mass breast lesions and the specificity of making the decision for biopsy of non-mass breast lesions.

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.

Production and characterization of a novel long-acting Herceptin-targeted nanobubble contrast agent specific for Her-2-positive breast cancers.

BACKGROUND: There is an unmet need for specific and sensitive imaging techniques to assess the efficacy of breast cancer therapy, particularly Her-2-expressing cancers. Ultrasonic microbubbles are being developed for use as diagnostic and therapeutic tools. However, nanobubbles circulate longer, are smaller, and diffuse into extravascular tissue to specifically bind target molecules. Here, we characterize a novel Herceptin-conjugated nanobubble for use against Her-2-expressing tumors. METHODS: Phospholipid-shelled nanobubbles conjugated with Herceptin (NBs-Her) were fabricated using a thin-film hydration method and characterized in vitro in breast cancer cell lines and in vivo in a mouse model. RESULTS: The average size of the unconjugated nanobubbles (NBs-Blank) and NBs-Her was 447.1 ± 18.4 and 613.0 ± 25.4 nm, respectively. In cell culture, the NBs-Her adhered to Her-2-positive cells significantly better than to Her-2-negative cells (p < 0.05). In vivo, the peak intensity and the half-time to washout of the NBs-Her were significantly greater than those of the NBs-Blank (p < 0.05). In addition, contrast-enhanced ultrasound imaging quality was improved through the use of the NBs-Her. The nanobubbles were able to penetrate into tumor tissue to allow extravascular imaging, but did not penetrate normal skeletal muscle. CONCLUSIONS: The Herceptin-conjugated nanobubble had many properties that made it useful for in vivo imaging, including longer circulation time and better tumor selectivity. This platform may be able to provide targeted delivery of therapeutic drugs or genes.

Ultrasound Elastography Combined With BI-RADS-US Classification System: Is It Helpful for the Diagnostic Performance of Conventional Ultrasonography?

PURPOSE: To evaluate the additive diagnostic performance of ultrasound elastography (UE) to ultrasound (US) with the 2003 or 2013 Breast Imaging Reporting and Data System (BI-RADS)-US classification systems for the differentiation of benign and malignant breast lesions. METHODS: From June 2010 to December 2012, 738 women with 770 breast lesions were recruited into this retrospective study. Breast lesions were evaluated separately by US, UE, and both. US assessment was based on the 2003 or 2013 BI-RADS-US, and UE assessment was based on a previously reported 5-point scale. Diagnostic performance of US, UE, and both was compared. RESULTS: Before category 4 lesions were subdivided, the area under the receiver operating characteristic curve (AUC) for US, UE, and both were, respectively, 0.735, 0.877, 0.878 (P < .01). When subcategories of 4 lesions were considered, the AUC for US, UE, and both were, respectively, 0.865, 0.877, and 0.883 (P > .05). Adding UE to analysis of 4A lesions can decrease the percentages of malignancy to 2.56%. CONCLUSION: When the 2003 BI-RADS was considered, UE could give US some help in differentiating breast lesions. However, when the 2013 BI-RADS was considered, UE gave little help to US, although it reduced unnecessary biopsies of benign category 4A lesions.

Could ultrasonic elastography help the diagnosis of breast cancer with the usage of sonographic BI-RADS classification?

OBJECTIVES: The purpose was to evaluate whether BI-RADS (the Breast Imaging Recording and Data System) combined with UE (ultrasound elastography) could improve the differentiation and characterization of benign and malignant breast lesions by comparing with BI-RADS. METHODS: A total of 1080 patients with 1194 breast lesions were studied retrospectively at 8 different institutions from 3 geographic areas across China (North, South, and West) from June 2010 to March 2012. Each institutional ethic review board approved the study and all patients gave written informed consent. All the cases were examined by conventional US (ultrasonography) and UE prior to ultrasound-guided core biopsy. Performance of BI-RADS and BI-RADS combined with UE were compared in different size groups, age groups and area groups. RESULTS: BI-RADS combined with UE cloud improve the accuracy by 13.2% compared to BI-RADS alone for all lesions, 23.2% for <10 mm lesions, 13.3% for ≥10-20 mm lesions, 6.3% for ≥20 mm lesions, 18.4% for <50 years group, 1.7% for ≥50 years group, 13.7% for northern area group, 17.7% for southern area group and 4.4% for western area group. CONCLUSIONS: The help which UE contributed to BI-RADS was greater for breast lesions <10mm and <50 years group.

Role of the mevalonate pathway in specific CpG site demethylation on AGEs-induced MMP9 expression and activation in keratinocytes.

BACKGROUND: Advanced glycation end products (AGEs) played an important role for the development of diabetic foot. In the present study we tried to show the mevalonate pathway and the key demethylation site(s) in the MMP-9 cis-promoter to the component of MMP-9 by AGEs in keratinocyte. METHOD: Human keratinocyte cell line (HaCaT) cells were exposed to AGE-BSA. The plasmid construction and site-directed mutagenesis, dual-luciferase reporter assays, immunoblot, zymography, pull down, bisulfite sequencing PCR analysis and Western blotting were applied. RESULTS: The AGE-BSA could increase and more activate the MMP9 in keratinocyte. The RhoA and ROCK1 also could be activated. These affects were blocked by the simvastatin. Meanwhile, the CpG site at -562 site was largely demethylated with AGE-BSA treatment. The cis-promoter sequences with -562 bp site methylated had a lower activity change, which had a highest expression activity and was decreased by simvastatin. Moreover, site-directed mutagenesis of CpG site (-562 bp) in the recombinant plasmid pCpGL-571 brought more reduction in activity, and the activity of methylated mutation pCpGL-571 remains decreased. CONCLUSION: The cis-promoter regions of MMP9 would be methylated by AGE-BSA in keratinocyte through the mevalonate pathway, especially the -562 bp site.