[Value of artificial intelligence in the improvement of diagnostic consistency of radiology residents].

OBJECTIVE: To explore the value of artificial intelligence (AI) in improving the detection rate of traumatic rib fractures by radiologist residents and the consistency among different readers. METHODS: Chest CT images of 393 patients with acute trauma from China-Japan Union Hospital of Jilin University (hospital 02) and Shanghai Ninth People' s Hospital (hospital 03) were collected in this research. The consensus achieved by three radiology experts was regarded as the reference standard. All the images assigned to three hospitals: Peking University First Hospital (hospital 01), hospital 02 and hospital 03, and were then randomly divided into two groups (group A and group B: group A included 197 patients, and group B included 196 patients). Each group was read by one radiologist resident from each hospital for rib fracture detection. Each case was read twice by the same radiologist, with and without the assistance of the AI ["radiologist-only" reading and "radiologist + AI" reading]. The detection rates of different types of rib fractures (displaced fractures and occult fractures) were compared between "radiologist-only" reading and "radiologist + AI" reading. The consistencies of different radiologists with different reading methods were evaluated. RESULTS: The detection rates of displaced rib fractures and occult rib fractures by "radiologist + AI" reading were significantly higher than those read by "radiologist-only" reading (94.56% vs. 78.40%, 76.60% vs. 49.42%, P < 0.001). For "radiologist-only reading", the Kappa coefficients of the radiologists between hospital 01 and hospital 03 were slightly greater than 0.4 (indicating moderate consistency), the coefficients of the radiologists between hospital 01/hospital 02 and hospital 02/hospital 03 were less than 0.4 (indicating poor consistency). The Phi coefficients of the radiologists among different hospitals were all less than 0.6 (indicating moderate correlation). With "radiologist + AI" reading, the Kappa and Phi coefficient among the radiologists in dif-ferent hospitals were greater than or equal to 0.6 (indicating good consistency and correlation). CONCLUSION: AI software can be used to automatically detect suspected rib fracture lesions, which helps to improve the detection rate of fracture lesions and the consistency among different readers.

[Investigation of treatment and analysis of prognostic risk on enterocutaneous fistula in China: a multicenter prospective study].

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn's disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn's disease (χ(2)=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ(2)=5.460, P=0.019), multiple ECF (χ(2)=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ(2)=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ(2)=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ(2)=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ(2)=179.699, P<0.001), sepsis (χ(2)=211.851, P<0.001), hemorrhage (χ(2)=85.300, P<0.001), pulmonary infection (χ(2)=60.096, P<0.001), catheter-associated infection (χ(2)=10.617, P=0.001) and malnutrition (χ(2)=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions: The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.

Inhibition of thyroid carcinoma cells with YAP1 protein interference and its mechanism.

OBJECTIVE: To investigate the effects and mechanism of yes-associated protein 1 (YAP1) on thyroid carcinoma cells. MATERIALS AND METHODS: Quantitative Real-time PCR (qRT-PCR) and Western blot assay were used to detect the expression of YAP1 in normal thyroid cells (HT-ori3) and four types of thyroid carcinoma cells: FTC-133, IHH-4, TPC-1 and NPA. The cell lines with the highest expression of YAP1 were selected as the experimental materials. qRT-PCR and Western blot assay were used to detect the interference effect of si-YAP1. The cell proliferation and the effect on the PI3K-Akt signal pathway were examined by MTT and Western blot. RESULTS: The expression of YAP1 significantly increased in the thyroid carcinoma cell line compared with normal thyroid cells, among which the expression of YAP1 in TPC-1 was the highest. Quantitative PCR and Western blot results showed significant interference effects. The MTT assay indicated that YAP1 interference suppressed the proliferation of cells and the expression of p-Akt. CONCLUSIONS: The interference of YAP1 can inhibit the growth of thyroid cancer cells, and its mechanism may be associated with the PI3K-Akt signaling pathway.

[The 458th case: fever, cytopenia, abdominal pain, and multiple intestinal ulcerations with perforation].

Trisomy 8 in myelodysplastic syndrome (MDS) plays an important role in concurrent intestinal Behçet's disease (BD) pathogenesis. Here, we reported a case of intestinal BD combined with MDS involving trisomy 8. A 48-year-old woman who has had a 20-year history of recurrent oral ulcer, perineal ulcer and iris, was diagnosed as MDS with trisomy 8 four years ago. She developed high fever and acute abdominal pain. Multiple ulcerative perforations in ileum and colon were found by endoscopy, meeting the criteria for intestinal BD. The patient was successfully treated with immunomodulatory drugs.

[Expression and significance of tumor necrosis factor alpha, matrix metalloproteinase 2 and collagen in skin tissue of pressure ulcer of rats].

OBJECTIVE: To observe the expressions of tumor necrosis factor alpha (TNF-α), matrix metalloproteinase 2 (MMP-2) and collagen in local skin tissue of pressure ulcer of rats, and to explore the possible mechanism of the pathogenesis of pressure ulcer. METHODS: Forty male SD rats were divided into normal control group, 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group according to the random number table, with 8 rats in each group. The rats in normal control group did not receive any treatment, whereas the rats in the latter 4 groups were established the deep tissue injury model (3 d compression group) and pressure ulcer model (the other 3 groups) on the gracilis muscle on both hind limbs using a way of cycle compression of ischemia-reperfusion magnet. The rats in 3 d compression group received only three cycles of compression, while the compressed skin of the rats in 5 d compression group, 7 d compression group, and 9 d compression group were cut through and received pressure to 5, 7 and 9 cycles after three cycles of compression, respectively. The rats in 3 d compression group were sacrificed immediately after receiving compression for 3 d (the rats in normal control group were sacrificed at the same time), and the rats in the other 3 groups were respectively sacrificed after receiving compression for 5, 7, and 9 d, and the skin tissue on the central part of gracilis muscle on both hind limbs were harvested. The morphology of the skin tissue was observed with HE staining. The expression of collagen fiber was observed with Masson staining. The expressions of collagen type Ⅳ and MMP-2 were detected by immunohistochemical method. The expressions of TNF-α and phosphorylated NF kappa B (NF-κB) were determined by Western blotting. Data were processed with one-way analysis of variance and LSD test. RESULTS: (1) In normal control group, the skin tissue of rats was stratified squamous epithelium, with the clear skin structure, and there was no obvious infiltration of inflammatory cells. In 3 d compression group, the skin layers of rats were clear, with quite a few fibroblasts, and the inflammatory cells began to infiltrate. In 5 d compression group, 7 d compression group, and 9 d compression group, the epidermis of rats thickened, with the number of fibroblasts reduced, and the infiltration of inflammatory cells enhanced with the compressed time prolonging. (2) In normal control group, the collagen fibers in skin tissue of rats were arranged in order, with rich content. In 3 d compression group, the collagen fibers in skin tissue of rats were arranged orderly, with high expression level, which was similar to that in normal control group (P>0.05). In 5 d compression group and 7 d compression group, the collagen fibers in skin tissue of rats were arranged in disorder, with the expression level gradually reduced, which were significantly lower than that in normal control group (with P values below 0.01). In 9 d compression group, the expression of collagen fiber in skin tissue of rats was a little higher than that in 7 d compression group, but it was still significantly lower than that in normal control group (P<0.01). (3) The expressions of collagen type Ⅳ in skin tissue of rats in normal control group, 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group were respectively 11.0±2.8, 9.0±1.7, 8.3±2.8, 5.1±1.8, and 5.4±1.2. The expression of collagen type Ⅳ in skin tissue of rats in 3 d compression group was similar to that in normal control group (P>0.05). The expressions of collagen type Ⅳ in skin tissue of rats in 5 d compression group, 7 d compression group, and 9 d compression group were significantly lower than that in normal control group (P<0.05 or P<0.01). The expression of MMP-2 in skin tissue of rats in 3 d compression group was similar to that in normal control group (P>0.05). The expressions of MMP-2 in skin tissue of rats in 5 d compression group, 7 d compression group, and 9 d compression group were significantly higher than that in normal control group (P<0.05 or P<0.01). (4) The expression of TNF-α in skin tissue of rats in normal control group was 0.48±0.11, and the expressions of TNF-α in skin tissue of rats in 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group were respectively 0.84±0.08, 1.13±0.19, 1.34±0.16, and 1.52±0.23, which were all significantly higher than that in normal control group (with P values below 0.01). The expressions of phosphorylated NF-κB in skin tissue of rats in 3 d compression group and 9 d compression group were similar to that in normal control group (with P values above 0.05), and the expressions of phosphorylated NF-κB in skin tissue of rats in 5 d compression group and 7 d compression group were significantly higher than that in normal control group (P<0.05 or P<0.01). CONCLUSIONS: The high expression of MMP-2 and reduction of collagen induced by inflammatory reaction mediated by the high expression of TNF-α in local skin tissue of pressure ulcer of rats may be one of the important reasons for the formation of pressure ulcer.

First Report of Mulberry Root Rot Caused by Lasiodiplodia theobromae in China.

Mulberry (Morus alba L.) is an important cash crop and medicinal plant that has been cultivated for more than 5,000 years in China. The area of mulberry production in Guangxi Province is 45% of total production in China, with 1.3 million ha planted. In recent years, a mulberry root rot occurred in Heng County covering all the mulberry planting farms. Observations of 200 diseased plants were made. The xylem of infected roots first turned brown, and then became black followed by cortex rot. The xylem and cortex of infected roots were easily separated. The xylem of the stem of symptomatic plants was also brown and the bark was slightly darker than normal. Leaves of diseased plants turned yellow and wilted, but the wilted leaves remained on the affected branches for about 3 weeks. All affected branches and stem dried after a month. The affected area was 12,000 ha with incidences varying from 13 to 52%. About 8% of young mulberry trees died in severely infested orchards. The disease caused more than $3 million in losses within a year in Heng County alone. The causal fungus was isolated from xylem tissues of symptomatic roots of 62 mulberry plants with an isolation rate of 90%. Pathogenicity test was made by inoculating 5-month-old healthy mulberry plants with PDA plugs (5 × 5 mm) grown 5 days with viable mycelia of the fungus. Nine healthy plants were wounded on the roots with a sterile knife, and mycelial plugs of three Lasiodiplodia theobromae (Pat.) Griffon & Maubl isolates were placed on the wounds, covered with sterile moist cotton, and wrapped with Parafilm. Nine control plants were treated with PDA plugs. The test was repeated three times. All treated plants were kept in a greenhouse at ~28°C and 40% RH. After 3 days, the root xylem of inoculated plants turned brown and gradually became dark, similar to symptoms observed in the field. After 8 days, inoculated seedlings gradually wilted, and all the treated plants died after 11 days with leaves undetached. The fungus was re-isolated from all nine diseased plants and no symptoms were observed on the roots of control plants. The causal agent, of which conidia were dark brown, one-septate, thick walled, and ellipsoid with 4 or 6 vertical lines of dashes, 12.50 to 13.75 × 13.75 to 25.63 µm (n = 100), was identified as L. theobromae based on morphological characters described by Punithalingam (3) and sequences of the ITS region of rDNA using primers ITS1 and ITS4 and EF1-α using primers EF728F and EF986R. The ITS sequence (HG917932) was similar to the ITS sequences of AY640255 (CBS164.96) and AY236952 (CMW9074) in GenBank with identities of 98.8 and 99.8%, respectively. The EF1-α sequence HG917934 was similar to that of AY640258 (CBS164.96) and AY236901 (CMW9074) with identities of 99.7 and 99.7%, respectively. L. theobromae is a cosmopolitan fungus causing both field and storage diseases on more than 280 plant species including crops, fruits, and cash fruit trees (1,2,5). Mulberry root rot caused by L. theobromae has been reported in India (4) and ours is the first report in China. This finding clarifies the pathogen of mulberry root rot previously thought as Fusarium sp. in China, which is critical to develop management strategies to control this disease. References: (1) N. M. Celiker and T. J. Michailides. New Dis. Rep. 25:12, 2012. (2) I. H. Fischer et al. Australia Plant Dis. Notes 3:116, 2008. (3) E. Punithalingam. Botryodiplodia theobromae. CMI Descriptions of Pathogenic Fungi and Bacteria No. 519. CAB International, Wallingford, UK, 1976. (4) N. V. Radhakrishnan et al. Indian Phytopathol. 48:490, 1995. (5) B. C. Sutton. The Coelomycetes. Commonwealth Mycology Institute, Kew, Surrey, England, 1980.

Two novel multiple mutations in chinese patients with adrenoleukodystrophy.

X-linked adrenoleukodystrophy (X-ALD) is a neurodegenerative disorder caused by mutations in the ABCD1 gene. Up to now, more than 1 050 mutations have been reported in the ABCD1 gene, of which only 10 are multiple mutations in one allele of the gene. In this study, we report 2 novel multiple mutations in 2 patients with X-ALD from 2 unrelated Chinese families. Total RNA and genomic DNA were isolated from peripheral blood of the 2 patients, and the ABCD1 gene was analyzed by direct sequencing and denaturing high-performance liquid chromatography. We detected [p.Ser108X+p.Arg259Trp] in patient 1, [p.Lys217Glu+p.Val489Val] in patient 2 in one allele of the ABCD1 gene. Both novel multiple mutations have not previously been reported and this is the first report of multiple mutations identified in Chinese patients with X-ALD.

High frequency occurrence of 1-OPRD variant of PRNP gene in gastric cancer cell lines and Chinese population with gastric cancer.

The prion protein gene PRNP encodes PrPc and PrPsc, causing a number of neurological disorders. Approximately 10-15% of human prion disease is inherited and more than 20 pathogenic mutations have been found. Most of the genetic alterations are point mutations, with the exception of genetic insertions of one to nine extra octapeptide repeats occurring in the important octapeptide-coding region. Our previous work showed that PrPc was overexpressed in gastric cancer. We wondered whether mutations of PrPc existed in human gastric cancer. DNA sequencing and gel electrophoresis were used to determine the possible mutation of PrPc in patients and cell lines of gastric cancer. We found that 1-OPRD (one octapeptide-repeat deletion) homozygosity or heterozygosity exists in several gastric cancer cell lines, e.g. MKN28 and KatoIII are homozygous for 1-OPRD, and SGC7901 and BGC-823 are heterozygous for 1-OPRD. The mutation frequency in tissues of gastric cancer cases is significantly higher than that in the common population (p<0.05). All positive cases in gastric cancer were found to be heterozygous for 1-OPRD. Further study of the variant may be helpful in understanding the mechanisms of occurrence and development of clinical gastric carcinoma as well as the biology of the mysterious gene PRNP.

Determination of idebenone in plasma by HPLC/MS.

AIM: To develop a sensitive method for the analysis of idebenone [Ide, 6-(10-hydroxydecyl)-2,3-dimethoxy-5-methyl-p-benzoquinone] in human plasma. METHODS: The concentrations in plasma were determined by a high performance liquid chromatography-mass spectrometry coupled with an atmosphere pressure chemical impact ion source method (LC/MS-APCI). RESULTS: The chromatograms indicated a good separation of the analytes and there was no interference by other compounds. The coefficients of determination of the calibration curves were above 0.999. The calibration range was 20-600 micrograms.L-1. Peak plasma idebenone concentration (Cmax) of (316 +/- 85) micrograms.L-1 was achieved within (96 +/- 34) min (Tpeak) after an oral dose of 30 mg. Lower limit of quantitation of the method for Ide determination was 20 micrograms.L-1. CONCLUSION: The advantages of using LC/MS-APCI technique include better sensitivity, higher selectivity, and less time consumption, compared with HPLC method.