Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis.

Background: A growing body of studies have examined the effect of exercise in people with multiple sclerosis (MS), while findings of available studies were conflicting. This meta-analysis aimed to explore the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Methods: We searched PubMed, Web of Science, Scopus, and Cochrane databases, through March 1, 2024. Inclusion criteria were: (1) RCTs; (2) included an intervention and control group; (3) had people with MS as study subjects; (4) had balance, walking ability, walking endurance, fatigue, or quality of life as the outcome measures. Exclusion criteria were: (1) non-English publications; (2) animal model publications; (3) review articles; and (4) conference articles. A meta-analysis was conducted to calculate weighted mean difference (WMD) and 95% confidence interval (CI). Cochrane risk assessment tool and Physiotherapy Evidence Database (PEDro) scale were used to evaluate the methodological quality of the included studies. Results: Forty studies with a total of 56 exercise groups (n = 1,300) and 40 control groups (n = 827) were eligible for meta-analysis. Exercise significantly improved BBS (WMD, 3.77; 95% CI, 3.01 to 4.53, P < 0.00001), TUG (WMD, -1.33; 95% CI, -1.57 to -1.08, P < 0.00001), MSWS-12 (WMD, -2.57; 95% CI, -3.99 to -1.15, P = 0.0004), 6MWT (WMD, 25.56; 95% CI, 16.34 to 34.79, P < 0.00001), fatigue (WMD, -4.34; 95% CI, -5.83 to -2.84, P < 0.00001), and MSQOL-54 in people with MS (WMD, 11.80; 95% CI, 5.70 to 17.90, P = 0.0002) in people with MS. Subgroup analyses showed that aerobic exercise, resistance exercise, and multicomponent training were all effective in improving fatigue in people with MS, with resistance exercise being the most effective intervention type. In addition, a younger age was associated with a larger improvement in fatigue. Furthermore, aerobic exercise and multicomponent training were all effective in improving quality of life in people with MS, with aerobic exercise being the most effective intervention type. Conclusion: Exercise had beneficial effects in improving balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Resistance exercise and aerobic exercise are the most effective interventions for improving fatigue and quality of life in people with MS, respectively. The effect of exercise on improving fatigue was associated with the age of the participants, with the younger age of the participants, the greater the improvement in fatigue. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371056, identifier: CRD42022371056.

Development of an Ultrasound-based Nomogram for Predicting Pathologic Complete Response and Axillary Response in Node-Positive Patients with Triple- Negative Breast Cancer.

BACKGROUND: The accurate prediction of pathological complete response (pCR) in the breast and axillary lymph nodes (ALN) before neoadjuvant chemotherapy (NAC) is of utmost importance for the development of treatment strategies. We aim to construct a nomogram on ultrasound (US) and clinical-pathologic factors to predict breast and ALN pCR in node-positive triple-negative breast cancers (TNBCs). METHODS: Patients identified with TNBCs from institution 1 (n = 328) were used for training cohort and those from institution 2 (n = 192) were for validation cohort. US was conducted before and after NAC, and characteristics were obtained from medical records. Univariate and multivariate regression analysis were performed to identify US and clinical-pathologic factors associated with breast and ALN pCR in the training cohort. The assessment of predictive performance was conducted using the receiving operating characteristic curve (ROC), discrimination, and calibration. RESULTS: Overall, 34.6% of patients achieved breast pCR and 48.1% of patients achieved ALN pCR. The nomogram 1 used for predicting pCR in the breast (AUC, 0.84; 95% CI: 0.79, 0.88) outperformed the clinical (AUC, 0.73; 95% CI: 0.68, 0.78) and US models (AUC, 0.79; 95% CI: 0.74, 0.83). The nomogram 2 used for predicting pCR in the axllia (AUC, 0.83; 95% CI: 0.78, 0.87) also outperformed the clinical (AUC, 0.64; 95% CI: 0.58, 0.69) and US models (AUC, 0.80; 95% CI: 0.75, 0.84). The calibration curve and discrimination curve indicate that the nomogram has good calibration performance and clinical applicability. CONCLUSION: The nomogram showed promising predictive performance for predicting breast and ALN pCR in patients with TNBCs.

The effect of exercise on flow-mediated dilation in people with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials.

Introduction: An increasing number of studies have investigated the effect of exercise on flow-mediated dilation (FMD) in people with type 2 diabetes mellitus (T2DM), while the findings were controversial. The primary aim of this systematic review and meta-analysis was to investigate the effect of exercise on FMD in T2DM patients, and the secondary aim was to investigate the optimal type, frequency, session duration, and weekly time of exercise for T2DM patients. Methods: Searches were conducted in PubMed, Cochrane Library, Scopus, Web of Science, Embase and EBSCO databases. The Cochrane risk of bias tool (RoB2) in randomized trial and Physiotherapy Evidence Database (PEDro) scale were used to assess the methodological quality of the included studies. Results: From the 3636 search records initially retrieved, 13 studies met the inclusion criteria. Our meta-analysis revealed that exercise had a significant effect on improving FMD in T2DM patients [WMD, 2.18 (95% CI, 1.78-2.58), p < 0.00001, I2 = 38%], with high-intensity interval training (HIIT) being the most effective intervention type [HIIT, 2.62 (1.42-3.82); p < 0.0001; aerobic exercise, 2.20 (1.29-3.11), p < 0.00001; resistance exercise, 1.91 (0.01-3.82), p = 0.05; multicomponent training, 1.49 (0.15-2.83), p = 0.03]. In addition, a higher frequency [> 3 times, 3.06 (1.94-4.19), p < 0.00001; ≤ 3 times, 2.02 (1.59-2.45), p < 0.00001], a shorter session duration [< 60 min, 3.39 (2.07-4.71), p < 0.00001; ≥ 60 min, 1.86 (1.32-2.40), p < 0.00001], and a shorter weekly time [≤ 180 min, 2.40 (1.63-3.17), p < 0.00001; > 180 min, 2.11 (0.82-3.40), p = 0.001] were associated with larger improvements in FMD. Conclusion: This meta-analysis provides clinicians with evidence to recommended that T2DM patients participate in exercise, especially HIIT, more than 3 times per week for less than 60 min, with a target of 180 min per week being reached by increasing the frequency of exercise. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42023466575.

Thoracic endovascular aortic repair under venoarterial extracorporeal membrane oxygenation for acute aortic dissection patients: a case report.

Background: Open repair and replacement of the diseased aorta is still the standard treatment for type A aortic dissection (TAAD) in most patients. In endovascular treatment alone, ensuring adequate blood supply to the brain while covering the dissection with a stent is difficult. Case presentation: This study includes a 71-year-old male patient with type A aortic dissection presented at a recent follow-up examination after having undergone thoracic endovascular aortic repair (TEVAR) plus left subclavian artery chimney stent reconstruction for descending aortic dissection 5 years ago. Preoperative computed tomographic angiography, computed tomographic perfusion, and transcranial Doppler showed an intact cerebral arterial ring and good collateral circulation. We successfully performed an endovascular repair of the thoracic aorta with venoarterial extracorporeal membrane oxygenation (V-A ECMO) to protect the craniocerebral blood supply, greatly increase the safety of the operation, and ensure a good prognosis. Conclusion: TEVAR under V-A ECMO protection is beneficial for patients with TAAD because of its minimal trauma, rapid recovery, few complications, and low mortality.

Inhibition of the MLCK/MLC2 pathway protects against intestinal heat stroke-induced injury in rats.

Intestinal barrier dysfunction often exists in the heat stroke (HS) pathological process, which increases intestinal permeability and induces endotoxemia. The upregulation of MLCK is a crucial player affecting intestinal permeability. This study aimed to explore whether inhibiting myosin light chain kinase (MLCK) can improve HS-induced intestinal injury in rats. Twelve-week-old Wistar male rats were divided into three groups: the control group, the HS model group, and the treatment group [HS model + ML-7 (MLCK inhibitor)]. HS impaired the tight junctions in the rat gut and increased permeability. Additionally, increased inflammatory factors in serum, activation of apoptosis, and downregulation of tight junction proteins were observed in intestinal cells. ML-7 significantly inhibited the MLCK/p-MLC2 signaling pathway, increased the expression of tight junction proteins, reduced intestinal permeability, reduced apoptosis and alleviated the intestinal damage caused by HS. ML-7 inhibited HS-induced apoptosis of intestinal epithelial cells by regulating the ERK/p38/HSP70 axis. Furthermore, inhibition of MLCK upregulated HSP70 expression through activation of the ERK pathway and inhibited cell apoptosis by abolishing the p38 MAPK pathway. In conclusion, inhibiting the MLCK/p-MLC2 signaling pathway reduces HS-induced intestinal permeability and protects the intestinal mucosal barrier.

Advanced Stimuli-Responsive Structure Based on 4D Aerogel and Covalent Organic Frameworks Composite for Rapid Reduction in Tetracycline Pollution.

Intelligentization of materials and structures is an important trend. Herein, the stimuli-responsive 4D aerogel is used as a smart substrate for rapid reduction in tetracycline (TC) pollution, in which this smart stimuli-responsive substrate is designated as P4D. Its fourth dimension originates from stimuli-responsive characteristics with time evolution. Meanwhile, the covalent organic frameworks (COFs) composite is constructed by BiPO4 and triazine-based sp2 carbon-conjugated g-C18N3-COF (COF-1), which is another key aspect of COF-1/BiPO4@P4D for rapid photocatalytic degradation regarding TC pollution. This emerging smart structure of COFs@P4D can fix programmable temporary state and recover permanent state under thermal or water stimulus without any complicated equipment. Its performance can be tailored by structure, composition, and function. Compared with traditional powder-form photocatalysts, this stimuli-responsive structure provides attractive advantages, such as high permeable framework, self-adaptivity, flexibly customized functional groups, and fast reduction in TC pollution. The predictable development of COFs@P4D could draw much attention for various promising applications in pollution treatment and sensors.

Combining primary tumor features derived from conventional and contrast-enhanced ultrasound facilitates the prediction of positive axillary lymph nodes in Breast Imaging Reporting and Data System category 4 malignant breast lesions.

PURPOSE: To determine whether the primary tumor features derived from conventional ultrasound (US) and contrast-enhanced US (CEUS) facilitate the prediction of positive axillary lymph nodes (ALNs) in breast cancer diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 4. METHODS: A total of 240 women with breast cancer who underwent preoperative conventional US, strain elastography, and CEUS between September 2016 and December 2019 were included. The multiple parameters of the primary tumor were obtained, and univariate and multivariate analyses were performed to predict positive ALNs. Then three prediction models (conventional US features, CEUS features, and the combined features) were developed, and the diagnostic performance was evaluated with receiver operating characteristic curves. RESULTS: On conventional US, the traits of large size and the non-circumscribed margin of the primary tumor were marked as two independent predictors. On CEUS, the features of vessel perforation or distortion and the enhanced range of the primary tumor were marked as two independent predictors for positive ALNs. Three prediction models were then developed: model A (conventional US features), model B (CEUS features), and model C (model A plus B). Model C yielded the highest area under the curve (AUC) of 0.82 [95% confidence interval (CI), 0.75-0.88] compared with model A (AUC 0.74; 95% CI, 0.68-0.81; P = 0.008) and model B (AUC 0.72; 95% CI, 0.65-0.80; P < 0.001) as per the DeLong test. CONCLUSION: CEUS, as a non-invasive examination technique, can be used to predict ALN metastasis. Combining conventional US and CEUS may produce favorable predictive accuracy for positive ALNs in BI-RADS category 4 breast cancer.

The effect of exercise on cognitive function in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: A growing body of research examining the effect of exercise on cognitive function in people with multiple sclerosis (MS), while findings of available studies were conflicting. We aimed to explore the effect of exercise on cognitive function in MS patients. METHODS: For this systematic review and meta-analysis, we searched PubMed, Web of Science, EBSCO, Cochrane, and Scopus electronic databases, through July 18, 2022. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. RESULTS: Twenty-one studies with a total of 23 experimental groups and 21 control groups met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in MS patients, while the effect size was small (Cohen's d = 0.20, 95% CI 0.06-0.34, p < 0.001, I2 = 39.31%). Subgroup analysis showed that exercise significantly improved memory (Cohen's d = 0.17, 95% CI 0.02-0.33, p = 0.03, I2 = 7.59%). In addition, multicomponent training, exercise conducted 8 weeks and 10 weeks, up to 60 min per session, 3 times or more per week, 180 min or more per week increased cognitive function significantly. Furthermore, a worse basal MS status (defined by the Expanded Disability Status Scale) and an older age were associated with greater improvement in cognitive function. CONCLUSION: MS patients are recommended to participate in at least three multicomponent training sessions per week, with each session lasting up to 60 min, and the exercise goal of 180 min per week can be achieved by increasing the frequency of exercise. Exercise lasting 8 or 10 weeks is best for cognitive function improvement. Additionally, a worse basal MS status, or the older the age, the greater effect on cognitive function.

Glutamine supplementation attenuates intestinal apoptosis by inducing heat shock protein 70 in heatstroke rats.

BACKGROUND: Heatstroke is the most hazardous heat-related illness and has a high fatality rate. We investigated whether glutamine supplementation could have a protective effect on heatstroke rats. METHODS: Twenty-five 12-week-old male Wistar rats (weight 305±16 g) were randomly divided into a control group (n=5), heatstroke (HS) group (n=10), and heatstroke+glutamine (HSG) group (n=10). Seven days before heat exposure, glutamine (0.4 g/[kg·d]) was administered to the rats in the HSG group by gavage every day. Three hours after heat exposure, serum samples were collected to detect white blood cells, coagulation indicators, blood biochemical indicators, and inflammatory cytokines in the rats. The small intestine tissue was stained to analyze pathological structural changes and apoptosis. Finally, immunohistochemistry and Western blotting were used to analyze the expression levels of heat shock protein 70 (HSP70). Multiple comparisons were analyzed by using one-way analysis of variance, and the Bonferroni test was conducted for the post hoc comparisons. RESULTS: After heat exposure, the core temperature of the HS group (40.65±0.31 °C) was higher than the criterion of heatstroke, whereas the core temperature of the HSG group (39.45±0.14 °C) was lower than the criterion. Glutamine supplementation restored the increased white blood cells, coagulation indicators, blood biochemical indicators, and inflammatory cytokines that were induced by heatstroke to normal levels. The intestinal mucosa was injured, and the structure of tight junctions was damaged in the HS group; however, the structure of intestinal mucosal epithelial cells was stable in the HSG group. Glutamine supplementation alleviated intestinal apoptosis and up-regulated HSP70 expression. CONCLUSION: Glutamine supplementation may alleviate intestinal apoptosis by inducing the expression of HSP70 and have a protective effect on heatstroke rats.

Effect of Neoadjuvant Therapy on the Functional Outcome of Patients With Rectal Cancer: A Systematic Review and Meta-Analysis.

AIMS: The impact of neoadjuvant therapy on the functional outcome of patients with resectable rectal cancer is still controversial. The aim of the present study was to explore the effects of neoadjuvant therapy on anorectal function (ARF), urinary function and sexual function in relevant patients. MATERIALS AND METHODS: PubMed, Embase, Web of Science and the Cochrane Library were searched systematically. All English-language studies, published from January 2000 to July 2021, that explored the (postoperative) effects of neoadjuvant therapy versus upfront surgery on ARF, urinary function and sexual function of patients were included (PROSPERO 2021: CRD42021281617). RESULTS: The data in this study were derived from 37 articles based on 33 studies; in total, 17 917 patients were enrolled. The meta-analysis revealed that the incidence of anorectal dysfunction in the neoadjuvant therapy group was significantly higher than that in the group of upfront surgery, which was manifested by a higher incidence of major low anterior resection syndrome (odds ratio = 3.09, 95% confidence interval = 2.48, 3.84; P < 0.001), reduction of mean squeeze pressure and mean resting pressure, and other manifestations, including clustering of stools, incontinence, urgency and use of pads. With the extension of follow-up time, the adverse effects of neoadjuvant therapy on major low anterior resection syndrome existed. Compared with patients undergoing upfront surgery, neoadjuvant therapy increased the risk of urinary incontinence (odds ratio = 1.31, 95% confidence interval = 1.00, 1.72; P = 0.05) and erectile dysfunction (odds ratio = 1.77, 95% confidence interval = 1.27, 2.45; P < 0.001). CONCLUSION: Compared with upfront surgery, neoadjuvant therapy is not only associated with impairment of ARF, but also with increased incidence of urinary incontinence and male erectile dysfunction. However, the influence of confounding factors (e.g. surgical method, tumour stage) needs to be considered.

Modified Lamaze Breathing Reduces Abdominal Pain in Patients during Colonoscopy.

Objective: To study the effects of modified Lamaze breathing on abdominal pain experienced during colonoscopy. Methods: Eighty-five patients who underwent common colonoscopy at our hospital between March 2021 and May 2021 were selected and randomly divided into the Lamaze group (n = 40) and a control group (n = 45). Their basic clinical information was collected, and the bowel cleanliness, the time for the endoscope to reach the ileocecal junction, and the degree of abdominal pain of the two groups were compared. Results: No significant difference was observed in age, gender, bowel cleanliness, and time of endoscope to reach the ileocecal junction between the two groups. However, the degree of abdominal pain (anal region, descending sigmoid colon junction, splenic flexure, and hepatic flexure) was significantly lower in the Lamaze group compared with the control group. Conclusion: Modified Lamaze breathing demonstrated promising effectiveness in reducing abdominal pain during colonoscopy and improving the quality of the examination.

Femoral artery variation was found during V-A ECMO catheterization.

BACKGROUND: High bifurcation of the deep femoral artery (DFA) is rare in clinical practice, and patients with this variation are less likely to receive venoarterial extracorporeal membrane oxygenation (V-A ECMO) treatment. Therefore, the method by which V-A ECMO is introduced in patients with vascular variation is very important. CASE PRESENTATION: A 52-year-old male patient had ST elevation myocardial infarction due to coronary heart disease. Angiography showed tripartite coronary artery lesions, and coronary artery stenting supported by V-A ECMO was needed. Vascular evaluation before ECMO catheterization revealed high bifurcation of the bilateral DFA located at the inguinal ligament. After discussion, the perfusion cannula was placed in the left superficial femoral artery (SFA) towards the heart, and the distal perfusion catheter (DPC) was placed in the left SFA towards the distal end. Nevertheless, after the patient's heart recovered, necrosis of the toe of the left lower limb still occurred. CONCLUSION: Common femoral artery assessment must be performed before V-A ECMO for patients with high bifurcation of the DFA. Incision catheterization and DPC placement are recommended. After decannulation, arterial repair under direct visualisation is recommended, and rigorous distal vascular assessment and management are needed.

Low 25-Hydroxyvitamin D Levels Are Associated With Residual Dizziness After Successful Treatment of Benign Paroxysmal Positional Vertigo.

Objective: Vitamin D (Vit D) regulates calcium and phosphate metabolism and helps to maintain otolith organ function. Residual dizziness (RD) is one of the most common complications after the successful treatment of benign paroxysmal positional vertigo (BPPV). Various theories have been suggested to explain the cause of RD, and otolith organ disorder is the most evident cause of RD. This study aimed to investigate the association between serum levels of Vit D and the occurrence of RD after the successful treatment of BPPV. Methods: A prospective study including patients who were diagnosed with de novo posterior semicircular canal-type BPPV (PC-BPPV) was conducted at our institution from May 2017 to May 2019. All the patients underwent canalith repositioning procedures and were followed up. Univariate and multivariate analyses were performed to investigate the relationship between serum 25-hydroxy vitamin D (25(OH)D) levels and RD occurrence after successful BPPV treatment. Results: In total, 123 patients with PC-BPPV were enrolled, and 41.5% (51/123) experienced RD. The serum level of 25(OH)D was significantly lower in PC-BPPV patients with RD [median 16.2 ng/ml (IQR 12.9-22.1)] than in patients without RD [median 20.5 ng/ml (IQR 16.5-26.5)] (P = 0.001). In multivariate models comparing the prevalence of RD in the insufficient group [25(OH)D ≥ 20 to <30 ng/ml], deficient group [25(OH)D < 20 ng/ml] and normal group [25(OH)D ≥ 30 ng/ml], the 25(OH)D levels in the deficient group were associated with the occurrence of RD (odds ratio = 5.48, 95% confidence interval = 1.08-27.71; P = 0.04). Conclusion: Low 25(OH)D levels are associated with the development of RD in patients with PC-BPPV after successful treatment. Further efforts to validate and elucidate the mechanism are needed.

Ultrasound-based radiomics nomogram for differentiation of triple-negative breast cancer from fibroadenoma.

OBJECTIVE: This study aimed to develop a radiomics nomogram that incorporates radiomics, conventional ultrasound (US) and clinical features in order to differentiate triple-negative breast cancer (TNBC) from fibroadenoma. METHODS: A total of 182 pathology-proven fibroadenomas and 178 pathology-proven TNBCs, which underwent preoperative US examination, were involved and randomly divided into training (n = 253) and validation cohorts (n = 107). The radiomics features were extracted from the regions of interest of all lesions, which were delineated on the basis of preoperative US examination. The least absolute shrinkage and selection operator model and the maximum relevance minimum redundancy algorithm were established for the selection of tumor status-related features and construction of radiomics signature (Rad-score). Then, multivariate logistic regression analyses were utilized to develop a radiomics model by incorporating the radiomics signature and clinical findings. Finally, the usefulness of the combined nomogram was assessed by using the receiver operator characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS: The radiomics signature, composed of 12 selected features, achieved good diagnostic performance. The nomogram incorporated with radiomics signature and clinical data showed favorable diagnostic efficacy in the training cohort (AUC 0.986, 95% CI, 0.975-0.997) and validation cohort (AUC 0.977, 95% CI, 0.953-1.000). The radiomics nomogram outperformed the Rad-score and clinical models (p < 0.05). The calibration curve and DCA demonstrated the good clinical utility of the combined radiomics nomogram. CONCLUSION: The radiomics signature is a potential predictive indicator for differentiating TNBC and fibroadenoma. The radiomics nomogram associated with Rad-score, US conventional features, and clinical data outperformed the Rad-score and clinical models. ADVANCES IN KNOWLEDGE: Recent advances in radiomics-based US are increasingly showing potential for improved diagnosis, assessment of therapeutic response and disease prediction in oncology. Rad-score is an independent predictive indicator for differentiating TNBC and fibroadenoma. The radiomics nomogram associated with Rad-score, US conventional features, and clinical data outperformed the Rad-score and clinical models.

Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review and Meta-Analysis.

BACKGROUND: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP. METHODS: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications. RESULTS: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention. CONCLUSIONS: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.

Regulation mechanism of three key parameters on catalytic characterization of molybdenum modified bimetallic micro-mesoporous catalysts during catalytic fast pyrolysis of enzymatic hydrolysis lignin.

Novel preparation of molybdenum modified bimetallic micro-mesoporous catalyst was proposed innovatively to conduct catalytic fast pyrolysis of enzymatic hydrolysis lignin. The optimal catalytic characterization of the prepared catalyst was attributed to appropriate porous structure, the interaction between zeolite support and metal species, and the synergetic and stable mechanism of bimetallic active sites. With the incorporation of metal species into micro-mesoporous catalyst, the distribution of active sites experienced a regulation, which contributed to MAHs production and cracking of oxygen-containing substances. NiMo/AZM catalyst exhibited the most obvious coke inhibition effect (8.47 wt% of mass yield) and converted more high-ordered graphite carbon to low-ordered one, so as to make it easier to remove and prolong the catalyst lifetime, and obtained the highest mass yield of MAHs (13.15 wt%) as well as the minimum selectivity of bulky oxygenates (3.82%), which was the joint contribution of three key parameters.

Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer.

OBJECTIVE: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound of axillary lymph nodes (ALNs) in predicting metastatic ALNs in patients with breast cancer. METHODS: This retrospective study included 259 patients with breast cancer who underwent conventional ultrasound and CEUS. The parameters and patterns evaluated on conventional ultrasound included short axis diameter (S), long axis/short axis (L/S) ratio, cortical thickness, resistive index (RI), lymph node (LN) morphology of greyscale ultrasound, hilum and vascular pattern. Meanwhile, enhancement pattern, wash-in time, time to peak (TP), maximum signal intensity, and duration of contrast enhancement were evaluated on CEUS. Univariate and multiple logistic regression analyses were performed to identify independent factors of ALN status. Three models (conventional ultrasound, CEUS, and combined parameters) were established. Receiver operating characteristic (ROC) curves were applied to evaluate the accuracy of the three predictive models. RESULTS: On conventional axillary ultrasound, LN morphology and vascular pattern were independent factors in predicting metastatic ALNs. On CEUS, maximum signal intensity, duration of contrast enhancement, and TP were independent factors in predicting metastatic ALNs. When combining conventional ultrasound and CEUS features, five independent factors obtained from the conventional ultrasound and CEUS were associated with ALN status. ROC curve analysis showed that the use of CEUS markers combined with conventional ultrasound features (AUC = 0.965) was superior to the use of CEUS markers (AUC = 0.936) and conventional ultrasound features alone (AUC = 0.851). CONCLUSION: Combining conventional ultrasound and CEUS features can enable discrimination of ALN status better than the use of CEUS and conventional ultrasound features alone. ADVANCES IN KNOWLEDGE: The axillary lymph node status in breast cancer patients impacts the treatment decision. Our ultrasonic data demonstrated that CEUS features of ALNs in breast cancer patients could be image markers for predicting ALN status. Combining conventional ultrasound and CEUS features of ALNs can improve specificity discrimination of ALN status better than the use of CEUS and the conventional ultrasound features alone, which will help the treatment planning optimization.

Diagnostic performance of contrast-enhanced ultrasound and enhanced magnetic resonance for breast nodules.

In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound (US), contrast-enhanced US (CEUS), combined US and CEUS and magnetic resonance imaging (MRI) in detecting focal solid breast lesions. Totally 117 patients with 120 BI-RADS category 4A-5 breast lesions were evaluated by conventional US and CEUS, and MRI, respectively. SonoVue was used as contrast agent in CEUS and injected as an intravenous bolus; nodule scan was performed 4 minutes after bolus injection. A specific sonographic quantification software was used to obtain color-coded maps of perfusion parameters for the investigated lesion, namely the time-intensity curve. The pattern of contrast enhancement and related indexes regarding the time-intensity curve were used to describe the lesions, comparatively with pathological results. Histopathologic examination revealed 46 benign and 74 malignant lesions. Sensitivity, specificity, and accuracy of US in detecting malignant breast lesions were 90.14%, 95.92%, and 92.52%, respectively. Meanwhile, CE-MRI showed sensitivity, specificity, and accuracy of 88.73%, 95.92%, and 91.67%, respectively. The area under the ROC curve for combined US and CEUS in discriminating benign from malignant breast lesions was 0.936, while that of MRI was 0.923, with no significant difference between them, as well as among groups. The time-intensity curve of malignant hypervascular fibroadenoma and papillary lesions mostly showed a fast-in/fast-out pattern, with no good correlation between them (kappa < 0.20). In conclusion, the combined use of conventional US and CEUS displays good agreement with MRI in differentiating benign from malignant breast lesions.