Improving the diagnostic performance of computed tomography angiography for intracranial large arterial stenosis by a novel super-resolution algorithm based on multi-scale residual denoising generative adversarial network.

BACKGROUND: Computed tomography angiography (CTA) is very popular because it is characterized by rapidity and accessibility. However, CTA is inferior to digital subtraction angiography (DSA) in the diagnosis of intracranial artery stenosis or occlusion. DSA is an invasive examination, so we optimized the quality of cephalic CTA images. METHODS: We used 5000 CTA images to train multi-scale residual denoising generative adversarial network (MRDGAN). And then 71 CTA images with intracranial large arterial stenosis were treated by Super-Resolution based on Generative Adversarial Network (SRGAN), Enhanced Super-Resolution based on Generative Adversarial Network (ESRGAN) and post-trained MRDGAN, respectively. Peak signal-to-noise ratio (PSNR) and structural similarity index measurement (SSIM) of the SRGAN, ESRGAN, MRDGAN and original CTA images were measured respectively. The qualities of MRDGAN and original images were visually assessed using a 4-point scale. The diagnostic coherence of digital subtraction angiography (DSA) with MRDGAN and original images was analyzed. RESULTS: The PSNR was significantly higher in the MRDGAN CTA images (35.96 ± 1.51) than in the original (31.51 ± 1.43), SRGAN (25.75 ± 1.18) and ESRGAN (30.36 ± 1.05) CTA images (all P < 0.001). The SSIM was significantly higher in the MRDGAN CTA images (0.95 ± 0.02) than in the SRGAN (0.88 ± 0.03) and ESRGAN (0.90 ± 0.02) CTA images (all P < 0.01). The visual assessment was significantly higher in the MRDGAN CTA images (3.52 ± 0.58) than in the original CTA images (2.39 ± 0.69) (P < 0.05). The diagnostic coherence between MRDGAN and DSA (κ = 0.89) was superior to that between original images and DSA (κ = 0.62). CONCLUSION: Our MRDGAN can effectively optimize original CTA images and improve its clinical diagnostic value for intracranial large artery stenosis.

Postoperative neovascularization, cerebral hemodynamics, and clinical prognosis between combined and indirect bypass revascularization procedures in hemorrhagic moyamoya disease.

OBJECTIVE: We evaluated what few studies emphasized the postoperative collateral formation and cerebral hemodynamics of hemorrhagic moyamoya disease (MMD). METHODS: Hemorrhagic MMD patients treated surgically were retrospectively collected and dichotomized into combined bypass (CB) and indirect bypass (IB) groups. CB used superficial temporal artery-to-middle cerebral artery anastomosis combined with encephaloduroarteriomyosynangiosis (STA-MCA+EDAMS), and IB used encephaloduroarteriomyosynangiosis (EDAMS) for revascularization. Postoperative complications and clinical prognosis, as well as pre- and post-operative Modified Rankin Scale (mRS), collateral circulation status, and cerebral hemodynamics were observed and compared between the CB and IB groups. RESULTS: A total of 37 patients with hemorrhagic MMD were identified. Of the 68 cerebral hemispheres, 47(69.1%) were combined revascularization, and the rest were indirect. During an average follow-up of 16.5 ± 8.7 months, the recurrent stroke events were significantly lower, as well as having a postoperative mRS scores≤ 2. A satisfactory postoperative collateral formation, and an improved dilation or extension of the anterior choroidal/posterior communication artery (AchA/PcoA) were significantly higher in the CB group than in the IB group (all P < .05). Compared with preoperative cerebral hemodynamics, relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT), and relative time to peak (rTTP) in the CB group; rCBF, rCBV, and MTT in the IB group were significantly improved (all P < .001). The CB group's postoperative rCBF was significantly improved compared with the IB group (P < .001). CONCLUSIONS: STA-MCA bypass combined with EDAMS can obtain better postoperative collateral formation, cerebral hemodynamics, and clinical prognosis than EDAMS alone.

Molecular mechanism of microRNA-21 promoting Schwann cell proliferation and axon regeneration during injured nerve repair.

At present, the functional recovery after nerve injury is not satisfactory in clinical practice. The aim of this study was to explore the molecular mechanism of miR-21 promoting Schwann cells (SC) proliferation and axon regeneration after peripheral nerve injury, providing a theoretical basis for injured nerve repair. Nerve injury models were constructed to determine the expression of miR-21 in the injured nerve by Quantitative Real-Time PCR (qRT-PCR). After miR-21 over-expression SC (mimic-miR-21) group, control SC (control-miR-21) group and blank SC (RSC96) group were constructed, SC proliferation was determined by CCK-8, cell cycle was analysed by flow cytometry, dorsal root ganglion neuron (DRGn) axon regeneration was observed after DRGn was cultured with SCs for 7 days, the expressions of TGFßI, TIMP3, EPHA4 as well as apoptosis-related proteins caspase-3 and caspase-9 were detected by qRT-PCR and Western blot in the three groups, respectively. Target genes were confirmed by dual-luciferase reporter gene assay. The expressions of TGFßI, TIMP3 and EPHA4 were assessed by immunofluorescence in vivo. qRT-PCR indicated that miR-21 expression was significantly higher in the model group than in the sham operation and blank groups. SC proliferation index (PI) was significantly higher, the apoptosis rate was significantly lower, the axon was significantly longer, and mRNA and protein expressions of TGFßI, TIMP3, EPHA4 as well as apoptosis-related proteins caspase-3 and caspase-9 were significantly lower in the mimic-miR-21 group than in the control-miR-21 and RSC96 groups. The double luciferase assay confirmed that TGFßI, TIMP3 and EPHA4 were potential target genes of miR-21. In vivo immunofluorescence also indicated that expressions of TGFßI, TIMP3, EPHA4 were lower in the mimic-miR-21 group than in the control-miR-21 and RSC96 groups. We conclude that during injured peripheral nerve repair, miRNA-21 plays an important role in promoting SC proliferation and axon regeneration by regulating TGFßI, TIMP3 and EPHA4 target genes.

Surgical procedures including carotid-carotid crossover bypass and ring-stripping hybrid operation for Rile's type 1A common carotid artery occlusion: an experience of 6 cases.

BACKGROUND: At present, there is no consensus on the treatment of common carotid artery occlusion (CCAO). We explored the surgical indications and observed the therapeutic effects of carotid-carotid crossover bypass and ring-stripping hybrid operation for treatment of Rile's type 1A CCAO. METHODS: The imaging data, clinical manifestations, surgical complications and postoperative ischemic events were retrospectively collected from the 6 cases with Rile's type 1A CCAO that underwent surgery in our department from 2011 to 2018. Of the 6 cases, 4 received carotid-carotid crossover bypass and 2 ring-stripping hybrid operation. RESULTS: Of the 6 cases, 4 were male and 2 females, with a mean age of 62.7 years. All cases had the left CCAO combined with decreased computed tomography perfusion (CTP) in the left internal carotid artery blood supply area. In the 4 cases receiving carotid-carotid crossover bypass, the mean operation time was 186±13 min, the mean hospital stay was 17±1 d, postoperative CTP improved, one case had swallowing foreign body sensation, synthetic vascular grafts were patent and no ischemic events occurred during the mean follow-up of 62.3±26.3 months. In the 2 cases receiving ring-stripping hybrid operation, the mean operation time was 118±11 min, the mean hospital stay was 5.5±0.7 d, postoperative CTP improved, and the opened common carotid arteries (CCA) were patent and no ischemic events occurred during the mean follow-up of 17.5±3.5 months. CONCLUSIONS: Rile's type 1A CCAO with related symptoms and decreased CTP should be treated by revascularization. The carotid-carotid crossover bypass is a good choice in bypass schemes because of its easy operation and good long-term patency. The ring-stripping hybrid operation may be an ideal surgical scheme for Rile's type 1A CCAO.

Complex Internal Carotid Aneurysms Treated by Superficial Temporal Artery Trunk-Radial Artery-Middle Cerebral Artery Bypass Combined with Balloon Occlusion of Internal Carotid Artery.

OBJECTIVE: To evaluate the feasibility to treat complex internal carotid aneurysms by superficial temporal artery trunk-radial artery-middle cerebral artery (STAT-RA-MCA) bypass combined with balloon occlusion of internal carotid artery. METHODS: Postoperative clinical symptoms, the patency of bridge vessels (radial artery graft [RAG]), STAT and RAG diameters, RAG flow, cerebral blood flow (CBF), and mean transit time (MTT) were observed in 14 cases. Their correlations were analyzed. RESULTS: Except 1 case, RAG was patent in 13 cases. Glasgow Outcome Scale score was 4 in one case and 5 in 13 cases. In the 13 cases with postoperative RAG patency, the mean diameter of STAT increased from 2.1 mm before operation to 3.0 mm on the first day after operation; the mean diameter of RAG was 3.7 mm on the first day after operation. In 3 of the 13 cases, STAT and RAG diameters further increased to 4.0 mm and 4.7 mm, respectively, 3 months after operation. There was a positive correlation between STAT and RAG diameters (P = 0.0005). The STAT (P < 0.0001, P < 0.0001) and RAG (P < 0.0001, P = 0.0042) diameters were positively correlated with RAG flow and CBF, but the STAT (r2 = 0.762, P < 0.0001) and RAG (r2 = 0.54, P = 0.0042) diameters were negatively correlated with MTT. CONCLUSIONS: STAT-RA-MCA bypass combined with balloon occlusion of internal carotid artery is feasible for the treatment of complex internal carotid aneurysms.

Effects of superficial temporal artery-middle cerebral artery bypass on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and middle cerebral artery.

OBJECTIVE: To observe the effects of superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and (or) middle cerebral artery. PATIENTS AND METHODS: The data of 63 patients who had the symptoms of cerebral ischemia in recent 3 months, intracranial segment of internal carotid artery (ISICA) and (or) middle cerebral artery (MCA) stenoses or occlusion showed by digital subtraction angiography (DSA), and reduced cerebral perfusion displayed by CT perfusion (CTP) imaging were retrospectively collected in this study. According to the patient's choice of different treatment methods (STA-MCA bypass and drugs), these patients were allocated into two groups: Bypass group (30 cases) and Drug group (33 cases). Postoperative symptoms, anastomotic patency and hemodynamics were observed in the Bypass group. Post-treatment ischemic events and clinical outcomes were recorded in the two groups and were compared between the two groups. RESULTS: In the Bypass group, DSA all showed anastomotic patency in 28 patients (93.3%, 28/30), and the improvement rate of CTP was all significantly higher in the patients with stage-III CTP than in the patients with stage-II CTP at post-operative 3 days and 6 months (95% vs 60%). Post-treatment ischemic event incidence (13.3% vs 48.5%) and annual stroke rate (6.7% vs 25.6%) were significantly lower in the Bypass group than in the Drug group (All P < 0.05). Pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (MRS) score were not significantly different between the two groups, but the NIHSS (2.87±0.19 and 2.4±0.19 vs 4.03±0.47 and 3.97±0.49) and MRS (1.13±0.09 and 1.0±0.07 vs 1.55±0.14 and 1.52±0.15) all were significantly lower in the Bypass group than in the Drug group at post-treatment 6 and 24 months (all P < 0.05). CONCLUSION: STA-MCA bypass can improve cerebral blood perfusion and reduce the incidence of stroke in the patients who have ISICA and (or) MCA-related symptoms, 70%-100% of stenosis, and above stage-ⅠCTP. However, this conclusion remains to be further confirmed.

[Diagnostic Value of Combining Permeability with T1 Perfusion Parameters in Quantitative Dynamic Contrast-enhanced Magnetic Resonance Imaging for Glioma Grading].

UNLABELLED: OBJECTIVE To investigate the diagnostic value of combining permeability with T1 perfusion parameters in quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioma grading. METHODS: Magnetic resonance imaging was performed in 16 patients with high grade gliomas (HGG) and 12 patients with low grade gliomas(LGG) confirmed by pathology. The permeability was quantitatively analyzed and the T1 perfusion parameters of the tumor were calculated by the pharmacokinetic model,including volume transfer constant (K(trans)),volume fraction of extravascular extracellular space (ve),reflux constant (kep),fractional plasma volume (vp),cerebral blood flow (CBF),cerebral blood volume (CBV),and mean transit time (MTT). A t-test was used to calculate the statistical significance of quantitative analysis parameters between HGG and LGG. The receiver operating characteristic curve analysis was also performed for evaluating the sensitivity,specificity,and area under curve (AUC) of the permeability parameters and perfusion parameters and the combination of these parameters. RESULTS: The differences of the K(trans),ve,CBF,and CBV values [(0.276<0.164)/min vs. (0.084<0.044)/min;0.486<0.191 vs. 0.274<0.132;(1.755<1.164)ml/(g·min) vs. (0.761<0.625) ml/(g·min);(0.204<0.101) ml/g vs. (0.115<0.097)ml/g] were statistically significant (t=3.934,3.293,2.672,2.338,P<0.05) between HGG and LGG. The differences of the kep,vp, and MTT value [(1.632<1.204)/min vs. (1.537<1.194)/min;0.114<0.107 vs. 0.055<0.039;(0.128<0.070)min vs. (0.145<0.066)min] were not statistically significant (t=0.208,1.823,0.688,P>0.05). When the K(trans) value was 0.105/min,the AUC was the largest (0.919) by the single parameter in glioma grading,and meanwhile the sensitivity and specificity were 87.5% and 83.3%,respectively. When the ve-CBF value was 0.631,the AUC was the largest (0.974) by the multiple parameter,and meanwhile the sensitivity and specificity were 93.7% and 100.0%,respectively. CONCLUSION: Combining permeability with perfusion parameters in quantitative DCE-MRI can improve the accuracy of the glioma grading.

Preparation of arsenic trioxide-loaded albuminutes immuno-nanospheres and its specific killing effect on bladder cancer cell in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, arsenic trioxide (As2O3) was considered as a novel anti-tumor agent. However, it showed severe toxicity effect on normal tissue at the same time. To improve its therapeutic efficacy and decrease its toxicity,we prepared arsenic trioxide-loaded albuminutes immuno-nanospheres [As2O3-(HAS-NS)-BDI-1] targeted with monoclonal antibody (McAb) BDI-1 and tested its specific killing effect against bladder cancer cell.</p><p><b>METHODS</b>As2O3-HAS-NS was prepared by chemical cross-linking method. Monoclonal antibody BDI-1 was purified with ammonium sulphate saltingout and chromatography. Albuminutes microspheres were conjugated with McAb by SPDP cross-linking method. Concentration of As in As2O3-(HAS-NS)-BDI-1 and As2O3-HAS-NS was measured by atomic fluometry method. As2O3-(HAS-NS)-BDI-1 and its activity were detected by SDS-PAGE reduction electrophoresis, indirect immunofluorescence test, light microscope and scanning electron microscope observation. Acridine orange staining and tritiated thymidine (3H-TdR) incorporation tests were used to indicate specific killing activity of As2O3-(HAS-NS)-BDI-1 in vitro.</p><p><b>RESULTS</b>In As2O3-(HAS-NS)-BDI-1 groups, we saw two protein bands in SDS-PAGE reduction electrophoresis. Albuminutes immuno-nanospheres were rounded with clear green fluorescence by immunofluorescence test. Under microscope, we observed that BIU-87 cells were covered with the As2O3-(HAS-NS)-BDI-1 and that As2O3-(HAS-NS)-BDI-1 moved with the BIU-87 cells. The albuminutes immuno-nanospheres were tightly junctioned with the BIU-87 cells. Specific killing activity of As2O3-(HAS-NS)-BDI-1 on bladder tumor cells was observed by acridine orange staining and 3H-TdR incorporation assays.</p><p><b>CONCLUSIONS</b>As2O3-(HAS-NS)-BDI-1 might bind specifically against BIU-87 cells, thus leading to high activity of killing bladder tumor cells.</p>

Expression of SSX2 gene in human urologic neoplasms / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of SSX(2)gene in human renal cell carcinoma and urinary transitional cell carcinoma.</p><p><b>METHODS</b>Reverse-transcription polymerase chain reaction (RT-PCR) was used for detecting SSX(2) gene in the specimens from renal cell carcinoma (n = 26), urinary transitional cell carcinoma (n = 27) and in 15 specimens taken from the tumor surrounding tissues.</p><p><b>RESULTS</b>Positive expression of SSX(2) gene at mRNA was detected in 69% renal cell carcinomas (18/26), in 81% urinary transitional cell carcinomas (22/27). The mRNA of SSX(2) was not detected in the 15 specimens from tumor surrounding tissues.</p><p><b>CONCLUSION</b>The SSX(2) gene is highly expressed in human renal cell carcinoma and urinary transitional cell carcinoma.</p>

Expression of melanoma antigen gene in urinary transitional cell carcinomas / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the significance of melanoma antigen (MAGE) gene expression in bladder transitional cell carcinoma (TCC).</p><p><b>METHODS</b>MAGE-A1, A2, A3, A4 mRNA expression was detected by reverse transcription polymerase chain reaction (RT-PCR) in 3 clusters bladder TCC cells and 20 samples of bladder TCC patients (T(1) 7 samples, T(2) 5 samples, T(3) 6 samples, T(4) 2 samples, G(1) 1 samples, G(2) 11 samples, G(3) 8 samples). MAGE-A4 protein was detected by immunohistochemistry in 105 samples of bladder TCC patients (T(1) 35 samples, T(2) 12 samples, T(3) 26 samples, T(4) 13 samples, G(1) 13 samples, G(2) 44 samples, G(3) 48 samples).</p><p><b>RESULTS</b>Three clusters bladder TCC cells had MAGE gene mRNA expression. In detection of MAGE mRNA of 20 samples of bladder TCC patients, 12 samples (60%) expressed MAGE-A1, 16 samples (80%) expressed MAGE-A2, 11 samples (55%) expressed MAGE-A3, 18 samples (90%) expressed MAGE-A4, 8 samples (40%) expressed all of MAGE-A1--A4. In 105 bladder TCC samples, 53 samples (50%) expressed MAGE-A4 protein. Strong expression (++ or +++) was significant higher in higher grade (13 samples/48 samples) or stage (14 samples/51 samples) than in lower grade (2 samples/57 samples) or stage (0 samples/35 samples).</p><p><b>CONCLUSION</b>MAGE gene highly expresses in bladder TCC. Bladder TCC of high grade or high stage has higher MAGE-A4 protein strong expression.</p>

In vitro and in vivo functional evaluation of anti-human bladder tumor human-mouse chimeric antibody ch-BDI / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the in vitro and in vivo function of anti-human bladder tumor human-mouse chimeric antibody ch-BDI and its future clinical application.</p><p><b>METHODS</b>With ch-BDI in high-expression cell-line medium, affinity chromatography was used for the purification. Labeled with (99m)Tc through reduction method, its immunoreactive fraction and association constant were measured. The constant was injected into nude mice with xenografted human bladder tumor. The biodistribution of the labeled ch-BDI was studied with radioimmunoimaging.</p><p><b>RESULTS</b>ch-BDI showed desirable immunoreactive fraction (76%) and association constant (3.56 x 10(9) M(-1)) in vitro and a terrific specific targeting effect in vivo.</p><p><b>CONCLUSION</b>ch-BDI has fairly good function against human bladder tumor both in vitro and in vivo, and is promising in clinical use.</p>