Radiomics-based model for accurately distinguishing between severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) and influenza A infected pneumonia.

Clinicians have been faced with the challenge of differentiating between severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) infected pneumonia (NCP) and influenza A infected pneumonia (IAP), a seasonal disease that coincided with the outbreak. We aim to develop a machine-learning algorithm based on radiomics to distinguish NCP from IAP by texture analysis based on computed tomography (CT) imaging. Forty-one NCP and 37 IAP patients admitted from January to February 6, 2019 admitted to two hospitals in Wenzhou, China. All patients had undergone chest CT examination and blood routine tests prior to receiving medical treatment. NCP was diagnosed by real-time RT-PCR assays. Eight of 56 radiomic features extracted by LIFEx were selected by least absolute shrinkage and selection operator regression to develop a radiomics score and subsequently constructed into a nomogram to predict NCP with area under the operating characteristics curve of 0.87 (95% confidence interval: 0.77-0.93). The nomogram also showed excellent calibration with Hosmer-Lemeshow test yielding a nonsignificant statistic (P = .904). The novel nomogram may efficiently distinguish between NCP and IAP patients. The nomogram may be incorporated to existing diagnostic algorithm to effectively stratify suspected patients for SARS-CoV-2 pneumonia.

Diagnosis and surgical treatment of retroperitoneal paraganglioma: A single-institution experience of 34 cases.

The present study aimed at identifying the clinical, radiological and pathological characteristics of retroperitoneal paragangliomas, and determining the association between the tumor features and the prognosis of patients following surgery. A total of 34 patients with retroperitoneal paragangliomas, who underwent resection between November 1999 and December 2015, were included in the present retrospective study. The patients' demographics, clinical symptoms and signs, tumor functional status, surgical procedure, intraoperative results, tumor pathology, radiological results, and postoperative survival time were recorded and analyzed. Of the 34 patients, the most common type of presenting symptom was abdominal mass (46%), followed by hypertension (39%) and abdominal pain (32%). Functional tumors occurred in 20 patients (59%). Computed tomography (CT) and magnetic resonance imaging revealed soft-tissue masses, with marked enhancement in the arterial phase, indicative of retroperitoneal paragangliomas. The preoperative CT diagnostic accuracy rate between 2010 and 2015 was markedly improved, compared with that between 1999 and 2009. The tumors were primarily located close to the renal arteries and veins surrounding the abdominal aorta and inferior vena cava. With the exception of one malignant paraganglioma, the majority of paragangliomas were positive for chromogranin A, S-100 protein, vimentin and heat-shock protein 90, and exhibited decreased expression of Ki-67 antigen and insulin-like growth factor 2. All tumors were completely removed by surgery. Distant metastasis, but not tumor size, functional status and local invasion, was markedly associated with survival. The preoperative diagnostic accuracy rate of retroperitoneal paragangliomas may be improved by focusing on the predilection sites and CT characteristics. In addition, immunohistochemical markers were useful to determine tumor malignancy. Complete surgical resection was appropriate for all patients and postoperative survival time was identified to be associated with tumor metastasis.

GSK-3ß suppresses the proliferation of rat hepatic oval cells through modulating Wnt/ß-catenin signaling pathway.

AIM: Glycogen synthase kinase 3ß (GSK-3ß) plays a crucial role in hepatic biology, including liver development, regeneration, proliferation and carcinogenesis. In this study we investigated the role of GSK-3ß in regulation of growth of hepatic oval cells in vitro and in liver regeneration in partially hepatectomized rats. METHODS: WB-F344 cells, the rat hepatic stem-like epithelial cells, were used as representative of oval cells. Cell viability was examined using a WST-8 assay. The cells were transfected with a recombinant lentivirus expressing siRNA against GSK-3ß (GSK-3ßRNAiLV) or a lentivirus that overexpressed GSK-3ß (GC-GSK-3ßLV). Adult rats underwent partial (70%) hepatectomy, and liver weight and femur length were measured at d 7 after the surgery. The expression of GSK-3ß, phospho-Ser9-GSK-3ß, ß-catenin and cyclin D1 was examined with immunoblotting assays or immunohistochemistry. RESULTS: Treatment of WB-F344 cells with the GSK-3ß inhibitor SB216763 (5 and 10 µmol/L) dose-dependently increased the levels of phospho-Ser9-GSK-3ß, but not the levels of total GSK-3ß, and promoted the cell proliferation. Knockout of GSK-3ß with GSK-3ßRNAiLV increased the cell proliferation, whereas overexpression of GSK-3ß with GC-GSK-3ßLV decreased the proliferation. Both SB216763 and GSK-3ßRNAiLV significantly increased the levels of ß-catenin and cyclin D1 in the cells, whereas GSK-3ß overexpression decreased their levels. In rats with a partial hepatectomy, administration of SB216763 (2 mg/kg, ip) significantly increased the number of oval cells, the levels of phospho-Ser9-GSK-3ß, ß-catenin and cyclin D1 in liver, as well as the ratio of liver weight to femur length at d 7 after the surgery. CONCLUSION: GSK-3ß suppresses the proliferation of hepatic oval cells by modulating the Wnt/ß-catenin signaling pathway.

[Surgical treatment and prognostic analysis of retroperitoneal paragangliomas: a study of 19 cases].

OBJECTIVE: To investigate the clinical characteristics, surgical treatment and prognostic analysis of retroperitoneal paragangliomas and to enhance the diagnostic and therapeutic levels of retroperitoneal paragangliomas. METHODS: The clinical data of all patients undergoing paraganglioma resection at our department from November 1999 to March 2009 were retrospectively analyzed. The parameters included clinical manifestations, tumor function, surgical findings, operative approach, tumor pathology, imaging study and post-operative survival time. RESULTS: (1) The ratio of male to female was 1.375:1 and the median age 50 years old. The most common presenting symptom was abdominal mass (9/19, 47%). And the preoperative CT misdiagnosis rate was high (89%). (2) The most common tumor location was periaortic and percival (9/19, 47%). The average maximal diameter of tumors was 8.6 cm. 58% (11/19) tumors had integral peplow, 42% (8/19) adhered to adjacent organs and 26% (5/19) required adjacent organ resection. (3) The rate of functional tumor was 63% (12/19). Preoperative and intra-operative hypertension occurred in 67% (8/12) and 33% (4/12) respectively. (4) Immunohistochemical staining was performed in 18 tumors of 16 patients. Among all tumors, 89% (16/18) showed positive immunoreactivity for chromogranin and 67% (12/18) for S-100. PCNA staining showed different proliferative activities (0%-48% positive). Only malignant tumors showed positive immunoreactivity for Ki-67 staining and P53 staining (20% & 34% respectively). (5) The overall 5-year survival was 77%. Survival was significantly worse after metastasis (χ2=6.604, P=0.01). But it was not dependent on tumor diameter (χ2=3.208, P=0.201), the secreting function of tumor (χ2=0.121, P=0.728) and the status of tumor margins (χ2=0.036, P=0.849). CONCLUSION: It is difficult to make an early diagnosis of retroperitoneal paragangliomas. Survival is significantly worse after metastasis. Lifelong follow-up for recurrence is important. And it is absolutely essential to perform immunohistochemical staining for tumors.

The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND: To investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. METHOD: Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS: All 32 patients underwent laparotomy including 18 (56.3%) pancreaticoduodenectomy (PD), six (18.7%) segmental resection (SR), and eight bypass procedures. And R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 78.1% (25/32), 43.8% (14/32), and 18.8% (6/32), respectively; moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (20/20), 70.0% (14/20), and 30.0% (6/20), which were significantly higher than those (41.7% = /12, 0%, and 0%) in patients with palliative operation (P < 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION: PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients especially for tumors of the distal duodenum.

The impact of expressions of CD97 and its ligand CD55 at the invasion front on prognosis of rectal adenocarcinoma.

BACKGROUND: Various evidence show that CD97 plays an important role in tumor differentiation, migration, invasiveness, and metastasis by binding its cellular ligand CD55. CD55 is a complement regulatory protein expressed by cells to protect them from bystander attack by complement, and it has been shown to be an indicator of poor prognostic in several cancers. METHODS: CD97 and CD55 stains were detected in tumor tissues from 71 cases of rectal adenocarcinomas and their corresponding normal colorectal tissues by immunohistochemistry. RESULTS: The expressions of CD97 and CD55 in rectal tumor tissues were significantly higher than those in normal colorectal tissues (P < 0.05, both). The patients with recurrence and/or metastasis had significantly higher expressions of CD97 at tumor cells and CD55 at stroma (67.8% [21/31] and 63.6% [21/33]) at the invasion front than those patients without recurrence and/or metastasis (25.0% [10/40] and 26.3% [10/38]). The expression of CD97 at tumor cell at the invasion front showed modest correlation with that of CD55 in the stroma at the invasion front(r = 0.392, P < 0.01). Univariate analysis revealed that lymph node metastasis (P = 0.001), stages II-IV (P = 0.026), and strong CD97 expression at tumor invasion front (P = 0.002) were shown to have a significant adverse impact on the postoperative survival rate. Moreover, lymph node metastasis (P = 0.037) and strong CD97 expression (P = 0.015) were associated with poor survival in a multivariate analysis. CONCLUSIONS: Elevated expression of CD97 and its ligand CD55 at the invasion front correlate with tumor recurrence and metastasis, and CD95 may be a poor prognostic factor for rectal adenocarcinoma.

Analysis of super-low anterior resection for rectal cancer from a single center.

PURPOSE: The purpose of this study was to evaluate the outcome and genitourinary complications of super-low anterior resection (SLAR) followed by adjuvant radiochemotherapy in the management of patients with low rectal cancer. METHOD: One hundred and six low rectal cancer patients managed with SLAR were analyzed retrospectively. RESULTS: There were seven patients who failed to follow up, and the 5-year survival rate was 65.7% (65/99). There were 35 patients (35.4%) who developed distant metastases, and 12 (12.1%) had local recurrence. The local recurrence rates were 21.1% (4/19), 7.1% (2/28), 5.9% (1/17), and 0% (0/2) in the patients with tumor distance of less than or equal to 2 cm, ranging from 2.1 to 3.0, from 3.1 to 4.0, from 4.1 to 5.0, and more than 5 cm, respectively. This implied local recurrence rate increased against the distance between the lower margin of tumor and resection line. Ninety-eight of 106 rectal patients had complete data of questionnaire: 58 scored 1, 32 scored 2, 7 scored 3, and 1 score 4. This revealed that the fecal function of most patients (91.8%, 90/98) was normal or nearly normal. Twenty-four of 37 males suffered from sexual dysfunction, and among them, eight were impotent (all older than 70 years), and 29 had retrograde ejaculation. Meanwhile, seven of 35 females suffered from sexual problem, 1 had dyspareunia, seven had decreased lubrication, and one had inability to achieve orgasm. CONCLUSIONS: SLAR followed by adjuvant radiochemotherapy can effectively control local-regional disease and can be one choice of avoiding the functional morbidity of abdominoperineal resection.

Radical resection and outcome for malignant tumors of the pancreatic body and tail.

AIM: To analyze the factors influencing radical (R0) resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS: The clinical and operative data and follow-up results of 214 pancreatic body and tail cancer patients were analyzed retrospectively. RESULTS: One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% (71/120), and the R0 resection rate was 40.8% (49/120). Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor (P<0.01), cystadenocarcinoma (P<0.01), less lymph node metastasis (P<0.01), less peri-pancreatic organ involvement (P<0.01) and earlier stage disease (P<0.01). The overall 1-, 3- and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% (25/197), 7.6% (15/197) and 2.5% (5/197), respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% (9/60), 6.7% (4/60) and 1.7% (1/60), respectively] than cystadenocarcinoma patients [53.8% (21/39), 28.2% (11/39) and 10.3% (4/39)] (P<0.01). Moreover, the 1-, 3- and 5-year overall survival rates in patients with R0 resection were 55.3% (26/47), 31.9% (15/47) and 10.6% (5/47), respectively, significantly better than those in patients with palliative resection [9.5% (2/21), 0 and 0] and in patients with bypass or laparotomy [1.2% (1/81), 0 and 0] (P<0.01). CONCLUSION: Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.

The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND: The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. METHOD: Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS: All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), which were significantly higher than those (50.0% = 5/10, 0%, and 0%) in patients with palliative operation (P > 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION: PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.

FOXP1 expression predicts polymorphic histology and poor prognosis in gastric mucosa-associated lymphoid tissue lymphomas.

UNLABELLED: RATIONALE/HYPOTHESIS: Forkhead box protein P1 (FOXP1) is one member of the forkhead box protein P (FOXP) subfamily, which are transcription factors that mediate signaling and affect gene regulation, and elevated expression of FOXP1 has been reported to correlate with poor prognosis of diffuse large B-cell lymphoma (DLBCL). Recently, it was also found that FOXP1 expression occurs in mucosa-associated lymphoid tissue (MALT) lymphomas. OBJECTIVE: FOXP1 expression and its relationship to morphology and prognosis in a series of 43 gastric MALT lymphomas were investigated retrospectively. FINDINGS: The FOXP1 nuclear expression (44.2%, 19/43) of tumors between mono- and polymorphic histology (4 of 26 [15.4%] vs. 15 of 17 [88.2%]) was significantly different (p < 0.001). All 14 relapsed tumors after operation featured strong nuclear FOXP1 positivity. A significantly shorter cumulative 10-year survival (52.6%,10/19) was found in high FOXP1 expression patients, compared with patients with negative expression (83.3%, 20/24) (p < 0.01). Also, the cumulative 10-year survival rate (30.8%, 4/13) for stage IIE+IV was significantly shorter than that (83.3%, 25/30) in stage I+II (p < 0.01). Moreover, high FOXP1 expression and advanced stage IIE+IV were independent prognostic factors in multivariate Cox regression analysis. CONCLUSIONS: Our results show that FOXP1 expression is correlated with morphic histology, and FOXP1 and clinical staging appear to be independent prognostic factors in gastric MALT lymphomas.

Diagnosis and surgical treatment of intrahepatic hepatolithiasis associated cholangiocarcinoma.

Liver malignancy is known to be associated with hepatolithiasis. The present report summarises the results and our experience for management of 23 patients with intrahepatic hepatolithiasis associated cholangiocarcinoma (IHHCC). The correct diagnosis rates of US (ultrasonography), CT (computed tomography), and MRCP (magnetic resonance cholangiopancreatography) were 82.6% (19/23), 95.7% (22/23), and 91.7% (11/12), respectively. Carbohydrate antigen 19-9 (CA 19-9) was helpful in the diagnosis of IHHCC. All 23 patients with IHHCC underwent laparotomy. The surgical procedure consisted hepatectomy with a bile duct exploration in 16 patients (69.6%), a hepatectomy and drainage procedure such as sphincteroplasty and choledo-jejunostomy in three patients (13.0%), a bile duct exploration with biopsy in two patients (8.7%), and simple laparotomy and biopsy in two patients (8.7%). All the IHHCC patients who underwent a palliative procedure or laparotomy died within 1 year, and the overall cumulative survival rates at 1, 3, and 5 years were 43.8% (10/23), 13.0% (3/23), and 4.3% (1/23), respectively, and those patients who underwent curative resection were 88.9% (8/9), 33.3% (3/9), and 11.1% (1/9), respectively, which significantly longer than those (20.0%, 2/10; 0.0%, 0/10; and 0.0%, 0/10) patients who underwent palliative resection, respectively (p < 0.05). A suspicion of malignancy is necessary when managing patients with long-term hepatolithiasis. Hepatic resection with postoperative treatment is the treatment of choice for cholangiocarcinoma when it is resectable.

Hepatoblastoma in adult: review of the literature.

UNLABELLED: This study is to review and retrieve data on adult hepatoblastoma (HB) from English literatures in order to gain a better understanding of this disease. We performed Medline, PubMed (from January 1966 to February 2008), and library searches (National Science and Technology Library, Beijing, China, and Wenzhou Medical College Library, from January 1980 to February 2008) using the key words hepatoblastoma in adult, hepatic tumor, hepatoblastoma and adult. Previously reported HB cases were collected and published reviews were also examined. Fifteen cases that met the search criteria were selected. Review of the cases revealed a slight female preponderance. The patients' age ranged from 17 to 82, with median age of 70 for male and 27 for female. The survival time ranged from two weeks to 38 months, and the median survival time was 6 months. In the articles reviewed, HB presented with non-specific initial symptoms, and the diagnosis was not identified until the tumor biopsy after operation or autopsy. Completely surgical resection is still the major treatment for patients with HB and is considered as the only chance of a better prognosis. Due to the rareness of HB in adults, the choice of treatment should be radical resection if possible, and combined with chemotherapy as adopted in children. HB in the adult is extremely rare and the pre-operative diagnosis is often overlooked. The prognosis is so poor that the awareness of the condition in the differential diagnosis in liver tumors could be beneficial. KEY WORDS: Hepatoblastoma; Adult; Diagnosis; Therapy.

The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND: Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by non-specific symptoms and late diagnosis, and treatments of PDAC have some controversies. METHOD: To investigate the early diagnosis and outcomes of surgical treatment of PDAC, 32 patients who were treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS: All 32 patients underwent laparotomy, including 18 patients (56.3%) with pancreaticoduodenectomy (PD), six patients (18.7%) with segmental resection (SR), and eight patients with bypass procedures. And, R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25 of 29), 48.3% (14 of 29), and 20.7% (six of 29), respectively. Moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19 of 19), 73.7% (14 of 19), and 31.6% (six of 19), which were significantly higher than those (50.0% = 5/10, 0% and 0%) in patients with palliative operation (P < 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (five of 18) in pancreaticoduodenectomy patients and 16.7% (one of six) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION: PD is suggested for the tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.