Optimal Lymph Node Staging System in Evaluating Prognosis of Gallbladder Carcinoma: A Multi-institutional Study.

BACKGROUND: Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR). METHODS: Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model. RESULTS: A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively. CONCLUSIONS: NMLN was the optimal LN staging system in evaluating prognosis of GBC.

Fabricating Composite Cell Sheets for Wound Healing: Cell Sheets Based on the Communication Between BMSCs and HFSCs Facilitate Full-Thickness Cutaneous Wound Healing

BACKGROUND@#Insufficient angiogenesis and the lack of skin appendages are critical challenges in cutaneous wound healing. Stem cell-fabricated cell sheets have become a promising strategy, but cell sheets constructed by a single cell type are inadequate to provide a comprehensive proregenerative microenvironment for wound tissue. @*METHODS@#Based on the communication between cells, in this study, bone marrow mesenchymal stem cells (BMSCs) and hair follicle stem cells (HFSCs) were cocultured to fabricate a composite cell sheet (H/M–CS) for the treatment of fullthickness skin wounds in mice. @*RESULTS@#Experiments confirmed that there is cell–cell communication between BMSCs and HFSCs, which enhances the cell proliferation and migration abilities of both cell types. Cell–cell talk also upregulates the gene expression of proangiogenic-related cytokines in BMSCs and pro-hair follicle-related cytokines in HFSCs, as well as causing changes in the properties of secreted extracellular matrix components. @*CONCLUSIONS@#Therefore, the composite cell sheet is more conducive for cutaneous wound healing and promoting the regeneration of blood vessels and hair follicles.

Expressions of TP53, P16 and K-ras in gallbladder high-grade intraepithelial neoplasia and early carcinoma and establishment of a random forest prediction model / 西安交通大学学报(医学版)

【Objective】 To explore the different expressions of TP53, P16 and K-ras in gallbladder high-grade intraepithelial neoplasia and early carcinoma, and establish their mutation random forest prediction model. 【Methods】 We retrospectively analyzed the clinicopathological data of 71 patients who underwent cholecystectomy at The First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to December 2018, including 20 cases of chronic cholecystitis, 28 cases of gallbladder high-grade intraepithelial neoplasia, and 23 cases of early gallbladder carcinoma. The immunohistochemical SP method was conducted to detect the expressions of TP53, P16 and K-ras in the gallbladder pathological tissues; the correlation between the above genes and clinicopathological data was analyzed. A random forest prediction model of each gene mutation was established based on the clinicopathological data and gene expression. 【Results】 The positive expressions of TP53, P16 and K-ras were related to the gallbladder with cholecystolithiasis or polyps and gallbladder pathological tissue type. The positive rates of the three genes in the gallbladder polyps were significantly higher than those in the cholecystolithiasis group (P<0.05). The positive rates of the three genes in the latter two groups of gallbladder high-grade intraepithelial neoplasia and early gallbladder carcinoma were significantly higher than those in the chronic cholecystitis (P<0.05), while there was no statistical difference between the latter two groups (P>0.05). The mutations of TP53, P16 and K-ras had a certain correlation (χ2=6.285, 19.595, 4.070, r=0.298, 0.525, 0.239, P<0.05). TP53, P16 and K-ras mutation prediction models based on random forest had good accuracy (AUC=77.42%, 80.06%, 71.75%, accuracy=76.06%, 76.06%, 67.61%). 【Conclusion】 TP53, P16 and K-ras gene mutations promote the transformation of chronic cholecystitis to gallbladder carcinoma. The mutation prediction model based on random forest has a good accuracy, which can provide an important reference for carcinogenesis and early diagnosis of gallbladder carcinoma.

Preliminary study on deoxyribonucleic acid methylation of breast cancer anti-resistance 1, phospho-diesterase 1C, opioid receptor delta 1 and neurexin 1 in gout and hyperuricemia / 中华风湿病学杂志

Objective:To provide a preliminary theoretical basis for gout and hyperuricemia of Deoxyribonucleic acid (DNA) methylation.Methods:Breast cancer anti-resistance 1(BCAR1), phospho-diesterase 1C (PDE1C), opioid receptor delta 1(OPRD1) and neurexin 1(NRXN1) methylation levels were measured by bisulfite pyrosequencing in 50 gout patients, 30 hyperuricemia patients and 50 matched healthy controls. Comparisons between groups were evaluated by F-test and Nonparametric tests. Results:Receiver operating characteristic showed that the methylation of PDE1C(pos4, pos5, pos6)(AUC: 0.712, 0.772, 0.775; all P values<0.05) had higher accuracy for diagnosis of gout, and OPRD1 pos4 (AUC=0.733, P<0.05) had higher accuracy for hyperuricemia. Conclusion:DNA methylation may play a role in the development of gout and hyperuricemia, however, further studies are needed.

Progress in treatment of henoch-schonlein purpura in children / 中国基层医药

Henoch-schonlein purpura is a common immune-mediated systemic vasculitis in childhood,and its clinical manifestations are mainly skin purpura,arthritis,gastrointestinal symptoms and acute glomerulonephritis.Clinically,purpura nephritis caused by henoch-schonlein purpura has seriously jeopardized children's life and health.At present,there is still no uniform treatment standard for the treatment of this disease.This article reviews the progress of the treatment of anaphylactoid purpura in children from two aspects of western medicine and traditional Chinese medicine.

Combined application of prenatal ultrasound and magnetic resonance imaging in diagnosis of fetal bladder exstrophy / 中华医学超声杂志（电子版）

Objective To summarized the ultrasound and MRI characteristics of fetuses with bladder exstrophy. Methods Four cases of bladder exstrophy (3 cases of single birth were conceived naturally, 1 twins were artificial pregnated) were diagnosed by ultrasound combined MRI which were confirmed by autopsy in Hubei Maternal and Child Heath Hospital, from February 2013 to December 2017, We summarized the ultrasonographic features of the four cases. Results The common abnormal ultrasound images of the 4 cases: the bladder in the pelvic cavity was not shown, the umbilical cordinsertion was low, the symphysis pubis was separated, the gender was difficult to be determined, and the amniotic water was normal. In one case, one of the twins combined with the absence of the right kidney and abdominal wall mass below the umbilical cord insertion, and 1 case was suspected to tethered cord syndrome. Four cases of fetal antenatal MRI showed the same abnormal imaging findings as ultrasonography, but none of the 4 cases of pubic symphysis separation were showed, excluding the ultrasonographic diagnosis of tethered cord syndrome. In comparison with the X-ray and pathological examination results after the labor induction, the prenatal MRI was supplemented with 4 cases of abdominal wall defects, and 3 cases more than ultrasound. Ultrasonography and MRI combined examination were performed to correctly diagnose 4 cases of fetal bladder exstrophy. No bladder showed in pelvic nor the abdominal cavity, the abdominal wall defect with bulging content, the umbilical cord insertion was low, pubic symphysis separation, genital malformation, normal kidney andamniotic fluid were the main clues for ultrasound and MRI diagnosis of bladder exstrophy. Conclusion The combination of US and MRI can further improve the diagnostic accuracy and avoid missed diagnosis of fetal BE.

Prenatal diagnosis of ultrasound and MRI in the vein of Galen aneurysmal malformation / 中华医学超声杂志（电子版）

Objective To explore the clinical value of prenatal ultrasound and magnetic resonance imaging in the vein of Galen aneurysmal malformation. Methods The ultrasonographic characteristics and magnetic resonance imaging features of 17 fetuses who were diagnosed as the vein of Galen aneurysmal malformation in Maternal and Child Heath Hospital of Hubei from January 2011 to December 2016 were compared. Results Fifteen cases of Galen aneurysmal malformation. Were diagnosed by prenatal ultrasound during the third trimester. The sonographic feature was a hypoechogenic structure located in the middle line with arteriovenous fistula waveform in doppler analysis, and the cerebral venous sinus of all cases were dilated. Real time three dimensional power doppler can display the angioarchitecture and the communications between widened vascular sinus. MRI feature was the expansion of venous aneurysm located in the middle line, greater cerebral venous pool and quadrigeminal area and tortuous flow void vessels. Among 17 cases, 2 cases of Galen venous aneurysm malformation were misdiagnosed and 7 cases were diagnosed by MRI. There were 15 terminations and 2 neonatal died after birth. Conclusions Galen aneurysmal malformations have typical sonographic findings, and MRI can show neurologic development and impairment. Combined application of ultrasound and magnetic resonance imaging technology can more accurately and comprehensively observe the pathological features of Galen venous aneurysm malformation and diagnose the related complications early.

Evaluation of intraventricular dyssynchrony in patients with coronary artery disease by two dimensional strain imaging / 中华超声影像学杂志

Objective To evaluate the dyssynchrony of left ventricle in patients with coronary artery disease(CAD) by two-dimensional strain echocardiography (2-DS). Methods The myocardium of left ventricle of 33 patients with CAD and 30 nomal controls were detected by 2-DS. The time from onset QRS complexes to peak systolic longitudinal strain(Ts) and the standard deviation of Ts of 18 left ventricular segments (Ts-SD)were measured. Results There were 168 segments whose flow was provided by coronary artery with stenosis≤75% ,210 segments whose flow was provided by coronary artery with stenosis 75 %. ①Ts was delayed significantly and Ts-SD was obviously higher in patients with stenosis≥75% when compared with the control group. ②Ts was delayed and Ts-SD was higher in patients with stenosis≥75% compared with those whose stenosis was ≤75%. ③There were no statistical differences in Ts and Ts-SD between the patients with stenosis ≤75% and the control group. ④When left ventricular systolic dyssynchrony was defined as Ts-SD≥33.0 ms, there were 22 patients with systolic dyssynchrony of all 26 patients whose coronary artery stenosis≥75%, there were no patient with systolic dyssynchrony of all 7 patients whose stenosis ≤75%. Conclusions Although there are no evident regional wall motion abnormalities by routine echocardiography,in patients with severe coronary artery stenosis,2-DS can detect exactly the dyssynchrony of left ventricle.

Evaluation of left ventricnlar systolic function in children at acute stage of Kawasaki disease using speckie-iracing imaging / 中华超声影像学杂志

Objective To access the left ventricular sysytolic function in children at acute stage of Kawasaki disease using speckle-tracing imaging. Methods Two-dimensional echocardiograghic images of 27 patients and 19 normals were collected in apical long-axis view, two-champer view, four-champer view, short-axis views at the levels of mitral annulus, papillary muscle and apex. The systolic peak values of longitudinal strain, radial strain and circumferential strain were measured by speckle-tracking imaging. Results Compared with controls the values of longitudinal strain and radial strain are lower in most segments in patients(P < 0.05). There were no significant differences between the patients and controls in circumferential strain(P>0.05). Longitudinal strain and radial strain measured were lower in 8 patients with coronary ectasia(including 7 cass with coronary artery aneurysms in vessels) than other 19 patients,but the two groups have no significant differences(P>0.05). Conclusions Long-axis and short-axis function of the heart decreased regardless of coronary artery ectasia.

Assessment of carotid atherosclerotic plaques using ultrasonographic elastography / 中华超声影像学杂志

Objective To evaluate the features of carotid atherosclerotic plaques on ultrasonographic elastography. Methods A total of 45 atherosclerotie plaques of the carotid artery in 33 patients were found with routine ultrasonography, all the 45 atherosclerotic plaques were divided into soft plaque, fibrous plaque, mixed plaque and calcified plaque. The elastograms of the plaques were oberseved and the strain contrast(stiffness ratio) of blood tissue in common carotid artery to plaques were calculated. Results Seventeen soft plaques, 15 mixed plaques and 13 calcified plaques were founded using routine ultrasonography, but 0 fibrous plaques were founded. The soft plaques were shown in green, the mixed plaques were showen as mosaic of green and blue and the calcified plaques were showen in blue by ultrasonographic elastography. The strain contrast in patients with calcified plaques and mixed plaques were significantly higher when compared with the soft plaques group(P 0. 001, P <0.05). The strain contrast in patients with calcified plaques was significantly higher than the mixed plaques group (P < 0.001). Conclusions Ultrasonographie elastography could be used in carotid arteries atherosclerotic plaques. Various of acoustic characteristics plaques has different elastography and strain contrast.

Evaluation of atrial septal defect using real-time three-dimensional echocardiography: comparison with surgical findings / 华中科技大学学报（医学）（英德文版）

The present study evaluated the application of three dimensional echocardigraphy (3DE) in the diagnosis of atrial septal defect (ASD) and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography (RT3DE) was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery (r=0.77, P<0.001). The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.

Evaluation of aortic valve function in patients with bicuspid aortic valve with echocardiography / 中华超声影像学杂志

Objective To evaluate the application of echocardiography in the diagnosis of bicuspid aortic valve and its pathophysiologic development and to demonstrate the degree of aortic valve dysfunction. Methods The echocardiographic characteristics and clinical data were analyzed retrospectively in 135 patients with bicuspid aortic valve to demonstrate the variation of aortic valve dysfunction in the progression of the course of the disease. Results Isolated aortic regurgitation was present in 68 (50%) patients, 19 (14%)patients had isolated aortic stenosis and 29 (22%)patients had combined aortic stenosis and regurgitation, 19 (14%) patients had neither stenosis nor regurgitation. Aortic regurgitation were all more commen within each age group, aortic regurgitation were also more commen within each age group in patients in their advanced course who went to surgical treatment. Conclusions Echocardiography is an effective method in the early diagnosis of aortic valve dysfunction.

Evaluation of myocardial viability after myocardial infarction with intravenous real-time myocardial contrast echocardiography / 华中科技大学学报（医学）（英德文版）

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions: homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.

Evaluation of left ventricular dyssynchrony of idiopathic dilated cardiomyopathy: two-dimensional speckle-tracking strain versus tissue velocity imaging / 中华超声影像学杂志

Objective To evaluate the dyssynchrony of left ventricle in patients with dilated cardiomyopathy by two-dimensional speckle-tracking strain (2DS) and tissue velocity imaging (TVI).Methods Study population consisted of 37 dilated cardiomyopathy patients. High frame rate two-dimensional images were recorded from the left ventricular short-axis views at the levels of mitral annulus,papillary muscles and apex, and the apical four-chamber view, two-chamber view and long-axis of the left ventricle. The time to peak myocardial longitudinal systolic velocity was measured by TVI, 2DS was acquired to measure the time to peak radial strain in the short axis and the time to peak longitudinal strain inthe long axis,left ventricular synchronization index (△T) was defined as the difference of the time to peak value between anterior septum and posterior wall. Results △T measured by 2DS on the long axis and the short axis increased significantly compared with TVI(P<0.01) in the basal segment; 2DS on the short axis had a more significantly increased △T than TVI(P<0.01) in the middle segment. △T measured by 2DS on the short axis significantly increased in the basal and middle segment compared with 2DS on the long axis(P<0.05). Dyssynchrony eases and the detection rate of dyssynchrony measured by 2DS on the long axis were significantly higher than 2DS on the short axis and TVI(P<0.01). Dyssynchrony cases and the detection rate measured by 2DS on the short axis were higher than those measured by TVI, but the difference had no statistical significance. Conclusions The dyssynchrony detection rate measured by longitudinal strain of 2DS is significantly higher than TVI and radial strain.

Two-dimensional strain in patients with coronary artery disease measured by speckle tracking echocardiography / 中华超声影像学杂志

Objective To assess the myocardial strain in patients with coronary artery disease by two dimensional strain echocardiography.Methods Forty-three patients with coronary artery disease and thirty five healthy subjects were included.High frame rate two-dimensional images were recorded from the left ventricular short-axis views at the levels of mitral annulus,papillary muscle and apex,and the apical four chamber view,two-chamber view and long-axis view of the left ventricle respectively.The longitudinal strain was measured in the apical views,radial strain and circumferential strain were measured in the left ventricular short-axis views using two-dimensional strain software.Results There were 96 segments whose flow was provided by coronary artery with stenosis＜75%,147 segments whose flow was provided by coronary artery with stenosis≥75%.The peak systolic longitudinal strain of different segments in patients with stenosis≥75% significantly reduced when compared with the control group(P＜0.05).The peak systolic radial strain and circumferential strain of different segments in patients with stenosis≥75% had no statistical difference compared with the control group(P＞0.05).When taking peak systolic longitudinal strain≥-16.1% as cut-off value for coronary artery stenosis of≥75%,the sensitivity and specificity were 78.7% and 76.4% respectively.There was no significant difference in systolic longitudinal strain,radial strain and circumferential strain between normal myocardium and stenosis＜75%(P＞0.05).Conclusions Although there are no evident regional wall motion abnormalities by two dimensional echocardiography,in patients with severe coronary artery stenosis,the longitudinal strain which can reflect the subendocardial myocardial function significantly reduced.