Dysregulation of MiR-199a/IL8 pathway in chronic Cr (VI)-induced tumor growth and angiogenesis.

Hexavalent chromium [Cr(VI)] is a well-known environmental carcinogen. Recent studies revealed that chronic exposure of human bronchial epithelial cells (BEAS-2B, B2B) to Cr(VI) activated several signaling pathways and induced cell malignant transformation and tumor growth. However, new mechanisms of Cr(VI) in inducing carcinogenesis remains to be elucidated. This study showed that miR-199a expression levels were significantly lower in Cr(VI)-transformed Cr-T cells. By using the mouse model, the expression levels of miR-199a were significantly decreased in blood samples and lung tissues of mice intranasally exposed to Cr(VI) for 12 weeks compared to the solvent exposure control. Overexpression of miR-199a inhibited tube formation and angiogenesis. C-X-C motif chemokine ligand 8 (CXCL8, IL8) levels were significantly higher in blood samples of Cr (VI)-exposed workers compared to normal workers, and forced expression of miR-199a in the cells suppressed IL8 levels. miR-199a suppression induced expression of hypoxia-inducible factor 1α (HIF-1α) and nuclear factor kappa B (NF-κB) p65 to increase IL8 expression. With animal experiment, the results showed that miR-199a overexpression inhibited tumor growth and angiogenesis through inhibiting IL8, HIF-1α and NF-κB p65 expression in vivo. These results show that miR-199a/IL8 pathway is important in Cr(VI)-induced carcinogenesis and angiogenesis.

Mapping of Lymph Node Metastasis From Thoracic Esophageal Cancer: A Retrospective Study.

OBJECTIVES: This retrospective study was designed to investigate the optimal extent of dissection for thoracic esophageal cancer (EC) based on the incidence of lymph node metastasis (LNM). METHODS: We retrospectively identified 1014 patients with thoracic esophageal carcinoma who underwent esophagectomy at our institution between May 2018 and November 2020. Also, the location and rate of LNM in relation to the postoperative pathological results were retrieved. We separately counted the metastasis rates of routinely excised lymph node stations according to the Japan Esophageal Society (JES) staging system. RESULTS: A total of 1666 consecutive patients were screened, and 1014 were enrolled. Generally, the rates of LNM in thoracic EC may be arranged in the descending order of station 7 > station 106recR > station 2 > station 106recL. Esophageal cancer in the middle and lower thoracic segment also had a high rate of LNM along bilateral recurrent laryngeal nerve. Stations 106tbL and 111 were the lowest frequent sites of metastasis with rate less than 5%; only the patients with clinically positive LNs need to dissect. The cT3-4, cN+, or G3 were independent risk factors for LNM and neoadjuvant therapy did not change the distribution of LNM for thoracic EC cases. CONCLUSIONS: This study accurately identified the distribution of LNM for thoracic EC patients. Neoadjuvant therapy could not change the overall distribution of LNM in thoracic EC patients. However, whether LNs dissection at stations 106tbL and 111 is related to the survival of thoracic EC or not, needs a long follow-up time to verify.

Circular RNA hsa_circ_0000277 promotes tumor progression and DDP resistance in esophageal squamous cell carcinoma.

BACKGROUND: Circular RNAs (circRNAs) are well-known regulators of cancer progression and chemoresistance in various types of cancers. This study was performed to investigate the function of hsa_circ_0000277 in esophageal squamous cell carcinoma (ESCC). METHODS: RNA levels were analyzed via the reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Cell Counting Kit-8 (CCK-8) assay was applied to determine cell proliferation and half maximal inhibitory concentration (IC50) of cisplatin (DDP). Colony formation ability was evaluated by colony formation assay. Cell cycle and apoptosis were measured using flow cytometry. RNA immunoprecipitation (RIP), pull-down assay and dual-luciferase reporter assays were performed for target interaction analysis. The protein levels were determined through western blot. Xenograft models were established for researching hsa_circ_0000277 function in vivo. RESULTS: Hsa_circ_0000277 expression was increased in ESCC cells and tissues, and it had important clinical significance. Downregulation of hsa_circ_0000277 repressed ESCC cell proliferation, colony formation, cell cycle, and DDP resistance. Hsa_circ_0000277 acted as a microRNA-873-5p (miR-873-5p) sponge and Sry-related high-mobility group box 4 (SOX4) was validated as a target of miR-873-5p. Moreover, hsa_circ_0000277/miR-873-5p axis and miR-873-5p/SOX4 axis regulated ESCC cell progression and DDP resistance. Hsa_circ_0000277/miR-873-5p axis activated SOX4/Wnt/ß-catenin signaling pathway. Hsa_circ_0000277 facilitated tumorigenesis and DDP resistance by miR-873-5p/SOX4 axis in vivo. CONCLUSION: These findings unraveled that hsa_circ_0000277 promoted ESCC progression and DDP resistance via miR-873-5p/SOX4/Wnt/ß-catenin axis, showing a specific molecular mechanism of carcinogenesis and chemoresistance in ESCC.

Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study.

OBJECTIVES: This study aimed to explore the effect of suturing upper mediastinum pleura on postoperative complications, surgery-related mortality, and hospital stay. METHODS: Four hundred and thirty-eight patients with esophageal cancer who underwent esophagectomy were identified. Patients were divided into two groups: those in the test group who received reconstruction of upper mediastinal pleura, those in the conventional group who did not. The incidence of postoperative complications, surgery-related mortality, and hospital stay were compared. To reduce the impact of confounding factors, a propensity score matching (PSM) method was performed. RESULTS: A total of 273 patients were treated with suturing upper mediastinal pleura and 165 were not. After PSM, compared with the conventional group, the incidence of atelectasis (7.2% vs. 1.4%, p = 0.035), anastomotic leakage (5.8% vs. 0.7%, p = 0.036), and delayed gastric emptying (10.8% vs. 3.6%, p = 0.034) were significantly lower in the test group. And suturing the upper mediastinal pleura could reduce the severity of leakage (p = 0.045), consistent with the results before PSM. Moreover, there were no significant differences in the incidence of other complications, postoperative hospital stay, and 30-day mortality (all p > 0.05). CONCLUSIONS: In this study, suturing the upper mediastinal pleura can reduce the incidence of atelectasis, anastomotic leakage, and delayed gastric emptying, and the severity of leakage, without increasing the incidence of other complications, surgery-related death, and postoperative hospital stay.

Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis.

BACKGROUND: This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied. METHODS: This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel-Haenszel and inverse variance models were used for the meta-analyses of end points. RESULTS: The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22-4.74), lower body mass index (WMD - 2.22; 95% CI - 2.65 to - 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72-4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28-2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38-2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD - 0.11; 95% CI - 0.19 to - 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75-3.81) and overall complications (OR 1.52; 95% CI 1.07-2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99-1.67), vocal cord palsy (OR 2.03; 95% CI 0.89-4.64), and major complications (≥ Clavien-Dindo grade III; OR 1.30; 95% CI 0.95-1.79) but not increased operation time, blood loss, or mortality. CONCLUSIONS: Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.

Neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for locally advanced oesophageal squamous cell carcinoma: a single-Centre, open-label, randomized, controlled, clinical trial (HCHTOG1903).

BACKGROUND: Neoadjuvant therapy plus oesophagectomy has been accepted as the standard treatment for patients with potentially curable locally advanced oesophageal cancer. No completed randomized controlled trial (RCT) has directly compared neoadjuvant chemotherapy and neoadjuvant chemoradiation in patients with oesophageal squamous cell carcinoma (ESCC). The aim of the current RCT is to investigate the impact of neoadjuvant chemotherapy plus surgery and neoadjuvant chemoradiotherapy plus surgery on overall survival for patients with resectable locally advanced ESCC. METHODS: This open label, single-centre, phase III RCT randomized patients (cT2-T4aN + M0 and cT3-4aN0M0) in a 1:1 fashion to receive either the CROSS regimen (paclitaxel 50 mg/m2; carboplatin (area under the curve = 2), q1w, 5 cycles; and concurrent radiotherapy, 41.4 Gy/23 F, over 5 weeks) or neoadjuvant chemotherapy (paclitaxel 175 mg/m2; and cisplatin 75 mg/m2, q21d, 2 cycles). Assuming a 12% 5-year overall survival difference in favour of the CROSS regimen, 80% power with a two-sided alpha level of 0.05 and a 5% dropout each year for an estimated 3 years enrolment, the power calculation requires 456 patients to be recruited (228 in each group). The primary endpoint is 5-year overall survival, with a minimum 5-year follow-up. The secondary endpoints include 5-year disease-free survival, toxicity, pathological complete response rate, postoperative complications, postoperative mortality and quality of life. A biobank of pre-treatment and resected tumour tissue will be built for translational research in the future. DISCUSSION: This RCT directly compares a neoadjuvant chemotherapy regimen with a standard CROSS regimen in terms of overall survival for patients with locally advanced ESCC. The results of this RCT will provide an answer for the controversy regarding the survival benefits between the two treatment strategies. TRIAL REGISTRATION: NCT04138212, date of registration: October 24, 2019.

Predictive Value of Body Mass Index for Short-Term Outcomes of Patients with Esophageal Cancer After Esophagectomy: A Meta-analysis.

BACKGROUND: The association between body mass index (BMI) and short-term outcomes after esophagectomy remains controversial. METHODS: A meticulous search for articles describing the association between BMI and perioperative outcomes after esophagectomy was conducted using PubMed, EMBASE, and the Cochrane Library. The study classified BMI according to the World Health Organization definitions and Asian-specific BMI cutoff values. Normal weight was selected as the comparator, and the odds ratio (OR) was calculated as the primary effect. RESULTS: This meta-analysis included 13 studies with 5480 patients. Obese patients exhibited higher risks of overall complication (OR 1.37; P = 0.013), anastomotic leakage (OR 1.74; P = 0.001), and thromboembolic complications (OR 2.05; P = 0.039). Subgroup analysis indicated that obese patients from Western countries had a higher risk of wound infection (OR 2.22; P = 0.022), whereas obese Asians were more likely to experience pulmonary complications (OR 1.64; P = 0.002). Overweight patients displayed no significant differences in major complications relative to normal-weight patients, except for the increased risk of overall complications (OR 1.32; P = 0.030). Additionally, underweight patients showed increased incidence of pulmonary complications (OR 1.92; P = 0.020 and anastomotic leakage (OR 1.64; P = 0.034). Morbid obesity also was analyzed separately with limited data, and this group displayed a higher risk of wound infection (OR 1.62; P = 0.027) and thromboembolic complications (OR 2.65; P = 0.003). No significant differences in mortality were observed among patients in different BMI categories. CONCLUSIONS: Obesity and underweight statuses were confirmed risk factors for several complications after esophagectomy, whereas overweight patients tended to experience greater benefit from surgery.

Comprehensive analysis of miRNA profiles reveals the role of Schistosoma japonicum miRNAs at different developmental stages.

Schistosomiasis is an important zoonotic disease affecting up to 40 kinds of animals and 250 million people. It has been reported that the miRNAs play a role in the metabolism, differentiation, development and reproduction in many organisms. However, the roles of miRNAs regulating the development, maturation and production in schistosome in both females and males remains unclear. Here we present the dynamic transcriptome analysis of all 79 known Schistosoma japonicum miRNAs from pairing to production, including 14 days post-infection (dpi), 16, 18, 20, 22, 24, 26, 28 dpi female and male, by small RNA sequencing. The miRNA expression profiles showed time-related characteristics in male and female from paring to production, which could be clustered into three patterns, characterized by pairing stage highly expressed (cluster 1), maturating stage highly expressed (cluster 2), and egg producing stage highly expressed (cluster 3). The enrichment of miRNA cluster targeted genes in female and male were distinctly different. Network analysis of miRNAs and their target regulation showed that cluster 1 had 15 miRNAs involved in the regulation of interaction, communication, immune response in female-male and parasite-host. The other 11 miRNAs were involved in gender differentiation and the meiotic cell cycle process. In cluster 2, 11 miRNAs were involved in development and sexual maturation. In cluster 3, 45 miRNAs possibly regulate metabolism and synthesis of the substance for egg production. Analysis of the miRNA regulation network would contribute to understanding the molecular mechanism in S. japonicum development and egg production.

Early Oral Feeding Following McKeown Minimally Invasive Esophagectomy: An Open-label, Randomized, Controlled, Noninferiority Trial.

OBJECTIVE: Our objective was to evaluate the impact of early oral feeding (EOF) on postoperative cardiac, respiratory, and gastrointestinal (CRG) complications after McKeown minimally invasive esophagectomy for esophageal cancer. SUMMARY BACKGROUND DATA: Nil-by-mouth with enteral tube feeding is routinely practiced after esophagectomy. METHODS: Patients were randomly allocated to receive oral feeding on the first postoperative day (EOF group) or late oral feeding (LOF group) 7 days after surgery. The primary endpoint was the occurrence of postoperative CRG complications, and the secondary outcomes included bowel function recovery and short-term quality of life (QOL). RESULTS: Between February 2014 and October 2015, 280 patients were enrolled in this study. There were 140 patients in the EOF group and 140 patients in the LOF group. EOF was noninferior to LOF for CRG complications (30.0% in the EOF group vs. 32.9% in the LOF group; 95% confidence interval of the difference: -13.8% to 8.0%). Compared with the LOF group, the EOF group showed significantly shorter time to first flatus (median of 2 days vs. 3 days, P = 0.001) and bowel movement (median of 3 vs. 4 days, P < 0.001). Two weeks after the operation, patients in the EOF group reported higher global QOL and function scores and lower symptom scores than patients in the LOF group. CONCLUSIONS: In patients after McKeown minimally invasive esophagectomy is noninferior to the standard of care with regard to postoperative CRG complications. In addition, patients in the EOF group had a quicker recovery of bowel function and improved short-term QOL.

RNA interference in vivo in Schistosoma japonicum: Establishing and optimization of RNAi mediated suppression of gene expression by long dsRNA in the intra-mammalian life stages of worms.

Schistosomes are parasitic platyhelminths that threaten over 600 million people globally. In recent years, RNA interference (RNAi) has been widely used as a molecular tool in research into the genomic function of parasites. We aim to develop effective protocols for application of RNAi technology in the intra-mammalian life stages of Schistosoma japonicum. In this work, the expression of the parasite gene encoding cathepsin B1 (SjCB1) was targeted by exposing the worms to 10 µg of long dsRNA dissolved in 0.1 ml of 0.7% NaCl injected into the tail vein of infected mice. This method was effective and specific for eliciting SjCB1 gene suppression in both male and female adult worms in vivo (>79.4% in male and >91.5% in female knockdown relative to control). In 60 cercaria infected mice, RNAi suppression of gene expression was best achieved by using 10 µg of target dsRNA for at least 4 days. The recommended procedure for interference producing long-term suppression was an injection of dsRNA on the first day of infection with booster injections administered every 4 days for up to 26 days. Long-term suppression of three published functional genes (peroxiredoxin-1, mago nashi, insulin receptor) in S. japonicum provided more information about the role of the expression of these genes in producing particular phenotypes. The protocols described here may be more convenient, economical and applicable, than currently available technology and have contributed to the observation of more phenotypes during worm development from schistosomula to adult. These approaches may promote and facilitate further studies into functional schistosome genomics.

Identification and characterization of the zinc finger protein SjZF in Schistosoma japonicum.

Schistosomiasis represents one of the most prevalent parasitic infections affecting over 249 million people worldwide. The pathological damage is mainly caused by the eggs laid by female schistosomes. Zinc finger proteins (ZFPs) usually play critical roles in many biological functions. In this study, we cloned, identified and characterized the zinc finger protein SjZF of Schistosoma japonicum. SjZF ortholog proteins were also identified in S. mansoni, S. haematobium, Opisthorchis viverrini and O. sinensis. Fluorescence localization showed that SjZF was particularly expressed in the worm gut of both genders and the vitelline glands of females. In vitro RNAi assay indicated that decreased expression of SjZF could affect the survival rate of adult worms. The immune protection assay indicated that rSjZF did partially protect mice with 54.8% reduction in the worm burden and 34.1% reduction in the liver eggs. Taken in concert, our preliminary results suggest that SjZF may be a potential vaccine candidate for schistosomiasis and may further provide evidence for a possible role of SjZF in the development of schistosomes.

FA01.03: USE OF 'NON-TUBE NO FASTING' ERAS PROTOCOL IN PATIENTS AFTER MIE WITH LI'S ANASTOMOSIS: OUTCOMES IN THE FIRST 113 PATIENTS PERFORMED BY A SURGEON AFTER TRAINING COURSE.

BACKGROUND: Use of enhanced recovery after surgery(ERAS) protocol in the patients after esophagectomy is reported to be feasible and safe in recent studies. And in Prof. Yin Li's research, patients after minimally invasive esophagectomy(MIE) with Li's anastomosis took oral feeding on the 1st day after operation (POD1). However, all the esophagectomy-procedures were proceeded by experienced experts. There was no report regarding whether ERAS protocol after MIE with Li's anastomosis could be safely proceeded by a young surgeon after training course. The aim of this study was to evaluate the feasibility and safety of 'Non-Tube No Fasting' ERAS Protocol in patients after MIE with Li's Anastomosis proceeded by a surgeon after the training course. METHODS: We retrospectively reviewed the clinical data of patients who underwent MIE for cancer from December 2015 to September 2017 by a new surgical team finished MIE training course in our department. During the study period, the new team performed Mckeown MIE with Li's anastomosis for 127 esophageal cancer patients. We analyzed the data of 113 patients who followed the protocol of 'Non-tube No Fasting' ERAS. The primary end-points were the incidence of anastomotic fistula, the injury of recurrent laryngeal nerve, pneumonia, and postoperative length of hospital-stay. RESULTS: All the 113 patients began oral feeding on POD1. Two patients exited the ERAS protocol on account of bucking caused by recurrent laryngeal nerve injury on POD3. The incidence of anastomotic fistula, recurrent laryngeal nerve injury and pneumonia were 3.5% (4/113), 12.4%(14/113) and 18.5%(21/113). The average length of postoperative hospital-stay was 8.6 ± 6.9 days. Both of the in-hospital mortality and 30-day mortality were 0. CONCLUSION: Our date indicated that it was feasible and safe for a selected surgeon after 'Non-tube no fasting' ERAS and MIE training courses to proceed the protocol. Of course, more clinical researches are needed to confirm this result. DISCLOSURE: All authors have declared no conflicts of interest.

Complete Mitochondrial Genome of a Tongue Worm Armillifer agkistrodontis.

Armillifer agkistrodontis (Ichthyostraca: Pantastomida) is a parasitic pathogen, only reported in China, which can cause a zoonotic disease, pentastomiasis. A complete mitochondrial (mt) genome was 16,521 bp comprising 13 protein-coding genes (PCGs), 22 tRNA genes, 2 rRNA genes, and 1 non-coding region (NCR). A phylogenetic tree drawn with the concatenated amino acid sequences of the 6 conserved PCGs (atp6, cox1-3, and nad2) showed that A. agkistrodontis and Armillifer armillatus constituted a clade Pentastomida which was a sister group of the Branchiura. The complete mt genome sequence of A. agkistrodontis provides important genetic markers for both phylogenetic and epidemiological studies of pentastomids.

[Clinical implications of the concentration and EGFR/KRAS mutations of plasma cell free DNA of patients with lung cancer and esophageal cancer].

OBJECTIVE: To analyze the correlation between the concentration of plasma cell free DNA (cfDNA) of patients with lung cancer or esophageal cancer and clinical features, and to assess the coincidence rate of the EGFR/KRAS mutations between the cfDNA and tumor tissue DNA. METHODS: A total of 30 cases lung cancer and esophageal cancer (including 15 lung cancer, 15 esophageal cancer) were enrolled in this study. The tumor tissue and plasma sample of patients were collected. The tumor tissue DNA and plasma cfDNA were extracted. The EGFR/KRAS mutations of the tumor tissue DNA and plasma cfDNA were detected by fluorescence PCR. RESULTS: The concentration of cfDNA of patients with lung cancer (5.0 ± 1.4) µg/L and esophageal cancer (7.0 ± 0.8) µg/L were positively correlated with tumor size (r = 0.574, P = 0.01). There was no significant correlation between the concentration of cfDNA and TNM stage of tumor, gender, and age of patients. There was no EGFR/KRAS gene mutations in tumor tissue DNA and plasma cfDNA of esophageal cancer. A total of 6 tumor tissue samples of lung cancer patients were detected EGFR mutation, and 1 tumor tissue sample was detected KRAS mutation. Meanwhile, 4 plasma cfDNA samples of lung cancer patients were detected EGFR mutation, and 1 plasma cfDNA sample was detected KRAS mutation. CONCLUSION: The concentration of cfDNA of patients with lung cancer and esophageal cancer was positively correlated with tumor burden. There was high coincidence rate of the EGFR/KRAS mutations between the cfDNA and tumor tissue DNA.

[Preliminary Genetic and Functional Analyses of Schistosoma japonicum Chymotrypsin-like Protease].

OBJECTIVE: To investigate the gene expression, localization and potential functions of Schistosoma japonicum chymotrypsin-like protease (SjCTRL) in the host, and evaluate its potential immune-protection efficacy against S. japonicum infection in mice. METHODS: The physicochemical properties of SjCTRL and its phylogenetic relationship with homologous genes from other species were analyzed with bioinformatic software. The distribution of SjCTRL transcripts in 26-day-old worms was investigated using whole-mount in situ hybridization. The transcriptional levels of SjCTRL in male and female worms at four development stages (14, 18, 22, and 26 days after infection) were measured with quantitative real-time PCR. The SjCTRL-dsRNA was prepared and used to induce RNA interference (RNAi) in 26-day-old worms via soaking in vitro, and confocal microscopy was used to observe the morphological changes of worms after RNAi. Primers were designed to amplify the encoding sequence (excluding the transmembrane region) from the S. japonicum cDNA. The truncated gene was subcloned into the pET-28a plasmid, transformed into E. coli BL21 (DE3) for expression. Mice were immunized with the purified recombinant protein and challenged with cercariae. The worms and mouse liver were collected on day 35 after the challenge, and the worm-reduction rate and egg-reduction rate were calculated. RESULTS: The in situ hybridization results showed that SjCTRL mRNA was located in the posterior segment of intestinal tract of female worms, and having abundence only in 26-day-old female worms. After RNAi with SjCTRL-dsRNA, the mRNA expression was reduced to 25.7% (P< 0.05), without significant morphological changes. Using the recombinant plasmid pET-28a/SjCTRL, expression of insoluble SjCTRL protein was induced. Mice immunized with this protein gained a worm-reduction rate of 25.4% and an egg-reduction rate of 80.5% in liver after being challenged with cercariae. CONCLUSION: This study proves a high transcriptional level of SjCTRL in the posterior segment of intestinal tract in 26-day-old female worms, which can be reduced by RNAi treatment in vitro. Immunization with the SjCTRL protein can reduce adult worms and liver eggs.

[Development and design of a new sonography rigid bronchoscopy and corollary vacuum-assisted biopsy device system].

The present study was to develop and design a new sonography rigid bronchoscopy and corollary vacuum-assisted biopsy device system with less injury and complication. The system combined ultrasonic-probe with ultrasound catheter, a new medical ultrasound technique, and rigid bronchoscopy (RB) which is improved with an auxiliary vacuum-assisted biopsy device. The principle of the device is vacuum suction and rotary knife. The reduced outer diameter of the RB led to less pain and lower complications for the patient. With the help of ultrasonic-probe (30 MHz), lesions and blood vessels can be identified clearly and unintentional puncture and damage to blood vessels can be avoided. Plenty of lesions can be obtained quickly through the vacuum-assisted biopsy device without getting puncture needle in and out repeatedly. The novel endobronchial sonography rigid bronchoscopy and matched vacuum-assisted biopsy device has many remarkable advantages. It can enlarge the applied range of the RB from endobronchial to mediastinal lesions, avoiding unintentional puncture of vessels. Obtaining multiple samples with a higher accuracy rate than that by other sampling techniques, minimizing operation time, alleviating pain and decreasing the complication rate, the system makes up the technical deficiency for the diagnosis and treatment of the mediastinal lesions, to a certain degree.

Semi-supervised learning in diagnosis of infant hip dysplasia towards multisource ultrasound images.

Background: Automated diagnosis of infant hip dysplasia is heavily affected by the individual differences among infants and ultrasound machines. Methods: Hip sonographic images of 493 infants from various ultrasound machines were collected in the Department of Orthopedics in Yangzhou Maternal and Child Health Care Service Centre. Herein, we propose a semi-supervised learning method based on a feature pyramid network (FPN) and a contrastive learning scheme based on a Siamese architecture. A large amount of unlabeled data of ultrasound images was used via the Siamese network in the pre-training step, and then a small amount of annotated data for anatomical structures was adopted to train the model for landmark identification and standard plane recognition. The method was evaluated on our collected dataset. Results: The method achieved a mean Dice similarity coefficient (DSC) of 0.7873 and a mean Hausdorff distance (HD) of 5.0102 in landmark identification, compared to the model without contrastive learning, which had a mean DSC of 0.7734 and a mean HD of 6.1586. The accuracy, precision, and recall of standard plane recognition were 95.4%, 91.64%, and 94.86%, respectively. The corresponding area under the curve (AUC) was 0.982. Conclusions: This study proposes a semi-supervised deep learning method following Graf's principle, which can better utilize a large volume of ultrasound images from various devices and infants. This method can identify the landmarks of infant hips more accurately than manual operators, thereby improving the efficiency of diagnosis of infant hip dysplasia.

E4bp4-Cyp3a11 axis in high-fat diet-induced obese mice with weight fluctuation.

OBJECTIVE: Weight regain after weight loss is a challenge in obesity management. The metabolic changes and underlying mechanisms in obese people with weight fluctuation remain to be elucidated. In the present study, we aimed to profile the features and clinical significance of liver transcriptome in obese mice with weight regain after weight loss. METHODS: The male C57BL/6J mice were fed with standard chow diet or high-fat diet (HFD). After 9 weeks, the HFD-induced obese mice were randomly divided into weight gain (WG), weight loss (WL) and weight regain (WR) group. After 10 weeks of dietary intervention, body weight, fasting blood glucose (FBG), intraperitoneal glucose tolerance, triglycerides (TG), total cholesterol (T-CHO) and low-density lipoprotein cholesterol (LDL-C) were measured. Morphological structure and lipid droplet accumulation in the liver were observed by H&E staining and oil red O staining, respectively. The liver transcriptome was detected by RNA sequencing. Protein expressions of liver cytochrome P450 3a11 (Cyp3a11) and E4 promoter-binding protein 4 (E4bp4) were determined by Western blot. RESULTS: After 10 weeks of dietary intervention, the body weight, FBG, glucose area under the curve, T-CHO and LDL-C in WL group were significantly lower than those in WG group (P < 0.05). At 4 weeks of HFD re-feeding, the mice in WR group presented body weight and T-CHO significantly lower than those in WG group, whereas higher than those in WL group (P < 0.05). Hepatic vacuolar degeneration and lipid droplet accumulation in the liver were significantly alleviated in WL group and WR group, compared to those in WG group. The liver transcriptome associated with lipid metabolism was significantly altered during weight fluctuation in obese mice. Compared with those in WG group, Cyp3a11 in the liver was significantly upregulated, and E4bp4 was significantly downregulated in WL and WR groups. CONCLUSION: Obese mice experience weight regain after weight loss by HFD re-feeding, but their glucose and lipid metabolism disorders are milder than those induced by the persistence of obesity. Downregulated E4bp4 and upregulated Cyp3a11 are detected in obese mice after weight loss, suggesting that the E4bp4-Cyp3a11 axis may involved in metabolic mechanisms underlying weight regulation.