[Diagnostic value of digital breast tomosynthesis for mass lesions in dense breast]

Objective: To explore the diagnostic efficiency of digital breast tomosynthesis (DBT) for mass lesions in dense breast by comparing with digital mammography (DM). Methods: A retrospective analysis was made of 125 female patients with breast masses confirmed by pathology in the First Affiliated Hospital of Jinzhou Medical University from June 2018 to April 2019, all of whom were dense breast. Pathological results were taken to compare the diagnostic value of DM, DBT and the combination of the two for breast mass lesions. Results: The overall detection rates of DM, DBT and their combination were 77.6% (97/125), 88.8%(111/125) and 92.8%(116/125) in dense breast. The detection rates of burr sign and lobulation sign by DM and DBT in malignant tumors were 39.7%(31/78), 60.3%(47/78) and 48.7%(38/78), 67.9%(53/78), respectively, with statistically significant differences (all P<0.05). The sensitivity of DM, DBT and their combination in differentiating benign from malignant breast mass lesions of dense breast was 75.6% (59/78), 83.3%(65/78), 93.6%(73/78), the specificity was 63.8%(30/47), 80.9% (38/47), 76.6%(36/47),and the area under ROC curve(AUC) was 0.697, 0.821 and 0.852, respectively. Conclusion: DBT is more effective than DM in the diagnosis of dense breast mass lesions, and the combination of DBT and DM is more significant.

The generation of two specific cancer costing algorithms using Ontario administrative databases

Cancer treatment and management have become increasingly economically burdensome. Consequently, to help with planning health service delivery, it is vital to understand the associated costs. Administrative databases can be used to help understand and generate real-world system-level costs. Using databases to generate costs can take one of two approaches: top-down or bottom-up. Top-down approaches disaggregate the total health care spending from a global health care budget by sector and provider. A bottom-up approach begins with individual-level health care use and its costs, which are then aggregated.

MiRNA-155 promotes the invasion of colorectal cancer SW-480 cells through regulating the Wnt/β-catenin

OBJECTIVE

To investigate the role of microRNA-155 (miR-155) in the potential invasion of colon cancer cell and the underlying mechanism.

PATIENTS AND METHODS

The expression level of miR-155 in colon cancer and adjacent normal tissues was detected by Real-time quantitative polymerase chain reaction (RT-PCR). miR-155 mimics (miR-155), or siRNA against β-catenin (β-catenin siRNA), was transfected into human colon cancer cell line SW-480 using Lipofectamine 2000, respectively. RT-PCR was used to measure the expression levels of miR-155 and β-catenin mRNA, and β-catenin protein expression level was detected by Western blot. The in-vitro cell invasion abilities were determined by transwell invasion assays after up-regulating miR-155 or knocking down of β-catenin.

RESULTS

MiR-155 directly regulates β-catenin at the transcriptional level, and promotes the invasion potential of colon cancer cell, at least partly through the upregulation of β-catenin.

CONCLUSIONS

The findings of this study suggest that miR-155 and β-catenin may have a unique potential as a novel biomarker candidate for diagnosis and treatment of tumor metastasis.

Different roles of Rac1 in the acquisition and extinction of methamphetamine-associated contextual memory in the nucleus accumbens

Rationale: Repeated methamphetamine (METH) exposure induces long-term cognitive deficits and pathological drug-associated memory that can be disrupted by manipulating memory reconsolidation and extinction. The nucleus accumbens (NAc) is the key region of the brain reward system and predominantly consists of two subtypes of medium spiny neurons (MSNs) based on the expression of D1 or D2 dopamine receptors (D1-MSNs or D2-MSNs). Spine structural plasticity in the NAc is critical for the acquisition, reconsolidation and extinction of drug-associated memory. However, the molecular mechanisms underlying METH-associated memory and spine remodelling in each type of MSNs in the NAc remain unknown. Here, we explored whether Rac1 in the NAc mediates METH-associated contextual memory and spine remodelling.

Methods: Pharmacological and genetic manipulations of Rac1 were used to investigate its role during the acquisition, reconsolidation and extinction of METH-associated contextual memory. Recombinant adeno-associated viruses expressing mCherry under the control of the dopamine D1 receptor gene promoter (Drd1-mCherry) or dopamine D2 receptor gene promoter (Drd2-mCherry) were used to specifically label D1-MSNs or D2-MSNs.

Results: Using viral-mediated gene transfer, we demonstrated that decreased Rac1 activity was required for the acquisition of METH-associated contextual memory and the METH-induced increase in thin spine density, whereas increased Rac1 signalling was important for the extinction of METH-associated contextual memory and the related elimination of thin spines. Moreover, the increase of dendritic spines was both found in D1-MSNs and D2-MSNs during the acquisition process, but extinction training selectively decreased the spine density in D1-MSNs. Interestingly, Rac1 was responsible for METH-induced spine plasticity in D1-MSNs but not in D2-MSNs. Additionally, we found that microinjection of a Rac1 inhibitor or activator into the NAc was not sufficient to disrupt reconsolidation, and the pharmacological activation of Rac1 in the NAc facilitated the extinction of METH-associated contextual memory. Regarding cognitive memory, decreased Rac1 activity improved the METH-induced impairment in object recognition memory.

Conclusion: Our findings indicate that Rac1 plays opposing roles in the acquisition and extinction of METH-associated contextual memory and reveal the cell-specific role of Rac1 in METH-associated spine remodelling, suggesting that Rac1 is a potential therapeutic target for reducing relapse in METH addiction and remediating METH-induced recognition memory impairment.

Paramagnon drag in high thermoelectric figure of merit Li-doped MnTe

Local thermal magnetization fluctuations in Li-doped MnTe are found to increase its thermopower α strongly at temperatures up to 900 K. Below the Néel temperature (T _N ~ 307 K), MnTe is antiferromagnetic, and magnon drag contributes α_md to the thermopower, which scales as ~T ³. Magnon drag persists into the paramagnetic state up to >3 × T _N because of long-lived, short-range antiferromagnet-like fluctuations (paramagnons) shown by neutron spectroscopy to exist in the paramagnetic state. The paramagnon lifetime is longer than the charge carrier-magnon interaction time; its spin-spin spatial correlation length is larger than the free-carrier effective Bohr radius and de Broglie wavelength. Thus, to itinerant carriers, paramagnons look like magnons and give a paramagnon-drag thermopower. This contribution results in an optimally doped material having a thermoelectric figure of merit ZT > 1 at T > ~900 K, the first material with a technologically meaningful thermoelectric energy conversion efficiency from a spin-caloritronic effect.

[The value of red blood cell distribution width in the evaluation of patients with obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the relationship between red blood cell distribution width (RDW) and severity of obstructive sleep apnea hypopnea syndrome (OSAHS). Method:A total of 112 patients with OSAHS who were diagnosed by PSG monitoring were selected as OSAHS group, and 61 healthy subjects with matched age, gender and BMI were selected as the control group. The peripheral venous blood of all subjects was collected in the morning, and relevant hematological indexes such as RDW, white blood cell count, red blood cell count, hemoglobin, mean red blood cell volume, and platelet count were obtained. Result:The RDW level in the OSAHS group was significantly higher than that in the control group. The RDW value increased gradually with the severity of OSAHS and was positively correlated with AHI(r=0.259), the mean SaO₂ (r=-0.279), the lowest SaO₂( r=-0.328), BMI(r=0.203) and negatively correlated with sleep time(r=-0.204). Conclusion:The elevated level of RDW may be an indicator of the severity of OSAHS. Since RDW is usually included in the complete blood count, it can provide an economical and practical indicator to initially assess the condition of OSAHS patients and prioritize polysomnography monitoring.

[Association between weight control and recurrence of atrial fibrillation after catheter ablation in overweight and obese patients]

Objectives: This study explored the relationship between weight control and atrial fibrillation (AF) recurrence after catheter ablation in overweight and obese patients. Methods: We prospectively enrolled consecutive 333 overweight and obese patients aged 28 to 87 years old, who underwent catheter ablation for AF in Beijing Anzhen Hospital between October 2015 and February 2016. Data of patients' characteristics, laboratory examination and treatment were collected at baseline. Each patient was followed up at 3, 6 and 12 months after ablation to collect information on weight, AF recurrence, stroke, major bleeding, hospitalization for cardiovascular reasons and death, etc. Patients were divided into weight controlled group (ΔBMI<-1 kg/m(2)) and weight uncontrolled group (ΔBMI≥-1 kg/m(2)), according to the changes in the most recent exposure BMI before AF recurrence in patients with recurrence or the BMI at 12 months' follow-up in patients without recurrence and the BMI at baseline. Multivariate logistic regression was performed to adjust other known risk factors of AF recurrence and to explore the association between weight control and AF recurrence after catheter ablation. Results: There were 54 patients in weight controlled group and 279 patients in weight uncontrolled group. There were no significant differences in age, gender, education level, left atrial size and history of hypertension between the two groups (all P>0.05). The proportion of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was higher in the weight controlled group (50.0%(27/54) vs. 34.8%(97/279), P=0.034). However, there was no significant difference in the proportion of patients with obesity (33.3% (18/54) vs. 29.7% (83/279)), paroxysmal AF (59.3% (32/54) vs. 56.6% (158/279)) and AF duration less than 5 years (76.9% (40/52) vs. 65.4% (178/272)) between the weight controlled group and the uncontrolled group. During 1-year follow-up after ablation, the recurrence rate of AF was significantly lower in the weight controlled group than that in the weight uncontrolled group (14.8% (8/54) vs. 32.6%(91/279), P=0.009). Multivariable logistic regression analysis shows that weight control is independently associated with a lower postoperative AF recurrence rate (OR=0.40, 95%CI 0.18-0.90, P=0.026). Conclusion: Weight control is strongly associated with a lower AF recurrence rate after catheter ablation in overweight and obese patients.

Tetramethylpyrazine supplementation reduced Salmonella Typhimurium load and inflammatory response in broilers

The present study tested whether tetramethylpyrazine (TMP) supplementation could influence the growth performance, Salmonella Typhimurium (S. Typhimurium) load, inflammasomes, cytokines, and chemokines in broilers. Treatments were a 2 × 2 factorial design, including negative control (NC), S. Typhimurium challenge (SC), and NC/SC + TMP (150 mg/kg of diet). The trial lasted for 28 D, and S. Typhimurium subclinical challenge was occurred on day 8. The results showed that S. Typhimurium challenge worsened (P < 0.05) growth performance, S. Typhimurium load in intestinal digesta and visceral tissues, intestinal inflammatory responses, and permeability compared to the NC treatment. TMP supplementation increased (P < 0.05) feed intake, weight gain, and feed efficiency by 4.3 to 12.0%, but decreased (P < 0.05) S. Typhimurium load by 5.4 to 45.8%, inflammasomes (caspase-1/3/9, gasdermin A/E, and nod-like receptor protein 3) by 25.0 to 59.0%, chemokines (C-C motif ligand 2 and C-X-C motif 10) by 40.2 to 47.2%, intestinal permeability by 28.2% compared to the SC treatment. The TMP also reduced inflammatory response by influencing tumor necrosis factor α, interleukin 1β/4/6. Factorial analysis indicated that TMP and SC were interactive (P < 0.05) on most parameters due to the more pronounced TMP effect in S. Typhimurium challenge groups. It is concluded that TMP can promote growth and mitigate S. Typhimurium infection by reducing the S. Typhimurium load and inflammatory response in broilers.

[Relationship of BMI and wrist joint index with carpal tunnel syndrome in manual laborers]

Objective: To evaluate the severity of median nerve damage in patients with carpal tunnel syndrome (CTS) , and to analyze its relationship with body mass index (BMI) and wrist joint index. Methods: From May 2016 to January 2017, 23 patients with mild CTS (mild group) and 35 patients with moderate to severe CTS (moderate to severe group) were enrolled in this study. And 22 healthy volunteers matched for sex and age were selected as control group. The neuroelectrophysiological monitor was used to measure the median nerve movement and sensory nerve conduction in the subjects. The BMI and wrist joint index were calculated. The relationship of neuroelectrophysiological parameters with BMI and wrist joint index was analyzed in the CTS patients. Results: Compared with the control group, the mild group and the moderate to severe group had significantly higher wrist joint index, significantly longer distal motor latency (DML) of the median nerve, and significantly lower sensory nerve conduction velocity (SNCV) and sensory nerve action potential (SNAP) amplitude of the finger 1-wrist and finger 3-wrist (P<0.01) ; the moderate to severe group had significantly higher BMI and significantly lower composite muscle action potential (CMAP) amplitude (P<0.01) . The wrist joint index and BMI were positively correlated with DML of the median nerve and negatively correlated with SCV and SNAP amplitude of the finger 1-wrist and finger 3-wrist (all P<0.05) . The patients with a wrist joint index of >0.73 had a significantly higher risk of CTS than those with a wrist joint index of <0.73 (odd ratio=30.67, 95% confidence interval: 3.79-248.36) . Conclusion: A wrist joint index of >0.73 is an independent risk factor for CTS in manual laborers. CTS should be prevented in the manual laborers with high wrist joint index and BMI.

Hip or spine surgery first?: a survey of treatment order for patients with concurrent degenerative hip and spinal disorders

AIMS

Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain.

MATERIALS AND METHODS

Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining.

RESULTS

Responses were received from 51 hip surgeons (46%) and 37 spine surgeons (37%). The percentages of hip surgeons recommending 'hip first' differed significantly among scenarios: 59% for scenario 1; 73% for scenario 2; 47% for scenario 3; 47% for scenario 4; and 10% for scenario 5 (p < 0.001). The percentages of spine surgeons recommending 'hip first' were 49% for scenario 1; 70% for scenario 2; 19% for scenario 3; 78% for scenario 4; and 0% for scenario 5. There were significant differences between the groups for scenarios 3 (more hip surgeons recommended 'hip first'; p = 0.012) and 4 (more hip surgeons recommended 'spine first'; p = 0.006).

CONCLUSION

In patients with coexistent OA of the hip and degenerative disorders of the spine, the question of 'hip or spinal surgery first' elicits relatively consistent answers in some clinical scenarios, but remains controversial in others, even for experienced surgeons. The nature of neurological symptoms can influence surgeons' decision-making. Cite this article: Bone Joint J 2019;101-B(6 Supple B):37-44.

Feasibility of Fully Automated Hypnosis, Analgesia, and Fluid Management Using 2 Independent Closed-Loop Systems During Major Vascular Surgery: A Pilot Study

Automated titration of intravenous anesthesia and analgesia using processed electroencephalography monitoring is no longer a novel concept. Closed-loop control of fluid administration to provide goal-directed fluid therapy has also been increasingly described. However, simultaneously combining 2 independent closed-loop systems together in patients undergoing major vascular surgery has not been previously detailed. The aim of this pilot study was to evaluate the clinical performance of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop controllers in patients undergoing major vascular surgery before implementation within a larger study evaluating true patient outcomes.

Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial

PURPOSE

To investigate the effects of metabolic abnormalities, hyperandrogenemia and ovulation induction by clomiphene/acupuncture on liver function parameters among women with polycystic ovary syndrome (PCOS).

METHODS

This is a secondary analysis of a randomized controlled trial. All 1000 subjects were diagnosed as PCOS by modified Rotterdam criteria. Liver function parameters, metabolic panel and hormone profile were measured at baseline and after treatment. The relationship between liver parameters with metabolic, hormonal parameters and ovulation induction was examined.

RESULTS

PCOS women with metabolic syndrome had higher liver enzyme levels but lower bilirubin and bile acid levels than without. PCOS women with hyperandrogenemia had higher liver enzyme, bilirubin levels than without. Correlation analyses showed that worsening of metabolic parameters was associated with higher liver enzyme levels but lower bilirubin and bile acid levels, while increased androgen levels were associated with higher liver enzyme, bilirubin and bile acid levels. Ovulation induction with clomiphene citrate could decrease bilirubin and bile acid levels, while acupuncture had no obvious effect on liver function.

CONCLUSIONS

Among PCOS women, metabolic abnormalities and hyperandrogenemia impaired different liver function parameters. Clomiphene could decrease the bilirubin and bile acid levels while acupuncture had no obvious effect on liver function.

[Comparative study on the efficacy and safety between pegfilgrastim (PEG-rhG-CSF) and recombinant human granulocyte colony-stimulating factor in promoting hematopoietic recovery after allogeneic hematopoietic stem cell transplantation after hematological malignancy]

Objective: To observe the efficacy and safety between Pegfilgrastim (PEG-rhG-CSF) and Recombinant human granulocyte colony stimulating factor (rhG-CSF) in hematological malignancy after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: 157 patients after allo-HSCT were enrolled in this study from June 2015 to November 2016. Two agents of G-CSF were used to stimulate hematopoietic recovery after transplantation. There were 65 cases in PEG-rhG-CSF and 92 cases in rhG-CSF groups. Patients in PEG-rhG-CSF group were given a single subcutaneous dose of 6 mg on the first day and +8 d, while cases in rhG-CSF group were given in dose of 5 μg·kg(-1)·d(-1) by subcutaneous injection from +1 d continuing to neutrophils more than 1.5×10(9)/L, and then the indicators and survival rates in two groups after transplantation were compared. Results: ①There were no significant differences of the neutrophil implantation time[13.5 (8-12) d vs 13 (9-24) d, P=0.393] and platelet implantation time [14 (9-160) d vs 14 (9-92) d, P=0.094] between PEG-rhG-CSF and rhG-CSF groups respectively. There were no significant differences in terms of neutropenia period (P=0.435) , number of cases who got fever during neutropenia (P=0.622) , and the median time of fever in neutropenia period (P=0.460) , respectively between the two groups. There were no significant differences of erythrocyte and platelet transfusions (P=0.074, P=0.059) within 1 month after transplantation. ②There were no significant differences with regard to the incidences of acute GVHD[23.1% (15/65) vs 34.8% (32/92) , P=0.115], chronic GVHD[20.0% (13/65) vs 32.6% (32/92) , P=0.081], Ⅱ-Ⅳdegree of acute GVHD[30.0% (13/65) vs 30.4% (30/92) , P=0.287] and extensive chronic GVHD[9.2% (6/65) vs 20.7% (19/92) , P=0.135] between PEG-rhG-CSF and rhG-CSF groups. ③There were no significant differences in terms of disease free survival (DFS) (62.5% vs 61.4%, P=0.478) and overall survival (OS) (67.4% vs 67.3%, P=0.718) between PEG-rhG-CSF and rhG-CSF groups. ④There was no significant difference of the non-relapse mortality (NRM) between PEG-rhG-CSF and rhG-CSF groups[20.5% (95%CI 11.4%-37.0%) vs 32.6% (95%CI 22.2%-47.9%) , P=0.141]. The relapse rate was not statistically significant[14.9% (95%CI 7.4%-29.8%) vs 10.0% (95%CI 5.0%-20.0%) , P=0.299]. Conclusion: Compared with rhG-CSF, PEG-rhG-CSF could reduce the times of injection. There were no differences in terms of hematopoietic recovery, the incidence of GVHD, relapse rate, DFS and OS rates after allo-HSCT between two groups.

SP1-induced upregulation of long noncoding RNA LINC00313 contributes to papillary thyroid cancer progression via the miR-422a

OBJECTIVE

Long noncoding RNA LINC00313 (LINC00313) has been reported to be dysregulated in several tumors, including papillary thyroid carcinoma (PTC). Our present study aimed to further explore the potential mechanism of LINC00313 in the progression of papillary thyroid carcinoma (PTC).

PATIENTS AND METHODS

RT-PCR was performed to detect the expression of LINC00313 in both PTC tissues and cell lines. Luciferase reporter and chromatin immunoprecipitation (ChIP) assays were performed to explore whether SP1 could bind to the promoter region of LINC00313 and activate its transcription. The biological functional correlation of LINC00313 was determined by down-regulating the expression of LINC00313 on PTC cell proliferation, apoptosis, migration and invasion. The regulating relationship between LINC00313 and miR-422a was investigated in PTC cells using luciferase reporter assays.

RESULTS

We observed that LINC00313 expression was significantly up-regulated in both PTC tissues and cell lines. Next, the results of bioinformatics analysis and luciferase reporter assays indicated that the transcription factor SP1 can bind to the promoter region of LINC00313 resulting in the overexpression of LINC00313 in PTC. Moreover, functional study revealed that knockdown of LINC00313 significantly suppressed cells proliferation, migration, invasion and EMT. Finally, our results indicated that LINC00313 functioned as an oncogene in PTC in part through serving as a competing endogenous RNA to modulate mi-422a expression.

CONCLUSIONS

Overall, our data demonstrated that SP1-induced LINC00313 contributed to PTC progression by via competitively binding to miR-422a, which may provide a novel therapeutic strategy for PTC.

[Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps]

Objective: To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods: From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly. Results: All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal. Conclusions: The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.

Clinical significance of angiopoietin-like protein 3 expression in patients with glioblastoma

There is strong evidence that angiopoietin-like peptide family is involved in the invasiveness and metastasis of cancer. Angiopoietin-like protein 3 (ANGPTL3) is proven to be involved in angiogenesis and tumor development. However, there is no published data on the role ANGPLT3 plays in glioblastomas. The present study was conducted to examine ANGPLT3 proteins expression and its association with clinicopathological factors and prognosis in human glioblastomas. Immunohistochemistry was used to evaluate the expression of ANGPTL3, EGFR and VEGFR. We found that 33 cases (57.9%) that showed strong immunostaining for ANGPTL3 proteins. However, there was no significant difference between the expression of ANGPTL3 and the proangiogenic factors, including EGFR or VEGFR. Patients with high/moderate expression of ANGPTL3 had a significantly shorter survival time (6.3 months) than those (median survival time 13.8 months) with low/negative expression. The overall survival (OS) was also investigated and analyzed by the Kaplan-Meier method, which showed a significant difference (P=0.0045, Breslow test). The present data leads to new insights into the role of ANGPTL3 in glioblastomas and provides an independent predictive factor.