Forecasting and change point test for nonlinear heteroscedastic time series based on support vector regression

SVR-ARMA-GARCH models provide flexible model fitting and good predictive powers for nonlinear heteroscedastic time series datasets. In this study, we explore the change point detection problem in the SVR-ARMA-GARCH model using the residual-based CUSUM test. For this task, we propose an alternating recursive estimation (ARE) method to improve the estimation accuracy of residuals. Moreover, we suggest using a new testing method with a time-varying control limit that significantly improves the detection power of the CUSUM test. Our numerical analysis exhibits the merits of the proposed methods in SVR-ARMA-GARCH models. A real data example is also conducted using BDI data for illustration, which also confirms the validity of our methods.

Minimal invasive treatment for post-liver and renal transplant lymphatic leaks

INTRODUCTION

Persistent lymphatic leakage from the surgical drain is a troubling complication occasionally encountered postoperatively. This study investigated lymphatic leaks after renal or liver transplantation, comparing the treatment efficacy of traditional catheter drainage vs. minimally invasive lymphatic interventions. We also discuss access and treatment targets considering the physiology of lymphatic flow.

METHODS

Between September 2018 and September 2020, 13 patients with lymphatic leakage were treated with minimally invasive lymphatic interventions; 11 had received a renal transplant, and two received a liver transplant. The control group included 10 patients with post-renal transplant lymphatic leakage treated with catheter drainage. The treatment efficacy of catheter drainage, lymphatic interventions, and different targets of embolization were compared.

RESULTS

The technical success rate for lymphatic intervention was 100%, and the clinical success rate was 92%, with an 82.9% percent reduction in drain volume on the first day after treatment. The duration to reach clinical success was 5.9 days with lymphatic intervention, and 33.9 days with conservative catheter drainage.

CONCLUSION

Lymphangiography and embolization are minimally invasive and efficient procedures for treating persistent lymphatic leaks after renal or liver transplantation. We suggest prompt diagnosis and embolization at upstream lymphatics to reduce the duration of drain retention, days of hospitalization and associated comorbidities. This article is protected by copyright. All rights reserved.

First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients

BACKGROUND

This study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period.

METHODS

This study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI.

RESULTS

The intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = -0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05).

CONCLUSIONS

The APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.

Autosegmentation of Prostate Zones and Cancer Regions from Biparametric Magnetic Resonance Images by Using Deep-Learning-Based Neural Networks

The accuracy in diagnosing prostate cancer (PCa) has increased with the development of multiparametric magnetic resonance imaging (mpMRI). Biparametric magnetic resonance imaging (bpMRI) was found to have a diagnostic accuracy comparable to mpMRI in detecting PCa. However, prostate MRI assessment relies on human experts and specialized training with considerable inter-reader variability. Deep learning may be a more robust approach for prostate MRI assessment. Here we present a method for autosegmenting the prostate zone and cancer region by using SegNet, a deep convolution neural network (DCNN) model. We used PROSTATEx dataset to train the model and combined different sequences into three channels of a single image. For each subject, all slices that contained the transition zone (TZ), peripheral zone (PZ), and PCa region were selected. The datasets were produced using different combinations of images, including T2-weighted (T2W) images, diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) images. Among these groups, the T2W + DWI + ADC images exhibited the best performance with a dice similarity coefficient of 90.45% for the TZ, 70.04% for the PZ, and 52.73% for the PCa region. Image sequence analysis with a DCNN model has the potential to assist PCa diagnosis.

Ultrasound-guided dextrose injection treatment for chronic myofascial pain syndrome: A retrospective case series

BACKGROUND

Due to the lack of an evidence-based consensus, managing refractory myofascial pain syndrome is challenging for clinicians. Dextrose injection (dextrose prolotherapy) emerged as a promising, cost-effective treatment. This study evaluated the efficacy of targeted ultrasound-guided dextrose injection for localized myofascial pain syndrome.

METHODS

We retrospectively reviewed the clinical outcomes of 45 patients with myofascial pain syndrome refractory to alternative treatments with targeted ultrasound-guided dextrose injection. Pretreatment symptom severity and symptomatic response 1 month after treatment were statistically analyzed using a visual analog scale (VAS)-based scoring system.

RESULTS

Of 45 patients, 8 (24.4%) reported complete resolution of symptoms at the treated site. In total, 36 (80.0%) patients reported greater than 50% improvement in their symptoms. The mean pretreatment and posttreatment VAS scores were 7.0 and 2.44 (p < 0.001), indicating an overall 65.0% reduction in symptom severity.

CONCLUSION

Targeted ultrasound-guided dextrose injection was remarkably effective for refractory localized myofascial pain syndrome, significantly reducing symptom intensities in the majority of treated patients within 1 month after a single injection.

MON-459 Bilateral Killian-Jamieson Diverticulum Mimicking Thyroid Nodules

Background

In recent years, incidence and prevalence of thyroid and extrathyroid lesion is increasing in the worldwide due to increase awareness of medical check-up, and widespread use of imaging techniques. A Killian Jamieson diverticulum (KJD), a rare type of hypopharyngeal pulsion diverticulum outpouching from the lateral wall of the proximal cervical esophagus, was incidentally detected and likely to be misinterpreted as a thyroid nodule while performing thyroid sonography. Clearly differentiate between those lesions is essential to avoid unnecessary invasive procedure. Here we report a typical case of bilateral Killian Jamieson diverticulum mimicking thyroid nodules.

Clinical case

A 57-year-old Taiwanese man was referred to our endocrine outpatient department for further evaluation of thyroid nodules. The lesions were discovered while sonographic examination performed in the clinic for routine medical check-up. He denied having dysphagia, epigastric pain, odynophagia, halitosis, chronic cough or acid regurgitation, body weight loss, fever and dyspnea. He had no previous systemic disease and no prior radiation therapy. He lives in Nangang District, Taipei city. His body weight was 70 kg and BMI was 25. An examination of head and neck was unremarkable. Laboratory data revealed normal thyroid function (TSH: 0.67 uIU/ml; range 0.4~4.0, free T4: 0.83 ng/dl; range 0.9~1.8 and aTPO <1.0 IU/ml; range <5). Thyroid ultrasonography demonstrated oval, hypoechoic nodule-like lesions containing bright foci with acoustic shadow in the posterior aspect of the both lobes of thyroid gland. The rest of thyroid glands were normal appearance. An esophagography was performed and showed two contrast-filling anterior outpouching lesions at both sides of the cervical esophagus, around C7 level and both lesions were showing anterior outpouching appearance, consider Killian-Jamieson diverticulum. Taken together, he was diagnosed as KJD and clinical follow-up alone is suggested.

Clinical lessons

KJD is usually incidentally detected and misdiagnosed as a thyroid nodule containing punctuate microcalcification foci as found in papillary thyroid carcinoma. To differentiate these nodules, real time sonographic examination is important. Although rare, non-thyroid lesions originating from the esophagus should be considered in the differential diagnosis of the thyroid nodules to avoid unnecessary invasive fine needle aspiration of thyroid gland.

Safety of Perfluorobutane (Sonazoid) in Characterizing Focal Liver Lesions

Background:

The purpose of this study was to report the safety of perfluorobutane (Sonazoid) as a vascular-phase imaging agent in characterizing focal liver lesions (FLLs).

Materials and Methods:

From May 2014 to April 2015, a total of 54 individuals who received Sonazoid contrast-enhanced ultrasound (CEUS) were enrolled at 5 hospitals of 4 medical centers. All individuals were included in safety evaluation. A prospective study to evaluate the adverse effect (AE) incidences after intravenous administration of Sonazoid.

Results:

Sonazoid was well tolerated. Treatment-emergent adverse events (TEAEs) representing AE were recorded for 13 (24.1%) patients. The most common AE was abdominal pain (9.3%), followed by heart rate irregularity (5.6%). The majority of these patients (69.2%) experienced TEAEs that were mild in intensity. Sonazoid causes no significant AEs after intravenous injection. The only noteworthy AEs are related to tolerable myalgia (3.7%), abdominal pain (1.9%), and headache (1.9%). None of the 54 patients showed serious adverse effects.

Conclusion:

Sonazoid shows good safety and tolerance of intravenous use during CEUS of the liver for evaluation of FLLs.

c-MYC expression in T (III/IV) stage oral squamous cell carcinoma (OSCC) patients

Purpose: c-MYC has been noted in many tumor types, but its functional significance and clinical utility in oral squamous cell carcinoma (OSCC) are not well known. Here we studied the expression of c-MYC in correlation to clinical outcome in patients with oral squamous cell carcinoma. Methods: The current study, using immunohistochemical staining, first examined c-MYC expression in OSCC patients and further correlated its expression with clinicopathological parameters. Results: c-MYC was expressed in the majority of OSCC patients (n=133). The c-MYC expression is associated with histological grade (P=0.0205) of patients with oral squamous cell carcinoma. Multivariate Cox regression analysis revealed that TN stage (P<0.001), American Joint Committee on Cancer (AJCC) stage (P<0.0001), and tumor differentiation (P=0.0025) were independent factors for overall survival in patients with OSCC except for c-MYC expression (P>0.05). Multiplicative-scale interaction between T stage (III/IV) and low c-MYC expression on mortality risk was identified (P=0.0233). Kaplan-Meier survival analysis demonstrated that oral cancer patients (T III/IV stage) with high c-MYC expression had better survival than those with low and medium c-MYC expression (P=0.0270). Conclusion: Our data indicate that c-MYC is a potential biomarker that can be used as a therapeutic target for treating OSCC patients with T stage (III/IV).

Proton Shell Evolution below ^{132}Sn: First Measurement of Low-Lying β-Emitting Isomers in ^{123,125}Ag

The β-delayed γ-ray spectroscopy of neutron-rich ^{123,125}Ag isotopes is investigated at the Radioactive Isotope Beam Factory of RIKEN, and the long-predicted 1/2^{-} β-emitting isomers in ^{123,125}Ag are identified for the first time. With the new experimental results, the systematic trend of energy spacing between the lowest 9/2^{+} and 1/2^{-} levels is extended in Ag isotopes up to N=78, providing a clear signal for the reduction of the Z=40 subshell gap in Ag towards N=82. Shell-model calculations with the state-of-the-art V_{MU} plus M3Y spin-orbit interaction give a satisfactory description of the low-lying states in ^{123,125}Ag. The tensor force is found to play a crucial role in the evolution of the size of the Z=40 subshell gap. The observed inversion of the single-particle levels around ^{123}Ag can be well interpreted in terms of the monopole shift of the π1g_{9/2} orbitals mainly caused by the increasing occupation of ν1h_{11/2} orbitals.

CIP2A overexpression in Taiwanese oral cancer patients

Introduction: Oral cancer is a prevalent form of cancer worldwide, particularly in Taiwan, and mechanisms involved in oral squamous cell carcinoma (OSCC) progression remain relatively unknown. Cancerous inhibitor of protein phosphatase 2A (CIP2A), an oncoprotein, is aberrantly expressed in many human malignant tumors including oral cancer. However, the expression and role played by CIP2A in oral cancer pathogenesis remain obscure. Methods: In this study, immunohistochemistry was used to analyze CIP2A expression between OSCC tissues and their adjacent noncancerous tissues. Furthermore, associations between CIP2A expression and histopathological parameters were investigated. Results: In this study, we showed that CIP2A was overexpressed in most of the OSCC tissues. High CIP2A expression was significantly associated with moderate/poor tumor differentiation (P=0.02). No significant association was found between CIP2A expression and other clinical parameters. Kaplan-Meier analysis revealed that high CIP2A expression showed poorer survival rates than those with low CIP2A expression (P=0.047). Multivariate Cox regression analysis indicated that CIP2A expression, N stage, American Joint Committee on Cancer stage and clinical therapy were independent prognostic factors for survival. Conclusion: Thus, our study suggests that CIP2A is an independent prognostic marker for OSCC and a novel target for OSCC treatment.

Percutaneous ethanol ablation of intrahepatic arterial pseudoaneurysm: A case report

Hepatic arterial pseudoaneurysm is a rare but potentially fatal condition that requires prompt management. We report a case of hepatic arterial pseudoaneurysm developed after radiofrequency ablation of a hepatocellular carcinoma. The patient was successfully treated with percutaneous absolute ethanol injection under ultrasound guidance. Follow-up studies with ultrasound and computed tomography for 2 years after treatment revealed no evidence of local recurrence of hepatocellular carcinoma and of the pseudoaneurysm.

Ultrasound-Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single-Arm Prospective Study

OBJECTIVES

Prolotherapy is an injection-based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy.

METHODS

Thirty-one patients with chronic moderate-to-severe shoulder pain were recruited from September 2015 to September 2017. Ultrasound-guided prolotherapy was performed by injecting 10 mL of a 15% dextrose solution into the acromial enthesis of the deltoid or acromioclavicular joint capsule aseptically. Prolotherapy was given in 2 sessions separated by a 1-month interval. The pretreatment-to-posttreatment change in the pain visual analog scale (VAS) score was recorded as the primary outcome. The mean follow-up duration was 61.8 days. A paired t test was used to assess the difference in pretreatment and posttreatment VAS scores. A univariate logistic regression analysis was conducted to identify the demographic variables associated with substantial pain reduction after the intervention. Substantial pain reduction was defined as a posttreatment VAS score of 3 or less.

RESULTS

Twenty of the 31 patients reported substantial pain reduction without adverse effects after the intervention. The mean VAS score reduction ± SD was 4.3 ± 2.6 (pretreatment, 6.8 ± 1.5; posttreatment, 2.5 ± 2.1; P < .01).

CONCLUSIONS

Ultrasound-guided prolotherapy with a 15% dextrose solution is an effective and safe therapeutic option for moderate-to-severe acromial enthesopathy and acromioclavicular joint arthropathy.

Histogram analysis of prostate cancer on dynamic contrast-enhanced magnetic resonance imaging: A preliminary study emphasizing on zonal difference

Background

This study evaluated the performance of histogram analysis in the time course of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for differentiating cancerous tissues from benign tissues in the prostate.

Methods

We retrospectively analyzed the histograms of DCE-MRI of 30 patients. Histograms within regions of interest(ROI) in the peripheral zone (PZ) and transitional zone (TZ) were separately analyzed. The maximum difference wash-in slope (MWS) and delay phase slope (DPS) were defined for each voxel. Differences in histogram parameters, namely the mean, standard deviation (SD), the coefficient of variation (CV), kurtosis, skewness, interquartile range (IQR), percentile (P10, P25, P75, P90, and P90P10), Range, and modified full width at half-maximum (mFWHM) between cancerous and benign tissues were assessed.

Results

In the TZ, CV for ROIs of 7.5 and 10mm was the only significantly different parameter of the MWS (P = 0.034 and P = 0.004, respectively), whereas many parameters of the DPS (mean, skewness, P10, P25, P50, P75 and P90) differed significantly (P = <0.001–0.016 and area under the curve [AUC] = 0.73–0.822). In the PZ, all parameters of the MWS exhibited significant differences, except kurtosis and skewness in the ROI of 7.5mm(P = <0.001–0.017 and AUC = 0.865–0.898). SD, IQR, mFWHM, P90P10 and Range were also significant differences in the DPS (P = 0.001–0.035).

Conclusion

The histogram analysis of DCE-MRI is a potentially useful approach for differentiating prostate cancer from normal tissues. Different histogram parameters of the MWS and DPS should be applied in the TZ and PZ.

Characterization and management of various renal cystic lesions by sonographic features

Renal cysts are common incidental findings in clinical practice. Most renal cysts detected in medical imaging are benign simple cysts. However, some are complicated by hemorrhage or infection or are associated with calcification. In these instances, difficulties can be encountered distinguishing the complicated cysts from cystic renal tumors such as cystic renal cell carcinoma, multilocular cystic nephroma, and mixed epithelial and stromal tumors. The Bosniak classification is widely used to categorize cystic renal lesions but is used to classify those discovered via computed tomography. Ultrasonography (US) and color Doppler US are the most frequently used imaging techniques for abdominal surveys and long-term follow-up because of their noninvasiveness, relatively low cost, wide availability, and frequently, lack of contrast medium. Herein, we review the features of various cystic lesions of the kidney that can be found using US, discuss differential diagnoses using US, and propose a feature-oriented algorithmic approach to classifying renal cystic lesions using US.

A Case of Tubular Adenoma of Gallbladder Diagnosed Using Contrast-Enhanced Ultrasonography

Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.

Shoulder joint synovial chondromatosis presenting as multiple axillary masses: A case report

Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue, tenosynovium, or bursal lining. We describe the case of a patient who initially presented with multiple axillary masses. Breast ultrasound (US) was requested due to the concern of a breast tumor with axillary lymph node metastases. US study was helpful and provided adequate information to suggest the diagnosis.

Algorithmic approaches to the diagnosis of gallbladder intraluminal lesions on ultrasonography

Ultrasound is a frequently used diagnostic tool for gallbladder diseases. Polypoid lesions are commonly depicted at routine abdominal ultrasonography (US). The characteristics of these lesions vary. Since most early malignant tumors in the gallbladder are asymptomatic, differentiation between malignancy and benignity is crucial. Knowledge of gallbladder polypoid lesions is important so that they can be appropriately included in the differential diagnosis in patients presenting with intra-gallbladder nodules on US. This article summarizes the algorithmic approach to the diagnosis of these lesions and our recent experience with contrast-enhanced US. The clinical and imaging features of gallbladder polypoid lesions are reviewed.

The use of fine needle aspiration and trends in incidence of thyroid cancer in Taiwan

BACKGROUND

Thyroid cancer is the most prevalent endocrine malignancy, and the incidence of thyroid cancer has increased worldwide. Fine needle aspiration (FNA) for cytology of thyroid tissue is used for differentiating thyroid cancers from benign thyroid nodules. Overuse of FNA may detect subclinical thyroid cancer and play a role in the increased incidence of thyroid cancer. The aim of this study was to evaluate trends in incidence of thyroid cancer and the use of palpation-guided FNA thyroid and ultrasound-guided FNA thyroid in Taiwan.

METHODS

By retrospectively analyzing a cohort dataset of one million people randomly sample to represent as NHI beneficiaries of Taiwan National Health Insurance Research Database from 2004 to 2010, patients who received palpation-guided and ultrasound-guided thyroid FNA were identified. Individuals who were diagnosed as having thyroid cancer were determined. Age-standardized, yearly rates of palpation-guided thyroid FNA and ultrasound-guided FNA, and age-standardized, yearly incidence rates of thyroid cancer were calculated.

RESULTS

In the study period, a total of 541 patients were newly diagnosed with thyroid cancer, 14,240 individuals received palpation-guided thyroid FNA, and 3823 individuals underwent ultrasound-guided thyroid FNA. There was a 94.8% increase in the age-standardized annual incidence rate of thyroid cancer. The age-standardized rates of palpation-guided thyroid FNA and ultrasound-guided thyroid FNA increased by 10.9% and 349.3%, respectively.

CONCLUSION

FNA for cytology of thyroid tissue, especially ultrasound-guided FNA, was conducted by physicians more frequently in Taiwan. Increased use of FNA, especially ultrasound-guided FNA for cytology of thyroid tissue, may attribute to the increased incidence of thyroid cancer in Taiwan.

Risk of complications of ultrasound-guided renal biopsy for adult and pediatric patients with systemic lupus erythematosus

Objective The objective of this paper is to identify the risk of complications of real-time ultrasound-guided renal biopsy in adult and pediatric patients with systemic lupus erythematosus (SLE). Materials and methods This retrospective study examined outcomes of 296 renal biopsy procedures in 275 SLE patients. Imaging-confirmed symptomatic hematoma was regarded as a major complication when intervention (blood transfusion, angiographic embolization, or surgery) was required or as a minor complication otherwise. Clinical and laboratory data were compared between groups with or without complications after initial or subsequent renal biopsy. Binary logistic regressions were used to evaluate complication risk of initial renal biopsy. Results Overall complication rate of initial renal biopsy was 8.7% (major: 2.9%, minor: 5.8%). Three patients expired from pulmonary hemorrhage, thrombotic microangiopathy, and pneumonia. Pediatric SLE patients tended to have a higher rate of major complications (12.5%) than adult patients (2.3%). According to multivariable analysis results, elevated serum creatinine (SCr) level (OR 1.45; 95% CI 1.17-1.81 per mg/dl), prolonged prothrombin time (PT) (OR 2.2; 95% CI 1.05-4.62 per second), and thrombocytopenia (OR 4.3; 95% CI 1.56-11.9) increased overall complication risk of initial renal biopsy. Age < 18 years (OR 8.43; 95% CI 1.21-58.8), thrombocytopenia (OR 16.4; 95% CI 2.44-110.5), and elevated SCr level (OR 1.97; 95% CI 1.36-2.86 per md/dl) increased risk of major complications. Thrombocytopenia, prolonged PT, and elevated SCr level were associated with complications after subsequent renal biopsy (all p = 0.01). Conclusions SLE patients, particularly patients under 18 years old or with elevated SCr level, prolonged PT, or thrombocytopenia, have an increased risk of complications after initial or subsequent renal biopsy.

Enlarging vascular stents after pediatric liver transplantation

BACKGROUND

Endovascular intervention with stent placement to treat portal vein (PV) and hepatic vein (HV) stenosis after pediatric liver transplantation (LT) is still controversial in small children owing to the potential risk of functional stenosis after growth. The aim of this study is to evaluate the safety and efficacy of stent placement in this population.

METHODS

Between 2004 and 2016, 6 children (all <3 years) received HV (n = 2) and PV (n = 4) stents placement among 46 pediatric LT patients at our institution. The clinical outcome and patency rate were followed. Morphologic changes of stents were assessed from plain films by a new index: the stent diameter ratio (SDR).

RESULTS

The median age of the patients at LT was 8.9 months. The patency rate was 100% without functional stenosis during a median follow-up period of 65.5 months. The "stent growth" phenomenon was demonstrated by SDR with significant resolution of hourglass deformity 2 years after stent placement (p for trend <.001).

CONCLUSION

Vascular stent placement is a safe and effective method for the management of PV and HV stenosis following pediatric LT because these stents will enlarge as children grow.

TYPE OF STUDY

Case Series with no Comparison Group LEVEL OF EVIDENCE: Level IV.

Correlation between histological and ultrasonographic findings of soft tissue tumors: To verify the possibility of cell-like resolution in ultrasonography

BACKGROUND

The purpose of this study is to test the possibility of obtained cell-like resolution in soft tissue tumors on the basis of ultrasound echotexture.

METHODS

This is a prospective study consisting of 57 patients (29 females and 28 males, age range: 9-83 years, average age: 44.5 years) with palpable soft tissue mass, referred from the Departments of Orthopedics and Oncology for ultrasound (US)-guided biopsy. The study was approved by the institutional review board (IRB) of our hospital. Ultrasonographic images were recorded by still imaging in the biopsy tract in each biopsy session. Equipment included curvilinear and linear array probes. After biopsy, a radiologist and a pathologist correlated the US image and the observations regarding the histology of the tissue specimen in low-power (40 × magnification) and high-power (100-400 × magnification) fields.

RESULTS

The histologic results included 22 benign and 35 malignant lesions. The echotexture of the soft tissue tumors correlated well with the cellular distribution and arrangement: the greater the number of cells and the more regular their arrangement as seen histologically, the greater is the hypoechogenicity on the ultrasound. The echogenicity of the soft tissue tumor also correlated well with the presence of fat cells, hemorrhage, cartilage, and osteoid tissue, all of which cause an increase in echogenicity.

CONCLUSION

This study showed that the echotexture of soft tissue tumors can predict some details of cellular histology.

Muscle ultrasound: A useful tool in newborn screening for infantile onset pompe disease

Our study aimed to evaluate the utility of muscle ultrasound in newborn screening of infantile-onset Pompe disease (IOPD) and to establish a system of severity grading. We retrospectively selected 35 patients with initial low acid alpha-glucosidase (GAA) activity and collected data including muscle ultrasound features, GAA gene mutation, activity/performance, and pathological and laboratory findings. The echogenicity of 6 muscles (the bilateral vastus intermedius, rectus femoris, and sartorius muscles) was compared to that of epimysium on ultrasound and rated either 1 (normal), 2 (mildly increased), or 3 (obviously increased). These grades were used to divide patients into 3 groups. IOPD was present in none of the grade-1 patients, 5 of 9 grade-2 patients, and 5 of 5 grade-3 patients (P < .001). Comparing grade-2 plus grade-3 patients to grade-1 patients, muscle ultrasound detected IOPD with a sensitivity and specificity of 100.0% (95% confidence interval [CI]: 69.2%-100%) and 84.0% (95% CI: 63.9%-95.5%), respectively. The mean number of affected muscles was larger in grade-3 patients than in grade-2 patients (4.2 vs. 2.0, P = .005). Mean alanine transaminase (ALT), aspartate transaminase (AST), creatine kinase (CK), and lactate dehydrogenase (LDH) levels were differed significantly different between grade-3 and grade-1 patients (P < .001). Because it permits direct visualization of injured muscles, muscle ultrasound can be used to screen for IOPD. Our echogenicity grades of muscle injury also correlate well with serum levels of muscle-injury biochemical markers.

Solitary fibrous tumor of the breast: A case report and review of the literature

Solitary fibrous tumor (SFT) is an uncommon neoplasm of mesenchymal origin, which can be benign or malignant. Most SFTs develop from the pleura, but they can also be found in other sites. There are only few reports of SFT occurring in the breast. We herein report such a rare case. Sonography demonstrated an ovoid lesion mimicking a fibroadenoma, whereas color Doppler imaging showed marked internal vascularity. A brief literature review on imaging features of SFTs is added. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:350-354, 2017.

Right-Sided Colonic Diverticulitis: Clinical Features, Sonographic Appearances, and Management

PURPOSE

This study aims to evaluate patients with right-sided colonic diverticulitis detected at ultrasonography (US).

METHODS

We retrospectively analyzed 14 patients. Demographic data, clinical features, and US images were documented.

RESULTS

In the 14 patients, clinical manifestations included right lower abdominal tenderness (93%), leukocytosis (57.1%), and fever (28.6%). Diverticulitis occurred in cecum and ascending colon with a similar frequency (35.7%). US features included diverticular wall thickening (50%), surrounding echogenic fat (50%), intradiverticular echogenic material (50%), adjacent lymph node enlargement (21.4%), intradiverticularor peridiverticular fluid collection (28.6%), and color flow signals on or surrounding the diverticula (14.3%). Two (14.2%) patients suffered from recurrence. Two (14.3%) patients had abscess formation, and one (7.1%) patient had diverticulum perforation. Most (85.7%) patients received conservative treatment only. One (7.1%) patient received computed tomography-guided drainage due to diverticulum perforation and pocket of abscess formation. One patient underwent surgery due to recurrent diverticulitis-related fistula.

CONCLUSION

Common US features of diverticulitis include diverticular wall thickening, surrounding echogenic fat, and intradiverticular echogenic material. Proper recognizing of these features helps in differentiating diverticulitis from appendicitis and may obviate an unnecessary emergent surgery.

Cognitive MRI-TRUS fusion-targeted prostate biopsy according to PI-RADS classification in patients with prior negative systematic biopsy results

BACKGROUND

The purpose of this study was to evaluate the prostate cancer yield rate of targeted transrectal ultrasound (TRUS)-guided biopsy with cognitive magnetic resonance imaging (MRI) registration without concurrent systematic biopsy in patients with previous negative systematic TRUS-guided biopsy results and persistently elevated prostate-specific antigen (PSA) levels.

METHODS

In this prospective study conducted from August 2013 to January 2015, patients with at least one previous negative systematic TRUS-guided biopsy and persistently high PSA (≥4 ng/mL) levels were referred for multiparametric MRI (mpMRI). Those patients with suspicious findings on mpMRI received a subsequent cognitive MRI-TRUS fusion biopsy. The cancer-detection rate, tumor location, and Gleason score were confirmed, and PSA-related data were compared between cancer-yield and noncancer-yield groups.

RESULTS

In total, 48 patients were included in this study. MRI was designated to be four and five in 17 patients. Fifteen patients received a cognitive fusion-targeted biopsy, and prostate cancers were detected in 10 patients. The cancer-detection rate was 20.8% (10/48), and the positive-predictive value of MRI was 66.7%. No significant differences were observed in the PSA level, PSA velocity, or transitional zone volume between the cancer-yield and noncancer-yield groups; however, the corresponding difference in PSA transitional zone density was significant (p=0.025).

CONCLUSION

Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.

Epidermoid cyst of the testis: An atypical sonographic appearance

Epidermoid cysts are rare. They represent the most common benign tumor of the testis. The sonographic appearances of testicular epidermoid cysts usually include avascular, mostly lamellated, heterogeneous internal echotexture, with hypoechoic and hyperechoic concentric rings, accounting for the typical onion-ring appearance. On MRI, epidermoid cysts show a low-signal-intensity center, with internal concentric rings of alternating high- and low-signal intensity on T2-weighted images, which correlates with the onion-ring appearance. We report a patient with testicular epidermoid cyst with atypical ultrasound and MRI appearances that led to the erroneous initial diagnosis of "burned-out" tumor. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:448-451, 2016.

Evolutionary magnetic resonance appearance of renal cell carcinoma after percutaneous cryoablation

Objective:

To determine the evolutionary MRI appearance of renal cell carcinoma (RCC) following cryoablation.

Methods:

For this institution review board-approved study, we recruited patients with biopsy-proven RCC and treated them with percutaneous cryoablation between November 2009 and October 2014. Two radiologists retrospectively reviewed the pre-procedural and follow-up MRI. The findings included tumour sizes, signal intensities on T₁ weighted imaging (T1WI), T₂ weighted imaging (T2WI), diffusion-weighted imaging, apparent diffusion coefficient (ADC) map and contrast enhancement patterns. The ADC values of the tumours before and after treatment were measured.

Results:

A total of 26 patients were enrolled. The ablated tumours exhibited predominantly high signals on T1WI at 1–9-month follow-up (47.1% strong hyperintense at 3 months) and subsequently returned to being isointense. In T2WI, the signals of the ablated tumours were highly variable during the first 3 months and became strikingly hypointense after 6 months (58.3% strong hypointense at 6 months). Diffusion restriction was prominent during the first 3 months (lowest ADC: 0.62 ± 0.29 × 10⁻³ mm² s⁻¹ at 1 month). Contrast enhancement persisted up to 6 months after the procedure. The residual enhancement gradually increased in the dynamic scan and was most prominent in the delay phase.

Conclusion:

The MRI of the cryoablated renal tumour follows a typical evolutionary pattern.

Advances in knowledge:

Familiarity of practitioners with the normal post-cryoablation change of RCC on MRI can enable the early detection and prevention of tumour recurrence.

Diagnostic value of transvaginal color Doppler ultrasound on endometrial lesions

OBJECTIVE

To discuss the diagnostic value of transvaginal color Doppler ultrasound on endometrial lesions.

MATERIALS AND METHODS

The study included 126 cases diagnosed with endometrial lesions by transvaginal color Doppler ultrasound that were examined by hysteroscopy, biopsy, and curettage pathology, and compared with pathology.

RESULTS

The transvaginal color Doppler ultrasound diagnosis corresponded to 92.6% (117 of 126 cases) of the pathology diagnosis.

CONCLUSIONS

Transvaginal color Doppler ultrasound has important diagnostic value in the case of endometrial lesions, has a high rate of detection and diagnostic on endometrial lesions, and is the best method for diagnosis of endometrial lesions.

Minimization or withdrawal of immunosuppressants in pediatric liver transplant recipients

BACKGROUND

We aimed to minimize the dose of tacrolimus in pediatric patients undergoing liver transplantation prospectively.

METHODS

Pediatric liver transplant recipients with stable graft function >1year (transplant at <1year of age), or 2years (transplant at >1year of age) post transplant were screened. After baseline graft biopsy, patients were enrolled into our protocol for elective tacrolimus dose reduction. Patients were assessed by liver function test and protocol biopsy during and after tacrolimus dose reduction.

RESULTS

From January 2011 to December 2012, 16 patients were recruited, of whom 15 completed follow-up at a mean 40.75±5.98months. Six patients were preliminarily weaned off tacrolimus, and five remained tacrolimus-free for more than 2years. Of the 10 patients who were not weaned off tacrolimus, six experienced seven episodes of clinical rejection. Five patients had a reduction in tacrolimus dosage to an undetectable trough level, another five to a trough level <4ng/ml, including one patient who was off the study. At the last patient visit, all of the patients had normal liver function test results with no graft loss. Three patients had low-grade graft fibrosis. The patients with metabolic liver disease (p=0.039) and who were recruited earlier after transplantation (p=0.028) were more likely to be weaned off tacrolimus.

CONCLUSION

Tacrolimus withdrawal is feasible in select pediatric liver transplant recipients, and long-term follow-up for these patients is suggested.

Management of rotator cuff calcific tendinosis guided by ultrasound elastography

BACKGROUND

Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US elastography as an aid for the selection of aspiration or fine-needle repeated puncture for the treatment of rotator cuff calcific tendinosis.

METHODS

This prospective study included 39 patients (32 males, 7 females; mean age, 52.9 years) who received US elastography and gray-scale ultrasonography before US-guided treatment for rotator cuff calcific tendinosis. The morphology of the calcifications was classified as arc, fragmented, nodular, and cystic types. US elastography using virtual touch imaging (acoustic radiation force impulse) technique was performed to examine the calcified region to obtain an elastogram that was graded dark, intermediate, or bright. The hardness of the calcifications were recorded, and graded as hard, sand-like, or fluid-like tactile patterns during the US-guided treatment, and the tactile patterns were compared with the results of US elastography and gray-scale ultrasonography.

RESULTS

Though the morphologies of the calcifications were significantly related to the tactile pattern of the needle punctures (p < 0.001), gray-scale US could not accurately demonstrate the hardness of the calcifications. With the aid of elastography, the fluid-like tactile pattern could be predicted well as a nondark pattern by elastography (p < 0.001).

CONCLUSION

Ultrasound elastography is a useful modality for evaluation of rotator cuff calcific tendinosis, and as an aid to guide management. If elastography shows the calcified area as a non-dark pattern, then fine-needle aspiration should be performed.

Comparison of the analgesic effect of xylocaine only with xylocaine and corticosteroid injection after ultrasonographically-guided percutaneous treatment for rotator cuff calcific tendonosis

BACKGROUND

The analgesic effect of xylocaine alone versus xylocaine with corticosteroid injection after ultrasonographically (US)-guided treatment of rotator cuff calcific tendonosis has not been described in English literature. The aim of this study was to compare the analgesic effect of xylocaine only with xylocaine and corticosteroid following US-guided percutaneous treatment of rotator cuff calcific tendonosis.

METHODS

This prospective study enrolled 88 patients who were given different analgesic treatments [xylocaine only, n = 23; xylocaine with corticosteroid, n = 44; control (no xylocaine or corticosteroid), n = 21]. The assessment of a patient's painful symptoms was recorded before treatment, and 1 day, 1 week, 1 month and 3 months after treatment using the visual analogue scale (VAS).

RESULTS

There were no significant differences in age, sex, calcification size before and after treatment, and amount of calcification decrease after treatment, but there was a significant difference in calcification morphology among the groups (p = 0.010). General linear model analysis indicated that the three groups had no difference in pain prior to treatment. After treatment, the xylocaine only and the xylocaine with corticosteroid groups had less pain than the control group at 1 day, 1 week, and 1 month after treatment. At 3 months after treatment, the xylocaine only group had less pain than the control group (p = 0.039), and the xylocaine with corticosteroid and control groups had similar levels of pain.

CONCLUSION

Injection of xylocaine alone after US-guided treatment of rotator cuff calcific tendonosis provided a longer pain relief period than that of a mixture of xylocaine with corticosteroid.

Thyroid metastasis from breast cancer presenting with diffuse microcalcifications on sonography: a case report

Microcalcifications are frequently associated with papillary thyroid cancers. Metastatic nodules from extrathyroid malignancies may mimic primary thyroid neoplasm on sonography, but do not present with microcalcifications. We report the case of a 45-year-old woman with a history of invasive ductal carcinomas of bilateral breasts, status post surgery and neoadjuvant chemotherapy. Four years after surgery, thyroid sonography revealed diffuse microcalcifications without nodular component. Core needle biopsy confirmed thyroid metastasis from primary breast cancer.

Sleep apnea and risk of pneumonia: a nationwide population-based study

BACKGROUND

Evidence evaluating the risk of pneumonia in patients with obstructive sleep apnea is limited and mostly focuses on patients who receive continuous positive airway pressure (CPAP) therapy or on pediatric patients. We aimed to explore the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy.

METHODS

From Jan. 1, 2000, we identified adult patients with sleep apnea from the Taiwan National Health Insurance Research Database. A control cohort without sleep apnea, matched for age, sex and comorbidities, was selected for comparison. The 2 cohorts were followed until Dec. 31, 2010, and observed for occurrence of pneumonia.

RESULTS

Of the 34,100 patients (6816 study patients and 27,284 matched controls), 2757 (8.09%) had pneumonia during a mean follow-up period of 4.50 years, including 638 (9.36%) study patients and 2119 (7.77%) controls. Kaplan-Meier analysis showed a higher incidence of pneumonia among patients with sleep apnea (log rank test, p < 0.001). After multivariate adjustment, patients with sleep apnea experienced a 1.20-fold (95% confidence interval 1.10-1.31) increase in incident pneumonia. The risk was even higher among patients who received CPAP therapy.

INTERPRETATION

Sleep apnea appeared to confer a higher risk for future pneumonia, possibly in a severity-dependent manner.

Imaging spectrum after pancreas transplantation with enteric drainage

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.

Otorrhea as a sign of medical treatment failure in acute otitis media: two cases with silent mastoiditis complicated with facial palsy

We report two children with otitis media who developed facial palsy despite prompt antibiotic therapy. Brain images revealed silent mastoiditis. Persistent otorrhea may be a cautious sign of medical treatment failure or complication of acute otitis media, including mastoiditis or facial palsy. Delayed identification of coexisting mastoiditis or hesitation over surgical intervention may lead to treatment failure and complications. Adequate intravenous antibiotics and myringotomy provide reasonable and appropriate management to prevent permanent sequelae.

Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

Background

Cortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography. We performed the Dynamic Tissue Perfusion Measurement (DTPM) of the transplant’s renal cortex using color Doppler ultrasonography (PixelFlux technique), and compared the results with the histopathological findings of transplant biopsies.

Methods

Ninety-six DTPM studies of the renal transplant’s cortex followed by transplant biopsies were performed in 78 patients. The cortical perfusion data were compared with the parameter of peritubular inflammatory cell accumulation (PTC 0 to 3) based on Banff-classification system.

Results

A significant decrease of cortical perfusion could be demonstrated as the inflammatory cells accumulation in peritubular capillaries increased. Increasing peritubulitis caused a perfusion loss from central to distal layers of 79% in PTC 0, of 85% in PTC 1, of 94% in PTC 2, and of 94% in PTC 3. Furthermore, the perfusion loss due to peritubular inflammation was more prominent in the distal cortical layer. The extent of perfusion decline with increasing peritubulitis (from PTC 0 to PTC 3) was 64% in proximal 20% cortical layer (p20), 63% in proximal 50% cortical layer (p50), increased to 76% in distal 50% cortical layer (d50), and peaked at 90% in the distal 20% cortical layer (d20). For those without peritubulitis (PTC 0), the increase in the the Interstitial Fibrosis/Tubular Atrophy (IF/TA) score was accompanied by a significantly increased cortical perfusion. A Polyomavirus infection was associated with an increased cortical perfusion.

Conclusions

Our study demonstrated that the perfusion of the renal transplant is associated with certain pathological changes within the graft. DTPM showed a significant reduction of cortical perfusion in the transplant renal cortex related to peritubular capillary inflammation.

High nuclear expression of phosphorylated extracellular signal-regulated kinase in tumor cells in colorectal glands is associated with poor outcome in colorectal cancer

Extracellular signal-regulated kinase (ERK) is a major downstream transducer of Ras and plays an important role in transducing extracellular signals to the nuclei of cells. It is located in both the cytoplasm and the nucleus of cells. The nuclear localization of phosphorylated or activated ERK is involved in the invasive behavior of tumor cells. We studied the association between Ras mutation/ERK activation and the prognosis of patients with colorectal cancer. We analyzed 126 surgically resected colorectal cancer specimens for K-Ras mutation using direct sequencing. Activation/phosphorylation of ERK was assayed by immunohistochemistry with tissue microarray, and the staining intensity was analyzed using a semiquantitative scoring system. K-Ras mutations were detected in 32.5% (41/126) of the colorectal tumors. Colorectal glands are important functional organs in colorectal tissue and form the origin of colorectal carcinomas. Tissue microarray immunohistochemistry tests showed that tumors in colorectal cancer specimens were significantly stained for phospho-ERK (100%; 126/126), whereas nonneoplastic colorectal glands mainly showed faint phosphorylated ERK staining. High nuclear phospho-ERK expression in tumors was associated with highly invasive cancer stage and T status of the disease. Kaplan-Meier analysis showed that nuclear but not cytoplasmic phosphorylated ERK expression correlated with the patients' overall survival rate (P = .039). Colorectal adenomas including tubular adenomas and tubulovillous adenomas mainly showed weak cytoplasmic phospho-ERK expression. Our results suggest that immunohistologic analysis of phosphorylated ERK expression in colorectal glands may aid the diagnosis of colorectal cancer and that nuclear phosphorylated ERK might be a valuable prognostic marker for colorectal cancer.

Sonographic presentations of metaplastic breast cancers

BACKGROUND

Metaplastic carcinoma of the breast (MPCB) is a rare breast cancer. We reviewed sonographic findings for MPCB.

METHODS

Grayscale ultrasonography (US), color Doppler US (CDUS), and spectral Doppler US (SDUS) findings for 10 patients with MPCB breast were retrospectively reviewed.

RESULTS

The prevalence of MPCB was 3.9% among cases of breast cancer in our hospital. All patients had a rapidly growing palpable breast mass. The mean lesion size was 5.7 cm. On US, the lesion shape was most commonly gently lobulated (90%); only one showed an irregular shape (10%). The lesion shape was most commonly circumscribed (90%). Nine tumors had an abrupt boundary and one had an indistinct boundary. Lesion echogenicity was hypoechoic and very hypoechoic (40%), hypoechoic (30%), or very hypoechoic, hypoechoic, and hyperechoic (30%). All our cases had cystic parts with posterior acoustic enhancement, representing necrosis or hemorrhage. CDUS showed peripheral, central and marginal color flow signals. The resistivity index (RI) of tumor vessels in the lesions ranged from 0.7 to 1.3. The axillary lymph nodes were enlarged on US and were positive for metastasis in three cases (30%).

CONCLUSION

MPCB is a rare rapidly growing tumor. US findings included gently lobulated, complex mass lesion with cystic parts and posterior acoustic enhancement, representing necrosis or hemorrhage. Increased color flow signals and relative high RI of the feeding arteries were also seen.

Investigating the efficacy of subharmonic aided pressure estimation for portal vein pressures and portal hypertension monitoring

The efficacy of using subharmonic emissions from Sonazoid microbubbles (GE Healthcare, Oslo, Norway) to track portal vein pressures and pressure changes was investigated in 14 canines using either slow- or high-flow models of portal hypertension (PH). A modified Logiq 9 scanner (GE Healthcare, Milwaukee, WI, USA) operating in subharmonic mode (f(transmit): 2.5 MHz, f(receive): 1.25 MHz) was used to collect radiofrequency data at 10-40% incident acoustic power levels with 2-4 transmit cycles (in triplicate) before and after inducing PH. A pressure catheter (Millar Instruments, Inc., Houston, TX, USA) provided reference portal vein pressures. At optimum insonification, subharmonic signal amplitude changes correlated with portal vein pressure changes; r ranged from -0.82 to -0.94 and from -0.70 to -0.73 for PH models considered separately or together, respectively. The subharmonic signal amplitudes correlated with absolute portal vein pressures (r: -0.71 to -0.79). Statistically significant differences between subharmonic amplitudes, before and after inducing PH, were noted (p ≤ 0.01). Portal vein pressures estimated using subharmonic aided pressure estimation did not reveal significant differences (p > 0.05) with respect to the pressures obtained using the Millar pressure catheter. Subharmonic-aided pressure estimation may be useful clinically for portal vein pressure monitoring.

Vaginal superficial myofibroblastoma: a rare mesenchymal tumor of the lower female genital tract and a study of its association with viral infection

Superficial myofibroblastoma is a rare mesenchymal tumor in the lower female genital tract. The exact etiology of superficial myofibroblastoma remains unclear. The association of viral infection and mesenchymal tumors has been well established in some particular types of soft tissue tumors. In the lower female genital tract, the intimate correlation of viral infection and tumor pathogenesis has been also proposed. We present a 59-year-old woman with postcoital bleeding for 1 month. The pelvic examination revealed a 2-cm polypoid mass mimicking leiomyoma at the vaginal fornix. Local excision was performed, and the pathological examination revealed a superficial myofibroblastoma. No tumor recurrence was noted during the 12-month follow-up. Pathological differential diagnosis of this tumor from other mesenchymal tumors is essential because of its distinct clinicopathological features. Furthermore, fluorescence in situ hybridization of human papilloma virus (HPV) and Epstein-Barr virus (EBV), as well as immunohistochemical staining of human herpesvirus 8 (HHV8), was negative in tumor cells. To the best of our knowledge, we are the first group to study the possible relationship of viral infection and the occurrence of this mesenchymal tumor. Our results suggested no association of vaginal superficial myofibroblastoma and infection with HPV, EBV, or HHV8.

Improvement of Sperm Production in Subfertile Boars by Cordyceps militaris Supplement

Cordyceps species have been traditionally used for the enhancement of sexual function, however, there is few direct evidence to prove this. We investigated the spermatogenic effect of Cordyceps militaris (CM) by supplementation with CM mycelium to subfertile boars. Seventeen Duroc and 12 Landrace boars (29 to 40 months old) were selected to feed with regular diet (control groups, n = 8 and 6, respectively) or diet supplemented with CM mycelium (treatment groups, n = 9 and 6, respectively) for 2 months. Semen was collected once a week. The quality of fertile sperm (normally greater than 62% of motility and 70% of normal morphology) and the quantity (semen volume, and total sperm number) were compared in these boars. The result showed that sperm production was enhanced significantly at the end of first month ( p < 0.05), peaked at the second month ( p < 0.01) of supplementation with CM and was maintained for 2 weeks after stopping the treatment ( p < 0.01). Plasma cordycepin concentration was detected in boars supplemented with CM but not in the controls. More importantly, the percentages of motile sperm cells and sperm morphology were also improved significantly in most of treated boars during the second month of supplementation ( p < 0.01) and 2 weeks after the treatment ( p < 0.05) as compared to their initial values. These results indicate that supplementation with CM mycelium improves sperm quality and quantity in subfertile boars and may partly support the role of Cordyceps in sexual enhancement.

Expression of Eps8 correlates with poor survival in oral squamous cell carcinoma

AIMS

Epidermal growth factor receptor pathway substrate 8 (Eps8) is a signaling protein implicated in the development of many human cancers including oral squamous cell carcinoma (OSCC). This study examined the expression of Eps8 and assessed its significance in patients with OSCC.

METHODS

Immunohistochemical staining for Eps8 was conducted in 205 cases of OSCC collected over 7 years. The results were analyzed and correlated with patients' clinical outcomes.

RESULTS

We identified Eps8 expression in 186 of the 205 cases of OSCC (91%) and the aberrance occurred primarily in the cytoplasm of OSCC cells. Univariate analysis revealed that patients with Eps8 expression had significantly poorer 5-year overall survival (OS) than those without it (43% vs 74%, P = 0.014). Eps8 expression was also identified as an independent predictive factor for poorer OS by a multivariate analysis in regression modeling (P = 0.021, HR = 2.7). A Kaplan-Meier analysis showed that patients with positive Eps8 expression had a significantly poorer OS than patients with negative/low Eps8 expression (P = 0.038). The difference in disease-free survival between positive Eps8 expression and negative/low Eps8 expression nearly reached statistical significance (P = 0.051).

CONCLUSION

Eps8 is frequently expressed in OSCC. The aberrant expression of Eps8 closely correlated with poor survival in patients with OSCC.

Presynaptic inhibition of GABAergic synaptic transmission by adenosine in mouse hypothalamic hypocretin neurons

Hypocretin neurons in the lateral hypothalamus, a new wakefulness-promoting center, have been recently regarded as an important target involved in endogenous adenosine-regulating sleep homeostasis. The GABAergic synaptic transmissions are the main inhibitory afferents to hypocretin neurons, which play an important role in the regulation of excitability of these neurons. The inhibitory effect of adenosine, a homeostatic sleep-promoting factor, on the excitatory glutamatergic synaptic transmissions in hypocretin neurons has been well documented, whether adenosine also modulates these inhibitory GABAergic synaptic transmissions in these neurons has not been investigated. In this study, the effect of adenosine on inhibitory postsynaptic currents (IPSCs) in hypocretin neurons was examined by using perforated patch-clamp recordings in the acute hypothalamic slices. The findings demonstrated that adenosine suppressed the amplitude of evoked IPSCs in a dose-dependent manner, which was completely abolished by 8-cyclopentyltheophylline (CPT), a selective antagonist of adenosine A1 receptor but not adenosine A2 receptor antagonist 3,7-dimethyl-1-(2-propynyl) xanthine. A presynaptic origin was suggested as following: adenosine increased paired-pulse ratio as well as reduced GABAergic miniature IPSC frequency without affecting the miniature IPSC amplitude. Further findings demonstrated that when the frequency of electrical stimulation was raised to 10 Hz, but not 1 Hz, a time-dependent depression of evoked IPSC amplitude was detected in hypocretin neurons, which could be partially blocked by CPT. However, under a higher frequency at 100 Hz stimulation, CPT had no action on the depressed GABAergic synaptic transmission induced by such tetanic stimulation in these hypocretin neurons. These results suggest that endogenous adenosine generated under certain stronger activities of synaptic transmissions exerts an inhibitory effect on GABAergic synaptic transmission in hypocretin neurons by activation of presynaptic adenosine A1 receptors, which may finely regulate the excitability of these neurons as well as eventually modulate the sleep-wakefulness.