Nanoarchitectonic Engineering of Thermal-Responsive Magnetic Nanorobot Collectives for Intracranial Aneurysm Therapy

Stent-assisted coiling is a main treatment modality for intracranial aneurysms (IAs) in clinics, but critical challenges remain to be overcome, such as exogenous implant-induced stenosis and reliance on antiplatelet agents. Herein, an endovascular approach is reported for IA therapy without stent grafting or microcatheter shaping, enabled by active delivery of thrombin (Th) to target aneurysms using innovative phase-change material (PCM)-coated magnetite-thrombin (Fe3O4-Th@PCM) FTP nanorobots. The nanorobots are controlled by an integrated actuation system of dynamic torque-force hybrid magnetic fields. With robust intravascular navigation guided by real-time ultrasound imaging, nanorobotic collectives can effectively accumulate and retain in model aneurysms constructed in vivo, followed by controlled release of the encapsulated Th for rapid occlusion of the aneurysm upon melting the protective PCM (thermally responsive in a tunable manner) through focused magnetic hyperthermia. Complete and stable aneurysm embolization is confirmed by postoperative examination and 2-week postembolization follow-up using digital subtraction angiography (DSA), contrast-enhanced ultrasound (CEUS), and histological analysis. The safety of the embolization therapy is assessed through biocompatibility evaluation and histopathology assays. This strategy, seamlessly integrating secure drug packaging, agile magnetic actuation, and clinical interventional imaging, avoids possible exogenous implant rejection, circumvents cumbersome microcatheter shaping, and offers a promising option for IA therapy.

Efficacy of low-intensity pulsed ultrasound in the treatment of COVID-19 pneumonia

PURPOSE

As a public health emergency of international concern, coronavirus disease 2019 (COVID-19) still lacks specific antiviral drugs, and symptomatic treatment is currently the mainstay. The overactivated inflammatory response in COVID-19 patients is associated with a high risk of critical illness or even death. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of LIPUS therapy for COVID-19 pneumonia.

MATERIALS AND METHODS

62 patients were randomly assigned to a treatment group (LIPUS treatment area - Group 1; self-control area - Group 2) and an external control group (Group 3). The primary outcomes were the volume absorption rate (VAR) and the area absorption rate (AAR) of lung inflammation in CT images.

RESULTS

After an average duration of treatment 7.2 days, there were significant differences in AAR and VAR between Group 1 and Group 2 (AAR 0.25 vs 0.12, p=0.013; VAR 0.35 vs 0.11, p=0.005), and between Group 1 and Group 3 (AAR 0.25 vs 0.11, p=0.047; VAR 0.35 vs 0.19, p=0.042). Neither AAR nor VAR was statistically different between Group 2 and Group 3. After treatment, C-reactive protein, interleukin-6, leukocyte, and fingertip arterial oxygen saturation (SaO2) improved in Group 1, while in Group 3 only fingertip SaO2 increased.

CONCLUSION

LIPUS therapy reduced lung inflammation and serum inflammatory factor levels in hospitalized COVID-19 patients, which might be a major advancement in COVID-19 pneumonia therapy.

Development of a nomogram-based model combining intra- and peritumoral ultrasound radiomics with clinical features for differentiating benign from malignant in Breast Imaging Reporting and Data System category 3-5 nodules

Background

The differences in benign and malignant breast tumors are not only within the nodules but also involve changes in the surrounding tissues. Radiomics can reveal many details that are not discernible to the naked eye. This study aimed to distinguish between benign and malignant breast nodules using an ultrasound-based intra- and peritumoral radiomics model.

Methods

This study retrospectively collected the information from 379 patients with Breast Imaging Reporting and Data System (BI-RADS) category 3-5 nodules and clear pathological diagnosis of breast nodules screened by routine ultrasound examination in the Sixth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University from January 2017 to December 2022. The largest dimension of the lesion on the 2D ultrasound image was selected to outline the area of interest which was conformally and outwardly expanded automatically by 5 mm to extract intra- and peritumor radiomics features. The included cases were randomly divided into training sets and test sets in a ratio of 7:3. The optimal features of the included models were retained by statistical and machine learning methods of dimensionality reduction, and logistic regression was used as the classifier to build an intratumoral model and a combined intratumoral-peritumoral radiomics model, respectively; through single-factor and multifactor logistic regression, the optimal features that could predict benign and malignant breast tumors were screened. The clinical and imaging models were established by selecting independent risk factors as clinical and imaging features through univariate and multifactorial logistic regression.

Results

Among 379 BI-RADS category 3-5 breast nodules, there were 124 malignant nodules and 255 benign nodules; patients were aged 14 to 88 (46.22±15.51) years, and the age differences, radiomics score, and mass diameter between the training and test sets were not statistically significant (P>0.05). The intra- and peritumor radiomics model had an area under the curve (AUC) of 0.840 [95% confidence interval (CI): 0.766-0.914] in the test set. The model with intra- and peritumoral ultrasound radiomics features combined with clinical features had an AUC value of 0.960 (95% CI: 0.920-0.999).

Conclusions

The nomogram, developed using intratumoral and peritumoral radiomics features combined with clinical risk features, demonstrated superior performance in distinguishing between benign and malignant BI-RADS 3-5 lesions.

Ultrasonographic study of female perineal body and its supportive function on pelvic floor

Objectives

The study aimed to observe, measure the size and elastic value of perineal body (PB) and assess its association with levator hiatus.

Methods

Datasets were acquired in 45 nulliparous, 66 POP women and 70 postpartum women using ultrasound. The PB was measured in depth, height, and Young's modulus. The datasets were compared to assess whether there are some differences in the morphology, dimension and elastography modulus of PB among women. Pearson correlation analysis was used to evaluate the association between the morphology measurements (ΔValsalva-rest[v-r]), tissue mechanical properties (ΔValsalva-rest[v-r]) of the PB and levator hiatus area (ΔValsalva-rest[v-r]) to preliminarily explore whether PB can influence levator hiatus.

Results

Four representative manifestations of PB were presented in our study. Nulliparous women had smaller diameters and bigger Young's modulus while postpartum women had bigger diameters and smaller Young's modulus. POP and postpartum women had bigger levator hiatal distensibility and PB extensibility. There was no statistical association between PB measurements and levator hiatal area.

Conclusion

It is feasible to observe the morphology of PB and assess the dimension and elastography modulus by high-frequency ultrasound. The manifestations and measurements of PB are influenced by parity and long-term increased abdominal pressure. Our study preliminarily shows that PB has little effect on levator hiatus area.

Transiently impaired endothelial function during thyroid hormone withdrawal in differentiated thyroid cancer patients

Purpose

Endothelial dysfunction, which was associated with chronic hypothyroidism, was an early event in atherosclerosis. Whether short-term hypothyroidism following thyroxine withdrawal during radioiodine (RAI) therapy was associated with endothelial dysfunction in patients with differentiated thyroid cancer (DTC) was unclear. Aim of the study was to assess whether short-term hypothyroidism could impair endothelial function and the accompanied metabolic changes in the whole process of RAI therapy.

Methods

We recruited fifty-one patients who underwent total thyroidectomy surgery and would accept RAI therapy for DTC. We analyzed thyroid function, endothelial function and serum lipids levels of the patients at three time points: the day before thyroxine withdrawal(P₁), the day before ¹³¹I administration(P₂) and 4-6 weeks after RAI therapy(P₃). A high-resolution ultrasound named flow-mediated dilation (FMD) was used to measure endothelial function of the patients.

Results

We analyzed the changes of FMD, thyroid function and lipids at three time points. FMD(P₂) decreased significantly compared to FMD(P₁) (P₁vsP₂, 8.05 ± 1.55vs 7.26 ± 1.50, p<0.001). There was no significant difference between FMD(P₃) and FMD(P₁) after restoring TSH (thyroid stimulating hormone) suppression therapy (P₁ vs P3, 8.05 ± 1.55 vs 7.79 ± 1.38, p=0.146). Among all parameters, the change of low-density lipoprotein (ΔLDL) was the only factor correlated negatively with the change of FMD (ΔFMD) throughout the RAI therapy process (P_1-2, r=-0.326, p=0.020; P_2-3, r=-0.306, p=0.029).

Conclusion

Endothelial function was transiently impaired in DTC patients at short-term hypothyroidism state during the RAI therapy, and immediately returned to the initial state after restoring TSH suppression therapy.

Efficacy of low-intensity pulsed ultrasound for the treatment of viral pneumonia: study protocol for a randomized controlled trial

BACKGROUND

Viral pneumonia has always been a problem faced by clinicians because of its insidious onset, strong infectivity, and lack of effective drugs. Patients with advanced age or underlying diseases may experience more severe symptoms and are prone to severe ventilation dysfunction. Reducing pulmonary inflammation and improving clinical symptoms is the focus of current treatment. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of therapeutic LIPUS in improving lung inflammation in hospitalized patients with viral pneumonia.

METHODS

Sixty eligible participants with clinically confirmed viral pneumonia will be assigned to either (1) intervention group (LIPUS stimulus), (2) control group (null stimulus), or (3) self-control group (LIPUS stimulated areas versus non-stimulated areas). The primary outcome will be the difference in the extent of absorption and dissipation of lung inflammation on computed tomography. Secondary outcomes include changes in lung inflammation on ultrasonography images, pulmonary function, blood gas analysis, fingertip arterial oxygen saturation, serum inflammatory factor levels, the sputum excretion volume, time to the disappearance of pulmonary rales, pneumonia status score, and course of pneumonia. Adverse events will be recorded.

DISCUSSION

This study is the first clinical study of the efficacy of therapeutic LIPUS in the treatment of viral pneumonia. Given that the current clinical recovery mainly depends on the body's self-limiting and conventional symptomatic treatment, LIPUS, as a new therapy method, might be a major advance in the treatment of viral pneumonia.

TRIAL REGISTRATION

ChiCTR2200059550 Chinese Clinical Trial Registry, May 3, 2022.

Three-dimensional pelvic ultrasound is a practical tool for the assessment of anal fistula

OBJECTIVE

This study aims to investigate the diagnostic value of three-dimensional pelvic ultrasound in the preoperative assessment of anal fistula compared with findings of MRI and surgery.

METHODS

A total of 67 patients (62 males) with suspected anal fistula were analyzed retrospectively. Preoperative three-dimensional pelvic ultrasound and magnetic resonance imaging were performed in all patients. The number of internal openings and the type of fistula were recorded. The accuracy of three-dimensional pelvic ultrasound was determined by comparing these parameters with surgical outcomes.

RESULTS

At surgery, 5 (6%) were extrasphincteric, 10 (12%) were suprasphincteric, 11 (14%) were intersphincteric, and 55 (68%) were transsphincteric. There was no significant difference in the accuracy of pelvic 3D US and MRI, based on internal openings (97.92%, 94.79%), anal fistulas (97.01%, 94.03%), and those under Parks classification (97.53%, 93.83%).

CONCLUSION

Three-dimensional pelvic ultrasound is a reproducible and accurate method for determining the type of fistula and detecting internal openings and anal fistulas.

Nomogram based on preoperative conventional ultrasound and shear wave velocity for predicting central lymph node metastasis in papillary thyroid carcinoma

OBJECTIVE

To establish a nomogram for predicting cervical lymph node metastasis (CLNM) based on the preoperative conventional ultrasound (US) and shear wave velocity (SWV) features of papillary thyroid carcinoma (PTC).

METHODS

A total of 101 patients with pathologically confirmed thyroid nodules were enrolled. These patients were divided into the CLNM-positive (n = 40) and CLNM-negative groups (n = 61). All patients underwent the preoperative conventional US and shear wave elastography (SWE) evaluation, and the US parameters and SWV data were collected. The association between SWV ratio and CLNM was compared to assess the diagnostic efficacy of SWV ratio alone as opposed to SWV ratio in combination with the conventional US for predicting CLNM.

RESULTS

There were significant differences in shape, microcalcification, capsule contact, SWV mean, and SWV ratio between the CLNM-positive and CLNM-negative groups (P < 0.05). Logistic regression analysis showed that taller-than-wide shape, microcalcification, capsule contact, and SWV ratio > 1.3 were risk factors for CLNM; Logistic(P)=-6.93 + 1.647 * (microcalcification)+1.138 * (taller-than-wide-shape)+1.612 * (capsule contact)+2.933 * (SWV ratio > 1.3). The area under the curve (AUC) of the receiver operating characteristic (ROC) of the model for CLNM prediction was 0.87, with 81.19% accuracy, 77.5% sensitivity, and 85.25% specificity.

CONCLUSION

The nomogram based on conventional US imaging in combination with SWV ratio has the potential for preoperative CLNM risk assessment. This nomogram serves as a useful clinical tool for active surveillance and treatment decisions.

Obesity-Induced Hepatic Steatosis Is Partly Mediated by Visceral Fat Accumulation in Subjects with Overweight/Obesity: A Cross-Sectional Study

INTRODUCTION

We explored whether visceral fat accumulation mediates the development of hepatic steatosis in individuals living with overweight and obesity.

METHODS

This cross-sectional study enrolled 769 outpatients with overweight and obesity aged 18-65 years. The controlled attenuation parameter (CAP) was used to quantify the degree of hepatic steatosis. Visceral fat accumulation, represented by the visceral fat area (VFA), was measured using magnetic resonance imaging. The associations of body mass index (BMI), VFA, and CAP with each other were assessed by univariate analysis, multivariate linear regression, and mediation analysis, respectively.

RESULTS

Compared with women, male subjects had higher BMI, VFA, and CAP levels. In both sex, CAP was positively correlated with BMI and VFA by the univariate analysis. After adjusting for demographic and serum characteristics, the linear correlation coefficients between BMI and CAP were 1.738 (95% confidence interval (CI): 1.100, 2.377), 1.524 (95% CI: 0.798, 2.249), and 2.650 (95% CI: 1.292, 4.009) in all subjects, females, and males, respectively, while those between VFA and CAP were 0.190 (95% CI: 0.133, 0.247), 0.184 (95% CI: 0.117, 0.252), and 0.194 (95% CI: 0.086, 0.301). Mediation analysis showed that visceral fat accumulation contributed to 51.37%, 53.85%, and 26.51% of obesity-induced hepatic steatosis in the total, female, and male subjects, respectively.

CONCLUSION

Visceral fat accumulation partially mediates obesity-induced hepatic steatosis in individuals with overweight and obesity, especially in women. More focus on visceral fat reduction is needed in individuals with obesity.

Joint effects of carotid plaques and renal impairment on the risk of cardiovascular disease and all-cause death in a community-based population: The Kailuan cohort study

OBJECTIVE

It is unknown whether renal impairment and atherosclerosis increase the risk of cardiovascular disease (CVD) and death. Atherosclerosis already raises the risk of CVD and all-cause death. This study investigated the joint effects of carotid plaques and renal impairment on CVD and all-cause death in community-based populations.

METHODS

The study cohort consisted of 20,416 participants from the Kailuan Study who completed a carotid plaque ultrasound in 2012. A glomerular filtration rate (GFR) of < 60 ml/min or trace semiquantitative proteinuria or higher were both considered signs of renal insufficiency. We divided them into four groups according to the presence of carotid plaque and renal impairment. These groups were categorized as no carotid plaque, estimated glomerular filtration rate (eGFR) ≥ 60 ml/min, and proteinuria < trace; no carotid plaque, eGFR < 60 ml/min, and proteinuria ≥ trace; carotid plaque, eGFR ≥ 60 ml/min and proteinuria < trace; and carotid plaque, eGFR < 60 ml/min, and proteinuria ≥ trace, respectively. We investigated the combined effect of renal impairment and carotid plaque on cardiovascular events and all-cause death in the Kailuan community-based population.

RESULT

Participants with carotid plaque, eGFR < 60 ml/min and proteinuria had a 2.88-fold higher risk of all-cause death (95% CI, 2.18-3.80), which was significantly higher than those with lone factors (HR, 1.57; 95% CI, 1.04-2.36; and HR, 1.91; 95% CI, 1.56-2.32), compared to participants with no carotid plaque, eGFR ≥ 60 ml/min and proteinuria

CONCLUSION

The joint of carotid plaques and renal impairment may further increase the risk of CVD and all-cause death compared with participants with alone factors in the age of ≥ 50 years, but not in the age of < 50 years, from a community-based study.

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Key Words

• all-cause death
• cardiovascular disease
• carotid plaque
• community-based populations
• estimated glomerular filtration rate

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Analysis of diastolic left ventricular wall shear stress in normal people of different age groups

Background

Diastolic wall shear stress (WSS), assessed by using vector flow mapping (VFM), is the result of the interaction between the blood flow and the ventricular wall. This study aimed to evaluate the trend of left ventricular (LV) WSS in normal subjects.

Methods and results

A total of 371 healthy volunteers were recruited and divided into four age groups (group I: 18–30 years; group II: 31–43 years; group III: 44–56 years; group IV: 57–70 years). LV WSS of different age groups was measured at each diastolic phase (P1: isovolumic diastolic period, P2: rapid filling period, P3: slow filling period, and P4:atrial contraction period) to evaluate the change trend of LV WSS. In each age group, LV WSS coincided with a trend of increasing-decreasing-increasing during P1–P4 (P < 0.05). Besides, among groups I, II, III, and IV, WSS of anterolateral, inferoseptal, and anteroseptal in P1 and WSS of inferolateral, inferoseptal, and anteroseptal in P4 all showed an increasing trend with age (P < 0.05). Regarding sex differences, women had greater diastolic WSS compared to men (P < 0.05).

Conclusion

LV WSS showed a regular variation and had specific age- and sex-related patterns in different diastolic phases.

Simple surrogate equations to predict controlled attenuation parameter values for screening non-alcoholic fatty liver disease in a Chinese population

Objective

Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease. The controlled attenuation parameter (CAP) obtained by FibroScan reflects the level of liver steatosis in patients with obesity. Our study aimed to construct a simple equation to predict the CAP, to facilitate the screening and monitoring of patients at high risk for NAFLD.

Methods

A total of 272 subjects were randomly divided into derivation and validation cohorts at a ratio of 1:2. The derivation set was used for constructing a multiple linear regression model; the validation set was used to verify the validity of the model.

Results

Several variables strongly correlated with the CAP were used to construct the following equation for predicting CAP values:CAP1 = 2.4 × BMI + 10.5 × TG+ 3.6 × NC + 10.3 × CP +31.0, where BMI is body mass index, TG is triglyceride, NC is neck circumference and CP is C-peptide. The CAP1 model had an R2 of 0.764 and adjusted R2 of 0.753. It was then simplified to derive CAP2 included only simple anthropometric parameters: CAP2 = 3.5 × BMI + 4.2 × NC + 20.3 (R2 = 0.696, adjusted R2 = 0.689). The data were well fitted by both models. In the verification group, the predicted (CAP1 and CAP2) values were compared to the actual CAP values. For the CAP1 equation, R2 = 0.653, adjusted R2 = 0.651. For the CAP2 equation, R2 = 0.625, adjusted R2 = 0.623. The intra-class correlation coefficient (ICC) values were 0.781 for CAP1 and 0.716 for CAP2 (p &lt; 0.001). The actual CAP and the predicted CAP also showed good agreement in Bland-Altman plot.

Conclusion

The equations for predicting the CAP value comprise easily accessible variables, and showed good stability and predictive power. Thus, they can be used as simple surrogate tools for early screening and follow-up of NAFLD in the Chinese population.

A Prediction Equation to Estimate Vascular Endothelial Function in Different Body Mass Index Populations

Objective

Vascular endothelial dysfunction is considered an early predictor of endothelial injury and the initiating factor of atherosclerosis (AS). Brachial artery flow-mediated dilation (FMD) can detect endothelial injury early and provide important prognostic information beyond traditional cardiovascular (CV) risk factors. This study aimed to find the influencing factors of FMD and develop a simple prediction model in populations with different body mass indices (BMIs).

Methods

In total, 420 volunteers with different BMIs were recruited in our study. Subjects were randomly assigned to the derivation and validation cohorts (the ratio of the two was 1:2) with simple random sampling. The former was used for influencing factors searching and model construction of FMD and the latter was used for verification and performance evaluation.

Results

The population was divided into two groups, i.e., 140 people in the derivation group and 280 people in the verification group. Analyzing in the training data, we found that females had higher FMD than males (p < 0.05), and FMD decreased with age (p < 0.05). In people with diabetes, hypertension or obesity, FMD was lower than that in normal individuals (p < 0.05). Through correlation analysis and linear regression, we found the main influencing factors of FMD: BMI, age, waist-to-hip radio (WHR), aspartate aminotransferase (AST) and low-density lipoprotein (LDL). And we developed a simple FMD prediction model: FMD = −0.096BMI−0.069age−4.551WHR−0.015AST−0.242LDL+17.938, where R² = 0.599, and adjusted R² = 0.583. There was no statistically significant difference between the actual FMD and the predicted FMD in the verification group (p > 0.05). The intra-class correlation coefficient (ICC) was 0.77. In a Bland-Altman plot, the actual FMD and the predicted FMD also showed good agreement. This prediction model had good hints in CV risk stratification (area under curve [AUC]: 0.780, 95 % confidence intervals [95% CI]: 0.708–0.852, p < 0.001), with a sensitivity and specificity of 73.8 and 72.1%, respectively.

Conclusions

Males, older, obesity, hypertension, diabetes, smoking, etc. were risk factors for FMD, which was closely related to CV disease (CVD). We developed a simple equation to predict FMD, which showed good agreement between the training and validation groups. And it would greatly simplify clinical work and may help physicians follow up the condition and monitor therapeutic effect. But further validation and modification bears great significance.

Marriage of Virus-Mimic Surface Topology and Microbubble-Assisted Ultrasound for Enhanced Intratumor Accumulation and Improved Cancer Theranostics

The low delivery efficiency of nanoparticles to solid tumors greatly reduces the therapeutic efficacy and safety which is closely related to low permeability and poor distribution at tumor sites. In this work, an "intrinsic plus extrinsic superiority" administration strategy is proposed to dramatically enhance the mean delivery efficiency of nanoparticles in prostate cancer to 6.84% of injected dose, compared to 1.42% as the maximum in prostate cancer in the previously reported study. Specifically, the intrinsic superiority refers to the virus-mimic surface topology of the nanoparticles for enhanced nano-bio interactions. Meanwhile, the extrinsic stimuli of microbubble-assisted low-frequency ultrasound is to enhance permeability of biological barriers and improve intratumor distribution. The enhanced intratumor enrichment can be verified by photoacoustic resonance imaging, fluorescence imaging, and magnetic resonance imaging in this multifunctional nanoplatform, which also facilitates excellent anticancer effect of photothermal treatment, photodynamic treatment, and sonodynamic treatment via combined laser and ultrasound irradiation. This study confirms the significant advance in nanoparticle accumulation in multiple tumor models, which provides an innovative delivery paradigm to improve intratumor accumulation of nanotherapeutics.

CircANKRD52 Promotes the Tumorigenesis of Hepatocellular Carcinoma by Sponging miR-497-5p and Upregulating BIRC5 Expression

CircRNAs participate in the pathogenesis of a variety of cancers. Previous studies showed that baculoviral IAP repeat containing 5 (BIRC5) can promote tumor progression. But, the mechanisms by which circRNAs regulate BIRC5 expression in hepatocellular carcinoma (HCC) remain unknown. The clinical prognosis of BIRC5 or miR-497-5p expression in patients with HCC was assessed by TCGA RNA-seq dataset. hsa_circ_0026939 (circANKRD52) or BIRC5 was identified to bind with miR-497-5p by luciferase gene report, RIP and circRIP assays. MTT, colony formation, Transwell assays and a xenograft tumor model were used to estimate the role of miR-497-5p or circANKRD52 in HCC cells. As a result, we found that elevated expression of BIRC5 or decreased expression of miR-497-5p was linked to poor survival in HCC. Restored expression of miR-497-5p repressed cell proliferation, colony formation and invasiveness by targeting BIRC5, but its inhibitor showed the opposite results. Furthermore, circANKRD52 possessed a tumor-promoting effect by acting as a sponge of miR-497-5p and thereby upregulated BIRC5 in HCC cells. In conclusion, our findings demonstrated that circANKRD52 enhances the tumorigenesis of HCC by sponging miR-497-5p and upregulating BIRC5 expression.

Serum Creatinine-to-Cystatin C Ratio in the Progression Monitoring of Non-alcoholic Fatty Liver Disease

Background

The simultaneous assessment of visceral adiposity and muscle mass might be useful to monitor the risk of non-alcoholic fatty liver disease (NAFLD) progression in large population. We aimed to investigate the value of serum creatinine-to-cystatin C ratio (CCR) in evaluating these two parameters and predicting liver steatosis and fibrosis.

Methods

154 overweight/obese inpatients (49 males, 105 females) scheduled for bariatric surgery and 49 non-overweight/obese volunteers (18 males, 31 females) responded to the hospital advertisement were involved in the cross-sectional study. Liver steatosis and fibrosis were diagnosed with transient elastography (TE). The psoas muscle area (PMA) and visceral fat area (VFA) were measured using magnetic resonance imaging.

Results

The body mass index, insulin resistance, and lipid profiles showed significant differences between the CCR tertiles. Multiple regression analyses revealed that the CCR was significantly associated with the controlled attenuation parameter (β = −0.30, P = 0.006 in males; β = −0.19, P = 0.017 in females) and liver stiffness measurements in males (β = −0.246, P = 0.044). A low CCR was associated with moderate-to-severe steatosis (P < 0.001), significant liver fibrosis (P < 0.01), and excellent predictive power for these two conditions (P < 0.01). The CCR had a negative correlation with the VFA/PMA ratio (r = −0.584, P < 0.001 in males; r = −0.569, P < 0.001 in females).

Conclusions

The CCR is a serum marker for muscle-adjusted visceral fat mass, and a low CCR is associated with an increased risk of progressive NAFLD.

Relationship Between Morphologic Characteristics of Ultrasonic Calcification in Thyroid Nodules and Thyroid Carcinoma

The aim of this study was to investigate the relationship between morphologic characteristics of the calcifications detected by ultrasound in thyroid nodules and thyroid carcinoma. Morphologic characteristics of the calcifications on pre-operative ultrasound examinations of thyroids were compared with post-operative pathologic diagnoses in 543 patients undergoing thyroid surgery. Calcifications were divided into microcalcifications (≤2 mm) and macrocalcifications (>2 mm), and the latter were divided into eggshell calcifications in a row, eggshell discontinuous calcifications, irregular calcifications and multilayer-like calcifications, labeled types I-V. We found that thyroid microcalcifications and partial macrocalcifications, such as eggshell discontinuous calcifications, and multilayer-like calcifications were associated with thyroid carcinoma. In conclusion, microcalcifications were more commonly found in malignant thyroid nodules, particularly in papillary thyroid carcinoma. Eggshell discontinuous macrocalcifications and multilayer-like macrocalcifications also occurred mainly in malignant nodules.

Low-frequency ultrasound-mediated microvessel disruption combined with docetaxel to treat prostate carcinoma xenografts in nude mice: A novel type of chemoembolization

The aim of the present study was to investigate whether low-frequency ultrasound (US)-mediated microvessel disruption combined with docetaxel (DTX) can be used as a novel type of chemoembolization. Mice were assigned to four groups: i) The USMB group, treated with low-frequency US combined with microbubbles (USMB); ii) the DTX group, treated with DTX; iii) the USMB + DTX group, treated with combined therapy; and iv) the control group, which was untreated. Immediately after the first treatment, the average peak intensity (API) on contrast-enhanced US was calculated, and tumors were excised for hematoxylin and eosin (HE) staining. At 2 weeks post-treatment, the tumor volumes and wet weights were calculated, and tumors were excised for immunohistochemistry to calculate apoptotic index (AI), proliferative index (PI) and microvessel density (MVD) values. Immediately after the first treatment, in the DTX and control groups, the tumors demonstrated abundant perfusion enhancement, while in the USMB + DTX and USMB groups, blood perfusion of the tumors was interrupted. Compared with that of the control group, the API was significantly lower in the USMB + DTX USMB groups (all P<0.001). HE staining showed that tumor microvasculature was disrupted into flaky hematomas and severely dilated microvessels in the USMB + DTX and USMB groups. In the DTX and control groups, there was no distinct evidence of the disruption and dilation of blood microvessels. At the end of the treatment, the mean tumor inhibition ratio was 73.33, 46.67 and 33.33% for the USMB + DTX, DTX and USMB groups, respectively. The USMB + DTX group had the highest AI, and the lowest PI and MVD compared with the other groups, although the difference between the USMB + DTX and DTX groups with regard to PI and MVD was not significant (USMB + DTX vs. DTX group, P=0.345 and P=0.059, respectively). In conclusion, as a novel type of chemoembolization, USMB combined with DTX is more effective than USMB or DTX alone in inhibiting tumor growth via the enhancement of apoptosis, and the suppression of proliferation and angiogenesis.

Low-frequency and low-intensity ultrasound-mediated microvessel disruption enhance the effects of radiofrequency ablation on prostate cancer xenografts in nude mice

The aim of the present study was to examine the impact of low-frequency, low-intensity ultrasound (US)-stimulated microbubbles (USMB) on radiofrequency ablation (RFA) in the treatment of nude mice with human prostate cancer xenografts. The tumor‑bearing nude mice were divided into three groups: The USMB+RFA group was treated with USMB immediately followed by RFA, the RFA group was treated with RFA alone, and the control group remained untreated. The animals underwent enhanced US to calculate the tumor volumes, ablation volumes and ablation rates. Subsequently, the tumors were excised for hematoxylin and eosin staining, to identify necrosis in the tumors following the treatments, and immunohistochemical staining, to analyze the apoptotic index (AI), proliferative index (PI) and microvessel density (MVD) at 1, 4 and 7 days post-treatment. Each group contained five mice at each time‑point. Necrosis was apparent in the center of the tumors in the treatment groups. Ablation lesion volumes of the USMB+RFA group were larger than those in the RFA group at 1 and 4 days post‑treatment (P=0.002 and P=0.022, respectively), and the ablation rates of the USMB+RFA group were significantly higher, compared with the RFA group at the three time‑points (all P<0.001). There were fewer apoptotic cells and more proliferative cells in the RFA group, compared with the control group 1,4 and 7 days post‑treatment (all P<0.05). The AI of the USMB+RFA group was higher than that of the control group and lower than that of the RFA group 1 day post-treatment (P=0.034 and P=0.016, respectively). The PI of the USMB+RFA group was lower than that of the control group and higher than that of the RFA group 4 and 7 days post-treatment (all P<0.05). No significant differences were observed in MVD among the three groups throughout the experiment. In conclusion, exposure to USMB prior to RFA produced larger volumes of ablation, compared with treatment with RFA alone, and increased AI and reduced PI in the residual carcinoma cells induced by RFA.

Optimization of low-frequency low-intensity ultrasound-mediated microvessel disruption on prostate cancer xenografts in nude mice using an orthogonal experimental design

The present study aimed to provide a complete exploration of the effect of sound intensity, frequency, duty cycle, microbubble volume and irradiation time on low-frequency low-intensity ultrasound (US)-mediated microvessel disruption, and to identify an optimal combination of the five factors that maximize the blockage effect. An orthogonal experimental design approach was used. Enhanced US imaging and acoustic quantification were performed to assess tumor blood perfusion. In the confirmatory test, in addition to acoustic quantification, the specimens of the tumor were stained with hematoxylin and eosin and observed using light microscopy. The results revealed that sound intensity, frequency, duty cycle, microbubble volume and irradiation time had a significant effect on the average peak intensity (API). The extent of the impact of the variables on the API was in the following order: Sound intensity; frequency; duty cycle; microbubble volume; and irradiation time. The optimum conditions were found to be as follows: Sound intensity, 1.00 W/cm²; frequency, 20 Hz; duty cycle, 40%; microbubble volume, 0.20 ml; and irradiation time, 3 min. In the confirmatory test, the API was 19.97±2.66 immediately subsequent to treatment, and histological examination revealed signs of tumor blood vessel injury in the optimum parameter combination group. In conclusion, the Taguchi L₁₈ (3)⁶ orthogonal array design was successfully applied for determining the optimal parameter combination of API following treatment. Under the optimum orthogonal design condition, a minimum API of 19.97±2.66 subsequent to low-frequency and low-intensity mediated blood perfusion blockage was obtained.

Combined low-frequency ultrasound and microbubble contrast agent for the treatment of benign prostatic hyperplasia

BACKGROUND AND PURPOSE

Benign prostatic hyperplasia is one of the most common conditions in middle-aged and elderly men. The aim of the study was to investigate the treatment effects of low-frequency ultrasound combined with a microbubbles agent on benign prostatic hyperplasia.

METHODS

Eighteen 7-year-old male beagles with prostatic hyperplasia were randomly divided into six groups (n=3): Control group, 21 kHz ultrasound group, 21 kHz ultrasound and microbubble contrast agent group, 1 MHz ultrasound group, 1 MHz ultrasound and microbubble contrast agent group, and microbubble contrast agent group. The histopathologic damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), and super oxidase dimutase (SOD) were detected by enzyme-linked immunosorbent assay. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr) were detected by the Biochemistry Automatic Analyzer.

RESULTS

Significant tissue injury, mitochondria injury, and cell apoptosis were observed in 21 kHz ultrasound and the microbubble contrast agent group. Compared with the control and microbubbles contrast agent groups, the decrease in levels of PSA or increase in levels of iNOs and SOD in the other four groups were statistically significant (P<0.05). The lowest level of PSA and the highest levels of iNOs and SOD were observed in the 21 kHz ultrasound and microbubbles contrast agent group. No significant changes in levels of AST, ALT, BUN, and Cr were observed between the six groups.

CONCLUSIONS

Our results suggest that lower frequency ultrasound may have a better effect on benign prostatic hyperplasia, and microbubble contrast agent application further strengthens this biological effect.

Enhancement of recombinant adeno-associated virus mediated transgene expression by targeted echo-contrast agent

Ultrasound-targeted microbubble destruction (UTMD) has been recently developed for destroying bubbles carrying drugs or genes, thereby permitting local release of these target molecules. We investigated whether SonoVue®, a new contrast agent that contains phospholipid-stabilized microbubbles filled with sulfur hexafluoride vapor, is effective at delivering a recombinant adeno-associated viral (rAAV) vector to the rat heart by UTMD. Serotype-2 (rAAV2) marked with green fluorescent protein (GFP) as a reporter gene was attached to the surface of sulfur hexafluoride-filled microbubbles. Microbubbles were infused into the tail vein of rats with or without simultaneous echocardiography. Additional controls included ultrasound microbubbles that did not contain virus, virus alone, and virus plus ultrasound. One group underwent echocardiographic destruction of microbubbles followed by rAAV2-GFP infusion. Rats were killed after 4 weeks and examined for GFP expression. Green fluorescence was detected in all groups that received the rAAV2-GFP vector, indicating expression of the rAAV2 transgene; however, GFP expression in the UTMD group was significantly higher than that in control groups. We conclude that ultrasound-mediated destruction mediated by SonoVue is a promising method for delivery of rAAV2 to the heart in vivo.