Publications by authors named "Jinfeng Xu"

105 Publications

Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis.

Eur J Radiol 2021 Oct 2;144:109991. Epub 2021 Oct 2.

Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China. Electronic address:

Purpose: This systematic review and meta-analysis aimed to evaluate the diagnostic performance of ultrasound elastography in the differentiation of benign and malignant breast non-mass lesions (NMLs).

Methods: PubMed, Cochrane Library, and Embase databases were searched for eligible studies up to end of June 2021. The diagnostic performance of elastography for NMLs was investigated using pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio (DOR), post-test probability, and the area under hierarchical summary receiver operating characteristic curve (HSROC).

Results: Eleven studies involving 812 NMLs (malignant 414) were included. The pooled sensitivity, specificity, DOR, positive likelihood ratio, and negative likelihood of elastography for the differentiation of benign and malignant breast NMLs were 79% (95 %CI: 71-85), 86% (95 %CI: 79-91), 23.32 (95 %CI: 13.38-40.66), 5.67 (95 %CI: 3.79-8.47), and 0.24 (95 %CI: 0.17-0.34), respectively. No significant publication bias existed. The area under the HSROC curve was 90% (95 %CI: 87-92). Fagan plots demonstrated good clinical utility. However, substantial heterogeneity existed. Country, measurement index, and number of lesions served as potential sources of heterogeneity.

Conclusions: The results of this study suggest that elastography has high diagnostic accuracy in differentiating between malignant and benign NMLs. Elastography can be a feasible and non-invasive tool for breast NMLs.
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http://dx.doi.org/10.1016/j.ejrad.2021.109991DOI Listing
October 2021

Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta.

BMC Pregnancy Childbirth 2021 Sep 21;21(1):640. Epub 2021 Sep 21.

Department of Obstetrics and Gynecology, Ministry of Education, West China Second University Hospital of Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.

Background: Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta.

Methods: A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected.

Results: Median estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0-31.5) verus 3 (0-39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05).

Conclusions: PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.
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http://dx.doi.org/10.1186/s12884-021-04103-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456564PMC
September 2021

Metanephric adenoma: association between the imaging features of contrast-enhanced ultrasound and clinicopathological characteristics.

Gland Surg 2021 Aug;10(8):2490-2499

Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.

Background: This study aimed to improve the understanding of metanephric adenoma (MA) by retrospective analysis of contrast-enhanced ultrasound (CEUS) findings and clinicopathological characteristics of MAs.

Methods: Gray-scale ultrasound (US) and CEUS findings of 7 adult MA patients, confirmed by postoperative pathology, were summarized via collection of clinicopathological and ultrasonographic imaging data, including tumor location, size, echo intensity, color flow, presence or absence of calcification, and liquefactive necrosis, contrast-enhanced pattern, enhancement characteristics, and contrast wash-out compared with adjacent parenchyma, and the presence or absence of a pseudocapsule. Histopathological analyses, including hematoxylin and eosin (HE) and immunohistochemical (IHC) staining, were conducted with the EnVision method.

Results: All 7 participants were female, aged 29-73 years (mean age, 54 years), with flank pain (3/7). All tumors were solid (7/7) with sizes of 2.0-5.0 cm (mean diameter, 3.07 cm), including 4 in the left kidney, 3 in the right kidney, 2 in the renal pelvis, and 5 in the renal parenchyma. On the gray-scale US, MA was shown as hypoechoic (4/7), slightly hyperechoic (2/7), isoechoic (1/7), and with a defined border. The morphology was regular and rounded (7/7), internal echogenicity was homogeneous (5/7), and no calcification was seen (7/7). The CEUS showed clear boundaries (7/7), homogeneous isodensity (5/7), with calcification (0/7), necrosis (2/11), heterogeneous hyperattenuation (2/7), pseudocapsule (2/7), and medullary phase fast wash-out (7/7). The surgical methods were radical nephrectomy (4/7) and partial nephrectomy (3/7). The duration of follow-up period for all participants was 3-74 months, and no local or distant recurrences were found. The IHC staining showed that most tumor cells were positive for WT1, cytokeratins AE1/AE3, vimentin, and CD57, and exhibited focal positivity for CK7, while negative for CD10, AMACR, and CK720. The proliferative index (Ki-67) was 2-3%.

Conclusions: On gray-scale US, MA appears as a solid nodule with a well-defined boundary, regular morphology, and homogeneous echogenicity; CEUS shows slow progression and slightly lower homogeneous enhancement and fast wash-out in the medullary phase. These findings may provide insight into the progression of MA and aid in the development of diagnostic and therapeutic strategies.
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http://dx.doi.org/10.21037/gs-21-437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411086PMC
August 2021

Characterization of NAC family genes in Salvia miltiorrhiza and NAC2 potentially involved in the biosynthesis of tanshinones.

Phytochemistry 2021 Nov 25;191:112932. Epub 2021 Aug 25.

Key Laboratory of Plant Secondary Metabolism and Regulation of Zhejiang Province, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, 310018, China. Electronic address:

The NAC (NAM, ATAF, and CUC) family members are specific transcription factors in plants. The large family is involved in many plant growth and developmental processes, as well as in abiotic/biotic stress responses. It has been well studied in the genomes of various plants, including Arabidopsis thaliana, tomato, and quinoa. However, identification and functional studies of NAC family members in medicinal Salvia miltiorrhiza are limited. Here, we systematically identified 84 NAC genes and named them according to their gene IDs in the recently sequenced genome. The phylogeny of NAC family protein sequences was analyzed using bioinformatics methods, which divided them into nine subfamilies. Then, their chromosomal locations, gene structures and conserved domains were analyzed comprehensively. To further investigate the regulatory functions of NACs in S. miltiorrhiza, we analyzed the response of 10 selected NAC genes to methyl jasmonate and used NAC2 for transgenic experiments. The overexpression of Sm-NAC2 decreased the tanshinone I and IIA contents by 56% and 62%, respectively. However, Sm-NAC2-RNAi promoted the accumulation of four tanshinones, tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone I, which increased 3.68-, 4.1-, 3.13- and 5.9- fold, respectively, compared with wild type. In the tanshinone biosynthetic pathways, the overexpression of Sm-NAC2 down-regulated CYP76AH1, and the silencing of Sm-NAC2 up-regulated the expression levels of HMGR1, DXS2, KSL2, and CYP76AH1. This study provides information on the evolution of Sm-NAC genes and their possible functions, and it lays a foundation for further research into the NAC family-associated regulation of tanshinone biosynthesis.
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http://dx.doi.org/10.1016/j.phytochem.2021.112932DOI Listing
November 2021

Tumor elastography and its association with cell-free tumor DNA in the plasma of breast tumor patients: a pilot study.

Quant Imaging Med Surg 2021 Aug;11(8):3518-3534

Shenzhen Key Laboratory of Viral Oncology, Center for Clinical Research and Innovation (CCRI), Shenzhen Hospital, Southern Medical University, Shenzhen, China.

Background: Breast tumor stiffness, which can be objectively and noninvasively evaluated by ultrasound elastography (UE), has been useful for the differentiation of benign and malignant breast lesions and the prediction of clinical outcomes. Liquid biopsy analyses, including cell-free tumor DNA (ctDNA), exhibit great potential for personalized treatment. This study aimed to investigate the correlations between the UE and ctDNA for early breast cancer diagnosis.

Methods: Breast tumor stiffness in 10 patients were assessed by shear wave elastography (SWE), and the ctDNA of eight collected plasma specimens with different tumor stiffness were analyzed by whole-genome sequencing (WGS). Subsequently, the distribution of carcinoma-associated fibroblasts (CAFs) was investigated by detecting the expression levels of alpha-smooth muscle actin (α-SMA) in tissues of breast lesions. We validated the function of discoidin domain receptor 2 (DDR2) in breast tumor CAFs by knockout of fibroblast activation protein (FAP) with different tumor stiffness during cancer progression and .

Results: The UE estimates of tumor stiffness positively correlated with CAF-rich (α-SMA) tumors (P<0.05). Copy number profiles and percent genome alterations were remarkably different between benign and malignant breast lesions. Somatic genomic alterations or structural variants of , , , and genes were identified in ctDNA of plasma from breast lesions with high SWE values and an increase in the CAF content obtained from clinical samples. Deletion of FAP in breast tumor CAFs by CRISPR/Cas9-mediated gene knockout and decreased tumor stiffness resulted in downregulated expression of (P<0.05), which in turn led to decreasing the tumor stiffness and carcinogenesis process and .

Conclusions: These results have established proof of principle that WGS analysis of ctDNA could complement current UE approaches to assess tumor stiffness changes for the early diagnosis and prognostic assessment of breast cancer.
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http://dx.doi.org/10.21037/qims-20-443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245960PMC
August 2021

Causal mediation analysis with latent subgroups.

Stat Med 2021 Nov 15;40(25):5628-5641. Epub 2021 Jul 15.

Department of Statistics and Actuarial Science, University of Hong Kong, Pokfulam, Hong Kong SAR, China.

In biomedical studies, the causal mediation effect might be heterogeneous across individuals in the study population due to each study subject's unique characteristics. While individuals' mediation effects may differ from each other, it is often reasonable and more interpretable to assume that individuals belong to several distinct latent subgroups with similar attributes. In this article, we first show that the subgroup-specific mediation effect can be identified under the group-specific sequential ignorability assumptions. Then, we propose a simple mixture modeling approach to account for the latent subgroup structure where each mixture component corresponds to one latent subgroup in the linear structural equation model framework. Model parameters can be estimated using the standard expectation-maximization (EM) algorithm. Each individual's subgroup membership can be inferred based on the posterior probability. We propose to use the singular Bayesian information criterion to consistently select the number of latent subgroups by recognizing that the Fisher information matrix for mixture models might be singular. We then propose to use nonparametric bootstrap method to compute standard errors and confidence intervals. We conducted simulation studies to evaluate the empirical performance of our proposed method named iMed. Finally, we reanalyzed a DNA methylation data set from the Normative Aging Study and found that the mediation effects of two well-documented DNA methylation CpG sites are heterogeneous across two latent subgroups in the causal pathway from smoking behavior to lung function. We also developed an R package iMed for public use.
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http://dx.doi.org/10.1002/sim.9144DOI Listing
November 2021

Development and validation of a nomogram based on multiparametric magnetic resonance imaging and elastography-derived data for the stratification of patients with prostate cancer.

Quant Imaging Med Surg 2021 Jul;11(7):3252-3262

Department of Ultrasound, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.

Background: This study sought to develop and validate a nomogram combining the elastographic Q-analysis score (EQS), the Prostate Imaging Reporting and Data System (PI-RADS) score, and clinical parameters for the stratification of patients with prostate cancer (PCa).

Methods: A retrospective study was conducted of 375 patients with 375 lesions who underwent volume-navigation transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (MP-MRI)-fusion targeted biopsies between April 2017 and January 2020. Based on a multivariate logistic regression model, a nomogram was created to assess any PCa and high-risk PCa [Gleason score (GS) ≥4+3] using data from patients diagnosed between April 2017 and June 2019 (n=271), and was validated in patients diagnosed after July 2019 (n=104). The nomogram's performance was evaluated based on its discrimination, calibration, and clinical usefulness.

Results: The areas under the curve (AUCs) of the nomogram for predicting any PCa and high-risk PCa were 0.949 [95% confidence interval (CI), 0.921 to 0.978] and 0.936 (95% CI, 0.906 to 0.965), respectively, in the training cohort, and 0.946 (95% CI, 0.894 to 0.997) and 0.971 (95% CI, 0.9331 to 1), respectively, in the validation cohort. The nomogram was well calibrated, and no significant difference was found between the predicted and observed probabilities. A decision curve analysis (DCA) for the nomogram with and without the EQS showed that the threshold probability of for any PCa was <67%.

Conclusions: The nomogram that combined elastography-derived and MP-MRI data was more clinically useful than the model based on PI-RADS and clinical parameters alone. Our nomogram could aid urologists to make decisions and avoid unnecessary biopsies.
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http://dx.doi.org/10.21037/qims-20-978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250010PMC
July 2021

Category encoding method to select feature genes for the classification of bulk and single-cell RNA-seq data.

Stat Med 2021 08 24;40(18):4077-4089. Epub 2021 May 24.

Zhongtai Securities Institute for Financial Studies, Shandong University, Jinan, China.

Bulk and single-cell RNA-seq (scRNA-seq) data are being used as alternatives to traditional technology in biology and medicine research. These data are used, for example, for the detection of differentially expressed (DE) genes. Several statistical methods have been developed for the classification of bulk and single-cell RNA-seq data. These feature genes are vitally important for the classification of bulk and single-cell RNA-seq data. The majority of genes are not DE and they are thus irrelevant for class distinction. To improve the classification performance and save the computation time, removal of irrelevant genes is necessary. Removal will aid the detection of the important feature genes. Widely used schemes in the literature, such as the BSS/WSS (BW) method, assume that data are normally distributed and may not be suitable for bulk and single-cell RNA-seq data. In this article, a category encoding (CAEN) method is proposed to select feature genes for bulk and single-cell RNA-seq data classification. This novel method encodes categories by employing the rank of sequence samples for each gene in each class. Correlation coefficients are considered for gene and class with the rank of sample and a new rank of category. The highest gene correlation coefficients are considered feature genes, which are the most effective for classifying bulk and single-cell RNA-seq dataset. The sure screening method was also established for rank consistency properties of the proposed CAEN method. Simulation studies show that the classifier using the proposed CAEN method performs better than, or at least as well as, the existing methods in most settings. Existing real datasets were analyzed, with the results demonstrating superior performance of the proposed method over current competitors. The application has been coded into an R package named "CAEN" to facilitate wide use.
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http://dx.doi.org/10.1002/sim.9015DOI Listing
August 2021

Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis.

Ultrasonography 2021 Oct 2;40(4):465-473. Epub 2021 Feb 2.

Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.

Purpose: The aim of this study was to evaluate the value of elastography in the differential diagnosis of benign versus malignant testicular lesions.

Methods: The PubMed, Cochrane Library, and Embase databases were searched for relevant studies. The diagnostic accuracy of elastography was evaluated using pooled sensitivity, specificity, likelihood ratio, post-test probability, diagnostic odds ratio, and by summarizing the area under the hierarchical summary receiver operating characteristic (HSROC) curve.

Results: Seven studies with 568 lesions were included. The pooled sensitivity and specificity were 87% (95% confidence interval [CI], 81% to 92%) and 81% (95% CI, 65% to 90%), respectively. The pooled estimates of the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.48 (95% CI, 2.37 to 8.47), 0.16 (95% CI, 0.10 to 0.25), and 28.11 (95% CI, 11.39 to 69.36), respectively. The area under the HSROC curve was 90% (95% CI, 88% to 93%).

Conclusion: Elastography is useful for assessing the stiffness of testicular lesions and for differentiating benign from malignant lesions. Elastography can be an effective supplement to conventional ultrasonography.
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http://dx.doi.org/10.14366/usg.20191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446503PMC
October 2021

Phasic Off responses of auditory cortex underlie perception of sound duration.

Cell Rep 2021 Apr;35(3):109003

School of Biomedical Engineering, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou 510515, China; Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou 510220, China. Electronic address:

It has been proposed that sound information is separately streamed into onset and offset pathways for parallel processing. However, how offset responses contribute to auditory perception remains unclear. Here, loose-patch and whole-cell recordings in awake mouse primary auditory cortex (A1) reveal that a subset of pyramidal neurons exhibit a transient "Off" response, with its onset tightly time-locked to the sound termination and its frequency tuning similar to that of the transient "On" response. Both responses are characterized by excitation briefly followed by inhibition, with the latter mediated by parvalbumin (PV) inhibitory neurons. Optogenetically manipulating sound-evoked A1 responses at different temporal phases or artificially creating phantom sounds in A1 further reveals that the A1 phasic On and Off responses are critical for perceptual discrimination of sound duration. Our results suggest that perception of sound duration is dependent on precisely encoding its onset and offset timings by phasic On and Off responses.
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http://dx.doi.org/10.1016/j.celrep.2021.109003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154544PMC
April 2021

The additional use of hydroxychloroquine can improve the live birth rate in pregnant women with persistent positive antiphospholipid antibodies: A systematic review and meta-analysis.

J Gynecol Obstet Hum Reprod 2021 Oct 18;50(8):102121. Epub 2021 Mar 18.

Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China. Electronic address:

Purpose: To evaluate the efficacy of additional treatment with hydroxychloroquine (HCQ) for pregnant women with persistent positive antiphospholipid antibodies or antiphospholipid antibody syndrome (APS).

Method: We conducted a systematic search of the PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials databases from inception to 31th December 2019. Two authors performed study selection, data collection, and data analysis independently.

Result: Five retrospective studies involving 477 pregnancies were selected. The live birth rate was significantly improved in the experimental group (OR, 3.29; 95 % CI, 1.45-7.49; P = 0.004). Additionally, pregnancy loss was associated with the additional use of HCQ (OR, 0.30;95 % CI, 0.13-0.69; P = 0.004). However, HCQ had no significant association with preterm delivery (OR, 0.43; 95 % CI, 0.13-1.37; P = 0.16) and fetal growth restriction showed an OR of 0.22 (95 % CI, 0.13-1.88; P = 0.55).

Conclusion: These data suggest that receiving HCQ as an additional treatment can improve the live birth rate in pregnant women with persistent antiphospholipid antibodies.
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http://dx.doi.org/10.1016/j.jogoh.2021.102121DOI Listing
October 2021

The study of antiviral drugs targeting SARS-CoV-2 nucleocapsid and spike proteins through large-scale compound repurposing.

Heliyon 2021 Mar 1;7(3):e06387. Epub 2021 Mar 1.

Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, 510632, China.

Contributing to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clinical treatment, a drug library encompassing approximately 3,142 clinical-stage or FDA-approved small molecules is profiled to identify the candidate therapeutic inhibitors targeting nucleocapsid protein (N) and spike protein (S) of SARS-CoV-2. 16 screened candidates with higher binding affinity are evaluated via virtual screening. Comparing to those under trial/temporarily used antivirus drugs (i.e., umifenovir, lopinavir), ceftriaxone, cefotaxime, and cefuroxime show higher binding affinities to the N-terminal domain of N protein (N-NTD), C-terminal domain of N protein (N-CTD), and receptor-binding domain of S protein (S-RBD). Cefotaxime and cefuroxime have high binding affinities towards S-RBD with angiotensin-converting enzyme 2 (ACE2) complex via influence the critical interface sites at the interface of S-RBD (Arg, Tyr, Trp, Gly, Phe, Asnand Tyr) and ACE2 (Asn, His, Glu, Asp, Lys, Ala, Ala, Gln, Pro, Phe and Arg) complex.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919521PMC
March 2021

Ultrasound molecular imaging-guided tumor gene therapy through dual-targeted cationic microbubbles.

Biomater Sci 2021 Apr 17;9(7):2454-2466. Epub 2021 Feb 17.

Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, First Clinical Medical College of Southern University of Science and Technology, Shenzhen 518020, China.

The success of gene therapy depends largely on the development of gene vectors and effective gene delivery systems. It has been demonstrated that cationic microbubbles can be loaded with negatively charged plasmid DNA and thus improve gene transfection efficiency. In this study, we developed dual-targeting cationic microbubbles conjugated with iRGD peptides(Cyclo(Cys-Arg-Gly-Asp-Lys-Gly-Pro-Asp-Cys)) and CCR2 (chemokine (C-C motif) receptor 2) antibodies (MB) for ultrasound molecular imaging and targeted tumor gene therapy. The ultrasound molecular imaging experiments showed that there were significantly enhanced ultrasound molecular imaging signals in the tumor that received MB, compared with those that received MB, MB, or MB. As a therapy plasmid, pGPU6/GFP/Neo-shAKT2, carrying an expression cassette for the human AKT2 RNA interference sequence, was used. Our results demonstrated that MB had a significantly higher gene transfection efficiency than MB, MB, or MB under ultrasound irradiation, resulting in much lower AKT2 protein expression and stronger tumor growth inhibition effects in vivo and in vitro. In conclusion, our study demonstrated a novel gene delivery system via MB for ultrasound molecular-imaging-guided gene therapy of breast cancer.
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http://dx.doi.org/10.1039/d0bm01857kDOI Listing
April 2021

One step further into the blackbox: a pilot study of how to build more confidence around an AI-based decision system of breast nodule assessment in 2D ultrasound.

Eur Radiol 2021 Jul 6;31(7):4991-5000. Epub 2021 Jan 6.

The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, and The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan, 250012, People's Republic of China.

Objectives: To investigate how a DL model makes decisions in lesion classification with a newly defined region of evidence (ROE) by incorporating "explainable AI" (xAI) techniques.

Methods: A data set of 785 2D breast ultrasound images acquired from 367 females. The DenseNet-121 was used to classify whether the lesion is benign or malignant. For performance assessment, classification results are evaluated by calculating accuracy, sensitivity, specificity, and receiver operating characteristic for experiments of both coarse and fine regions of interest (ROIs). The area under the curve (AUC) was evaluated, and the true-positive, false-positive, true-negative, and false-negative results with breakdown in high, medium, and low resemblance on test sets were also reported.

Results: The two models with coarse and fine ROIs of ultrasound images as input achieve an AUC of 0.899 and 0.869, respectively. The accuracy, sensitivity, and specificity of the model with coarse ROIs are 88.4%, 87.9%, and 89.2%, and with fine ROIs are 86.1%, 87.9%, and 83.8%, respectively. The DL model captures ROE with high resemblance of physicians' consideration as they assess the image.

Conclusions: We have demonstrated the effectiveness of using DenseNet to classify breast lesions with limited quantity of 2D grayscale ultrasound image data. We have also proposed a new ROE-based metric system that can help physicians and patients better understand how AI makes decisions in reading images, which can potentially be integrated as a part of evidence in early screening or triaging of patients undergoing breast ultrasound examinations.

Key Points: • The two models with coarse and fine ROIs of ultrasound images as input achieve an AUC of 0.899 and 0.869, respectively. The accuracy, sensitivity, and specificity of the model with coarse ROIs are 88.4%, 87.9%, and 89.2%, and with fine ROIs are 86.1%, 87.9%, and 83.8%, respectively. • The first model with coarse ROIs is slightly better than the second model with fine ROIs according to these evaluation metrics. • The results from coarse ROI and fine ROI are consistent and the peripheral tissue is also an impact factor in breast lesion classification.
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http://dx.doi.org/10.1007/s00330-020-07561-7DOI Listing
July 2021

Diagnosis of Deep Infiltrating Endometriosis Using Transvaginal Ultrasonography.

Front Med (Lausanne) 2020 23;7:567929. Epub 2020 Nov 23.

Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China.

To evaluate the performance of transvaginal ultrasonography (TVS) in diagnosis of deep infiltrating endometriosis (DIE). We retrospectively analyzed 198 patients with pathological diagnosis of DIE in our hospital from January 2017 to December 2019 and assessed the performances of pre-operative TVS diagnosis of DIE with regarding to sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV), using the pathological diagnosis as the ground truth. We also characterized the ultrasonographic features of the DIE lesions. Among all the 198 cases, 170 cases were uterosacral ligament (USL) involvement, SE: 96.47% and SP: 85.71%; 79 cases were intestinal involvement, SE: 94.94% and SP: 94.96%; 57 cases were vaginal rectal septum (VRS) involvement, SE: 73.68% and SP: 94.33%; 20 cases were vaginal involvement, SE: 50% and SP: 97.21%; three cases were bladder involvement, SE: 66.7% and SP: 100%; nine cases were ureter involvement, SE: 55.56% and SP: 100%; and 10 cases were broad ligament involvement, SE: 10% and SP: 100%. TVS showed high accuracy in diagnosing DIE.
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http://dx.doi.org/10.3389/fmed.2020.567929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719798PMC
November 2020

Development and validation of a nomogram for predicting prostate cancer in men with prostate-specific antigen grey zone based on retrospective analysis of clinical and multi-parameter magnetic resonance imaging/transrectal ultrasound fusion-derived data.

Transl Androl Urol 2020 Oct;9(5):2179-2191

Department of Ultrasound, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen Medical Ultrasound Engineering Center, Shenzhen, China.

Background: Urologists face a dilemma when deciding whether prostate biopsy is required for patients with prostate-specific antigen (PSA) levels in the grey zone (4 to 10 ng/mL).

Methods: We retrospectively analyzed data from consecutive patients with PSA levels in grey zone, who underwent targeted multiparametric magnetic resonance imaging (MP-MRI)/transrectal ultrasound (TRUS) fusion biopsy with elastography between November 2017 and December 2019 in our hospital. The patientse data including age, PSA, fPSA (free PSA), fPSA/PSA, PSA density (PSAD), prostate volume, elastography Q-analysis score (EQS), and prostate imaging-reporting and data system (PI-RADS) score were collected. The nomogram was built using logistic regression and the final cohort of patients was randomly divided into a training cohort (70%) and a validation cohort (30%) by R software. The models were evaluated by receiver operating characteristic curve (ROC) analysis and calibration curve analysis. The nomogram was constructed from the best model.

Results: The final study cohort consisted of 155 patients (training cohort, 109 patients; validation cohort, 46 patients) with PSA in the grey zone, of which 36 patients were pathologically diagnosed with PCa. The EQS model, -EQS model, +EQS model were built. The +EQS model that consisted of fPSA/PSA, EQS, and PI-RADS score had the best PCa diagnostic accuracy (development and validation, 0.783 and 0.781) and probability score (development and validation, 0.939 . 0.622). The new nomogram based on this model was constructed, in which fPSA/PSA ratio had the largest impact, followed by PI-RADS and EQS.

Conclusions: Elastography and pre-biopsy MP-MRI has clinical significance for patients with PSA in the grey zone. The new nomogram, which is based on pre biopsy data including serological analysis, PI-RADS score, and EQS, can be helpful for clinical decision-making to avoid unnecessary biopsy.
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http://dx.doi.org/10.21037/tau-20-1154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658138PMC
October 2020

Accuracy of transvaginal ultrasound for diagnosis of deep infiltrating endometriosis in the uterosacral ligaments: Systematic review and meta-analysis.

J Gynecol Obstet Hum Reprod 2021 Mar 22;50(3):101953. Epub 2020 Oct 22.

Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China. Electronic address:

Objectives: To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of uterosacral ligaments (USL) in patients with clinical suspicion of deep infiltrating endometriosis (DIE).

Methods: Extensive searches were conducted in PubMed, EMBASE and Cochrane libraries to search studies published between January 1989 and September 2, 2019. The inclusion criteria were the preoperative assessment of USL endometriosis by TVS in patients with clinically suspected DIE, using laparoscopy and histological results as the reference standard. The assessment of research quality uses preferred reporting items, including the System Review and Meta Analysis (PRISMA) guidelines, as well as the quality assessment of diagnostic accuracy study 2 (QUADAS-2) tools.

Results: During our advanced search, 7562 studies were identified. Finally, 11 of which were recognized as qualified and incorporated into this study. The pooled sensitivity, specificity, positive probability ratio (LR+) and negative probability ratio(LR-) of TVS for detecting DIE in the USL were 65 %(95 %CI:43-83), 92 %(95 %CI:84-96), 7.80 (95 %CI:4.7-13.0) and 0.38(95 %CI:0.22-0.66), respectively. There was significant heterogeneity in sensitivity (I: 97.40 %; Cochran Q, 385.09; P<0.001) and specificity (I, 93.89 %; Cochran Q, 163.75; P < 0.001).

Conclusion: TVS provides an excellent comprehensive diagnostic performance for DIE of the USL. However, further research is required to improve the diagnostic quality.
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http://dx.doi.org/10.1016/j.jogoh.2020.101953DOI Listing
March 2021

Analysis of clustered interval-censored data using a class of semiparametric partly linear frailty transformation models.

Biometrics 2020 Nov 2. Epub 2020 Nov 2.

Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, People's Republic of China.

A flexible class of semiparametric partly linear frailty transformation models is considered for analyzing clustered interval-censored data, which arise naturally in complex diseases and dental research. This class of models features two nonparametric components, resulting in a nonparametric baseline survival function and a potential nonlinear effect of a continuous covariate. The dependence among failure times within a cluster is induced by a shared, unobserved frailty term. A sieve maximum likelihood estimation method based on piecewise linear functions is proposed. The proposed estimators of the regression, dependence, and transformation parameters are shown to be strongly consistent and asymptotically normal, whereas the estimators of the two nonparametric functions are strongly consistent with optimal rates of convergence. An extensive simulation study is conducted to study the finite-sample performance of the proposed estimators. We provide an application to a dental study for illustration.
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http://dx.doi.org/10.1111/biom.13399DOI Listing
November 2020

The Association Between Coffee Consumption and Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis.

Adv Nutr 2021 06;12(3):708-721

School of Biological Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.

Previous meta-analyses that found an inverse association between coffee consumption and metabolic syndrome pooled data from cross-sectional and longitudinal studies, which could lead to potentially misleading conclusions. Hence, this work aimed to reassess this association by analyzing data from the 2 types of studies separately and including recent studies. Online databases including PubMed, Scopus, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Science Direct were searched for relevant studies published up to July 2020. Both cross-sectional and longitudinal studies were included if published after 1999, reported both effect estimates and CIs, and presented results adjusted for confounding variables. Data of the highest coffee consumption level in each study, as well as those of medium consumption levels in studies with ≥3 consumption categories, were pooled using random-effect models, with sex-stratified and sex-adjusted results being analyzed separately. Results were obtained based on data from 13 cross-sectional studies involving 280,803 participants and 2 longitudinal studies involving 17,014 participants. The overall sex-adjusted association of the highest consumption level was not significant (n = 9 studies; OR: 0.88; 95% CI: 0.70, 1.10; I2: 91.5%) and the 2 longitudinal studies both yielded no association. Subgroup analysis revealed inverse associations in both males and females, as well as in Caucasians with medium coffee consumption (n = 4 studies, OR: 0.88; 95% CI: 0.84, 0.93; I2: 0%). Although residual confounding could affect the results of this meta-analysis, our findings suggested with a low certainty that coffee consumption may not be associated with metabolic syndrome, a finding that is different from those of previous meta-analyses and could be due to variation in characteristics of study participants. More longitudinal studies are also needed to further assess the temporal association between coffee consumption and metabolic syndrome. This meta-analysis was registered at https://www.crd.york.ac.uk/prospero as CRD42018110650.
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http://dx.doi.org/10.1093/advances/nmaa132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166542PMC
June 2021

Marine fish peptides (collagen peptides) compound intake promotes wound healing in rats after cesarean section.

Food Nutr Res 2020 31;64. Epub 2020 Aug 31.

Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.

Background: Wound complications are a major source of morbidity after cesarean section (CS) and contribute to increased risks in subsequent pregnancies. In the present study, we aim to investigate the wound healing potential of a kind of oligopeptide compound, mainly derived from the marine fish peptides (MFPs), in rats after CS by biomechanical, biochemical, and histological methods.

Methods: Eighty-four pregnant Sprague-Dawleyrats were randomly assigned to four groups, namely the control group and 1.1, 2.2, and 4.4 mg/kg MFP groups, respectively. The MFPs or normal saline of the equal volume was intragastrically administered every morning on the second day after CS. On days 5, 10, and 15 after the surgery, seven rats from each group were randomly selected. The samples of skin wound and uterus were harvested and then used for the following experiments and analyses.

Results: Using the CS rat model, this study demonstrated that in the MFP groups, the skin tensile strength, uterine bursting pressure, and hydroxyproline (Hyp) were significantly higher than those in the control group at all three time points ( < 0.05). The formation of collagen and smooth muscle fibers and the expression of CD34 and connective tissue growth factor at the incision site were increasingly observed in the MFP groups ( < 0.05).

Conclusions: MFPs have a great potential to accelerate the process and quality of wound healing in rats after CS.
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http://dx.doi.org/10.29219/fnr.v64.4247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534952PMC
August 2020

Ultrasonic irradiation and SonoVue microbubbles-mediated RNA interference targeting PRR11 inhibits breast cancer cells proliferation and metastasis, but promotes apoptosis.

Biosci Rep 2020 11;40(11)

Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China.

The present study compared the effects of ultrasonic irradiation and SonoVue microbubbles (US) or Lipofectamine 3000 on the transfection of small interfering RNA for PRR11 (siPRR11) and Proline-rich protein 11 (PRR11) overexpression plasmid into breast cancer cells. SiPRR11 and PRR11 overexpression plasmid were transfected into breast cancer MCF7 cells mediated by US and Lipofectamine 3000. PRR11 expressions in breast cancer and normal tissues were determined using Gene Expression Profiling Interactive Analysis (GEPIA). The viability, proliferation, migration, invasion and apoptosis of breast cancer cells were respectively measured by MTT assay, clone formation assay, scratch wound-healing assay, Transwell assay and flow cytometry. PRR11 and epithelial-to-mesenchymal transition (EMT)-related and apoptosis-related (B-cell lymphoma 2, Bcl-2; Bcl-2-associated protein X, Bax) proteins' expressions were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as appropriate. As ultrasonic intensity increased, the viability of MCF7 cells was decreased. Results from GEPIA suggested that PRR11 was up-regulated in breast cancer. Silencing PRR11 mediated by US showed a higher efficiency than by Lipofectamine 3000. SiPRR11 transfected by Lipofectamine 3000 suppressed cells growth and metastasis, while promoted cell apoptosis. Moreover, E-cadherin (E-cad) and Bax expressions were high but N-cadherin (N-cad), Snail and Bcl-2 expressions were low. However, overexpressed PRR11 caused the opposite effects. More importantly, transfection of siPRR11 and PRR11 overexpression plasmid using US had a higher efficacy than using Lipofectamine 3000. US transfection of PRR11 siRNA showed better effects on inhibiting breast cancer progression. The current findings contribute to a novel treatment for breast cancer.
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http://dx.doi.org/10.1042/BSR20201854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607193PMC
November 2020

Detecting Carotid Intima-Media From Small-Sample Ultrasound Images.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:2129-2132

Cardiovascular diseases are the biggest threat to human being's health all over the world, and carotid atherosclerotic plaque is the leading cause of ischemic cardiovascular diseases. To determine the location and shape of the plaque, it is of great significance to detect the intima-media (IM). In this paper, a new IM detection method based on convolution neural network (IMD-CNN) is proposed for the detection of IM of blood vessels in longitudinal ultrasonic images. In IMD-CNN, firstly the region of interest (ROI) is automatically extracted by morphological processing, then the patch-wise training data are constructed, and finally a simple CNN is trained to detect the IM. The experimental results obtained on 23 images show that the test accuracy of IMD-CNN is over 86% and the performance of IMD-CNN is also visually proved to be effective.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176282DOI Listing
July 2020

First report of Meloidogyne graminicola on rice in Anhui province, China.

Plant Dis 2020 Aug 18. Epub 2020 Aug 18.

Anhui Agricultural University, 12486, 130 Changjiangxilu, Hefei, Anhui, P.R. China, Hefei, Anhui, China, 230036;

Meloidogyne graminicola, a devastating plant pathogen of rice (Oryza sativa), is considered to a severe constraint to productivity in rice-growing areas (Zhan et al., 2018). In April 2020, irrigated paddy rice field in Qianshan City, Anhui Province, China, showed symptoms with stunting, thinning, chlorosis, and typical hook-shaped root tips. Females and egg masses of Meloidogyne sp. were found inside the cortex of the root galls, males were found in soil and roots. The morphological characteristics of females, males and second-stage juveniles (J2) were identified as described previously (Tian et al., 2017; Wang et al., 2017). The perineal pattern of the females (n=12) was dorsoventrally oval with low and round dorsal arches, with lateral fields obscure or absent. Most of the striae were smooth, and occasionally broken by short and irregular striae. Morphological measurements (mean±sd, range) of female nematodes (n=20) were body length (543.0±66.0 µm, 448.0-629.0 µm), stylet (11.6±1.9 µm, 7.9-14.2 µm), dorsal pharyngeal gland orifice to stylet base (DGO) (4.0±0.4 µm, 3.4-4.7 µm), vulval slit length (24.1±4.9 µm, 14.8-32.8 µm), vulval slit to anus distance (16.1±3.0 µm, 8.4-20.2 µm). The male nematodes were cylindroid, vermiform, and rounded tail, with the measurements (n=20) body length (1673.0±125 µm, 1346.0-1822.0 µm), stylet (15.5±0.8 µm, 14.0-17.1 µm), DGO (3.7±0.5 µm, 2.9-5.5 µm), and spicule (30.7±2.5 µm, 23.4-34.6 µm). The J2 were vermiform with a gradually tapering hyalines, its measurements (n=20) were body length (452.0±33.0 µm, 391.0-511.0 µm), stylet (13.4±0.8 µm, 12.0-15.2 µm), DGO (3.6±0.6 µm, 2.5-4.7 µm), tail length (72.1±5.2 µm, 59.8-84.8 µm) and hyaline tail terminus (21.7±2.5 µm, 18.0-29.7 µm). DNA extracted from individual females (n=10) were used for molecular identification. The D2/D3 region of 28S RNA was amplified with D2A (5'-ACA AGT ACC GTG AGG GAA AGT TG-3') and D3B (5'-TCG GAA GGA ACC AGC TAC TA-3') (De Ley et al. 1999). The ITS region was amplified with AB28 (5'-ATA TGC TTA AGT TCA GCG GGT-3') and TW81 (5'-GTT TCC GTA GGT GAA CCT GC-3') (Curran et al. 1994). The fragments of D2/D3 region (GenBank accession No. MT576694) and ITS region (GenBank accession No. MT573412) were 766 bp and 579 bp respectively, they all exhibited 99%-100% similarity with those of M. graminicola isolates available in the GenBank. Therefore, both morphological and molecular characterization confirmed the status of this nematode as Meloidogyne graminicola. In green house test, twenty 2-week-old rice seedlings (cv. Longliangyou) were individually maintained in pots with sterilized sand and soil (3:1) and inoculated with 300 J2, other ten non-inoculated rice seedlings as negative control. Rice seedlings were grown in green house at 28℃/25℃ with a 16 h/8 h light/dark photoperiod. After 30 days, all inoculated rice seedling showed symptoms with stunting, chlorosis, and typical hook-shaped root tips, which were similar with that in fields. The nematode reproduction index (final population density/initial population density) were 7.86-10.32. No symptoms were observed on non-inoculated rice seedlings. These results confirmed the pathogenicity of M. graminicola on rice. To our knowledge, this is the first report of M. graminicola in Anhui Province, China. References Curran, J., et al. 1994. Mycol. Res. 98:547. https://doi.org/10.1016/S0953-7562(09)80478-4. De Ley, P., et al. 1999. Nematology. 1:591. https://doi.org/10.1163/156854199508559. Tian, Z., et al. 2017. Plant Disease. http://dx.doi.org/10.1094/PDIS-06-17-0832-PDN. Wang, G., et al. 2017. Plant Disease. http://dx.doi.org/10.1094/PDIS-12-16-1805-PDN. Zhan, L., et al. 2018. BMC Plant Biol. 18:50. https://doi.org/10.1186/s12870-018-1266-9.
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http://dx.doi.org/10.1094/PDIS-06-20-1319-PDNDOI Listing
August 2020

SCEBE: an efficient and scalable algorithm for genome-wide association studies on longitudinal outcomes with mixed-effects modeling.

Brief Bioinform 2021 05;22(3)

Janssen Research and Development LLC, Raritan, NJ, USA.

Genome-wide association studies (GWAS) using longitudinal phenotypes collected over time is appealing due to the improvement of power. However, computation burden has been a challenge because of the complex algorithms for modeling the longitudinal data. Approximation methods based on empirical Bayesian estimates (EBEs) from mixed-effects modeling have been developed to expedite the analysis. However, our analysis demonstrated that bias in both association test and estimation for the existing EBE-based methods remains an issue. We propose an incredibly fast and unbiased method (simultaneous correction for EBE, SCEBE) that can correct the bias in the naive EBE approach and provide unbiased P-values and estimates of effect size. Through application to Alzheimer's Disease Neuroimaging Initiative data with 6 414 695 single nucleotide polymorphisms, we demonstrated that SCEBE can efficiently perform large-scale GWAS with longitudinal outcomes, providing nearly 10 000 times improvement of computational efficiency and shortening the computation time from months to minutes. The SCEBE package and the example datasets are available at https://github.com/Myuan2019/SCEBE.
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http://dx.doi.org/10.1093/bib/bbaa130DOI Listing
May 2021

Two-Dimensional and Three-Dimensional Transthoracic Echocardiography as Predictive and Prognostic Indicators of All-Cause Mortality in Heart Failure with Reduced Ejection Fraction in Patients with Ischemic Heart Disease.

Med Sci Monit 2020 Jun 7;26:e922129. Epub 2020 Jun 7.

Department of Cardiology, FuWai Hospital, Chinese Academy of Medical Science, Shenzhen, Guangdong, China (mainland).

BACKGROUND This study aimed to compare the predictive role of two-dimensional transthoracic echocardiography (2D-TTE) and three-dimensional transthoracic echocardiography (3D-TTE) on in-hospital all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF) due to ischemic heart disease (IHD). MATERIAL AND METHODS Patients (N-224) with HFrEF due to IHD who had a left ventricular ejection fraction (LVEF) <40% on admission when measured by 2D-TTE and 3D-TTE were studied and divided into survival and mortality groups. Baseline demographic and clinical characteristics were compared. RESULTS Compared with the survival group (n=142), patients who died during hospitalization (n=82) were more commonly older (67.3 vs. 62.6 years), female (48.8% vs. 38.7%), with diabetes mellitus (51.2% vs. 32.4%), chronic kidney disease (48.8% vs. 32.4%), intravenous inotropes (85.4% vs. 76.1%), and intravenous vasodilators (70.7% vs. 61.3%). Regression model analysis for all-cause mortality identified significant associations with age, diabetes mellitus, myocardial infarction (MI), intravenous inotropes, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and LVEF following 2D-TTE. Age, diabetes mellitus, prior MI, the use of intravenous inotropes, NT-proBNP, LVEF, and left ventricular end-diastolic volume (LVEDV) index following 3D-TTE were significantly associated with all-cause mortality. Modeling of 2D-TTE parameters showed that the concordance statistic (C-index) increased significantly after including the LVEF, from 0.72 to 0.77 and from 0.72 to 0.80, respectively. Modeling of 3D-TTE parameters showed that the C-index increased significantly after including the LVEDV index (from 0.80 to 0.76). CONCLUSIONS In patients with HFrEF due to IHD, 3D-TTE was a better predictor than 2D-TTE of in-hospital all-cause mortality.
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http://dx.doi.org/10.12659/MSM.922129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299062PMC
June 2020

The role of grey-scale ultrasound in the diagnosis of adhesive capsulitis of the shoulder: a systematic review and meta-analysis.

Med Ultrason 2020 Sep 14;22(3):305-312. Epub 2020 Apr 14.

Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasond Engineering Center, Shenzhen People's Hospital.

Aims: In this systematic review and meta-analysis, we discuss the value of grey-scale ultrasonography (US) in diagnosing adhesive capsulitis of the shoulder (ACS).

Material And Methods: We retrieved relevant studies from PubMed, Cochrane Library, and Embase before 8 April 2019. We selected 7 studies concerning 446 patients (490 shoulders) that used grey-scale US to diagnose ACS and magnetic resonance imaging (MRI) or arthroscopy as the reference standard. We assessed the diagnostic accuracy of US on the basis of combined sensitivity, specificity, likelihood ratio (LR), and the area under the summary receiver operating characteristic (SROC) curve (AUC).

Results: The combined sensitivity, specificity, positive LR and negative LR were found to be 88% (95%CI: 74-95), 96% (95%CI: 88-99), 23.89 (95%CI: 6.31-90.51) and 0.12 (95%CI: 0.05-0.29), respectively. The AUC was 0.97 (95%CI: 0.96-0.98). ACS was diagnosed on the basis of four US features: coracohumeral ligament thickening, inferior capsule/axillary recess capsule thickening, rotator interval abnormality, and restriction of the range of motion. The corresponding sensitivities were 64.4 (95%CI: 48.8-78.1), 82.1 (95%CI: 73.8-88.7), 82.6 (95%CI: 74.1-89.2) and 94.3 (95%CI: 84.3-98.8), respectively, and specificities were 88.9 (95%CI: 76.0-96.3), 95.7 (95%CI: 90.3-98.6), 93.9 (95%CI: 89.8-96.7), and 90.9 (95%CI: 75.7-98.1), respectively.

Conclusions: Our meta-analysis showed that grey-scale US plays a significant role in the diagnosis of ACS. Because of its high sensitivity and specificity, US can be added to the existing clinical diagnosis program.
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http://dx.doi.org/10.11152/mu-2430DOI Listing
September 2020

Successful management of Klippel-Trenaunay syndrome in a pregnant Asian woman: A case report.

Medicine (Baltimore) 2020 May;99(19):e19932

Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University.

Rationale: Klippel-Trenaunay Syndrome (KTS) is a congenital vascular disease characterized by cutaneous hemangiomas, venous varicosities, and limb hypertrophy. Although extremely rare in pregnant women, the present vascular alterations may be aggravated, consequent to postural and hormonal changes inherent to the pregnancy. Pregnancy is not advised in KTS women due to increased obstetrical risk.

Patient Concerns: A 31-year-old pregnancy woman presented with prominent vascularity in pelvis, right lower limb, spleen, and liver at 28 weeks of gestation. We started administration of anticoagulant therapy and obstetrics management.

Diagnosis: MRI and ultrasound revealed that multiple varicosities in her pelvis, right lower limb, spleen, and liver. She was diagnosed with KTS.

Interventions: At her first visit at 28 weeks of gestation, multidisciplinary evaluation had been done. Blood transfusion and iron supplement had been given for anemia correction. Anticoagulant therapy was performed to prevent potential thrombus risk. She had a vaginal delivery with a healthy newborn in her second visit without any complications at the gestation of 36 weeks due to rupture of preterm membranes.

Outcomes: After successful management, the patient was discharged without any complications 2 days after vaginal delivery. No symptoms of hemorrhage or thrombus were observed. At 6 months follow-up, her right lower toes enlarged obviously, MRI revealed that no obvious changes of hemangiomas was found compared to those during the pregnancy and ultrasound revealed that there was no thrombus in her right lower limb.

Lessons: Patients with KTS can be pregnant and have healthy babies safely with regularly monitor and reasonable treatment during pregnancy. A careful follow-up and guidance are necessary.
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http://dx.doi.org/10.1097/MD.0000000000019932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220078PMC
May 2020

Diagnostic performance of ultrasound for rotator cuff tears: a systematic review and meta-analysis.

Med Ultrason 2020 May 16;22(2):197-202. Epub 2020 Feb 16.

Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasond Engineering Center,Shenzhen People's Hospital, Shenzhen ,China.

Aim: Rotator cuff (RC) tears are considered to be the main reason for shoulder pain. Although ultrasound is a useful method to detect it, its effectiveness when diagnosing RC tears has been a heated discussion. Therefore, we aimed at evaluating RC tears' ultrasound accuracy by conducting a systemically review and pooled comprehensive analysis.

Materials And Methods: Relevant articles up to May 2018 were searched from the Cochrane Library, Embase, and Pubmed databases. Either arthroscopy or magnetic resonance imaging (MRI) was considered as a reference standard. The results were estimated by pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled-diagnostic odds ratio (P-DOR), pooled-likelihood ratio+ (PLR+), pooled-likelihood ratio- (P-LR-), and the area under the summary receiver operating characteristic (SROC).

Result: We selected seven prospective studies in accordance with the inclusion criteria that covered 554 rotator cuff tears in 868 patients. The P-SEN, P-SPE, P-LR+, P-LR-, P-DOR, area under the SROC curve of diagnostic performance of ultrasound for RC and post-test probability were 95% (95% CI: 88 - 98), 72% (95% CI: 61 - 81), 3.41 (95% CI: 2.40 - 4.84), 0.08 (95% CI: 0.03 - 0.16), 45.31 (95% CI: 21.04 - 97.59), 89% (95% CI: 0.86 - 0.91), and 46% and 2%, respectively.

Conclusion: Our metaanalysis demonstrates that ultrasound has a high efficiency for RC tears' diagnosis. It can be a promising method in patients with suspected RC tears because of its high sensitivity, specificity and diagnostic accuracy.
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http://dx.doi.org/10.11152/mu-2352DOI Listing
May 2020

A novel quantification of information for longitudinal data analyzed by mixed-effects modeling.

Pharm Stat 2020 07 27;19(4):388-398. Epub 2020 Jan 27.

Data Science, Translational Research, Genmab US Inc., Princeton, New Jersey.

Nonlinear mixed-effects (NLME) modeling is one of the most powerful tools for analyzing longitudinal data especially under the sparse sampling design. The determinant of the Fisher information matrix is a commonly used global metric of the information that can be provided by the data under a given model. However, in clinical studies, it is also important to measure how much information the data provide for a certain parameter of interest under the assumed model, for example, the clearance in population pharmacokinetic models. This paper proposes a new, easy-to-interpret information metric, the "relative information" (RI), which is designed for specific parameters of a model and takes a value between 0% and 100%. We establish the relationship between interindividual variability for a specific parameter and the variance of the associated parameter estimator, demonstrating that, under a "perfect" experiment (eg, infinite samples or/and minimum experimental error), the RI and the variance of the model parameter estimator converge, respectively, to 100% and the ratio of the interindividual variability for that parameter and the number of subjects. Extensive simulation experiments and analyses of three real datasets show that our proposed RI metric can accurately characterize the information for parameters of interest for NLME models. The new information metric can be readily used to facilitate study designs and model diagnosis.
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http://dx.doi.org/10.1002/pst.1996DOI Listing
July 2020

The association between GSTP1 polymorphism and pre-eclampsia risk: a system review and meta-analysis.

Arch Gynecol Obstet 2020 01 24;301(1):11-18. Epub 2019 Dec 24.

Department of Gynecology and Obstetrics, Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, China.

Purpose: Oxidative stress is thought to play an important role in the pathophysiology of pre-eclampsia. Polymorphism of Glutathione S-transferase P1 (GSTP1) protect cells against the cytotoxic effects of reactive compounds. Published data on the association between the GSTP1 polymorphism and pre-eclampsia risk are controversial. A meta-analysis was performed to assess whether the polymorphisms of GSTP1 are associated with pre-eclampsia risk.

Methods: Medline, Embase, China National Knowledge Infrastructure, and Chinese Biomedicine Databases were searched to identify eligible studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for GSTP1 polymorphism and pre-eclampsia were appropriately derived from fixed-effects or random effects models.

Results: A total of six studies were enrolled in this meta-analysis. The pooled analyses revealed that GSTP1 polymorphism was not associated with pre-eclampsia risk. Heterogeneity among studies was founded in allele contrast. Galbraith plot analyses were performed to assess the source of heterogeneity and one study was found to be contributor of heterogeneity. The heterogeneity decreased significantly after excluding that study.

Conclusion: Present meta-analysis demonstrates that GSTP1 polymorphism may be not correlated with pre-eclampsia risk.
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http://dx.doi.org/10.1007/s00404-019-05411-6DOI Listing
January 2020
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