Publications by authors named "Xiaoyan Xie"

181 Publications

Ultrasound characteristics combined with gamma-glutamyl transpeptidase for diagnosis of biliary atresia in infants less than 30 days.

Pediatr Surg Int 2021 May 19. Epub 2021 May 19.

Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.

Purpose: To retrospectively assess the diagnostic performance of grey-scale ultrasound (US) characteristics and gamma-glutamyl transpeptidase (GGT) alone or combined in distinguishing biliary atresia (BA) from other cholestasis diseases in infants younger than 30 days.

Materials And Methods: Between January 2012 and October 2020, the demographic characteristics, laboratory results and US characteristics of 35 BA and 52 non-BA infants younger than 30 days were retrospectively evaluated. Areas under the receiver operating characteristic curves (AUCs) were used to estimate the probability of predicting BA, which were compared by DeLong test.

Results: The diagnostic performance of gallbladder classification in identifying BA was higher than that of fibrotic cord thickness (AUC 0.900 vs. 0.771, P = 0.03). With the cutoff level of 188 IU/L, serum GGT had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 77.1%, 69.2%, 62.8%, and 81.8%, respectively. Combined with gallbladder classification and GGT, the sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 63.5%, 64.8%, 100.0% and 78.2%.

Conclusions: Gallbladder classification was more valuable than fibrotic cord thickness in the diagnosis of BA among infants less than 30 days. Combined with gallbladder classification and GGT, the sensitivity for the diagnosis of BA can reach 100.0%.
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http://dx.doi.org/10.1007/s00383-021-04923-0DOI Listing
May 2021

Systemic Inflammatory Score predicts Overall Survival in patients with Cervical Cancer.

J Cancer 2021 30;12(12):3671-3677. Epub 2021 Apr 30.

Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.

To evaluate the prognostic value of the systemic inflammatory score (SIS) in cervical cancer patients. A total of 264 patients with FIGO stage (2009) IB-IIA cervical cancer undergoing radical resection from January 2014 to December 2017 were recruited. The optimal cutoff values for inflammatory biomarkers were calculated by X-tile software. The prognostic factors were investigated using univariate and multivariate Cox analyses. Time-dependent receiver operating characteristic (time-ROC) analysis and the concordance index (C-index) were used to compare the prognostic impact of factors. In total, 264 patients with cervical cancer were included in the study. The optimal cutoff value for lymphocyte-to-monocyte ratio (LMR) was 4.1. In multivariate analysis, FIGO stage, lymphovascular invasion, lymph node metastasis, preoperative serum albumin (Alb), and LMR were independent prognostic factors (P<0.05). Then, we combined preoperative Alb and LMR to establish the SIS. Multivariate analysis showed that the SIS was an independent factor that affected survival (P<0.05). When stratified by FIGO stage, significant differences in survival were also found for patients with different SISs (P<0.05). When the SIS and FIGO stage were combined, the time-ROC curve was superior to that of FIGO stage only. The C-index of the model combining the SIS and FIGO stage was 0.786 (95% CI 0.699-0.873), which was significantly higher than that of the model with FIGO stage only (0.676, 95% CI 0.570-0.782, P=0.0049). The preoperative SIS is a simple and useful prognostic factor for postoperative survival in patients with cervical cancer. It might assist in the identification of high-risk patients among patients with the same FIGO stage.
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http://dx.doi.org/10.7150/jca.56170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120179PMC
April 2021

The combination of conventional ultrasound and shear-wave elastography in evaluating the segmental heterogeneity of liver fibrosis in biliary atresia patients after Kasai portoenterostomy.

Pediatr Surg Int 2021 May 9. Epub 2021 May 9.

Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.

Objective: To retrospectively assess the value of the combination of conventional ultrasound and shear-wave elastography (SWE) in evaluating the segmental heterogeneity of liver fibrosis in biliary atresia (BA) patients after Kasai portoenterostomy.

Methods: A total of 35 BA patients with liver segmental deformation were enrolled. The segmental deformation was assessed by conventional ultrasound followed with SWE examinations for evaluating the liver stiffness. Liver biopsy was performed in 11 patients in the region of SWE measurement and liver fibrosis was assessed using the Metavir classification. Aminotransferase to platelet ratio index (APRI) was calculated for comparison. The correlations between serum biochemical tests with SWE values were evaluated. Spearman's rank coefficient test was performed to evaluate the correlation between variables.

Results: The SWE values of the biopsy segments had significant positive correlations with liver fibrosis severity (r = 0.828, p = 0.001), which was better than APRI (r = 0.366, p = 0.242). The levels of bilirubin and transaminase showed significant correlations with the SWE values at hypertrophic segments in all patients (r from 0.336 to 0.576, all p < 0.05).

Conclusions: Awareness of the segmental heterogeneity of liver fibrosis evaluated by conventional ultrasound and SWE may assist in selecting an appropriate biopsy location and predicting postoperative surveillance for patients with BA.
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http://dx.doi.org/10.1007/s00383-021-04920-3DOI Listing
May 2021

Contrast-Enhanced Ultrasonography Findings Correlate with Pathologic Grades of Pancreatic Neuroendocrine Tumors.

Ultrasound Med Biol 2021 Apr 29. Epub 2021 Apr 29.

Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address:

The correlation of sonographic findings with pathologic grades of pancreatic neuroendocrine tumors (PNETs) remains unclear. This study aimed to evaluate the usefulness of sonographic features in diagnosing the pathologic grade of PNETs. Conventional and contrast-enhanced ultrasonography findings of PNETs diagnosed by surgical pathology from July 2010 to June 2020 were retrospectively reviewed. Sonographic features were compared among three pathologic grades of PNETs according to the World Health Organization 2010 classification. Ordinal regression models were constructed to evaluate the usefulness of the sonographic features in diagnosing the pathologic grade of PNETs. This study enrolled 93 participants with PNETs: 50 grade 1, 31 grade 2 and 12 grade 3. Multivariate ordinal regression analysis suggested that tumor size ≥2 cm (odds ratio [OR], 0.110; 95% confidence interval [CI], 0.020-0.606; p = 0.011), dilation of the main pancreatic duct (OR, 0.103; 95% CI, 0.025-0.430; p = 0.002), hepatic metastases (OR, 0.250; 95% CI, 0.072-0.869; p = 0.029) and hyper-enhancement in arterial phase (OR, 4.676; 95% CI, 1.656-13.206; p = 0.004) were significantly associated with the pathologic grades of PNETs. The accuracy of the ordinal logistic regression model in identifying grade 1, 2 and 3 PNETs was 77.4%, 67.7% and 90.3%, respectively. The findings suggest that sonographic features, including tumor size, pancreatic duct dilation and hepatic metastasis, as well as the enhancement level in arterial phase, may help identify different pathologic grades of PNETs.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2021.02.013DOI Listing
April 2021

Development of a pediatric liver CEUS criterion to classify benign and malignant liver lesions in pediatric patients: a pilot study.

Eur Radiol 2021 Mar 5. Epub 2021 Mar 5.

Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.

Objectives: To analyze the contrast-enhanced ultrasound (CEUS) characteristics of pediatric patients with focal liver lesions (FLLs) and develop a pediatric liver CEUS criterion to improve the diagnostic performance of CEUS in differentiating pediatric benign and malignant liver lesions.

Methods: Between March 2011 and May 2020, patients < 18 years who underwent CEUS were retrospectively evaluated. The CEUS characteristics of FLLs were analyzed. A pediatric liver CEUS criterion categorized as CEUS-1 to CEUS-5 was developed. The diagnostic performance of the criterion (i.e., sensitivity, specificity, PPV, and NPV) was assessed. Chi-square and Mann-Whitney tests were used.

Results: After exclusion, the study included 130 lesions (mean diameter, 7.1 cm; range, 0.8-17.0 cm) from 130 patients (mean age, 36.0 months; range, 0.03-204.0 months; 74 boys). Hyperenhancement with washout in patients < 5 years or with early washout (≤ 45 s) was used to predict hepatoblastoma, with a sensitivity and specificity of 90.7% (95% confidence interval [CI]: 77.9%, 97.4%) and 93.6% (95% CI: 84.3%, 98.2%), respectively. Peripheral discontinuous globular hyperenhancement was used to diagnose hemangioma, with a sensitivity and specificity of 84.6% (95% CI: 65.1%, 95.6%) and 100% (95% CI: 95.4%, 100.0%), respectively. The rates of malignancies within the pediatric liver CEUS-1, CEUS-2, CEUS-3, CEUS-4, and CEUS-5 categories were 0.0%, 0.0%, 5.6%, 50.0%, and 96.1%, respectively. Besides, the incidences of hepatoblastoma in pediatric liver CEUS-3, CEUS-4, and CEUS-5 were 5.6%, 16.7%, and 67.5%, respectively.

Conclusions: The pediatric liver CEUS criterion is useful in differentiating benign focal liver lesions from malignancies, especially hepatoblastoma from hemangioma.

Key Points: • Hyperenhancement with washout in patients
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http://dx.doi.org/10.1007/s00330-021-07784-2DOI Listing
March 2021

FGF8 induces epithelial-mesenchymal transition and promotes metastasis in oral squamous cell carcinoma.

Int J Oral Sci 2021 03 1;13(1). Epub 2021 Mar 1.

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management & West China Hospital of Stomatology, Sichuan University, Chengdu, China.

Oral squamous cell carcinoma (OSCC) is one of the most common cancers worldwide, and with 354 864 new cases each year. Cancer metastasis, recurrence, and drug resistance are the main causes to cripples and deaths of OSCC patients. As potent growth factors, fibroblast growth factors (FGFs) are frequently susceptible to being hijacked by cancer cells. In this study, we show that FGF8 is upregulated in OSCC tissues and high FGF8 expression is related with a set of clinicopathologic parameters, including age, drinking, and survival time. FGF8 treatment enhances the invasive capability of OSCC cells. Lentivirus-based FGF8 expression promotes OSCC metastasis in a mouse lung metastasis model. Further, mechanistic study demonstrates that FGF8 induces epithelial-mesenchymal transition (EMT) in OSCC cells. These results highlight a pro-metastatic function of FGF8, and underscore the role of FGF8 in OSCC development.
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http://dx.doi.org/10.1038/s41368-021-00111-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921665PMC
March 2021

Ensembled deep learning model outperforms human experts in diagnosing biliary atresia from sonographic gallbladder images.

Nat Commun 2021 02 24;12(1):1259. Epub 2021 Feb 24.

Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.

It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural area without relevant expertise. To help diagnose BA based on sonographic gallbladder images, an ensembled deep learning model is developed. The model yields a patient-level sensitivity 93.1% and specificity 93.9% [with areas under the receiver operating characteristic curve of 0.956 (95% confidence interval: 0.928-0.977)] on the multi-center external validation dataset, superior to that of human experts. With the help of the model, the performances of human experts with various levels are improved. Moreover, the diagnosis based on smartphone photos of sonographic gallbladder images through a smartphone app and based on video sequences by the model still yields expert-level performances. The ensembled deep learning model in this study provides a solution to help radiologists improve the diagnosis of BA in various clinical application scenarios, particularly in rural and undeveloped regions with limited expertise.
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http://dx.doi.org/10.1038/s41467-021-21466-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904842PMC
February 2021

Two-Dimensional Shear Wave Elastography Predicts Liver Fibrosis in Jaundiced Infants with Suspected Biliary Atresia: A Prospective Study.

Korean J Radiol 2021 06 29;22(6):959-969. Epub 2021 Jan 29.

Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.

Objective: This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers.

Materials And Methods: This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used.

Results: The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 ( < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis.

Conclusion: 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.
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http://dx.doi.org/10.3348/kjr.2020.0885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154778PMC
June 2021

Should the solid variant of odontogenic keratocyst and keratoameloblastoma be classified as the same entity? A clinicopathological analysis of nine cases and a review of the literature.

Pathology 2021 Jun 5;53(4):478-486. Epub 2021 Feb 5.

Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China; Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China. Electronic address:

The solid variant of odontogenic keratocyst (SOKC) is an extremely rare odontogenic lesion, which remains poorly defined even in the 2017 World Health Organization odontogenic tumour classification. It is difficult to distinguish between SOKC and so called keratoameloblastoma (KAB), both rare lesions that have similarities in clinical, histological and biological characteristics. Here, we report clinicopathological data and results of molecular analysis of nine cases with a literature review. First, they were compared to previously reported cases of SOKC and/or KAB, and many overlaps were found in clinical and pathological characteristics. Second, we performed PCR analysis for BRAF V600E mutation. Although ameloblastoma-like epithelia were often encountered, none exhibited BRAF V600E mutation, which has been reported to occur frequently in ameloblastomas but not in odontogenic keratocysts (OKCs). One of two cases of SOKC in the present series from which fresh frozen tissue specimens were available was found to harbour PTCH1 mutations, indicating that these were more likely to be a subtype of OKC. Moreover, we also examined the differences between SOKC and primary intraosseous carcinoma (PIOC) with regard to the expression of cytokeratins (pan-CK, CK5/6, CK7, CK8/18, CK10, CK14 and CK19), p53 and Ki-67. The proportions of p53-and Ki-67-positive cells were significantly higher in PIOC than in SOKC. These findings suggest that immunostaining for p53 and Ki-67 would be useful to differentiate between SOKC and PIOC. We also conducted a review of SOKC and KAB cases reported in the English language literature.
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http://dx.doi.org/10.1016/j.pathol.2020.09.028DOI Listing
June 2021

Rapid and sensitive detection of hepatitis B virus by lateral flow recombinase polymerase amplification assay.

J Virol Methods 2021 05 4;291:114094. Epub 2021 Feb 4.

Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, 523059, China.

Hepatitis B virus (HBV) infection is a major public health priority. In the present study, a lateral flow strip combined with the recombinase polymerase amplification (LF-RPA) assay was developed and evaluated for rapid HBV detection. A primer/probe pair targeting the conserved region of the HBV genome was designed and applied to the LF-RPA. TheRPA was achieved at the isothermal temperature of 39℃ for 30 min, and the RPA products were detected using the LF test. DNA extraction, RPA reaction and endpoint detection will take about 70 min. The LF-RPA assay could detect HBV at as low as 10 copies/reaction, with no cross-reactions with other common pathogens. The LF-RPA assay was performed on 85 samples. Of these, 36 samples tested HBV positive, whereas 49 were negative. Similar results were obtained using the conventional polymerase chain reaction method. Thus, the newly developed LF-RPA assay can be an improved diagnostic tool for rapid and simple HBV detection.
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http://dx.doi.org/10.1016/j.jviromet.2021.114094DOI Listing
May 2021

Clinical and Microbiological Characteristics of Invasive and Hypervirulent Infections in a Teaching Hospital in China.

Infect Drug Resist 2020 9;13:4395-4403. Epub 2020 Dec 9.

Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China.

Purpose: To investigate the clinical and microbiological characteristics of invasive and hypervirulent (HvKP) in a teaching hospital in Southern China.

Patients And Methods: A total of 495 non-repetitive strains were isolated from Dongguan People's Hospital affiliated to Southern Medical University in 2018. Multivariate analysis was performed using the patients' clinical data to identify the risk factors for HvKP.

Results: Eighty-one isolates were HvKP (16.4%, 81/495), of which 43 (53.1%) were invasive HvKP, whereas 38 (46.9%) were non-invasive HvKP. The incidence of extended spectrum beta-lactamases (ESBLs) in HvKP and classic (cKP) were 7.4% (6/81) and 28.0% (116/414), respectively (p<0.05). Multivariate analysis indicated that diabetes mellitus (odds ratio [OR]=12.849, 95% confidence interval [CI]: 1.494-110.511, P=0.020) was an independent risk factor for invasive HvKP infection. Altogether, 51.2% (22/43) of invasive HvKP infections were treated with antimicrobial therapy combined with surgical drainage, and achieved good prognosis. K1-ST23 HvKP accounted for a higher proportion of invasive infections than non-invasive infections (P<0.05), but there was no statistical difference in the prognosis between the two groups (P>0.05). The most prevalent virulence genes in HvKP were 98.7% (80/81), followed by (82.7%, 67/81), (98.7%, 80/81), and 90.1% (70/81). There was no significant difference in the distribution of virulence genes between invasive HvKP and non-invasive HvKP isolates (P>0.05).

Conclusion: Invasive HvKP infection in this study was positively associated with diabetes as independent risk factors. Antibiotic therapy combined with surgical drainage is one of the most effective treatment measures of HvKP infection. Adequate attention should be paid to HvKP infection in clinical and microbiological laboratories.
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http://dx.doi.org/10.2147/IDR.S282982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734077PMC
December 2020

KMT2A/C mutations function as a potential predictive biomarker for immunotherapy in solid tumors.

Biomark Res 2020 Dec 9;8(1):71. Epub 2020 Dec 9.

Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.

Epigenetic factors play important roles in tumor immunology. Histone-lysine N-methyltransferase 2 (KMT2) family genes exert histone H3 methylation, but its role in immunotherapy remains unclear. Our study is the first to investigate the correlation between KMT2 gene mutations and the clinical benefit of immune checkpoint inhibitors (ICI) treatment. We firstly collected a primary ICI-treated cohort (n = 546) and found that patients with KMT2A/C mutations yielded better prognosis in terms of progression-free survival (PFS, Hazard ratio [HR] = 0.66, P = 0.002), objective response rate (ORR, 40.9% vs 20.3%, P < 0.001), durable clinical benefit (DCB, 48.3% vs 29.8%, P = 0.001) and overall survival (OS, HR = 0.70, P = 0.033). Furthermore, we validated the predictive potential of KMT2A/C mutations in an expanded ICI-treated cohort (n = 1395). KMT2A/C-mutant patients achieved better OS compared with KMT2A/C-wildtype patients (HR = 0.68, P = 0.003); and the survival advantages appeared in the majority of cancer subtypes. Our study suggests that KMT2A/C mutations function as a novel and potential predictive biomarker for ICI treatment in multiple solid tumors and the underlying mechanism is worth investigating.
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http://dx.doi.org/10.1186/s40364-020-00241-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724704PMC
December 2020

Radiofrequency ablation versus hepatic resection for recurrent hepatocellular carcinoma: an updated meta-analysis.

BMC Gastroenterol 2020 Nov 27;20(1):402. Epub 2020 Nov 27.

Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.

Background: The clinical benefits of treatment with radiofrequency ablation (RFA) and repeat hepatic resection (RHR) for recurrent hepatocellular carcinoma (RHCC) remain controversial. This meta-analysis aims to evaluate the outcomes and major complications of RFA versus RHR in patients with early-stage RHCC.

Methods: PubMed, Embase, Web of Science and the Cochrane Library were systematically searched for comparative studies on the evaluation of RHR versus RFA for RHCC. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and major complications. Meta-analysis was performed using a random-effects model or fixed-effects model, and heterogeneity was tested by the Cochran Q statistic.

Results: Ten studies with 1612 patients (RHR = 654, RFA = 958) were included in the meta-analysis. The meta-analysis showed that RHR had superior OS (HR 0.77, 95% CI =0.65-0.92, P = 0.004) and PFS (HR 0.81, 95% CI =0.67-0.98, P = 0.027) compared to RFA, whereas major complications may be less frequent in the RFA group (OR 0.15, 95% CI = 0.06-0.39, P < 0.001). In the subgroup analysis of patients with single RHCC ≤3 cm, OS (HR 1.03, 95% CI =0.69-1.52, P = 0.897) and PFS (HR 0.99, 95% CI = 0.71-1.37, P = 0.929) showed no significant differences in the comparison of RHR and RFA. In single RHCC> 3 cm and ≤ 5 cm, RFA showed an increased mortality in terms of OS (HR 0.57, 95% CI = 0.37-0.89, P = 0.014).

Conclusion: RHR offers a longer OS and PFS than RFA for patients with RHCC, but no statistically significant difference was observed for single RHCC ≤3 cm. The advantages of fewer major complications may render RFA an alternative treatment option for selected patients.
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http://dx.doi.org/10.1186/s12876-020-01544-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693504PMC
November 2020

Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3.

Int J Gen Med 2020 10;13:1067-1074. Epub 2020 Nov 10.

Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.

Background: Post-menopausal patients with cervical intraepithelial neoplasia (CIN) have a high rate of residual or recurrent lesions after treatment, and their risk for cervical cancer later in life is higher than the general population. Hence, management for this specific group of post-menopausal patients needs more attention.

Objective: The study aimed to identify risk factors associated with the presence of residual disease in hysterectomy specimens in post-menopausal patients with cervical intraepithelial neoplasia grade 3 (CIN 3).

Methods: This study was a retrospective analysis of data from post-menopausal women who had undergone hysterectomy following conization for CIN 3 from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, parity, Thinprep cytology results, human papillomavirus (HPV) genotype, biopsy results, pre-cone endocervical curettage (ECC) results, conization method, operating surgeon, cone dimension, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with residual disease in hysterectomy specimens.

Results: Analysis of data from 129 women was performed. The proportion of residual disease was 43.41% overall. A higher grade according to colposcopy biopsy, abnormal pre-cone ECC results, the cone method (LEEP vs CKC), a cone volume >1.57 cm, and positive margins in conization specimens were found to be significantly associated with residual lesions on univariable analysis. After multivariate analysis, only an abnormal pre-cone ECC result (odds ratio 3.99; 95% confidence interval (CI) 1.41-11.33; p = 0.009) remained significant.

Conclusion: The rate of residual lesions in uterine specimens was high regardless of the cone margin status in post-menopausal women with CIN 3. Risk-based strategies are needed to identify patients who have abnormal pre-cone ECC results, and definitive treatment with hysterectomy should be considered in post-menopausal patients with an elevated risk for residual lesions.
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http://dx.doi.org/10.2147/IJGM.S280576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667014PMC
November 2020

Low Red Blood Cell Count as an Early Indicator for Myometrial Invasion in Women with Endometrioid Endometrial Carcinoma with Metabolic Syndrome.

Cancer Manag Res 2020 29;12:10849-10859. Epub 2020 Oct 29.

Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, People's Republic of China.

Purpose: We investigated the relationship between metabolic syndrome (MetS) and its components and erythrocyte parameters such as red blood cell count (RBC) and hemoglobin (Hb) levels, and their association with the risk of deep myometrial invasion in endometrioid endometrial carcinoma (EEC).

Patients And Methods: A total of 473 women diagnosed with EEC between January 2012 and December 2018 were included in the study. MetS was diagnosed using a modified version of the Chinese Diabetes Society 2004 criteria. Demographic and clinical characteristics were stratified by MetS and compared. Logistic regression analyses were performed to calculate the odds ratios (ORs) of myometrial invasion.

Results: The prevalence of MetS was 18.8% (89/473). RBC and Hb levels were significantly higher in EEC patients with MetS. RBC and Hb values increased linearly with the number of MetS components. The OR of the MetS risk increased across the RBC quartiles (OR=2.212, 95% confidence interval [Cl]=1.125-4.350, P˂0.05). Among EEC patients with MetS, the OR of deep myometrial invasion increased with the decrease of the RBC quartiles (P=0.037). Similarly, in EEC patients with obesity and hyperglycemia or with ≥2 MetS criteria, the lowest RBC level (Q1) was a risk factor for deep myometrial invasion compared with the reference RBC group (Q4, P˂0.05). However, this trend was not evident in EEC patients without MetS and its components.

Conclusion: EEC with MetS and its components had higher RBC and Hb levels. The association between the erythrocyte parameters and myometrial invasion differed with MetS. RBC was identified as a risk factor of myometrial invasion in EEC patients with MetS and its components.
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http://dx.doi.org/10.2147/CMAR.S271078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605592PMC
October 2020

Feasibility and outcomes of percutaneous radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma after liver transplantation: a single-center experience.

Int J Hyperthermia 2020 ;37(1):1202-1209

Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Purpose: To evaluate the feasibility, effectiveness, and treatment outcomes of percutaneous radiofrequency ablation (RFA) in the application of intrahepatic recurrent hepatocellular carcinoma (r-HCC) after liver transplantation (LT).

Methods: From April 2008 to December 2019, a total of 37 patients (34 male and 3 female, mean age: 48.7 ± 10.5 years) with 61 r-HCCs after LT treated by RFA as a first-line option were enrolled. The technical success, recurrence-free survival (RFS), overall survival (OS) and complications were evaluated.

Results: After the first session of RFA, three patients were detected with residual foci. All of them received additional session of RFA and two tumors were successfully ablated. Therefore, the technical success was 97.3% (36/37). During the follow-up period, a total of 7 tumors developed local tumor progression (LTP) after 2.2-10.8 months. The LTP rate was 11.7% for r-HCC in the transplanted liver. The median RFS was 4.8 months (95% confidence interval [CI]: 2.2-7.3 months). The 1-, 3-, and 5-year cumulative OS rates were 68.5%, 40.3%, and 40.3%, respectively. Multivariate analyses revealed that tumor size was the only independent predictor for RFS (hazard ratio [HR] = 2.557, 95% CI, 1.015-6.444;  = .046) and limited extrahepatic metastasis was the only independent prognostic factors of OS after RFA for post-LT r-HCC (HR = 4.031, 95%CI, 1.218-13.339;  = .022). Major complications after RFA occurred in two patients (2/37, 5.4%).

Conclusion: Percutaneous RFA is safe and effective for intrahepatic r-HCC after LT, especially for those without limited extrahepatic metastasis.
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http://dx.doi.org/10.1080/02656736.2020.1834154DOI Listing
January 2020

Platelet-derived microparticles enhance megakaryocyte differentiation and platelet generation via miR-1915-3p.

Nat Commun 2020 10 2;11(1):4964. Epub 2020 Oct 2.

Stem Cells and Regenerative Medicine Lab, Institute of Health Service and Transfusion Medicine Beijing, Beijing, 100850, China.

Thrombosis leads to platelet activation and subsequent degradation; therefore, replenishment of platelets from hematopoietic stem/progenitor cells (HSPCs) is needed to maintain the physiological level of circulating platelets. Platelet-derived microparticles (PMPs) are protein- and RNA-containing vesicles released from activated platelets. We hypothesized that factors carried by PMPs might influence the production of platelets from HSPCs, in a positive feedback fashion. Here we show that, during mouse acute liver injury, the density of megakaryocyte in the bone marrow increases following an increase in circulating PMPs, but without thrombopoietin (TPO) upregulation. In vitro, PMPs are internalized by HSPCs and drive them toward a megakaryocytic fate. Mechanistically, miR-1915-3p, a miRNA highly enriched in PMPs, is transported to target cells and suppresses the expression levels of Rho GTPase family member B, thereby inducing megakaryopoiesis. In addition, direct injection of PMPs into irradiated mice increases the number of megakaryocytes and platelets without affecting TPO levels. In conclusion, our data reveal that PMPs have a role in promoting megakaryocytic differentiation and platelet production.
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http://dx.doi.org/10.1038/s41467-020-18802-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532443PMC
October 2020

Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition).

J Cancer Res Ther 2020 Sep;16(5):960-966

Department of Ultrasound, Chinese PLA General Hospital, China.

As a treatment option for cancer, thermal ablation has satisfactory effects on many types of solid tumors (such as liver and renal cancers). However, its clinical applications for the treatment of thyroid nodules and metastatic cervical lymph nodes are still under debate both in China and abroad. In 2015, the "Zhejiang Expert consensus on thermal ablation for thyroid benign nodules, microcarcinoma, and metastatic cervical lymph nodes (2015 edition)," was released by the Thyroid Cancer Committee of Zhejiang Anti-Cancer Association, China. To further standardize the application of thermal ablation for thyroid tumors, the Thyroid Tumor Ablation Experts Group of Chinese Medical Doctor Association has organized many seminars and finally produced a consensus to formulate the "Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition)."
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http://dx.doi.org/10.4103/jcrt.JCRT_558_19DOI Listing
September 2020

Deep Learning Radiomics Based on Contrast-Enhanced Ultrasound Might Optimize Curative Treatments for Very-Early or Early-Stage Hepatocellular Carcinoma Patients.

Liver Cancer 2020 Aug 31;9(4):397-413. Epub 2020 Mar 31.

Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Background: We aimed to evaluate the performance of a deep learning (DL)-based Radiomics strategy designed for analyzing contrast-enhanced ultrasound (CEUS) to not only predict the progression-free survival (PFS) of radiofrequency ablation (RFA) and surgical resection (SR) but also optimize the treatment selection between them for patients with very-early or early-stage hepatocellular carcinoma (HCC).

Methods: We retrospectively enrolled 419 patients examined by CEUS within 1 week before receiving RFA or SR (RFA: 214, SR: 205) from January 2008 to 2016. Two Radiomics signatures were constructed by the Radiomics model R-RFA and R-SR to stratify PFS of different treatment groups. Then, RFA and SR nomograms were built by incorporating Radiomics signatures and significant clinical variables to achieve individualized 2-year PFS prediction. Finally, we applied both Radiomics models and both nomograms to each enrolled patient to investigate whether there were space for treatment optimization and how much prognostic improvement could be expected.

Results: R-RFA and R-SR showed remarkable discrimination (C-index: 0.726 for RFA, 0.741 for SR). RFA and SR nomograms provided good 2-year PFS prediction accuracy and good calibrations. We identified 17.3% RFA patients and 27.3% SR patients should swap their treatment, so their average probability of 2-year PFS would increase 12 and 15%, respectively.

Conclusions: The proposed Radiomics models and nomograms achieved accurate preoperative prediction of PFS for RFA and SR, and they could facilitate the optimized treatment selection between them for patients with very-early or early-stage HCC.
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http://dx.doi.org/10.1159/000505694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506213PMC
August 2020

Oxidative-protective effect of nuclear receptor coactivator 7 on arecoline-induced endothelial-to-mesenchymal transition.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Nov 21;130(5):565-573. Epub 2020 Aug 21.

Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, P. R. China. Electronic address:

Objective: Overproduction of reactive oxygen species (ROS) has been implicated in inflammatory activities and tumorigenesis in oral submucous fibrosis (OSF). Nuclear receptor coactivator 7 (NCOA7) is capable of regulating cellular responses to ROS. The aim of this study was to investigate the expression of NCOA7 in endothelial cells and the role of NCOA7 in areca nut-induced endothelial-to-mesenchymal transition (EndMT).

Study Design: Immunohistochemistry and immunofluorescence were used to detect the expression of NCOA7 in endothelia. Human umbilical vein endothelial cells (HUVECs) were treated with various dosages of arecoline (0, 5, 10, 20 μg/mL); then NCOA7 expression, the correlation of NCOA7 with EndMT, and the potential signaling were analyzed by using small interfering RNA (siRNA) transfection, reverse transcription polymerase chain reaction, Western blotting, and flow cytometry.

Results: NCOA7 was significantly elevated in OSF tissues, as detected with immunohistochemistry and immunofluorescence. After arecoline treatment, NCOA7 expression and EndMT were induced in HUVECs. Transfection of HUVECs with si-NCOA7, which reduced 73% of NCOA7 expression, aggravated the arecoline-induced EndMT process. Inhibition of ROS markedly, but not completely, reverses this arecoline-induced EndMT in si-NCOA7 cells.

Conclusions: This study highlights NCOA7 as a potential target for therapeutic intervention to mediate EndMT via ROS species production.
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http://dx.doi.org/10.1016/j.oooo.2020.08.018DOI Listing
November 2020

Contrast-enhanced ultrasound-guided feeding artery ablation as add-on to percutaneous radiofrequency ablation for hypervascular hepatocellular carcinoma with a modified ablative technique and tumor perfusion evaluation.

Int J Hyperthermia 2020 ;37(1):1016-1026

Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.

Objectives: To establish a modified strategy of the feeding artery ablation (FAA) procedure as an add-on to percutaneous radiofrequency ablation (RFA) for patients with hypervascular hepatocellular carcinoma (HCC), and to evaluate the outcomes.

Materials And Methods: For this prospective, single-arm study, from June 2014 to August 2016, twenty-five patients with hypervascular HCC, 2-5 cm in diameter were treated by contrast-enhanced ultrasound (CEUS)-guided FAA before conventional RFA. Technical success of FAA and subsequent perfusion change of the tumor were evaluated by CEUS. Technical efficacy and ablation sizes were evaluated by CT/MRI at 1 month. Therapeutic outcomes, including local tumor progression (LTP), overall survival (OS), and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method.

Results: One or two target feeding arteries were visible on CEUS for 52.6% (61/116) of the hypervascular HCCs 2-5 cm in diameter. The technical success rate of the FAA was 100%; 13/25 (52.0%) target tumors were evaluated as complete perfusion response, while 12/25 (48.0%) were evaluated as partial perfusion response. The ablation volume was 41.9 ± 17.5 cm (14.9-78.2 cm) and the ablative safety margin was 8.2 ± 1.9 mm (4-12 mm) at the 1-month evaluation. These parameters did not differ significantly between the complete and partial subgroups. The cumulative rates of LTP at 1-, 2-, and 3-year follow-ups were 0.0%, 4.2% and 4.2%, respectively. The 3-year OS and RFS were 70.3% vs. 59.8%, respectively. There were no treatment-related deaths. Major complications occurred in one patient (4.0%).

Conclusion: As an add-on to conventional percutaneous RFA, tailored CEUS-guided FAA can reduce tumor perfusion and provide good local control of HCC.
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http://dx.doi.org/10.1080/02656736.2020.1811902DOI Listing
January 2020

Modulation of Tumor Hypoxia by pH-Responsive Liposomes to Inhibit Mitochondrial Respiration for Enhancing Sonodynamic Therapy.

Int J Nanomedicine 2020 6;15:5687-5700. Epub 2020 Aug 6.

Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, People's Republic of China.

Background And Purpose: Sonodynamic therapy (SDT) has been widely used for the noninvasive treatment of solid tumors, but the hypoxic tumor microenvironment limits its therapeutic effect. The current methods of reoxygenation to enhance SDT have limitations, prompting reconsideration of the design of therapeutic approaches. Here, we developed a tumor microenvironment-responsive nanoplatform by reducing oxygen consumption to overcome hypoxia-induced resistance to cancer therapy.

Methods: A pH-responsive drug-loaded liposome (MI-PEOz-lip) was prepared and used to reduce oxygen consumption, attenuating hypoxia-induced resistance to SDT and thereby improving therapeutic efficiency. Photoacoustic imaging (PAI) and fluorescence imaging (FI) of MI-PEOz-lip were evaluated in vitro and in breast xenograft tumor models. The pH-sensitive functionality of MI-PEOz-lip was applied for pH-triggered cargo release, and its capacity was evaluated. The MI-PEOz-lip-mediated SDT effect was compared with other treatments in vivo.

Results: MI-PEOz-lip was demonstrated to specifically accumulate in tumors. Metformin molecules in liposomes selectively accumulate in tumors by pH-responsive drug release to inhibit the mitochondrial respiratory chain while releasing IR780 to the tumor area. These pH-responsive liposomes demonstrated PAI and FI imaging capabilities in vitro and in vivo, providing potential for treatment guidance and monitoring. In particular, the prepared MI-PEOz-lip combined with ultrasound irradiation effectively inhibited breast tumors by producing toxic reactive singlet oxygen species (ROS), while the introduction of metformin inhibited mitochondrial respiration and reduced tumor oxygen consumption, resulting in excellent sonodynamic therapy performance compared with other treatments.

Conclusion: In this study, we present a novel strategy to achieve high therapeutic efficacy of SDT by the rational design of multifunctional nanoplatforms. This work provides a new strategy that can solve the current problems of inefficient oxygen delivery strategies and weaken resistance to various oxygen-dependent therapies.
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http://dx.doi.org/10.2147/IJN.S256038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418152PMC
September 2020

Arterial endothelium creates a permissive niche for expansion of human cord blood hematopoietic stem and progenitor cells.

Stem Cell Res Ther 2020 08 14;11(1):358. Epub 2020 Aug 14.

Stem Cell and Regenerative Medicine Lab, Institute of Health Service and Transfusion Medicine, Beijing, 100850, China.

Background: Although cord blood (CB) offers promise for treatment of patients with high-risk hematological malignancies and immune disorders, the limited numbers of hematopoietic stem cell (HSC)/progenitor cell in a CB unit and straitened circumstances in expanding ex vivo make it quite challenging to develop the successful cell therapies.

Methods: In this study, a novel strategy has been developed to support ex vivo expansion of hematopoietic stem and progenitor cells (HSPCs) by coculture with engineered human umbilical arterial endothelial cells (HuAECs-E4orf1-GFP), which expresses E4ORF1 stably by using a retroviral system.

Results: Coculture of CD34 hCB cells with HuAECs-E4orf1-GFP resulted in generation of considerably more total nucleated cells, CD34CD38, and CD34CD38CD90 HSPCs in comparison with that of cytokines alone or that of coculture with human umbilical vein endothelial cells (HuVECs) after 14-day amplification. The in vitro multilineage differentiation potential and in vivo repopulating capacity of the expanded hematopoietic cells cocultured with HuAECs-E4orf1-GFP were also markedly enhanced compared with the other two control groups. DLL4, a major determinant of arterial endothelial cell (EC) identity, was associated with CD34 hCB cells amplified on HuAECs-E4orf1-GFP.

Conclusions: Collectively, we demonstrated that HuAECs acted as a permissive niche in facilitating expansion of HSPCs. Our study further implicated that the crucial factors and related pathways presented in HuAECs may give a hint to maintain self-renewal of bona fide HSCs.
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http://dx.doi.org/10.1186/s13287-020-01880-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429738PMC
August 2020

An Abnormal Precone Endocervical Curettage Result Is an Independent Risk Factor for Positive Margins in Conization Specimens.

Oncol Res Treat 2020 7;43(10):518-525. Epub 2020 Aug 7.

Laboratory of Gynaecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,

Objective: This study aimed to identify risk factors associated with the presence of positive surgical margins in cervical conization specimens.

Methods: This study is a retrospective analysis of data from women who had undergone conization for cervical intraepithelial neoplasia (CIN) from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, gravidity, parity, menopausal status, precone Thinprep cytology test, human papillomavirus (HPV) test, precone biopsy, precone endocervical curettage (ECC) result, conization method, operating surgeon, cone dimension, and pathology of the conization specimen, including grade of CIN, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with positive margins.

Results: Data from 495 women were analysed. The proportion of positive margins was 24.85% overall, which varied according to the conization method (27.22% for loop electrosurgical excision procedure vs. 18.52% for cold-knife conization, p = 0.047) and was increased as the severity of the treated lesion increased (10.07% for CIN2 vs. 30.62% for CIN3, p < 0.001). HPV-16 genotype infection, abnormal precone ECC result, higher grade of biopsy, larger cone length and volume, and glandular involvement were significantly associated with positive margins on univariable analysis. After logistic regression analysis, only an abnormal precone ECC result (odds ratio 1.952; 95% confidence interval 1.037-3.676; p = 0.038) remained significant.

Conclusions: In the present study, an abnormal precone ECC result was identified as an independent risk factor for positive margins in cervical conization specimens. More aggressive treatment may be considered in patients with abnormal precone ECC results in clinical practice.
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http://dx.doi.org/10.1159/000509254DOI Listing
January 2021

Sanfu herbal patch applied at acupoints in patients with bronchial asthma: study protocol for a randomized controlled trial.

Trials 2020 Jul 29;21(1):684. Epub 2020 Jul 29.

Department of Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.

Background: Bronchial asthma is one of the most common inflammatory airway disorders. As one of the main non-drug therapies, the Sanfu herbal patch (SHP) has been widely used to treat bronchial asthma, although the evidence for its efficacy and associated mechanism are inconclusive. The objective of this trial is to clarify the clinical efficacy and safety of the SHP in the treatment of bronchial asthma in the chronic persistent or clinical remission stage and to provide high-quality data for further research.

Methods: We propose a multicentre, double-blinded, parallel, randomized, placebo-controlled clinical trial involving 4 study hospitals in China. A total of 72 eligible participants will be randomized into an SHP group and a placebo group. They will receive an SHP for 3 treatment sessions. The primary outcome will be changes in forced expiratory volume in 1 s after 3 treatment sessions. Secondary outcomes will include the following: (1) the Asthma Quality of Life Questionnaire, Asthma Control Test, and Asthma Long-term Follow-up Scale; (2) levels of Metallothionein-2 and Transgelin-2 in blood and urine; and (3) levels of IL-5, IL-13, IL-23, IL-25, and thymic stromal lymphopoietin in blood. Analysis of the data will be performed at baseline, at the end of the 2nd and 3rd treatment sessions, and at the 24-week follow-up. The safety of the SHP will be evaluated at each treatment session.

Discussion: The aims of this trial are to determine whether the SHP is more effective than placebo in the treatment of patients with bronchial asthma, as well as whether the SHP works by reducing airway inflammation and reversing bronchoconstriction.

Trial Registration: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), ChiCTR1900024616. Registered on 19 July 2019.
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http://dx.doi.org/10.1186/s13063-020-04604-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7389380PMC
July 2020

Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultrasound Med Biol 2020 10 24;46(10):2579-2604. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.04.030DOI Listing
October 2020

Cascaded one-shot deformable convolutional neural networks: Developing a deep learning model for respiratory motion estimation in ultrasound sequences.

Med Image Anal 2020 10 18;65:101793. Epub 2020 Jul 18.

CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Department of the Artificial Intelligence Technology, University of Chinese Academy of Sciences, Beijing 100049, China. Electronic address:

Improving the quality of image-guided radiation therapy requires the tracking of respiratory motion in ultrasound sequences. However, the low signal-to-noise ratio and the artifacts in ultrasound images make it difficult to track targets accurately and robustly. In this study, we propose a novel deep learning model, called a Cascaded One-shot Deformable Convolutional Neural Network (COSD-CNN), to track landmarks in real time in long ultrasound sequences. Specifically, we design a cascaded Siamese network structure to improve the tracking performance of CNN-based methods. We propose a one-shot deformable convolution module to enhance the robustness of the COSD-CNN to appearance variation in a meta-learning manner. Moreover, we design a simple and efficient unsupervised strategy to facilitate the network's training with a limited number of medical images, in which many corner points are selected from raw ultrasound images to learn network features with high generalizability. The proposed COSD-CNN has been extensively evaluated on the public Challenge on Liver UltraSound Tracking (CLUST) 2D dataset and on our own ultrasound image dataset from the First Affiliated Hospital of Sun Yat-sen University (FSYSU). Experiment results show that the proposed model can track a target through an ultrasound sequence with high accuracy and robustness. Our method achieves new state-of-the-art performance on the CLUST 2D benchmark set, indicating its strong potential for application in clinical practice.
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http://dx.doi.org/10.1016/j.media.2020.101793DOI Listing
October 2020

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultraschall Med 2020 Oct 24;41(5):562-585. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1055/a-1177-0530DOI Listing
October 2020

Ultrasound combined with biochemical parameters can be used to differentiate parathyroid carcinoma from benign tumors in patients with primary hyperparathyroidism.

Clin Hemorheol Microcirc 2020 ;76(3):351-359

Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

Background: Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone from parathyroid tumors. Differentiating parathyroid tumors can be challenging before operation.

Objectives: To differentiate parathyroid carcinoma from benign tumors in patients with PHPT by the application of ultrasound and biochemical parameters.

Methods: This study is a retrospective study. The study enrolled 17 patients with parathyroid carcinoma (PC) and 57 patients with parathyroid adenoma (PA), confirmed by postoperative pathology, between September 2010 and July 2017. This study retrospectively compared the ultrasonic features of the tumors included echotexture, maximum lesion diameter, shape, margin, blood flow inside the mass, intralesional calcifications, cysts in the mass, and biochemical parameters included serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALP) levels, gender distribution and age of patients between patients with PC and those with PA.

Results: In the US images, the two groups showed significant differences in heterogeneity, the appearance of a taller-than-wide shape, irregular or lobulated margins, and intralesional calcifications (p < #x003C;< #x200A;0.05). However, no significant difference was found in echogenicity, maximum lesion diameter, blood flow, and cystic components of the mass (p > #x003E;> #x200A;0.05). The mean PTH levels were significantly different between the two groups (p < #x003C;< #x200A;0.05). The PC and PA patients did not differ significantly in terms of mean serum calcium, mean serum phosphorus, and mean ALP levels (p > #x003E;> #x200A;0.05). There were significant differences to distinguish PC from PA in calcifications in mass or/and taller-than-wide shape combine with PTH > #x003E;> #x200A;1000 pg/mL (p < #x003C;< #x200A;0.05). Significant difference existed in the age between the two groups (p < #x003C;< #x200A;0.001). No significant difference existed in the gender distribution between the two groups (p > #x003E;> #x200A;0.05).

Conclusion: Ultrasound features especially intralesional calcifications and taller-than-wide shape combine with an extremely high serum PTH (>1000 pg/mL) are helpful in differentiating between benign and parathyroid tumors in patients with PHPT.
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http://dx.doi.org/10.3233/CH-200846DOI Listing
February 2021

Diagnostic Value of lncRNA ROR in Differentiating Ovarian Cancer Patients.

Clin Lab 2020 Jul;66(7)

Background: The current study aims to investigate the prognostic value of long non-coding RNA (lncRNA) ROR in ovarian cancer patients.

Methods: Sixty cases of ovarian cancer patients were collected from January 2017 to December 2017. The expression of lncRNA ROR in the plasma and tissues of ovarian cancer was detected by RT-qPCR. The relationship between the expression of lncRNA ROR and the clinicopathological characteristics was analyzed.

Results: The expression of lncRNA ROR in the plasma of ovarian cancer patients was significantly higher than that in healthy controls. Compared with that in the adjacent non-cancerous tissues, the level of lncRNA ROR was significantly enhanced in the ovarian cancer tissues. Further study showed that the expression of lncRNA ROR was closely related to FIGO stage, tumor grade, and lymph node metastasis. Pearson's correlation assay indicated that lncRNA ROR positively correlated with CA125 in ovarian cancer patients. Moreover, the combined detection of plasma lncRNA ROR and CA125 had the highest value in the diagnosis of ovarian cancer compared to that of lncRNA ROR or CA125 alone.

Conclusions: The enhanced level of plasma lncRNA ROR could be used as a potential biomarker for the diagnosis of ovarian cancer.
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http://dx.doi.org/10.7754/Clin.Lab.2019.191035DOI Listing
July 2020