Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma.

Background: American College of Radiology contrast agent–enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent2enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated. Purpose: To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC. Materials and Methods: Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with untreated liver nodules 20 mm or less were enrolled in this retrospective double-reader study. Each nodule was categorized according to the CEUS LI-RADS and World Federation for Ultrasound in Medicine and Biology (WFUMB)–European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria. Diagnostic performance of CEUS LI-RADS and WFUMB-EFSUMB characterization was evaluated by using tissue histologic analysis, multiphase contrast-enhanced CT and MRI, and imaging follow-up as reference standard and compared by using McNemar test. Results: The study included 175 nodules (mean diameter, 16.1 mm 6 3.4) in 172 patients (mean age, 51.8 years 6 10.6; 136 men). The sensitivity of CEUS LR-5 versus WFUMB-EFSUMB criteria in diagnosing HCC was 73.3% (95% confidence inter-val [CI]: 63.8%, 81.5%) versus 88.6% (95% CI: 80.9%, 94%), respectively (P, .001). The specificity of CEUS LR-5 versus WFUMB-EFSUMB criteria was 97.1% (95% CI: 90.1%, 99.7%) versus 87.1% (95% CI: 77%, 94%), respectively (P = .02). No malignant lesions were found in CEUS LR-1 and LR-2 categories. Only two nodules (of 41; 5%, both HCC) were malignant in CEUS LR-3 category. The incidences of HCC in CEUS LR-4, LR-5, and LR-M were 48% (11 of 23), 98% (77 of 79), and 75% (15 of 20), respectively. Two of 175 (1.1%) histologic analysis2confirmed intrahepatic cholangiocarcinomas were categorized as CEUS LR-M by CEUS LI-RADS and misdiagnosed as HCC by WFUMB-EFSUMB criteria. Conclusion: The contrast-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm was an effective tool for characterization of small (≤20 mm) liver nodules in patients at risk for hepatocellular carcinoma (HCC). Compared with World Federation for Ultrasound in Medicine and Biology2European Federation of Societies for Ultrasound in Medicine and Biology criteria, CEUS LR-5 demonstrated higher specificity for diagnosing small HCCs with lower sensitivity

Formation of Nanofoam carbon and re-emergence of Superconductivity in compressed CaC6

Pressure can tune material's electronic properties and control its quantum state, making some systems present disconnected superconducting region as observed in iron chalcogenides and heavy fermion CeCu2Si2. For CaC6 superconductor (Tc of 11.5 K), applying pressure first Tc increases and then suppresses and the superconductivity of this compound is eventually disappeared at about 18 GPa. Here, we report a theoretical finding of the re-emergence of superconductivity in heavily compressed CaC6. The predicted phase III (space group Pmmn) with formation of carbon nanofoam is found to be stable at wide pressure range with a Tc up to 14.7 K at 78 GPa. Diamond-like carbon structure is adhered to the phase IV (Cmcm) for compressed CaC6 after 126 GPa, which has bad metallic behavior, indicating again departure from superconductivity. Re-emerged superconductivity in compressed CaC6 paves a new way to design new-type superconductor by inserting metal into nanoporous host lattice.Comment: 31 pages, 12 figures, and 4 table

Impact of Clay Stabilizer on the Methane Desorption Kinetics and Isotherms of Longmaxi Shale, China

Knowing methane desorption characteristics is essential to define the contribution of adsorbed gas to gas well production. To evaluate the synthetic effect of a clay stabilizer solution on methane desorption kinetics and isotherms pertaining to Longmaxi shale, an experimental setup was designed based on the volumetric method. The objective was to conduct experiments on methane adsorption and desorption kinetics and isotherms before and after clay stabilizer treatments. The experimental data were a good fit for both the intraparticle diffusion model and the Freundlich isotherm model. We analyzed the effect of the clay stabilizer on desorption kinetics and isotherms. Results show that clay stabilizer can obviously improve the diffusion rate constant and reduce the methane adsorption amount. Moreover, we analyzed the desorption efficiency before and after treatment as well as the adsorbed methane content. The results show that a higher desorption efficiency after treatment can be observed when the pressure is higher than 6.84 MPa. Meanwhile, the adsorbed methane content before and after treatment all increase when the pressure decreases, and clay stabilizer can obviously promote the adsorbed methane to free gas when the pressure is lower than 19 MPa. This can also be applied to the optimization formulation of slickwater and the design of gas well production

Anti-tumor effect of polysaccharides from rhizome of Curculigo orchioides Gaertn on cervical cancer

Purpose: To investigate the anti-tumor effects of polysaccharides from Curculigo orchioides (PDC) on cervical cancer and the possible mechanisms involved.Methods: A Box–Behnken design (BBD) was employed to optimize extraction conditions for PDC. The anti-tumor effect of PDC on cervical cancer was investigated in vivo in mice injected with Hela cells. The parameters measured were tumor volume and weight. In vitro anti-tumor effects of PDC were assessed by measuring expressions of caspase-3, caspase-9 and P53 proteins in Hela cells via ELISA assay. Thymus and spleen indices were calculated for assessment of PDC effect on immune function.Results: The optimum extraction conditions predicted by the response surface methodology (RSM) were: extraction time = 1.58 h, ratio-of-water-to-sample = 30.05 mL/g and extraction number = 1.95. PDC showed significant anti-tumor effect on cervical cancer in mice. It significantly increased thymus and spleen indices in mice; and significantly up-regulated expressions of caspase-3, caspase-9 and P53 proteins in HeLa cells.Conclusion: PDC has significant anti-tumor effect on cervical cancer in vivo and in vitro, most probably through mechanisms involving enhancement on immune function and induction of apoptosis.Keyword: Curculigo orchioides, Polysaccharides, Cervical cancer, HeLa cells, Apoptosi

龙江医派和地理环境关系探述

This article through to the TCM faction of Longjiang in geography, climate, etc, the analysis of the ancient and modern, combined with traditional Chinese medicine theory and the generation of the acknowledgement to the understanding of the concept of holism, pointed out that in the history of the TCM, from breeding, germination to gradually expanding, its unique dialectical treatment system and geographic environment has an inseparable relationship.本文通过对龙江医派所处的地理、气候等方面古代和现代的分析，结合中医传统理论和各代医家对整体观的认识，指出龙江医派在祖国中医药事业的发展史中，从孕育、萌芽到逐步壮大，其独特的辩证论治体系与所处的地理环境有着不可分割的关系

Cost-effectiveness analysis of malaria rapid diagnostic test in the elimination setting

BACKGROUND: As more and more countries approaching the goal of malaria elimination, malaria rapid diagnostic tests (RDT) was recomendated to be a diagnostic strategy to achieve and maintain the statute of malaria free, as it’s less requirments on equipment and experitise than microscopic examination. But there are very few economic evaluations to confirm whether RDT was cost-effective in the setting of malaria elimination. This research aimed to offer evidence for helping decision making on malaria diagnosis strategy. METHODS: A cost-effectiveness analysis was conducted to compare RDT with microscopy examination for malaria diagnosis, by using a decision tree model. There were three strategies of malaria diagnostic testing evaluated in the model, 1) microscopy, 2) RDT, 3) RDT followed by microscopy. The effect indicator was defined as the number of malaria cases treated appropriately. Based on the joint perspective of health sector and patient, costs data were collected from hospital information systems, key informant interviews, and patient surveys. Data collection was conducted in Jiangsu from September 2018 to January 2019. Epidemiological data were obtained from local malaria surveillance reports. A hypothetical cohort of 300 000 febrile patients were simulated to calculate the total cost and effect of each strategy. One-way, two-way, and probabilistic sensitivity analysis were performed to test the robustness of the result. RESULTS: The results showed that RDT strategy was the most effective (245 cases) but also the most costly (United States Dollar [USD] 4.47 million) compared to using microscopy alone (238 cases, USD 3.63 million), and RDT followed by microscopy (221 cases, USD 2.75 million). There was no strategy dominated. One-way sensitivity analysis reflected that the result was sensitive to the change in labor cost and two-way sensitivity analysis indicated that the result was not sensitive to the proportion of falciparum malaria. The result of Monte Carlo simulation showed that RDT strategy had higher effects and higher cost than other strategies with a high probability. CONCLUSIONS: Compared to microscopy and RDT followed by microscopy, RDT strategy had higher effects and higher cost in the setting of malaria elimination

Differential regulation of auxin and cytokinin during the secondary vascular tissue regeneration in Populus trees

Tissue regeneration upon wounding in plants highlights the developmental plasticity of plants. Previous studies have described the morphological and molecular changes of secondary vascular tissue (SVT) regeneration after large-scale bark girdling in trees. However, how phytohormones regulate SVT regeneration is still unknown. Here, we established a novel in vitro SVT regeneration system in the hybrid aspen (Populus tremula x Populus tremuloides) clone T89 to bypass the limitation of using field-grown trees. The effects of phytohormones on SVT regeneration were investigated by applying exogenous hormones and utilizing various transgenic trees. Vascular tissue-specific markers and hormonal response factors were also examined during SVT regeneration. Using this in vitro regeneration system, we demonstrated that auxin and cytokinin differentially regulate phloem and cambium regeneration. Whereas auxin is sufficient to induce regeneration of phloem prior to continuous cambium restoration, cytokinin only promotes the formation of new phloem, not cambium. The positive role of cytokinin on phloem regeneration was further confirmed in cytokinin overexpression trees. Analysis of a DR5 reporter transgenic line further suggested that cytokinin blocks the re-establishment of auxin gradients, which is required for the cambium formation. Investigation on the auxin and cytokinin signalling genes indicated these two hormones interact to regulate SVT regeneration. Taken together, the in vitro SVT regeneration system allows us to make use of various molecular and genetic tools to investigate SVT regeneration. Our results confirmed that complementary auxin and cytokinin domains are required for phloem and cambium reconstruction.Peer reviewe

Alcohol intake and associated risk of major cardiovascular outcomes in women compared with men: a systematic review and meta-analysis of prospective observational studies

Adjustment factors of included studies. Figures S1. RR or RRR (female to male) of low alcohol intake and the risk of coronary disease. Figure S2. RR or RRR (female to male) of moderate alcohol intake and the risk of coronary disease. Figure S3. RR or RRR (female to male) of heavy alcohol intake and the risk of coronary disease. Figure S4. RR or RRR (female to male) of low alcohol intake and the risk of total mortality. Figure S5. RR or RRR (female to male) of moderate alcohol intake and the risk of total mortality. Figure S6. RR or RRR (female to male) of heavy alcohol intake and the risk of total mortality. Figure S7. RR or RRR (female to male) of low alcohol intake and the risk of ischemic stroke. Figure S8. RR or RRR (female to male) of low alcohol intake and the risk of cardiac death. Figure S9. RR or RRR (female to male) of low alcohol intake and the risk of stroke. Figure S10. RR or RRR (female to male) of moderate alcohol intake and the risk of cardiac death. Figure S11. RR or RRR (female to male) of moderate alcohol intake and the risk of stroke. Figure S12. RR or RRR (female to male) of moderate alcohol intake and the risk of ischemic stroke. Figure S13. RR or RRR (female to male) of heavy alcohol intake and the risk of cardiac death. Figure S14. RR or RRR (female to male) of heavy alcohol intake and the risk of stroke. Figure S15. RR or RRR (female to male) of heavy alcohol intake and the risk of ischemic stroke. Figure S16. Funnel plot of RRR (female to male) for low alcohol intake. Figure S17. Funnel plot of RRR (female to male) for moderate alcohol intake. Figure S18. Funnel plot of RRR (female to male) for heavy alcohol intake. (DOC 10344 kb

Can contrast enhanced ultrasound differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma?

BACKGROUND: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge. AIM: To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS. METHODS: Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified in the CEUS LI-RADS LR-M category) between January 2015 and October 2018 were included in this retrospective study. Each ICC was assigned a category as per the CEUS LI-RADS. The enhancement pattern, washout timing, and washout degree between the ICC and LR-M HCC were compared using the RESULTS: A total of 228 nodules (99 ICCs and 129 LR-M HCCs) in 228 patients were included. The mean sizes of ICC and LR-M HCC were 6.3 ± 2.8 cm and 5.5 ± 3.5 cm, respectively ( CONCLUSION: Rim APHE is a key predictor for differentiating ICC from LR-M HCC. Rim APHE plus elevated CA 19-9 and normal AFP is a strong predictor of ICC rather than LR-M HCC. Early washout and marked washout have limited value for the differentiation between the two entities