Do sex hormone imbalances contribute to idiopathic condylar resorption?

Idiopathic condylar resorption (ICR) is an aggressive form of temporomandibular joint disease that most frequently presents in adolescent girls during the pubertal growth spurt. Although numerous studies have indicated that the etiopathogenesis of ICR may be related to estrogen deficiency, the decisive role of estrogens remains controversial, and other sex hormone disturbances have not yet been investigated in this regard. Therefore, the aim of this study was to ascertain the role of serum estrogen levels and also the roles of other sex hormones in the pathogenesis of ICR. Ninety-four ICR patients and 324 disc displacement (DD) patients, of both sexes, were enrolled. Information on menstruation and serum levels of follicle-stimulating hormone, luteinizing hormone, prolactin, 17β-estradiol (E2), testosterone, and progesterone were recorded and analyzed. The results showed that female ICR patients had normal puberty onset, within the average age range. Use of oral contraceptives and other menstruation-regulating pharmaceuticals was similar in the two groups. Of note, neither serum E2 levels nor those of the other sex hormones differed significantly between female ICR and DD patients. However, male ICR patients had significantly increased serum testosterone levels (P=0.002) and relatively higher E2 levels (P=0.095) compared to DD patients. This study found that reduced serum E2 did not contribute to ICR; instead, systemic testosterone disturbances were found to be related to ICR.

The usage of deep neural network improves distinguishing COVID-19 from other suspected viral pneumonia by clinicians on chest CT: a real-world study

Objectives

Based on the current clinical routine, we aimed to develop a novel deep learning model to distinguish coronavirus disease 2019 (COVID-19) pneumonia from other types of pneumonia and validate it with a real-world dataset (RWD).

Methods

A total of 563 chest CT scans of 380 patients (227/380 were diagnosed with COVID-19 pneumonia) from 5 hospitals were collected to train our deep learning (DL) model. Lung regions were extracted by U-net, then transformed and fed to pre-trained ResNet-50-based IDANNet (Identification and Analysis of New covid-19 Net) to produce a diagnostic probability. Fivefold cross-validation was employed to validate the application of our model. Another 318 scans of 316 patients (243/316 were diagnosed with COVID-19 pneumonia) from 2 other hospitals were enrolled prospectively as the RWDs to testify our DL model’s performance and compared it with that from 3 experienced radiologists.

Results

A three-dimensional DL model was successfully established. The diagnostic threshold to differentiate COVID-19 and non-COVID-19 pneumonia was 0.685 with an AUC of 0.906 (95% CI: 0.886–0.913) in the internal validation group. In the RWD cohort, our model achieved an AUC of 0.868 (95% CI: 0.851–0.876) with the sensitivity of 0.811 and the specificity of 0.822, non-inferior to the performance of 3 experienced radiologists, suggesting promising clinical practical usage.

Conclusions

The established DL model was able to achieve accurate identification of COVID-19 pneumonia from other suspected ones in the real-world situation, which could become a reliable tool in clinical routine.

Key Points

• In an internal validation set, our DL model achieved the best performance to differentiate COVID-19 from non-COVID-19 pneumonia with a sensitivity of 0.836, a specificity of 0.800, and an AUC of 0.906 (95% CI: 0.886–0.913) when the threshold was set at 0.685.

• In the prospective RWD cohort, our DL diagnostic model achieved a sensitivity of 0.811, a specificity of 0.822, and AUC of 0.868 (95% CI: 0.851–0.876), non-inferior to the performance of 3 experienced radiologists.

• The attention heatmaps were fully generated by the model without additional manual annotation and the attention regions were highly aligned with the ROIs acquired by human radiologists for diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-020-07553-7.

[Optimal timing of antiviral therapy for chronic HBV-infected patients with normal ALT]

Whether to initiate antiviral therapy in chronic hepatitis B virus (HBV) infected population with normal alanine aminotransferase (ALT) is hot and difficult issue. Improvements in drug availability and affordability have paved the way for more data, which may become a medium for confirming whether this population needs antiviral treatment. Regardless of whether HBeAg is positive or negative, there are still a considerable number of patients with chronic HBV infection with normal ALT, who have obvious liver inflammation, fibrosis or cirrhosis and need to start antiviral therapy. Liver biopsy or non-invasive techniques can be used as diagnostic tools to begin an early treatment in population with liver fibrosis and inflammation.

Effects of ET-1 and TNF-α levels on the cardiac function and prognosis in rats with chronic heart failure

OBJECTIVE

To investigate the effects of ET-1 and TNF-α levels on cardiac function and prognosis in rats with chronic heart failure (CHF), to provide reference for clinical practice.

MATERIALS AND METHODS

120 SD rats were randomly divided into healthy group (n=60) and heart failure group (n=60). Rats from heart failure group were made into CHF models by an intraperitoneal injection of adriamycin. According to the average serum levels of ET-1 and TNF-α, 30 rats with higher level were enrolled in high expression subgroup, while 30 rats with lower level were enrolled in low expression subgroup. The sandwich enzyme-linked immunosorbent assay (ELISA) was employed to determine the ET-1 and TNF-α in rats from healthy group and heart failure group. Doppler echocardiography was used to measure the left ventricular ejection fraction, heart rate, and aortic diameter. After the death of heart failure rats, the total heart mass and left ventricle mass were measured and compared with those of the healthy rats. The serum levels of ET-1 and TNF-α were monitored to explore the influence of ET-1 and TNF-α levels on the prognosis of rats from study group.

RESULTS

The total heart mass and left ventricle mass of the heart failure group were higher than those of healthy group (p<0.05). The total heart mass and left ventricle mass of the low expression subgroup were lower than those of high expression subgroup (p<0.05).

CONCLUSIONS

The serum levels of ET-1 and TNF-α are higher than those in healthy rats. CHF rats with higher serum levels of ET-1 and TNF-α have a worse heart function and survival. Serum levels of ET-1 and TNF-α can be used as predictors of cardiac function and prognosis in CHF rats, providing references for clinical practice.

[Clinical cure strategy for hepatitis B: immunomodulatory therapy]

Chronic hepatitis B virus (HBV) infection remains a major world public health problem. Current guidelines of chronic hepatitis B (CHB) suggest the clinical cure as the ideal thearapeutic goal. Although the optimization of the existing antiviral treatment can make some patients achieve clinical cure, but for most patients with chronic hepatitis B, it is difficult to achieve clinical cure according to the existing antiviral treatment plan. The medical community has begun to work together to seek new treatment strategies, especially the immune intervention measures aimed at restoring the immune response in the liver microenvironment. Notably, immune antiviral response plays a crucial role in HBV clearance, and the clinical cure of chronic hepatitis B is finally achieved through the optimized combination of antiviral and immunomodulatory drugs.

Acupuncture in addition to budesonide does not further improve RQLQ apart from the sleep domain

BACKGROUND: Acupuncture can effectively alleviate the nasal symptoms of allergic rhinitis (AR); however, the mechanism is unclear. Previous studies suggested it may be related to improve hypothalamus-pituitary-adrenal (HPA) axis dysfunction. MATERIALS and METHODS: The study was a randomised controlled trial including ninety patients with moderate to severe persis- tent AR. Subjects were randomised 1:1:1 to the 8-weeks treatment with mind-regulating acupuncture combined with intranasal glucocorticosteroids (INGC), conventional acupuncture combined with INGC and INGC alone (MA, CA, GC respectively). The primary outcome was the change from baseline in the Visual Analogue Scale (VAS) score of nasal symptoms. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was a key secondary outcome. The levels of corticotrophin releasing hormone (CRH), cortisol (COR) and adrenocorticotropic hormone (ACTH) were also analysed. RESULTS: MA, CA and GC reduced VAS score and total RQLQ by a similar degree, but the sleep domain of RQLQ significantly impro- ved in MA and CA compared to GC. Meanwhile, the COR and ACTH level increased, and CRH level decreased after treatment in MA and CA, but the changes showed no difference among the three groups after Bonferroni correction. CONCLUSIONS: Although acupuncture combined with INGC may have potential effect on sleep quality, the combination therapy cannot further improve nasal symptoms or RQLQ compared to INGC alone in AR patients. The influence of acupuncture on HPA axis needs to be further explored.

A Fatal Case of Pediatric Primary Myxoid Liposarcoma of the Orbit: A Rare Tumor in an Unusual Location Presenting with Widespread Metastasis

Introduction/Objective

A liposarcoma is a tumor derived from primitive mesenchymal cells undergoing adipose differentiation. Liposarcomas are uncommon in childhood, representing only about 2% of childhood sarcomas. Among liposarcomas, is a very rare subtype, the so-called ‘pleomorphic myxoid liposarcoma’ which has extensive myxoid changes and scattered pleomorphic cells. Here we report an autopsy case of an extensively metastatic pleomorphic myxoid liposarcoma.

Methods

A 12 year-old, African-American boy presented in the ED with ascites and shortness of breath, who later expired despite resuscitation. Autopsy finding showed a primary lesion in the left superior orbital fissure with diffuse metastasis to liver, replacing most of the liver parenchyma (liver weigh 8500 g). Metastatic foci are also present in gallbladder, pancreas, large intestine, bilateral lungs, and inner and outer surfaces of cranium. Histologically, tumor at all sites shows similar morphology, revealing scattered pleomorphic lipoblasts and a myxoid background with arborizing vasculature. Lipoblasts show indented and distorted nuclei and cytoplasmic vacuoles.

Immunohistochemically the tumor cells are immunoreactive for p16 (diffusely and strongly) (Figure, D) and S100 (weakly) and negative for AE1/AE3, myogenin, synaptophysin, GFAP, EMA, and CD34. FISH was negative for MDM2 and t(12;16)(q13;p11.2) FUS-DDIT3 rearrangement, ruling out conventional myxoid liposarcoma.

Conclusion

This case shows the aggressive nature of a poorly studied entity in an uncommon age group and emphasize the need to study childhood liposarcomas in more detail.

“Duodenal Submucosal Glandular Lesion with Brunner and Paneth Cell Differentiation”: A Variant of Pyloric Gland Adenoma? Morphologic and Immunohistochemical Similarities and Differences

Introduction/Objective

Duodenal epithelial polyps are reported in up to 3% of patients referred for upper endoscopy. Most include non-neoplastic lesions such as Brunner gland nodule/polyp and pancreatic or gastric heterotopia.

Neoplastic lesions such as pyloric gland adenomas (PGA) are less frequently encountered and have the propensity to progress to adenocarcinoma. Herein we report a duodenal submucosal glandular lesion that has a morphologic resemblance to PGA, but very different in several aspects. We compare and contrast the characteristics of these two lesions.

Methods

This was a 63-year-old man referred for an upper GI endoscopy for complaints of indigestion, dyspepsia, and weight fluctuation. Endoscopy showed a 13 mm polypoid lesion in the second portion of the duodenum, opposite to and separate from the ampulla. An en-bloc hot snare was used to resect the polyp. Histopathologic examination showed features reminiscent of PGA, namely a complex submucosal proliferation of tightly packed variably dilated glands and villous fronds lined by a monolayer of columnar cells with basally located round nuclei and prominent nucleoli. In contrast, however, the columnar cells in most of the lesion contained abundant mucinous cytoplasm resembling Brunner’s glands as well as areas of prominent paneth cell differentiation. The characteristic amphophilic ground glass cytoplasm of PGAs was only noted in a minor component of the lesion. MUC6 and MUC5AC, immunostains that are typically expressed in PGA, were negative. Additionally, p53 showed a wild-type pattern, beta- catenin showed normal membranous staining, and the Ki-67 index was low.

Results

After review of the literature and expert consultation, we were not able to fully classify this lesion under any documented entity, however, we believe that it could be akin to PGA. Authors hypothesized that PGAs may originate from stem cells within Brunner glands as a response to chronic injury. These cells may then differentiate upwards, forming gastric foveolar metaplasia or downwards giving rise to Brunner gland hyperplasia.

Conclusion

Based on this hypothesis, the proliferating cells are prone to mutations resulting in a hyperplasia/metaplasia to dysplasia sequence that leads to the formation of PGAs or lesions such as the one demonstrated here.

[The role of large-scale testing platform in the prevention and control of the COVID-19 pandemic: an empirical study based on a novel numerical model]

Objective: China adopted an unprecedented province-scale quarantine since January 23rd 2020, after the novel coronavirus (COVID-19) broke out in Wuhan in December 2019. Responding to the challenge of limited testing capacity, large-scale (>20 000 tests per day) standardized and fully-automated laboratory (Huo-Yan) was built as an ad-hoc measure. There is so far no empirical data or mathematical model to reveal the impact of the testing capacity improvement since quarantine. Methods: Based on the suspected case data released by the Health Commission of Hubei Province and the daily testing data of Huo-Yan Laboratory, the impact of detection capabilities on the realization of "clearing" and "clearing the day" of supected cases was simulated by establishing a novel non-linear and competitive compartments differential model. Results: Without the establishment of Huo-Yan, the suspected cases would increase by 47% to 33 700, the corresponding cost of quarantine would be doubled, the turning point of the increment of suspected cases and the achievement of "daily settlement" (all newly discovered suspected cases are diagnosed according to the nucleic acid testing result) would be delayed for a whole week and 11 days. If the Huo-Yan Laboratory could ran at its full capacity, the number of suspected cases could start to decrease at least a week earlier, the peak of suspected cases would be reduced by at least 44%, and the quarantine cost could be reduced by more than 72%. Ideally, if a daily testing capacity of 10 500 tests was achieved immediately after the Hubei lockdown, "daily settlement" for all suspected cases could be achieved. Conclusions: Large-scale, standardized clinical testing platform, with nucleic acid testing, high-throughput sequencing, and immunoprotein assessment capabilities, need to be implemented simultaneously in order to maximize the effect of quarantine and minimize the duration and cost of the quarantine. Such infrastructure, for both common times and emergencies, is of great significance for the early prevention and control of infectious diseases.

[Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure]

Objective: To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients. Results: Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs(P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion: HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

Design, evaluation and initial imaging results of a PET insert based on strip-line readout for simultaneous PET/MRI

We present the development of a PET insert system for potential simultaneous PET/MR imaging using a 9.4 T small animal MRI scanner to test our system. The detectors of the system adopt a strip-line based multiplexing readout method for SiPM signals. In this readout, multiple SiPM outputs in a row share a common strip-line. The position information about a hit SiPM is encoded in the propagation time difference of the signals arriving at the two ends of the strip-line. The use of strip-lines allows us to place the data acquisition electronics remotely from the detector module to greatly simplify the design of the detector module and minimize the mutual electromagnetic interference. The prototype is comprised of 14 detector modules, each of which consists of an 8x4 LYSO scintillator array (each LYSO crystal is 3x3x10 mm³) coupled to two units of Hamamatsu MPPC arrays (4x4, 3.2 mm pitch) that are mounted on a strip-line board. On the strip-line board, outputs of the 32 SiPMs are routed to 2 strip-lines so that 16 SiPM signals share a strip-line. The detector modules are installed inside a plastic cylindrical supporting structure with an inner and outer diameter of 60 mm and 115 mm, respectively, to fit inside a Bruker BioSpec 9.4 Tesla MR scanner. The axial field of view of the prototype is 25.4 mm. The strip-lines were extended by using 5-meter cables to a sampling data acquisition (DAQ) board placed outside the magnet. The detectors were not shielded in the interest of investigating how they may affect and be affected by the MRI. Experimental tests were conducted to evaluate detection performance, and phantom and animal imaging were carried out to assess the spatial resolution and the MR compatibility of the PET insert. Initial results are encouraging and demonstrate that the prototype insert PET can potentially be used for PET/MR imaging if appropriate shielding will be implemented for minimizing the mutual interference between the PET and MRI systems.

Scarless neck endoscopic thyroidectomy via the breast approach: A preliminary report of 45 cases with total or near-total thyroidectomy plus central compartment dissection

Background

There are various endoscopic techniques for thyroid carcinoma dissection but few reports regarding the scarless neck technique and central compartment dissection (CCD) via the breast approach, especially for bilateral CCD are available. In this study, we reported 45 cases with scarless neck endoscopic total or near-total thyroidectomy plus CCD via the breast approach.

Materials and Methods

Forty-five female patients with papillary thyroid carcinoma (PTC) were enrolled in the study, from January 2011 to March 2013. In brief, 5 mm ultrasonic coagulation device (Harmonic Scalpel, HS; Ethicon Endosurgery, USA) was used to perform thyroid vessel management and thyroidectomy. Twenty patients underwent total thyroidectomy and 25 underwent near-total thyroidectomy. CCD was performed in all 45 patients, including 13 with bilateral CCD and 32 with ipsilateral CCD.

Results

The procedure was successful for all 45 patients. Sixteen patients (35.6%) had lymph node metastases in central compartments. Postoperative transient adverse events included voice changes (9 patients) and hypocalcemia (18 patients), including 7 (21.9%) in the unilateral group and 11 (84.6%) in bilateral group. There was no permanent hypocalcemia or recurrent laryngeal nerve (RLN) palsy. None of the case were converted to open surgical procedure. All patients were satisfied with the cosmetic result of the scarless neck endoscopic thyroidectomy (SET). No evidence of residual or recurrent disease was found during a mean follow-up of 22.84 months (range, 12-34 months).

Conclusions

Experienced thyroid surgeons performed the scarless neck endoscopic total or near-total thyroidectomy plus unilateral or bilateral CCD via the breast approach for selected PTC patients. The procedure was safe and feasible with excellent cosmetic results.

The Aortic Calcification Index is a risk factor associated with anastomotic leakage after anterior resection of rectal cancer

AIM

Anastomotic leakage (AL) is one of the most feared postoperative complications after anterior resection (AR) of rectal cancer. An adequate blood supply at the anastomotic site is regarded as a prerequisite for healing. We hypothesize that the Aortic Calcification Index (ACI) might reflect the severity of atherosclerosis in patients, and thereby be a risk factor for AL.

METHOD

AL was investigated retrospectively according to the definition of the International Study Group of Rectal Cancer in 423 rectal cancer patients who underwent anterior rectal resection. The ACI was measured by preoperative abdominal CT scan. The cross-section of the aorta was evenly divided into 12 sectors, the number of calcified sectors was counted as the calcification score of each slice. Lasso logistic regression and multivariate regression analysis were used to identify risk factors for AL.

RESULTS

The percentage of AL after AR was 7.8% (33/423); the mortality of patients who sustained a leak was 3.0% (1/33). Patients with a high ACI had a significantly higher percentage of AL than patients with low ACI (11.2% vs 5.6%, P = 0.04). Among patients with AL, a higher ACI was associated with greater severity of AL (the ACI of patients with grade A leakage, grade B leakage and grade C leakage was 0.5% ± 0.2%, 11.5% ± 9.2% and 24.2% ± 21.7%, respectively; P = 0.008). After risk adjustment, multivariate regression analysis showed that a higher ACI was an independent risk factor for AL (OR 2.391, P = 0.04).

CONCLUSION

A high ACI might be an important prognostic factor for AL after AR for rectal cancer. Confirmatory studies are required.

Prostate specific antigen as a biomarker for breast cancer: a meta-analysis study

OBJECTIVE

To determine whether prostate-specific antigen (PSA) could serve as a biomarker for breast cancer.

MATERIALS AND METHODS

We performed an electronic search on Medline, PubMed, SPRINGER, John Wiley, Science Direct, EBSCO, CNKI and Wanfang Data to identify relevant studies for our meta-analysis. The search terms included ['prostate specific antigen' or 'PSA' (MESH)] and ['breast cancer' or 'breast carcinoma' (MESH)].

RESULTS

A comprehensive meta-analysis of 10 studies comprising of 770 cases and 799 controls were included. Among the studies considered, the sensitivity of the tPSA test for diagnosis was 0.718 (95% CI: 0.630, 0.792), the specificity was 0.528 (95% CI: 0.299, 0.746) and the diagnostic odds ratios (DOR) was 2.852 (95% CI: 1.021, 7.969). The sensitivity of fPSA test for diagnosis was 0.783 (95% CI: 0.541, 0.917), specificity was 0.679 (95% CI: 0.209, 0.944) and diagnostic odds ratio (DOR) was 7.668 (95% CI: 0.331, 177.451).

CONCLUSIONS

Serum PSA could be a useful biomarker for the diagnosis of breast cancer, and a biomarker for the differential diagnosis of breast cancer from benign breast tumors.

[Combined anluohuaxianwan and entecavir treatment significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection]

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman's rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion: Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

[Clinical effect and safety of pegylated interferon-α-2b injection (Y shape, 40 kD) in treatment of HBeAg-positive chronic hepatitis B patients]

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion: In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.

[Combination of CT mulitplane 3D reconstruction, radial endobronchial ultrasound and rapid on-site evaluation for diagnosing peripheral solitary pulmonary nodules]

Objective: To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN). Methods: A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017. According to different methods, all the patients were divided into four groups: EG (i.e. R-EBUS+Guiding sheath (GS))group, CTE (i.e. CT-3DR+R-EBUS) group, RE (i.e. ROSE+R-EBUS) group, and triad (i.e. CT-3DR+ROSE+R-EBUS) group. Sampling was performed by transbronchial lung biopsy. The diagnostic yield and complications, procedure time and influencing factors in these four groups were retrospectively analyzed. The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated. Results: The diagnostic yield for total SPNs among four groups were 70.5% in EG group, 70.0% in CTE group, 69.0% in RE group and 74.0% in triad group, respectively. There was no significant difference among four groups (all P>0.05). The procedure time of EG group, CTE group, RE group and triad group were (34.0±6.3), (26.6±6.8), (27.2±7.8) and (19.4±5.4) min, respectively. The procedure time was the shortest in triad group compared with the other three groups (all P<0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P<0.001). The coincidence rates of CT-3DR navigation position with target bronchus were 87.5% in CTE group and 90.0% in triad group with no significant difference between these two groups (P>0.05). The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter<2 cm in all four groups (all P<0.05). The positive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P<0.05). In EG and RE groups, for those SPNs with the distance between the lesion and pleura≥2 cm, the diagnostic yield were higher than those withe the distance<2 cm (P<0.05) but no similar phenomenon was observed in CTE and triad groups. No significant correlation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P>0.05). ROSE was used in RE and triad groups. The coincidence rate of ROSE with histopathology was 82.6% and the value of Kappa was 0.608. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of ROSE were 0.818, 0.846, 0.931 and 0.647, respectively. Conclusions: CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN. Combination of CT-3DR, R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.

The application of high frequency ultrasound in the muscles, bones and the thoracodorsal artery in subscapular region and analysis of ultrasonic characteristics

OBJECTIVE

To analyze the application value of high-frequency ultrasound in the muscles, bones and the thoracodorsal artery in the subscapular region and summarize the characteristics of ultrasound.

PATIENTS AND METHODS

Subscapularis muscle, bone and thoracodorsal artery of 72 healthy subjects were examined using high-frequency ultrasound, the initial segment diameter of the thoracodorsal artery and peak systolic blood flow velocity were recorded, and the ultrasonographic characteristics of subscapularis muscle, bone and thoracodorsal artery were summarized.

RESULTS

The spinous processes of 7th thoracic vertebrae, 9th thoracic vertebrae and 11th thoracic vertebrae all showed strong echoes with posterior acoustic shadow. The vertebral plates of 8th thoracic vertebrae, 10th thoracic vertebrae and 11th thoracic vertebrae showed a strong linear echo on both sides of the spinous process, and the lateral side was connected with the transverse processes of 8th thoracic vertebrae, 10th thoracic vertebrae, and 11th thoracic vertebrae. The inferior scapular artery was launched from the axillary artery, along with the deep side of the inferior scapular muscle, the latissimus dorsi and teres major muscle, and then it went inferior and backward which was then divided into arteriae dorsalis scapulae and thoracodorsal artery, showing a tubular structure with no echo. Color Doppler Flow Imaging (CDFI) showed the endovascular blood flow signal of the inferior scapular artery and its branches. The internal diameter of the initial segment of the thoracodorsal artery of the male subjects was bigger than that of the female subjects, and the difference was statistically significant (p < 0.05).

CONCLUSIONS

High-frequency ultrasound can provide a reliable reference for the anatomical structure and adjacent relationship of subscapular muscles, bones and thoracodorsal artery, and is worthy of being promoted as a non-invasive and reliable mean of examination.

A baseline tool for predicting response to peginterferon alfa-2a in HBeAg-positive patients with chronic hepatitis B

BACKGROUND

Peginterferon induces off-treatment responses in approximately one-third of patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B.

AIM

To develop an easy-to-use baseline prediction score to identify hepatitis B virus (HBV) genotype B-/C-infected HBeAg-positive Asian patients likely to respond to peginterferon alfa-2a.

METHODS

Generalised additive models, multiple logistic regression (MLR) analysis and internal validation methods were applied to data from 647 HBeAg-positive patients from China, Hong Kong and Taiwan to develop a scoring system to predict response 24 weeks after completing a 48-week course of peginterferon alfa-2a.

RESULTS

Five baseline factors (age, sex, alanine aminotransferase ratio, hepatitis B surface antigen (HBsAg) level and HBV DNA level) were retained in the final MLR for HBeAg seroconversion and used to develop a scoring system from 0 to 7. Among patients with scores of 0-1, 2-3, 4 or ≥5, HBeAg seroconversion was achieved in 6.4% (6/94), 23.0% (61/265), 36.4% (67/184) and 54.8% (57/104), respectively, and a combined response (HBeAg seroconversion plus HBV DNA <2000 IU/mL) in 5.3% (5/94), 12.8% (34/265), 25.0% (46/184) and 36.5% (38/104), respectively. Among patients with scores of 0-1, 2-3, 4 or ≥5, 57.0% (53/93), 12.3% (31/253), 3.4% (6/178) and 1.0% (1/100) had HBsAg ≥20 000 IU/mL at treatment Week 12; only 3/91 (3.3%) with HBsAg ≥20 000 IU/mL experienced a combined response at 24 weeks post-treatment (negative predictive value = 97% [88/91]).

CONCLUSION

A pre-treatment scoring system using readily available baseline characteristics identifies HBeAg-positive Asian patients likely to experience sustained HBeAg seroconversion after treatment with peginterferon alfa-2a.