Modulating cAMP responsive element binding protein 1 attenuates functional and behavioural deficits in rat model of neuropathic pain

OBJECTIVE

Chronic neuropathic pain (NP) has become a worldwide public health problem. This study was aimed to establish graded NP model to investigate the effect of CREB1 on nerve repair and NP after peripheral nerve injury.

MATERIALS AND METHODS

Based on NP model, we measured the 50% paw withdrawal threshold (PWT) of rat hind paws and sciatic functional index (SFI). Luxol fast blue staining was performed to measure the ratio of distal myelin sheath to proximal (DPR). The c-Fos, GFAP, CX3CR1 and IBA-1 expressions in spinal cord were measured by Western blot. The expression levels of CREB1 and ATF-3 in dorsal root ganglion (DRG) were both measured. Intrathecal injection was performed by using recombinant CREB, or anti-CREB antibody for NP model, respectively. The above indexes were detected.

RESULTS

In NP model, the 50% PWTs and DPR were gradually reduced and SFI was increased. The c-Fos, GFAP, CX3CR1 and IBA-1 expressions were increased compared to control group. The CREB1 and ATF-3 expressions in DRG showed gradually increase. With the injection of recombinant CREB, the similar changes were found in rats compared with NP model. While after anti-CREB1 antibody injection, all effects of CREB1 were impaired. Likewise, anti-CREB1 antibody treatment increased 50% PWT and DPR, decreased SFI, decreased expressions of c-Fos, GFAP, CX3CR1 and IBA-1. Besides, ATF-3 expression was inhibited by CREB1 suppression.

CONCLUSIONS

CREB1 involved in the regulation of NP and nerve repair process, suggesting that CREB1 has potential as a new target for the treatment of chronic NP.

Abstract P1-08-12: Trends in incidence of bilateral breast cancer: A Population-based comparative study of the United States and Japan

Background: Previous studies demonstrated that the incidence rate of invasive contralateral breast cancer (CBC) was 5% within the first 10 years after the primary breast cancer (BC). However improving long-term breast cancer survivorship and advancements in diagnostic imaging have resulted in an increased detection of bilateral breast cancer (BBC), and trends of bilateral invasive and in situ breast cancer are not well established. The aim of this study was to assess national trends of BBC incidence of the United States (US) and Japan.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database (1973-2014) and the clinical database of Breast Oncology Center of Cancer Institute Hospital in Tokyo, Japan (Ganken) database (1946-2015) were used to identify nSEER=11,771 and nGanken=1,499 women diagnosed with BBC, respectively. BBC was defined as invasive BC and/or ductal or lobular carcinoma in situ diagnosed in both breasts simultaneously or after primary breast cancer diagnosis. BBC was grouped into synchronous or metachronous BBC by the interval between first BC and contralateral BC; synchronous cases were defined as CBC diagnosed at the same time or within an interval of 1 year from primary BC diagnosis whereas metachronous cases were defined as a diagnosis occuring 1 year following the primary BC. We assessed trends of BBC incidence and characteristics of BBC cases between the two countries. To determine temporal trends in the incidence of BBC and proportion of the characteristics, we compared them using the Cochrane-Armitage test for trend.

Results: The rates of BBC have significantly increased in both countries (Table 1, 2) [1975: 2.6%; 2014: 7.5% in SEER (p<0.001), 1946-1980: 3.3%; 2011-2015: 10.7% in Ganken (p<0.001)]. The increase was identified in both synchronous and metachronous BBC. In SEER, 40% of synchronous BBC were found as in situ BC and about 15% of BBC presented as invasive lobular carcinoma. More recently, CBC was more likely to be diagnosed at early stages (in situ and local disease) than in previous years [1975: 65%; 2014: 85% in SEER (p<0.001)]. The interval between first BC and contralateral BC have shortened, and CBC were more likely to be operated simultaneously in both countries [1985: 40%; 2014: 51% in SEER, 1946-1980: 24%; 2011-2015: 74% in Ganken].

[Table 1]Crude rates of BBC in all breast cancer in SEER 19751985199520052014All breast cancer941813618258766016471505BBC and rates (%)249 (2.6%)790(5.8%)1421(5.5%)3336(5.6%)5381(7.5%)Rates of synchronous BC2.1%2.8%2.3%2.6%3.5%Rates of metachronous BC0.5%3.0%3.2%3.0%4.0%BBC: Bilateral breast cancer

[Table 2]Crude rates of BBC in all breast cancer in Ganken 1946-19801981-19851991-19952001-20052011-2015All breast cancer47772162280637915241BBC and rates (%)157(3.3%)110(5.1%)188(6.7%)298(7.9%)559(10.7%)Rates of synchronous BC1.0%1.9%2.0%2.7%4.9%Rates of metachronous BC2.3%3.2%4.7%5.2%5.8%

Conclusion: In the modern era, the number of BBC cases have increased and are more likely to be found at an early stage. Further studies are needed to demonstrate the usefulness of early detection of CBC and to define the best means to tailor therapy for patients with bilateral disease.

Citation Format: Sakai T, Ozkurt E, Desantis S, Wong S, Rosenbaum L, Zheng H, Ohno S, Golshan M. Trends in incidence of bilateral breast cancer: A Population-based comparative study of the United States and Japan [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-12.

[Paclitaxel enhances the protective effect of myocardial ischemia preconditioning on ischemia/reperfusion injury in aged rat]

Objective: To investigate if paclitaxel can enhance the protective effect of myocardial ischemia preconditioning on ischemia/reperfusion injury in aged ratand explore related mechanism. Methods: Primary cardiomyocytes of Sprague-Dawley rats were isolated by trypsin and divided into 5 groups(n=6 each): control group, hypoxia injury group, hypoxia preconditioning group, paclitaxel group,and paclitaxel+hypoxia preconditioning group. The structure of microtubules and the expression of hypoxia-inducible factor-1α(HIF-1α) were analyzed by immunofluorescence staining. The Langendorff isolated heart perfusion model was applied in 4 groups: hypoxia reperfusion injury group, hypoxia preconditioning group, paclitaxel group, and paclitaxel+hypoxia preconditioning group. Each group was further divided into elderly subgroup and adult subgroup (n=6 each). Left ventricular developed pressure and maximum rate of rise in left ventricular pressure were analyzed. Results: (1) Primary cardiomyocyte experiments showed that the myocardial tubular microtubule structure in control group was intact and evenly stained; most of the microtubules in the hypoxia-injured group were absent and the tubular tissue was broken; the hypoxia-induced damage on microtubule structure was smaller in the hypoxic preconditioning group compared with the hypoxic injury group (microtubule staining was not uniform, and the lattice structure was broken, but not that obvious as in the hypoxia group); the tubular structure of the microtubules of the paclitaxel group was basically complete, and the staining was basically uniform.The integrity of tubular structure was maintained to some extent, similar to a normal microtubule structure in paclitaxel+hypoxia preconditioning group. The expression of HIF-1α in the cytoplasm and nucleus was very low in the control group, which was evidenced in both cytoplasm and nucleus in the hypoxic injury group.The expression was further increased in hypoxic preconditioning group, significant nuclear HIF-1 expression was found in the paclitaxel group, the expression was aggregated in the nucleus in the Paclitaxel+ hypoxia preconditioning group. (2)In Langendorff isolated heart perfusion model, left ventricular developed pressure was similar between the elderly subgroup and the adult subgroup at the end of the infusion,after precondition, 5 minutes of reperfusion, 30 minutes of reperfusion, and 60 minutes of reperfusion in the hypoxic injury group (all P> 0.05).In the hypoxic injury group, both the elderly subgroup and the adult subgroup had lower left ventricular developed pressure at 30 minutes of reperfusion when compared with the end of the infusion((15.63±4.88) mmHg (1 mmHg=0.133 kPa) vs. (95.63±22.14)mmHg and (17.31±2.75)mmHg vs. (91.00±9.58)mmHg, respectively,all P<0.05). In the hypoxic preconditioning group, the adult subgroup had higher left ventricular developed pressure at 5 and 30 minutes of reperfusion when compared with the elderly subgroup((7.13±1.02) mmHg vs. (3.75±1.06)mmHg and (43.94±3.21)mmHg vs.(16.31±1.54)mmHg, respectively,all P<0.01). In the paclitaxel group, the adult subgroup had higher left ventricular developed pressure at 30 and 60 minutes of reperfusion when compared with the elderly subgroup((44.31±7.59)mmHg vs. (5.44±1.21)mmHg, (51.56±6.03)mmHg vs. (22.19±5.14)mmHg, respectively, all P<0.01). In the paclitaxel+hypoxia preconditioning group, both the elderly subgroup and the adult subgroup had lower left ventricular developed pressure at 30 minutes of reperfusion when compared with the end of the infusion((18.63±4.30)mmHg vs. (99.94±8.23) mmHg, P<0.01; (49.69±5.34)mmHg vs. (95.31±5.26)mmHg, P<0.05). Meanwhile, the adult subgroup had higher left ventricular developed pressure at 30 minutes of reperfusion when compared with the elderly subgroup((49.69±5.34)mmHg vs. (18.63±4.33)mmHg, P<0.01).The adult subgroup had higher change rate of maximum rate of rise in left ventricular pressure at 60 minutes of reperfusion when compared with the elderly subgroup in hypoxia preconditioning group, paclitaxel group, and paclitaxel combined hypoxia preconditioning group((62.83±3.92)% vs. (33.33±3.20)%, (44.17±2.32)% vs. (36.67±2.88)%, (72.50±2.66)% vs. (53.17±2.56)%, respectively,all P<0.01). Conclusion: Paclitaxel can enhance the myocardial protective effect of myocardial ischemia preconditioning through stabilizing microtubules of cardiomyocytes and promoting HIF-1α localization in the nucleus.

[Etiological analysis and establishment of a discriminant model for lower respiratory tract infections in hospitalized patients]

Objective: To analyze the pathogens of lower respiratory tract infection(LRTI) including bacterial, viral and mixed infection, and to establish a discriminant model based on clinical features in order to predict the pathogens. Methods: A total of 243 hospitalized patients with lower respiratory tract infections were enrolled in Fujian Provincial Hospital from April 2012 to September 2015. The clinical data and airway (sputum and/or bronchoalveolar lavage) samples were collected. Microbes were identified by traditional culture (for bacteria), loop-mediated isothermal amplification(LAMP) and gene sequencing (for bacteria and atypical pathogen), or Real-time quantitative polymerase chain reaction (Real-time PCR)for viruses. Finally, a discriminant model was established by using the discriminant analysis methods to help to predict bacterial, viral and mixed infections. Results: Pathogens were detected in 53.9% (131/243) of the 243 cases.Bacteria accounted for 23.5%(57/243, of which 17 cases with the virus, 1 case with Mycoplasma pneumoniae and virus), mainly Pseudomonas Aeruginosa and Klebsiella Pneumonia. Atypical pathogens for 4.9% (12/243, of which 3 cases with the virus, 1 case of bacteria and viruses), all were mycoplasma pneumonia. Viruses for 34.6% (84/243, of which 17 cases of bacteria, 3 cases with Mycoplasma pneumoniae, 1 case with Mycoplasma pneumoniae and bacteria) of the cases, mainly Influenza A virus and Human Cytomegalovirus, and other virus like adenovirus, human parainfluenza virus, respiratory syncytial virus, human metapneumovirus, human boca virus were also detected fewly. Seven parameters including mental status, using antibiotics prior to admission, complications, abnormal breath sounds, neutrophil alkaline phosphatase (NAP) score, pneumonia severity index (PSI) score and CRUB-65 score were enrolled after univariate analysis, and discriminant analysis was used to establish the discriminant model by applying the identified pathogens as the dependent variable. The total positive predictive value was 64.7%(77/119), with 66.7% for bacterial infection, 78.0% for viral infection and 33.3% for the mixed infection. Conclusions: The mostly detected pathogens were Pseudomonas aeruginosa, atypitcal pathogens, Klebsiella pneumoniae, influenza A virus and human cytomegalovirus in hospitalized patients with LRTI in this hospital. The discriminant diagnostic model established by clinical features may contribute to predict the pathogens of LRTI.

The role of sp2 and sp3 hybridized bonds on the structural, mechanical, and electronic properties in a hard BN framework

A first-principles approach is used to systematically investigate the role of sp² and sp³ hybridized bonds on the structural, mechanical, and electronic properties in a new BN phase (denoted Hex-(BN)₁₂). Hex-(BN)₁₂ has the same number of sp² and sp³ hybridized atoms. The calculated cohesion energy, phonon frequencies, and elastic constants unambiguously confirm the structural stability of this compound. Due to the different types of hybridization and B–N covalent bonds with ionic characteristics, Hex-(BN)₁₂ has unequal bond lengths and bond angles in these hybrid orbitals. These cause the relative energetic stability to be slightly lower than c-BN and w-BN. The hardness of Hex-(BN)₁₂ is estimated to range from 33 to 40 GPa. The bond-breaking order under stress is sp³–sp³, sp²–sp³, and sp²–sp². DFT calculations with the gradient approximation (GGA) and HSE06 functional indicate the electronic structure contains an indirect band gap at 3.21 and 4.42 eV, respectively. The electronic states in the region near the Fermi level primarily arise from the 2p orbitals in sp²-hybridized atoms. In general, sp³ bonded B and N atoms guarantee higher mechanical properties, and sp² bonded atoms ensure ductility and even conductivity, although all changes vary with spatial structure. Hex-(BN)₁₂ can be obtained from multilayer yne-BN, and BN nanosheets, nanotubes and nanoribbons under pressure.

A first-principles approach is used to systematically investigate the role of sp² and sp³ hybridized bonds on the structural, mechanical, and electronic properties in a new BN phase (denoted Hex-(BN)₁₂).

[Screening of hot-spot deafness gene mutations among 277 cochlear implantation patients in Sichuan province]

Objective:To investigate the spectrum and incidence of the hot-spot deafness gene mutations of 277 patients with cochlear implantation in Sichuan province, and to provide information of the prevention and treatment for clinical application. Method: The data of the hotspot deafness gene mutations screening of 277 patients with cochlear implantation was analyzed retrospectively. A deafness related gene mutations detection kit was used to detect 9 mutation sites in four deafness-associated genes,including GJB2(35delG,176del16,235delC,299delAT), GJB3(538C＞T),SLC26A4(2168A＞G, IVS7-2A＞G), Mitochondrial 12SrRNA(1494C＞T, 1555A＞G). Result: ① A total of 122 patients with hot-spot Deafness Gene Mutations were detected in 277 cochlear implantation patients(44.04%),among which there were 39 patients were GJB2235delC homozygous mutation(14.08%), 23 patients were GJB2 235delC heterozygous mutation(8.30%), 1 patient was GJB2 299delAT homozygous mutation(0.36%), 2 patients were GJB2 176del16& 235delC compound heterozygous mutation(0.72%), 13 patients were GJB2 235delC& 299delAT compound heterozygous mutation(4.69%), 2 patients were SLC26A4 2168A＞G heterozygous mutation(0.72%), 16 patients were SLC26A4 IVS7-2A＞G homozygous mutation(5.78%), 22 patient were SLC26A4 IVS7-2A＞G heterozygous mutation(7.94%), 1 patients was SLC26A4 2168A＞G& IVS7-2A＞G compound heterozygous mutation(0.36%), 2 patients were mitochondrial 12SrRNA gene 1555A＞G homogenous mutation(0.72%), 1 patient carried both GJB2 235delC homozygous mutation and SLC26A4 IVS7-2A＞G heterozygous mutation(0.36%). ②A total of 49 patients with LVAS were found in 277 cochlear implantation patients: including 15 patients with IVS7-2A＞G homozygous mutation(30.61%), 22 patients with IVS7-2A＞G heterozygous mutation(44.90%), 1 patient with 2168A＞G heterozygous mutation(2.04%), 1 patient with complex heterozygosis mutations of 2168A＞G and IVS7-2A＞G(2.04%), 1 patient with GJB2 235delC homozygous mutation(2.04%) and 1 patient with GJB2 235delC&299delAT compound heterozygous mutation(2.04%), and no hotspot deafness gene mutations were found in 8 patients. ③There were 40 out of 277 cochlear implantation patients with definite family history.There was no statistic difference of the detection rate of hot-spot deafness gene mutations between in patients with family deafness history (57.50%) and in patients without family deafness history (41.77%). ④A total of 273 patients with profound binaural deafness were found among 277 cochlear implantation patients. Three patients with profound deafness in right ear and severe deafness in left ear were found among 277 cochlear implantation patients.Two patients of three were SLC26A4 IVS7-2A＞G heterozygosis mutations, and one patient of three was GJB2 235delC heterozygosis mutations; 1 patient with profound deafness in left ear and severe deafness in right ear was found among 277 cochlear implantation patients,and was GJB2 235delC heterozygosis mutations. Conclusion:① The detection rate of hotspot deafness gene mutations in 277 cochlear implantation patients is 44.04%(122/277). GJB2 Mutation is the most common, SLC26A4 mutation takes the second place, mitochondrial 12SrRNAgene mutation is not common and GJB3 mutation is not found in this study.② SLC26A4 mutation may not be the sole pathogenic factor of LVAS. ③ The results of this study suggest that the genetic background of cochlear implants patients has little effect on the data of the hotspot deafness gene mutations screening.

Trends in atmospheric particles and their light extinction performance between 1980 and 2015 in Beijing, China

This study explored the interdecadal variations and their horizontal and vertical light extinction performances of atmospheric particulate matter with aerodynamic diameters ≤2.5 μm (PM_2.5), particulate matter with aerodynamic diameters ≤ 10 μm (PM₁₀), and total suspended particulates (TSPs) in Beijing from 1980 to 2015, using data available from historical publications. Prominent declines of PM_2.5, PM₁₀, and TSPs were detected with long-term linear trends of -6.7, -4.3, and -1.9 μg m^-3 yr^-1, respectively. Generally, on the annual scale during the studied period, it was found that PM_2.5 displayed negative correlation (R² = 0.38, p < 0.01) with visibility and positive correlation (R² = 0.41, p < 0.01) with aerosol optical depth (AOD). Comparably, PM₁₀ exhibited robust negative correlation (R² = 0.61, p < 0.01) with visibility and positive correlation (R² = 0.82, p < 0.01) with AOD. The complicated interdecadal variations and light extinction performances of PM_2.5 were found, suggesting the changes on particle composition and vertical distribution of PM_2.5 in the atmosphere.

[Effect of different anesthetic techniques on the prognosis of hepatocellular carcinoma after hepatectomy]

Objective: To investigate the influence of different anesthetic techniques on the prognosis of hepatocellular carcinoma (HCC)after hepatectomy. Methods: A total of 185 consecutive patients with HCC confirmed underwent surgery in Cancer Hospital, Chinese Academy of Medical Sciences were recruited from January 2006 to January 2008. The patients were assessed as American Society of Anesthesiologists (ASA)Ⅰ-Ⅲ, with body mass index (BMI) (22.8±4.6)kg/m(2). There were 169 males, with an average age of 56 years old and 16 females, with an average age of 53 years old. According to the different anesthesia methods, 185 patients were divided into two groups: total intravenous anesthesia group (TIVA) (n=53) and intravenous-inhalation combined anesthesia group (n=132). Postoperative pain and adverse reactions were compared in recent follow-up, prognosis were compared in long-term follow-up. Results: Recent follow-up showed that the NRS scores 2 hours after operation in TIVA group was 2.0 (0-2.0), whereas those in intravenous-inhalation combined anesthesia group was 3.0 (1.0-3.0). The pain in TIVA groups was significantly lower than that in intravenous-inhalation combined anesthesia group (Z=-3.261, P=0.001). But for 24 hours after operation, the NRS scores in these two groups were 3.0 (2.0-5.0) and 3.0 (3.0-4.0), respectively. There was no significant difference in the two groups (Z=-0.035, P=0.972). In addition, there was no significant difference between the two groups in the incidence of sedation, nausea/vomiting, restlessness and other adverse reactions (all P>0.05). Long-term follow-up indicated that anesthetic techniques have no correlation with HCC prognosis in Kaplan-Meier analysis and Cox's regression analysis. Conclusion: There is no significant effect of two anesthesia methods on the long-term prognosis of HCC.

Acupuncture for patients with chronic functional constipation: A randomized controlled trial

BACKGROUND

Acupuncture is used to treat chronic functional constipation (CFC) in China, despite limited evidence. We aim to assess the effectiveness and safety of acupuncture in managing CFC.

METHODS

A multicenter randomized controlled trial was performed involving 684 patients with CFC; the patients were randomly allocated to receive He acupuncture (n = 172), Shu-mu acupuncture (n = 171), He-shu-mu acupuncture (n = 171), or oral administration of mosapride (n = 170). Sixteen sessions of acupuncture were given in the treatment duration of 4 weeks. The primary outcome was the change in spontaneous bowel movements (SBMs) at week 4 (at the end of treatment) compared to baseline. The secondary outcomes included stool consistency (Bristol scale), the degree of straining during defecation, and adverse events.

KEY RESULTS

The SBMs increased in all the four groups at week 4, and the magnitude of increase was equivalent in the four groups (He acupuncture, 2.7 [95% CI, 2.3-3.1]; Shu-mu acupuncture, 2.7 [95% CI, 2.3-3.0]; He-shu-mu acupuncture, 2.2 [95% CI, 1.9-2.5]; and mosapride, 2.4 [95% CI, 2.0-2.9]; P = .226). However, the change in SBMs at week 8 was significantly smaller in mosapride group (1.4 [95% CI, 1.0-1.8]) than the three acupuncture groups (2.4 [95% CI, 2.1-2.7], 2.3 [95% CI, 1.9-2.7], 2.1 [95% CI, 1.7-2.5] in He, Shu-mu, and He-shu-mu group, respectively, P = .005).

CONCLUSIONS & INTERFERENCES

The three acupuncture treatments were as effective as mosapride in improving stool frequency and stool consistency in CFC, but the magnitude of the treatment effect is unknown due to the lack of sham acupuncture control.

Electroacupuncture for patients with refractory functional dyspepsia: A randomized controlled trial

BACKGROUND

To test the efficacy of electroacupuncture for patients with refractory functional dyspepsia (FD).

METHODS

A 24-week, 2-arm, single-blind, randomized controlled trial was conducted at three hospitals in China. Patients with refractory FD were randomly assigned to receive 20 sessions of authentic or sham electroacupuncture in a treatment duration of 4 weeks. The primary outcome was complete absence of dyspeptic symptoms at 16 weeks after initiation of acupuncture (week 16). The secondary outcomes included adequate relief of dyspeptic symptoms, Leeds Dyspepsia Questionnaire (LDQ), Nepean Dyspepsia Index (NDI), and adverse events. Intention-to-treat analysis was performed.

KEY RESULTS

Two hundred patients were included, of which 196 (98%) completed follow-up data at week 24. At week 16, 17 (17%) patients in the authentic electroacupuncture group vs 6 (6%) patients in the sham group achieved the primary outcome (P = .014). Sixty-two (62%) patients had adequate relief in the authentic electroacupuncture group, as compared to 22 (22%) in the sham group (P = .001). The scores of LDQ and NDI were significantly improved in both groups at week 16, and patients in the authentic electroacupuncture group have more improvements (LDQ, mean difference, -2.2, 95% confidence interval, -2.3 to -2.1, P < .001; NDI, -7.3, -10.5 to -4.2, P < .001). Results were similar for all the outcomes assessed at week 24. No serious adverse events were reported in both groups.

CONCLUSION

Acupuncture efficaciously improves dyspeptic symptoms in patients with refractory FD.

Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome

BACKGROUND

Tong-Xie-Yao-Fang (TXYF) is a Chinese herbal formula for treating chronic diarrhoea accompanied by abdominal pain. The results were inconsistent in previous trials examining its effect.

AIM

To study the efficacy of TXYF granules for treating diarrhoea-predominant irritable bowel syndrome (IBS-D).

METHODS

We performed a double-blind, placebo-controlled randomised trial and enrolled 160 participants with IBS-D. The participants had VAS scores ≥3 cm in IBS-D global symptoms and ≥2 days in a week with abdominal pain and loose stools (Bristol score 5, 6 or 7). They were randomly assigned to received TXYF or placebo during a treatment period of 4 weeks, and they were followed up for 8 weeks after treatment. The primary outcome was adequate relief of IBS-D global symptoms for at least 2 of 4 weeks during weeks 1-4. Secondary outcomes included mean weekly VAS scores of IBS-D major symptoms, mean weekly stool frequency, mean weekly Bristol score, and adverse events.

RESULTS

155 of 160 patients completed the trial. We found a significantly higher rate of adequate relief of global symptoms in TXFY group during weeks 1 to 4 (57.5% vs 37.5%, χ² = 5.6391, P = 0.017); logistic regression analysis showed a similar result (OR 2.2, 95% CI 1.2-4.4, P = 0.016). Most of the secondary outcomes showed superiority of TXYF over placebo in weekly assessment from week 3 to week 7. The adverse event rate was low in both groups (3.8% vs 3.8%, P = 1.000).

CONCLUSION

During a 4 week trial, TXFY granules were superior to placebo in controlling symptoms of IBS-D.

Decoupling of magnetism and electric transport in single-crystal (Sr1-x A x )2IrO4 (A = Ca or Ba)

We report a systematical structural, transport and magnetic study of Ca or Ba doped Sr₂IrO₄ single crystals. Isoelectronically substituting Ca²⁺ (up to 15%) or Ba²⁺ (up to 4%) ion for the Sr²⁺ ion provides no additional charge carriers but effectively changes the lattice parameters in Sr₂IrO₄. In particular, 15% Ca doping considerably reduces the c-axis and the unit cell by nearly 0.45% and 1.00%, respectively. These significant, anisotropic compressions in the lattice parameters conspicuously cause no change in the Néel temperature which remains at 240 K, but drastically reduces the electrical resistivity by up to five orders of magnitude or even precipitates a sharp insulator-to-metal transition at lower temperatures, i.e. the vanishing insulating state accompanies an unchanged Néel temperature in (Sr_1-x A _x )₂IrO₄. This observation brings to light an intriguing difference between chemical pressure and applied pressure, the latter of which does suppress the long-range magnetic order in Sr₂IrO₄. This difference reveals the importance of the Ir1-O2-Ir1 bond angle and homogenous volume compression in determining the magnetic ground state. All results, along with a comparison drawn with results of Tb and La doped Sr₂IrO₄, underscore that the magnetic transition plays a nonessential role in the formation of the charge gap in the spin-orbit-tuned iridate.

[Crouzon syndrome coupled with OSAHS and congenital heart disease: a case report]

A case of Crouzon syndrome coupled with OSAHS and congenital heart disease in our hospital was reported. The patient who was a 2 years and 7 months old boy, was admitted in our hospital for repetitive sore throat, snoring with mouth breathing during sleep for more than 2 years and been found with some typical defect of Crouzon syndrome during physical examination. Half a year ago the boy underwent ventricular septal defect closure surgery. PSG shows severe apnea hypopnea and low ventilation existed. Under general anesthesia, the patient accepted bilateral tonsillectomy and adenoidectomy but dyspnea occurred after post-operative extubation till 2 days later the boy can breathe by himself. The follow-up at 6 months and 1 year revealed that the patient did not have snoring or mouth breathing during sleep. For this kind of case, we should assess detailed pre-operation and observe carefully post-operation so as to reduce the perioperative period risks.

Nomogram to predict lymph node metastasis in patients with early oesophageal squamous cell carcinoma

Background

Lymph node status is crucial in determining the prognosis for early oesophageal squamous cell carcinoma (SCC). This study aimed to develop and validate a nomogram for the prediction of lymph node metastasis in patients with early SCC.

Methods

A prediction model was developed in a derivation cohort of patients with clinicopathologically confirmed early SCC. Patients who underwent oesophagectomy for pT1 SCC between January 2010 and December 2013 were identified from an institutional database. Risk factors for lymph node metastasis were assessed using a binary logistic regression modelling technique. A nomogram for the prediction of lymph node metastasis was constructed using the results of multivariable analyses. For internal validation, bootstraps with 1000 resamples were performed. The predictive performance of the nomogram was measured by Harrell's concordance index (C-index). An independent cohort from the same hospital was used to validate the nomogram. This cohort included consecutive patients with early SCC who underwent oesophagectomy from January 2014 to December 2015.

Results

The derivation cohort included 281 patients. Four variables associated with lymph node metastasis were included in the model: depth of tumour invasion (odds ratio (OR) 4·37, 95 per cent c.i. 1·59 to 12·03; P = 0·004), grade of differentiation (OR 4·47, 1·02 to 19·70; P = 0·048), tumour size (OR 2·52, 1·11 to 5·75; P = 0·028) and lymphovascular invasion (OR 6·58, 2·54 to 17·05; P &lt; 0·001). The C-index was 0·790 (95 per cent c.i. 0·717 to 0·864) in the derivation cohort and 0·789 (0·709 to 0·869) for the validation cohort (198 patients).

Conclusion

A validated nomogram for patients with early oesophageal SCC can predict the risk of lymph node metastasis.

[Study on the career of Qu Yongqiu, a western medicine doctor in late Qing dynasty and the Republican Period]

Qu Yongqiu() was one of the first-generation western medicine doctors in China's recent history. He had ever been in charge of the affairs of Beiyang Medical School and Tianjin Health Bureau, which had made significant contributions to medical enterprise, medical education and epidemic prevention, etc. He had also treated several important politicians, and witnessed the death of Guangxu() Emperor and Yuan Shikai(), and other historical events. Through making some research, the author analyzed the differences aspects of his career recorded in different literatures.

First detection of foot-and-mouth disease virus O/ME-SA/Ind2001 in China

Foot-and-mouth disease (FMD) is endemic in China and is predominantly due to foot-and-mouth disease virus (FMDV) serotype O Mya-98 lineage. In recent years, FMDV O/ME-SA/Ind2001 lineage has spread from the Indian subcontinent to South-East Asia, Middle East and Africa, which may pose potential threats for future trans-regional livestock movements. In this study, we identified the appearance of FMDV O/ME-SA/Ind2001 in China; the first time that this virus lineage has been found there. Sequencing and phylogenetic analysis of VP1 sequences revealed that this newly determined strain belongs to O/ME-SA/Ind2001 sublineage d and is closely related to strains that have caused recent outbreaks of FMD in Nepal, Myanmar, Russia and South Korea. The results suggest extensive movements of the current O/ME-SA/Ind2001 sublineage d viruses and provide essential information for an effective national FMDV control programme in China.

Classify epithelium-stroma in histopathological images based on deep transferable network

Recently, the deep learning methods have received more attention in histopathological image analysis. However, the traditional deep learning methods assume that training data and test data have the same distributions, which causes certain limitations in real-world histopathological applications. However, it is costly to recollect a large amount of labeled histology data to train a new neural network for each specified image acquisition procedure even for similar tasks. In this paper, an unsupervised domain adaptation is introduced into a typical deep convolutional neural network (CNN) model to mitigate the repeating of the labels. The unsupervised domain adaptation is implemented by adding two regularisation terms, namely the feature-based adaptation and entropy minimisation, to the object function of a widely used CNN model called the AlexNet. Three independent public epithelium-stroma datasets were used to verify the proposed method. The experimental results have demonstrated that in the epithelium-stroma classification, the proposed method can achieve better performance than the commonly used deep learning methods and some existing deep domain adaptation methods. Therefore, the proposed method can be considered as a better option for the real-world applications of histopathological image analysis because there is no requirement for recollection of large-scale labeled data for every specified domain.

Preoperative CT texture analysis of gastric cancer: correlations with postoperative TNM staging

AIM

To explore the role of computed tomography (CT) texture analysis in predicting pathologic stage of gastric cancers.

MATERIALS AND METHODS

Preoperative enhanced CT images of 153 patients (112 men, 41 women) with gastric cancers were reviewed retrospectively. Regions of interest (ROIs) were manually drawn along the margin of the lesion on the section where it appeared largest on the arterial and venous CT images, which yielded texture parameters, including mean, maximum frequency, mode, skewness, kurtosis, and entropy. Correlations between texture parameters and pathological stage were analysed with Spearman's correlation test. The diagnostic performance of CT texture parameters in differentiating different stages was evaluated using receiver operating characteristic (ROC) analysis.

RESULTS

Maximum frequency in the arterial phase and mean, maximum frequency, mode in the venous phase correlated positively with T stage, N stage, and overall stage (all p<0.05) of gastric cancer. Entropy in the venous phase also correlated positively with N stage (p=0.009) and overall stage (p=0.032). Skewness in the arterial phase had the highest area under the ROC curve (AUC) of 0.822 in identifying early from advanced gastric cancers. Multivariate analysis identified four parameters, including maximum frequency, skewness, entropy in the venous phase, and differentiation degree from biopsy, for predicting lymph node metastasis of gastric cancer. The multivariate model could distinguish gastric cancers with and without lymph node metastasis with an AUC of 0.892.

CONCLUSION

Multiple CT texture parameters, especially those in the venous phase, correlated well with pathological stage and hold great potential in predicting lymph node metastasis of gastric cancers.

[Co-infections of HIV, syphilis and HSV-2 among men who have sex with men at the voluntary HIV counseling and testing clinics in Shanghai]

Objective: To understand the prevalence rates of HIV-syphilis and HIV-herpes simplex virus 2 (HSV-2) co-infections and related factors among men having sex with men (MSM) who had visited the voluntary HIV counseling and testing (VCT) clinics in Shanghai, China. Methods: 756 eligible MSM who attended the VCT clinics of Shanghai Municipality and Putuo district during March to August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood testing for HIV, syphilis and HSV-2. Results: A total of 732 participants completed a valid questionnaire survey. The prevalence rates were 3.3% (24/732) for HIV/Syphilis co-infection, 1.9% (14/732) for HIV/HSV-2 co-infection, and 0.7% (5/732) for HIV/Syphilis/HSV-2 co-infection, respectively. HIV prevalence appeared significantly higher among syphilis-infected participants (45.3%, 24/53) than those without Syphilis (7.2%, 61/679) (χ(2)=63.11, P<0.001), and was also significantly higher among HSV-2 infected participants (34.1%, 14/41) than those without the HSV-2 infection (10.3%, 71/691) (χ(2)=21.49, P<0.001). Results from the Multivariate regression analysis indicated that participants who were migrants (OR=3.50, 95%CI: 1.01-12.17), having had middle school or lower levels of education (OR=4.46, 95%CI: 1.54-12.87) or ever used illicit drugs (OR=4.25, 95%CI: 1.67-10.82, P=0.002) were under possible risks on HIV and Syphilis co-infection. Those participants who had high middle school or lower levels of education (OR=6.87, 95%CI: 1.86-25.42; OR=9.82, 95%CI: 2.25-42.85) were under risk on HIV and HSV-2 co-infection. Conclusion: HIV/Syphilis and HIV/HSV-2 co-infection were seen among MSM who attended the VCT clinics in Shanghai that called for special attention, especially on migrants, those with low education or illicit drug users.

Medium optimization for ε-poly-L-lysine production by Streptomyces diastatochromogenes using response surface methodology

Poly-ε-L-lysine is a natural homo-polyamide of L-lysine with excellent antimicrobial properties, which can be used as a novel preservative and has a wide range of applications. In this paper, the fermentation medium for ε-PL production by Streptomyces diastatochromogenes 6#-7 was optimized by Response Surface Methodology. The results of Plackett-Burman design showed that glucose, yeast extract and (NH₄ )₂ SO₄ were the major influencing factors in ε-PL production of S. diastatochromogenes 6#-7. The optimal concentrations of glucose, yeast extract and (NH₄ )₂ SO₄ were determined to be 60, 7·5 and 7·5 g l^-1 according to Box-Behnken experiment and regression analysis, respectively. Under the optimized conditions, the ε-PL yield in shake-flask fermentation was 0·948 ± 0·030 g l^-1 , which was in good agreement with the predicted value of 0·970 g l^-1 . The yield was improved by 43·1% from that with the initial medium. In 5 l jar-fermenter the ε-PL yield reached 25·5 g l^-1 , which was increased by 56·4% from the original medium. In addition, the fermentation time was reduced from 174 to 120 h.

SIGNIFICANCE AND IMPACT OF THE STUDY

Medium optimization is a very practical and valuable tool for fermentation industry to improve product yield and minimize by-products as well as reduce overall manufacturing costs. The response surface methodology is not new, but it is still a very effective method in medium optimization research. This study used ε-polylysine fermentation as an example to demonstrate how the product yield can be significantly increased by medium optimization through surface response methodology. Similar approach can be used in other microbial fermentations such as in pharmaceutical, food, agricultural and energy industries. As an example, ε-polylysine is one of a few newly approved natural food-grade antimicrobials for food and beverages preservations. Yield improvement is economically beneficial to not only ε-polylysine manufacturers but also to their users and consumers due to lower costs and price.

Electrical Control of Structural and Physical Properties via Strong Spin-Orbit Interactions in Sr_{2}IrO_{4}

Electrical control of structural and physical properties is a long-sought, but elusive goal of contemporary science and technology. We demonstrate that a combination of strong spin-orbit interactions (SOI) and a canted antiferromagnetic Mott state is sufficient to attain that goal. The antiferromagnetic insulator Sr_{2}IrO_{4} provides a model system in which strong SOI lock canted Ir magnetic moments to IrO_{6} octahedra, causing them to rigidly rotate together. A novel coupling between an applied electrical current and the canting angle reduces the Néel temperature and drives a large, nonlinear lattice expansion that closely tracks the magnetization, increases the electron mobility, and precipitates a unique resistive switching effect. Our observations open new avenues for understanding fundamental physics driven by strong SOI in condensed matter, and provide a new paradigm for functional materials and devices.

The epidemiology of hepatitis B virus infection in women of reproductive age in highly endemic areas in China

We describe the epidemiology of hepatitis B virus (HBV) infection among women of reproductive age residing in areas of China that are highly endemic for chronic HBV, and provide evidence useful for decision-makers to guide strategies for preventing mother-to-child transmission of HBV, and assess the impact of perinatal transmission PMTCT by projecting HBsAg prevalence trends without interventions. We conducted a cross-sectional HBV serological survey of women, 15-49 years of age, residing in Fujian, Guangdong, Guangxi and Hainan provinces. Demographic and other subject-level data were collected in face-to-face interviews, after which we obtain blood specimens. Specimens were tested for HBV sero-markers by ELISA (Beijing Wantai Biological Pharmacy), and HBV DNA was tested with PCR (Hunan Sansure Biotech). Weighted HBsAg and HBV (either HBsAg+ or anti-HBc+ indicating either present or past infection) prevalences were 11.82% and 57.16%, respectively. Among the HBsAg-positive women, 27% were also HBeAg positive. The proportion of individuals with HBV DNA loads >10⁵ IU/mL declined with increasing age. Among HBsAg-negative women, 0.9% had occult HBV infection. The prevalence of chronic HBV infection among reproductive women in these highly endemic provinces is high, posing a threat to maternal health and risk of mother-to-child transmission. Prevention of mother-to-child transmission remains critically important.

Skin resistance to UVB-induced oxidative stress and hyperpigmentation by the topical use of Lactobacillus helveticus NS8-fermented milk supernatant

AIMS

In this study, we investigated the preventive properties of the supernatant of Lactobacillus helveticus NS8-fermented milk (NS8-FS) against UV light-induced skin oxidative damage and hyperpigmentation.

METHODS AND RESULTS

NS8-FS exhibited significant radical scavenging activity in tests with ABST⁺ and DPPH scavenging methods, and as well strongly inhibited 3-morpholinosydnonimine (Sin-1)-induced ROS generation in HaCat keratinocytes. Unexpectedly, NS8-FS was found to inhibit melanin production in B16F10 melanoma cells and to exhibit inhibitory effects both to the enzymatic activity of tyrosinase (TYR) and the expression of proteins required for melanin synthesis. In SKH-1 hairless mice, topical application of NS8-FS alleviated UVB-induced skin photodamage, including the improvement of the appearance of epidermal thickness, transepidennal water loss and lipid peroxidation levels. In the tanning guinea pig model, the whitening effect of NS8-FS was demonstrated using Masson-Fontana staining and TYR staining. Furthermore, NS8-FS was shown to stimulate the nuclear translocation and activation of the Nrf2 protein, along with recovery of antioxidant enzyme activities.

CONCLUSION

NS8-FS exhibits the protective capacities against UV light-induced skin oxidative damage and hyperpigmentation.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our findings indicate the potential of cell-free fermented products of lactic acid bacteria in topical photoprotection.

[Epidemiological analysis of viral hepatitis A in China, 2004-2015]

Objective: To analyze the epidemiological characteristics of hepatitis A cases in China from 2004 to 2015. Methods: Data of hepatitis A were reported through national notifiable disease information reporting system, which covered the 31 provinces (Hong Kong, Macau and Taiwan excluded). The inclusion criteria was: date of illness onset was between January 1(st) 2004 and December 31(st) 2015, the status of reported card was confirmed, the case was classified as laboratory confirmed or clinical diagnosed, the disease was Hepatitis A. The information such as sex, date of birth, date of illness onset, place of residence was collected. The data was divided into three phases, 2004-2007, 2008-2011, 2012-2015, which represented the phase before expanded program on immunization (EPI), first 4 years after EPI, second 4 years after EPI. Results: From 2004 to 2015, there were totally 574 697 hepatitis A cases in China, the mean annual incidence was 3.62/100 000. The risk ratio of hepatitis A in 2015 was 0.23 when compared with 2004. Sichuan, Xinjiang and Yunnan contributed to 27.27% of the total cases in China. In 2012-2015, the incidence of western (3.46/100 000) region was significantly higher than that in central (1.21/100 000) and eastern (1.08/100 000) regions. From 2004-2015, number of cases in each age group declined greatly, with number of cases declining from 43 711 to 5 938 in the age group of 5-9 years, from 29 722 to 3 438 in 10-14, from 23 212 to 3 646 in 15-19. The number of cases declined from 24 079 to 10 304 in the age group of 0-4 (declined by 57.21%), but in 2012-2015, the incidence of 0-4 age group was still the highest, with 77.72% cases in Xinjiang and Sichuan. Famers, students and scattered children accounted for 69.95% of total cases, with student cases declined from 24.08% (2004-2007) to 8.67% (2012-2015). Conclusion: The incidence of hepatitis A in China is decreasing year by year, the risk has been decreasing to a relatively low level. However, in western regions and children under age five, the risk is still high. Precision intervention is needed for further prevention and control of hepatitis A.

[Comparative analyze on hepatitis B seroepidemiological surveys among population aged 1-29 years in different epidemic regions of China in 1992 and 2014]

Objective: To evaluate the effect of hepatitis B prevention and control by comparative analysis on the results of HBsAg, anti-HBs and anti-HBc prevalence from national hepatitis B seroepidemiological surveys in 1992 and 2014 in different epidemic regions of China. Methods: Data was from the national seroepidemiological surveys of hepatitis B conducted in 1992 and 2014. The survey in 1992 was conducted in 145 disease surveillance points of 30 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. The survey in 2016 was conducted in 160 disease surveillance points of 31 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. In the two surveys, face-to-face interviews with the subject by door to door or on the investigation site were conducted by trained staff using standard questionnaires to obtain basic information including birth date, gender, ethnicity, resident place and so on. And then 5 ml venous blood was collected to test the sero-markers of HBsAg, anti-HBs and anti-HBc. We analyzed unweighted point prevalence and 95% CI of HBsAg, anti-HBs and anti-HBc in 1992 which had no design weighting, and analyzed weighted point prevalence and 95%CI of HBsAg, anti-HBs and anti-HBc in 2014 which had design weighting. Results: 34 291 and 31 713 people aged 1-29 years were involved in 1992 and 2014 national serosurveys of China, respectively. For the people aged 1-29 years, HBsAg prevalence was 2.64% (95%CI: 2.28%-3.06%) in 2014 and decreased by 73.92% as compared with the rate 10.13% (95% CI: 9.81%-10.45%) in 1992. Anti-HBc prevalence was 13.01% (95%CI: 12.09%-14.00%) in 2014 and decreased by 71.61% as compared with the rate 45.84% (95% CI: 45.31%-46.37%) in 1992. Anti-HBs prevalence was 57.79% (95%CI: 56.33%-59.25%) in 2014 and ascended by 127.41% as compared with the rate 25.41% (95% CI: 24.95%-25.87%) in 1992. In high, medium and low epidemic region, for the people who born during 1992-2001 when hepatitis B vaccine was introduced in routine immunization management, HBsAg prevalence was 4.74% (95%CI: 3.79%-5.69%), 1.59% (95%CI: 1.09%-2.10%) and 2.53% (95%CI: 1.66%-3.39%), respectively, and anti-HBs prevalence was 64.25% (95% CI: 62.11%-66.39%), 56.34% (95% CI: 54.50%-58.57%), 54.49% (95%CI: 51.75%-57.23%), respectively, and anti-HBc prevalence was 15.16% (95%CI: 13.56%-16.76%), 11.07% (95%CI: 9.80%-12.33%), 7.61% (95%CI: 6.15%-9.07%), respectively. In high, medium and low epidemic region, for the people who born during 2002-2013 the duration which hepatitis B vaccine was integrated in expanded immunization program born during when HBsAg prevalence was 0.88% (95%CI: 0.66%-1.11%), 0.37% (95%CI: 0.24%-0.49%)and 0.71% (95%CI: 0.48%-0.94%), respectively, and anti-HBs prevalence was 60.74% (95%CI: 59.57%-61.90%), 59.46% (95%CI: 58.44%-60.49%), 52.56% (95% CI: 51.20%-53.92%), respectively, and anti-HBc prevalence was 3.30% (95% CI: 2.87%-3.72%), 1.91% (95%CI: 1.63%-2.20%), 2.25% (95%CI: 1.85%-2.66%), respectively. Conclusion: China had made great achievement in hepatitis B prevention and control. HBsAg prevalence among people aged 1-29 years old in 2014 decreased dramatically as compared with that in 1992. Since hepatitis B vaccine was integrated into expanded immunization program, China reduced HBsAg prevalence to less than 1% among people aged 1-12 years in 2014 in different epidemic region.

Deferoxamine-activated hypoxia-inducible factor-1 restores cardioprotective effects of sevoflurane postconditioning in diabetic rats

AIM

The cardioprotective effects of sevoflurane postconditioning (SpostC) are eliminated under diabetic conditions, and the underlying mechanism for this phenomenon remains unclear. Many studies have demonstrated that the hypoxia-inducible factor-1 (HIF-1) signalling pathway in the myocardium is impaired under diabetic conditions. This study was to investigate whether deferoxamine (DFO)-induced activation of HIF-1 signalling pathway can restore the cardioprotective effects of SpostC in diabetic rats.

METHODS

A model of myocardial ischaemia/reperfusion (I/R) injury was induced via ligation of the left anterior descending artery. SpostC was conducted by administering 1.0 MAC sevoflurane. After inducing the I/R injury, the following parameters were measured: myocardial infarct size, cardiac function, myocardial ultrastructure, mitochondrial respiratory function, respiratory chain enzyme activity, rate of reactive oxygen species (ROS) generation, and protein expression of HIF-1α, vascular endothelial growth factor (VEGF), cleaved caspase-3, Bcl-2 and Bax.

RESULTS

After DFO activated HIF-1 in the impaired myocardium of diabetic rats, SpostC significantly upregulated the protein expression of HIF-1α and its downstream mediator VEGF. This improved myocardial mitochondrial respiratory function and respiratory chain enzyme activity and reduced ROS generation as well as the protein expression of cleaved caspase-3 and Bax. As a result, myocardial infarct size decreased, and cardiac function and mitochondrial ultrastructure improved.

CONCLUSION

This study demonstrates for the first time that abolishment of the cardioprotective effects of SpostC in diabetic rats is associated with impairment of the HIF-1 signalling pathway and that DFO can activate HIF-1 to restore these cardioprotective effects of SpostC in diabetic rats.

Texture analysis of CT images in predicting malignancy risk of gastrointestinal stromal tumours

AIM

To explore the role of texture analysis of computed tomography (CT) images in predicting the malignancy risk of gastrointestinal stromal tumours (GISTs).

MATERIALS AND METHODS

Seventy-eight patients with histopathologically confirmed GISTs underwent preoperative CT. Texture analysis was performed on unenhanced and contrast-enhanced CT images, respectively. Fourteen CT texture parameters were obtained and compared among GISTs at different malignancy risks with one-way analysis of variance or independent-samples Kruskal-Wallis test. Correlations between CT texture parameters and malignancy risk were analysed with Spearman's correlation test. Diagnostic performance of CT texture parameters in differentiating GISTs at low/very low malignancy risk was tested with receiver operating characteristic (ROC) analysis.

RESULTS

Three parameters on unenhanced images (r=-0.268-0.506), four parameters on arterial phase (r=-0.365-0.508), and six parameters on venous phase (r=-0.343-0.481) imaging correlated significantly with malignancy risk of GISTs, respectively (all p<0.05). For identifying GISTs at low/very low malignancy risk, three parameters on unenhanced images (area under ROC curve [AUC], 0.676-0.802), four parameters on arterial phase (AUC, 0.637-0.811), and six parameters on venous phase (AUC, 0.636-0.791) imaging showed significant diagnostic performance, respectively (all p<0.05), especially maximum frequency on both unenhanced and contrast-enhanced images (AUC, 0.791-0.811).

CONCLUSION

Texture analysis of CT images holds great potential to predict the malignancy risk of GISTs preoperatively.