Type 1 diabetes complicated with cyclic vomiting syndrome and exogenous insulin antibody syndrome: A case report.

Every fifth individual with type 1 diabetes (T1D) suffers from an additional autoimmune disorder due to shared genetic factors and dysregulated immunity. Here we report an extremely rare case of T1D complicated with cyclic vomiting and hypoglycaemia. A 27-year-old Chinese woman with 14-year history of T1D was periodically hospitalized for severe vomiting of more than 30 times a day without apparent organic causes. The vomiting developed acutely and remitted spontaneously after 2-3 days, followed with intractable hypoglycaemia for another 3-4 days during the hospitalization. A few weeks after discharge, she was admitted once again with the same symptoms and disease course. Cyclic vomiting syndrome (CVS) was diagnosed according to the Rome IV criteria, a system developed to define the functional gastrointestinal disorders. Dynamic association and disassociation of exogenous insulin and insulin antibodies (IAs) were identified in her blood during hypoglycaemia, leading to the diagnosis of exogenous insulin antibody syndrome (EIAS). Treatment with rituximab to suppress the IAs was associated with a striking amelioration of hypoglycaemia. Unexpectedly, the episodes of cyclic vomiting were also dramatically reduced. In conclusion, we identified the first case with alternating CVS and EIAS in the setting of T1D. Dynamic measurements of free and total insulin are helpful for the diagnosis of EIAS. CVS is likely to be a latent autoimmune disorder considering the good response to rituximab treatment.

Superb microvascular imaging is as sensitive as contrast-enhanced ultrasound for detecting synovial vascularity in rheumatoid arthritis.

Background: Detection of synovitis is essential for assessing rheumatoid arthritis (RA) activity and predicting prognosis. This study aimed to compare the diagnostic performance of superb microvascular imaging (SMI) with that of contrast-enhanced ultrasound (CEUS) in patients with RA in clinical remission. Methods: SMI and CEUS were applied to 63 patients with active RA and 48 patients with RA in clinical remission. Differences in positive synovial vascularity (SV) and its semi-quantitative scale were observed, and the correlations of SMI and CEUS results with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were analyzed. Results: For the 63 joints with active RA, the detection rates of SV as determined by SMI and CEUS were 90.5% (95% CI: 83.0-97.9%) and 93.7% (95% CI: 87.5-99.8%), respectively, with no significant difference observed between the two modalities (t=-1.137; P=0.260). There was good agreement between the two modalities in detecting positive blood flow (Kappa =0.784) and blood flow signal score (Kappa =0.792). For the 48 joints with clinical remission, the detection rates of SV determined by SMI and CEUS were 79.2% (95% CI: 67.2-91.1%) and 83.3% (95% CI: 72.4-94.3%), respectively, with no significant difference found between the two modalities (t=1.000; P=0.322). There was high consistency between the two modalities in detecting positive blood flow (Kappa =0.727) and blood flow signal score (Kappa =0.661). The vascularity scores of SMI and CEUS were positively correlated with CRP, ESR, and RF in the joints with active RA, but not in those with clinical remission. Conclusions: SMI is as sensitive as CEUS for detecting vessels in the synovium and displaying local SV in patients with RA who achieve clinical remission.

[Clinical Application of Screening Cell Combination Method in the Prediction of Red Blood Cell Alloantibody].

OBJECTIVE: To explore the clinical application of screening cell combination method in the prediction of red blood cell alloantibody, so as to provide basis for clinical diagnosis. METHODS: From October 2018 to April 2020, 9 680 samples were screened with automatic blood group instrument, 79 patients with positive alloantibodies were identified by 4 sets of screening cells from different manufacturers (referred to as combined method). At the same time, cell panel Panocell-16 was used for comparative analysis. Meanwhile, the combined method was also used to identify the antibodies of 20 samples from National Center for Clinical Laboratories external quality assessment (EQA) in China and 12 samples from WHO EQA. RESULTS: The 79 alloantibodies included anti-Mia antibody (7 cases), anti-M antibody (13 cases), anti-Lea antibody (9 cases), anti-P1 antibody (2 cases), anti-E antibody (22 cases), anti-c + E antibody (9 cases), anti-D antibody (4 cases), anti-e antibody (2 cases), anti-C + e antibody (3 cases), anti-C antibody (3 cases), anti-H antibody (1 case), anti-Fyb antibody (1 case), anti-E + M antibody (1 case), autoantibody + anti-E (2 cases). However, 7 cases of anti-Mia antibody and 1 case of anti- Lea antibody were missed in Panocell-16 identification results. The results of antibody identification in 20 samples from National Center for Clinical Laboratories EQA in China and 12 samples from WHO EQA were 100% accurate by combination method. The identification results between combined method identification and Panocell-16 identification showed no significant difference. CONCLUSION: The combined method can identify the alloantibodies of red blood cells in Chinese population. The screening cells can be used for screening of irregular antibodies without wasting reagents at the same time.

Hypouricaemic and nephroprotective effects of Poria cocos in hyperuricemic mice by up-regulating ATP-binding cassette super-family G member 2.

CONTEXT: Poria coco F.A.Wolf (Polyporaceae) dispels dampness and promotes diuresis implying hypouricaemic action. OBJECTIVE: To examine hypouricaemic action of Poria coco. MATERIALS AND METHODS: Ethanol extract (PCE) was prepared by extracting the sclerotium of P. cocos with ethanol, and the water extract (PCW) was produced by bathing the remains with water. PCE and PCW (50, 100 and 200 mg/kg, respectively) were orally administered to hyperuricemic Kunming mice (n = 8) to examine its hypouricaemic effect. Also, molecular docking was performed. RESULTS: P. cocos showed excellent hypouricaemic action, decreasing the serum uric acid of hyperuricaemia (HUA) control (526 ± 112 µmol/L) to 178 ± 53, 153 ± 57 and 151 ± 62 µmol/L (p < 0.01) by PCE and 69 ± 23, 63 ± 15 and 62 ± 20 µmol/L (p < 0.01) by PCW, respectively. According to SCrs, BUNs and H&E staining, PCE and PCW partially attenuated renal dysfunction caused by HUA. They presented no negative effects on ALT, AST and ALP activities. They elevated ABCG2 (ATP-binding cassette super-family G member 2) mRNA and protein expression in comparison to HUA control. In molecular docking, compound 267, 277, 13824, 15730 and 5759 were predicted as the top bioactives of P. cocos against HUA, which even presented better scores than the positive compound, oestrone 3-sulfate. DISCUSSION AND CONCLUSIONS: This paper demonstrated the hypouricaemic and nephroprotective effects of P. cocos in hyperuricemic mice by up-regulating ABCG2. These results may be useful for the development of a hypouricaemic agent.

Risk Factors for Cognitive Impairment in Patients with Type 2 Diabetes.

OBJECTIVES: To investigate the risk factors for cognitive impairment in Chinese type 2 diabetes mellitus (T2DM) patients of advanced age and to identify effective biomarkers of mild cognitive impairment (MCI) in these patients. METHODS: Chinese T2DM patients (n = 120) aged 50-70 years were divided into groups with impaired (mild, moderate, and severe) and normal cognitive function based on Montreal Cognitive Assessment and Mini-Mental State Examination scores. Data regarding demographic characteristics, clinical features of diabetes, biochemical markers, and metabolomics were collected. RESULTS: Age, educational level, duration of diabetes, fasting blood glucose (FBG), HbA1c, total cholesterol (TC), triglyceride (TG), and 24-hour urine protein were significantly associated with cognitive impairment in T2DM patients of advanced age. The severity of fundus retinopathy and the incidence of macrovascular disease also differed significantly among the groups (P < 0.05). Metabolomics analysis suggested that increased levels of glutamate (Glu), phenylalanine (Phe), tyrosine (Tyr), proline (Pro), and homocysteine (Hcy) and a decreased level of glutamine (Gln) were significantly associated with cognitive impairment in the T2DM patients (P < 0.05). Receiver operating characteristic curve analysis demonstrated that Glu, Gln, Phe, and Pro levels were significant predictors of cognitive impairment in the T2DM patients. CONCLUSIONS: Age, educational level, duration of diabetes, and the levels of FBG, HbA1c, TC, TG, and 24-hour urine protein were considered as independent risk factors for cognitive impairment in older T2DM patients. Macrovascular and microvascular diseases also were closely associated with cognitive impairment in these patients. Together, Glu and Gln levels may represent a good predictive biomarker for the early diagnosis of cognitive impairment in T2DM patients.

Ginsenoside Rg3 protects heart against isoproterenol-induced myocardial infarction by activating AMPK mediated autophagy.

BACKGROUND: Panax ginseng is a well-known medicinal herb that is widely used in traditional Chinese medicine for treating various diseases. Ginsenoside Rg3 (Rg3) is thought to be one of the most important active ingredients of Panax ginseng. However, the molecular mechanism underlying the beneficial effects of Rg3 has been elusive. METHODS: In the mouse heart injury model induced by isoproterenol (ISO), we used brain natriuretic peptide (BNP), lactate dehydrogenase (LDH) and caspase-3 ELISA kits to test myocardium injury. To test whether Rg3 protects myocardial injury through AMPK mediated autophagy, we used specific AMPK inhibitor in combination with Rg3. NLRP3 inflammasome related molecules such as NLRP3, ASC and caspase-1 were measured by western-blot following Rg3 treatment. RESULTS: We found that Rg3 significantly reduced ISO induced myocardial injury indicated by the downregulation of serum BNP and LDH. In addition, we showed that the improvement of myocardial injury by Rg3 was associated with enhanced expression of autophagy related protein and activation of AMPK downstream signaling pathway. CONCLUSIONS: We observed that inhibition of AMPK significantly reversed the myocardial protective effect of Rg3, which is associated with a decrease of Rg3 induced autophagy. These together suggested that Rg3 may improve myocardial injury during MI through AMPK mediated autophagy. Our study also provides important translational evidence for using Rg3 in treating myocardial infarction (MI).

Differences among the Thyroid Imaging Reporting and Data System proposed by Korean, the American College of Radiology and the European Thyroid Association in the diagnostic performance of thyroid nodules.

The aim of this study was to evaluate the diagnostic performance of the Thyroid Imaging Reporting and Data System (TIRADS) in the forms proposed by Kwak (K-TIRADS), the American College of Radiology (ACR-TIRADS) and the European Thyroid Association (EU-TIRADS). A total of 846 thyroid nodules were evaluated by K-TIRADS, ACR-TIRADS and EU-TIRADS. All the ultrasound data were analyzed and classified according to the criteria of the three systems. In addition, we calculated the risk of malignancy and plotted receiver operating characteristic (ROC) curves. Moreover, the diagnostic efficacy for malignancy were compared. Of the 846 thyroid nodules, 316 were malignant nodules and 530 were benign nodules. The areas under the ROC curves of K-TIRADS (0.827) and ACR-TIRADS (0.817) were not significantly different (P=0.2425); however, they were greater than that of EU-TIRADS (0.758) (P=0.000). The sensitivity of K-TIRADS (94.94%) was higher than that of ACR-TIRADS (61.08%) or EU-TIRADS (58.86%) (P=0.000), while ACR-TIRADS (89.62%) and EU-TIRADS (83.21%) had higher specificity than K-TIRADS (50.75%) (P=0.000). Although all the K-TIRADS, ACR-TIRADS and EU-TIRADS have values in risk stratification for thyroid nodules, they cannot simultaneously achieve high sensitivity and high specificity. Further research should be performed to develop a TIRADS which is more suitable for the population of China.

Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma.

OBJECTIVE: To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. MATERIALS AND METHODS: Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. RESULTS: Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[-3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. CONCLUSION: Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.

Additional Value of Superb Microvascular Imaging for Thyroid Nodule Classification with the Thyroid Imaging Reporting and Data System.

Superb microvascular imaging (SMI) is an innovative vascular imaging technique for ultrasound (US). Compared with conventional color Doppler imaging (CDI) and power Doppler imaging (PDI), SMI can detect more blood flow in thyroid nodules. In this study, a total of 203 thyroid nodules (160 benign nodules, 43 malignant nodules) in 195 patients were assessed with the Thyroid Imaging Reporting and Data System (TI-RADS) published by the American College of Radiology in 2017) and SMI. With TI-RADS alone, 24 (15.0%), 76 (47.5%), 65 (40.6%) and 39 (24.4%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. However, with the combination of TI-RADS and SMI, 31 (19.4%), 79 (49.4%), 44 (27.5%) and 49 (30.6%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. The area under the receiver operating characteristic curves for the combination (0.952) was larger than that for TI-RADS alone (0.883) (Z = 3.478, p = 0.001). The efficiency of TI-RADS alone and the TI-RADS + SMI combination in diagnosing thyroid nodules was determined for all except TR2 nodules. Although no significant differences between the methods were observed for TR3 and TR5 thyroid nodules (p > 0.05), the diagnostic efficiency of TI-RADS + SMI for TR4 thyroid nodules was higher than that of TI-RADS alone for TR4 nodules (p < 0.05). This study indicated that the vascularity of thyroid nodules can be well characterized using SMI, and the combined use of gray-scale US and SMI can improve the diagnostic performance of TI-RADS for TR4 thyroid nodules.

Renal Masses: Evaluation with Contrast-Enhanced Ultrasound, with a Special Focus on the Pseudocapsule Sign.

The aim of this study was to analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant renal masses, with a special emphasis on the value of the pseudocapsule sign. A total of 163 consecutive patients with 163 renal masses were involved. The conventional ultrasonography and CEUS features were assessed. Sensitivity, specificity and the area under the receiver operating characteristic curve (Az) were calculated for qualitative CEUS, and a multivariate analysis was performed to analyze the correlation between the sonographic features and malignancy. Time to peak (TTP) and peak intensity (PI) were compared between benign and malignant renal masses for quantitative CEUS analysis in 72 of 163 patients. Intraclass correlations were calculated for variability in intensity and time parameters between qualitative and quantitative evaluation. Among all qualitative CEUS features, the pseudocapsule sign showed the highest Az (0.777; 95% confidence interval: 0.701-0.853) and yielded the highest sensitivity (67.4%) and specificity (88.0%); multivariate logistic regression analysis showed that the pseudocapsule sign and color Doppler flow imaging patterns were the two strongest independent predictors for malignancy. For quantitative CEUS analysis, higher PI and shorter TTP were found in malignant renal masses than those in benign ones. The Intraclass correlation coefficient values among qualitative and the quantitative assessments were 0.00 for time and 0.03 for intensity. The pseudocapsule sign offered the most efficient performance among all the qualitative and quantitative CEUS features.

The values of shear wave elastography in avoiding repeat fine-needle aspiration for thyroid nodules with nondiagnostic and undetermined cytology.

OBJECTIVE: To evaluate the value of shear wave elastography (SWE) in avoiding repeat fine-needle aspiration of thyroid nodules with nondiagnostic and undetermined cytology. METHODS: A total of 232 thyroid nodules with nondiagnostic (n = 132) and undetermined (n = 100) cytology underwent ultrasound (US) and SWE, followed by repeat ultrasound (US)-guided fine-needle aspiration cytology (FNAC). The final diagnosis was based on cytological or pathological findings. The US and SWE characteristics of benign and malignant nodules were compared using the χ2 -test. The receiver operating characteristic (ROC) curves of the thyroid imaging reporting and data system (TI-RADS) categories from the US and the EMean and ESD from the SWE were graphed, and the areas under the curves (AUCs) were compared using a Z test. RESULTS: There were significant differences between the benign and malignant nodules in terms of the echogenicity, shape, margin, calcification and TI-RADS categories (all P < 0.05). The differences were significant between the malignant and benign nodules for EMean [(34.57 ± 14.81) kPa vs. (19.18 ± 7.09) kPa] and ESD [(13.68 ± 13.01) kPa vs. (3.97 ± 2.58) kPa] (both P < 0.001). Though the difference in the AUCs of EMean (0.864) and ESD (0.876) was not significant (P = 0.745), they both had higher diagnostic performances in comparison with TI-RADS categories (0.762) (all P < 0.05). Moreover, ESD attained a sensitivity of 100% with a relatively higher specificity of 49.75% when its cut-off value was 3.3 kPa. CONCLUSIONS: Shear wave elastography is a promising imaging method for reducing repeat FNAC for benign thyroid nodules with nondiagnostic and undetermined cytology when using ESD as an index.

Anti-Hyperuricemic Effect of 2-Hydroxy-4-methoxy-benzophenone-5-sulfonic Acid in Hyperuricemic Mice through XOD.

Conventionally, benzophenone-type molecules are beneficial for alleviating the UV exposure of humans. More importantly, various compounds with this skeleton have demonstrated various biological activities. In this paper, we report the anti-hyperuricemic effect of the benzophenone compound 2-hydroxy-4-methoxybenzophenone-5-sulfonic acid (HMS). Preliminarily, its molecular docking score and xanthine oxidase (XOD) inhibition suggested a good anti-hyperuricemic effect. Then, its anti-hyperuricemic effect, primary mechanisms and general toxicity were examined on a hyperuricemic mouse model which was established using potassium oxonate and hypoxanthine together. HMS demonstrated a remarkable anti- hyperuricemic effect which was near to that of the control drugs, showing promising perspective. General toxicity was assessed and it showed no negative effects on body weight growth and kidney function. Moreover, anti-inflammatory action was observed for HMS via spleen and thymus changes. Its anti-hyperuricemic mechanisms may be ascribed to its inhibition of XOD and its up-regulation of organic anion transporter 1 (OAT1) and down-regulation of glucose transporter 9 (GLUT9).

Actions of Inonotus obliquus against Hyperuricemia through XOD and Bioactives Screened by Molecular Modeling.

Inonotus obliquus is an edible mushroom and also a remedy against various diseases, especially metabolic syndrome. In this paper we report the actions of an ethanol extract of I. obliquus (IOE) against hyperuricemia in hyperuricemic mice, and the screen of bioactives. The extract (IOE) was prepared by extracting I. obliquus at 65 °C with ethanol, and characterized by HPLC. IOE at low, middle, and high doses reduced serum uric acid (SUA) of hyperuricemic mice (353 µmol/L) to 215, 174, and 152 µmol/L (p < 0.01), respectively, showing similar hypouricemic effectiveness to the positive controls. IOE showed a non-toxic impact on kidney and liver functions. Of note, IOE suppressed xanthine oxidase (XOD) activity in serum and liver, and also down-regulated renal uric acid transporter 1 (URAT1). Four compounds hit highly against XOD in molecular docking. Overall, the four compounds all occupied the active tunnel, which may inhibit the substrate from entering. The IC50 of betulin was assayed at 121.10 ± 4.57 µM, which was near to that of allopurinol (148.10 ± 5.27 µM). Betulin may be one of the anti-hyperuricemia bioactives in I. obliquus.

FB1-induced programmed cell death in hemocytes of Ostrinia furnacalis.

Fumonisins are a type of mycotoxin produced by Fusarium spp., mainly F. proliferatum and F. vertieilliodes. Fumonisins represent a potential hazard to the health of animals and humans. Autophagic cell death is a method of programed cell death called type II PCD, which has complicated connections with apoptosis. Our results indicated that FB1 substantially inhibited cell viability and was cytotoxic to hemocytes of Ostrinia furnacalis in a time and concentration dependent manner. We verified the activation of FB1-induced autophagy according to MDC staining, Lyso-Tracker Red probe staining, TEM observation and atg8-PE expression levels. We discovered that FB1 induced apoptosis in only a few cells based on Annexin V-FITC and PI staining. These results suggested that FB1 induced survivin inhibition and triggered autophagic cell death in the cell line. These findings might provide a plausible explanation for the underlying mechanisms of FB1 toxicity in insect cellular immune system. In addition, we provided the atg8 gene sequence of Ostrinia furnacalis, and it would be very useful to researchers if they were to study corn borer.

The Fungicidal Activity of Tebuconazole Enantiomers against Fusarium graminearum and Its Selective Effect on DON Production under Different Conditions.

Tebuconazole, which consists of a pair of enantiomers with different fungicidal activities, is one of the most common fungicides used in the control of Fusarium graminearum. In this study, the fungicidal activity of rac-tebuconazole and its enantiomers against F. graminearum was determined at 0.997, 0.975, and 0.950 aw and at 20, 25, and 30 °C on wheat-based media. Then, F. graminearum was treated with rac-tebuconazole and its enantiomers at the EC10, EC50, and EC90 levels under different culture conditions, and DON production was measured. Finally, expression of the DON biosynthetic genes ( TRI5 and TRI6) was quantified by real-time RT-PCR after incubation with EC50 doses of rac-tebuconazole and its enantiomers for 4, 8, and 14 days at 30 °C and aw 0.997. The results showed that the fungicidal activity of tebuconazole was strongly influenced by temperature, aw, and the combined factors. (-)-Tebuconazole is higher in fungicidal activity than (+)-tebuconazole and rac-tebuconazole with 24-99-fold and 1.8-6.7-fold, respectively. However, (-)-tebuconazole was generally more favorable for DON production than (+)-tebuconazole under the same conditions. Additionally, (-)-tebuconazole and rac-tebuconazole induced significantly increased expression of the DON biosynthetic genes ( TRI5 and TRI6) compared to the control by the 14th day of treatment. In this research, the combination condition of 30 °C and 0.997 aw is the most suitable for DON production by F. graminearum. The test strains of F. graminearum treated with the EC10 dose of (-)-tebuconazole produced the greatest amounts of DON.

Is there an extraclinical value of automated breast volume scanner compared with hand-held ultrasound?: A pilot study.

The aim of this study was to investigate the extraclinical value of automated breast volume scanning (ABVS) in the diagnosis of breast tumor compare to hand-handle ultrasound (HHUS).One hundred twenty-four patients with breast tumor were performed HHUS and ABVS before operation. The research focused on whether there were newly found tumors or new findings on the coronal planes by using ABVS compared with HHUS. Then, the classification adjustments of breast imaging reporting and data system (BI-RADS) were made according to new findings on the coronal planes by using ABVS.There are totally 166 breast tumors found in 124 patients by HHUS, while 8 more were observed by ABVS, 4 of which were malignant and the rest were benign. The sensitivity and specificity of ABVS coronal plane findings were 37.0% and 92.5%, respectively. The area under receiver operating characteristic curve was 0.89 before the corrected classification versus 0.93 after the corrected classification, there were no significant differences (P > .05).There was no significant extraclinical value in differentiating diagnosis of malignant tumors and benign breast tumors by ABVS comparing to HHUS. However, those minimal lesions missed diagnosis could be found by ABVS with continuously automatic scanning.

Role of Contrast-Enhanced Ultrasound in Diagnosis of Thyroid Nodules in Acoustic Radiation Force Impulse "Gray Zone".

The aim of this study was to evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid nodules in the acoustic radiation force impulse (ARFI) "gray zone" (the shear wave velocity is in the range 2.5-3 m/s). ARFI was performed before thyroidectomy in 70 patients with 200 thyroid nodules, and then CEUS was performed in 40 thyroid nodules in the "gray zone." The accuracy of ARFI for the 200 thyroid nodules was 82% (164/200). The accuracy of ARFI for the 40 "gray zone" thyroid nodules was 70% (28/40), whereas the accuracy of CEUS for the "gray zone" thyroid nodules was 90% (36/40). There was a significant difference in accuracy (p < 0.05). CEUS has better accuracy for thyroid nodules in the ARFI "gray zone." CEUS supplemented ARFI in differential diagnosis of benign and malignant thyroid nodules.

Excessive activation of the TLR9/TGF-ß1/PDGF-B pathway in the peripheral blood of patients with systemic lupus erythematosus.

BACKGROUND: Our aim is to study the existence of the TLR9/TGF-ß1/PDGF-B pathway in healthy humans and patients with systemic lupus erythematosus (SLE), and to explore its possible involvement in the pathogenesis of lupus nephritis (LN). METHODS: Protein levels of the cytokines were detected by ELISA. mRNA levels of the cytokines were analyzed by real-time PCR. MTT assay was used to test the proliferation of mesangial cells under different treatments. RESULTS: Compared to healthy controls (N Control = 56), levels of Toll-like receptor (TLR)9, transforming growth factor (TGF)-ß1, and platelet-derived growth factor B (PDGF-B) were increased significantly in the peripheral blood of SLE patients (N SLE = 112). Significant correlations between the levels of TLR9, TGF-ß1, and PDGF-B were observed in both healthy controls and SLE patients. The levels of TGF-ß1 and PDGF-B were greatly enhanced by TLR9 activation in primary cell cultures. The proliferation of mesangial cells induced by the plasma of SLE patients was significantly higher than that induced by healthy controls; PDGF-B was involved in this process. The protein levels of PDGF-B homodimer correlated with the levels of urine protein in SLE patients with LN (N LN =38). CONCLUSIONS: The TLR9/TGF-ß1/PDGF-B pathway exists in humans and can be excessively activated in SLE patients. High levels of PDGF-B may result in overproliferation of mesangial cells in the kidney that are involved in the development of glomerulonephritis and LN. Further studies are necessary to identify TLR9, TGF-ß1, and PDGF-B as new therapeutic targets to prevent the development of glomerulonephritis and LN.

Toxicity of the mycotoxin fumonisin B1 on the insect Sf9 cell line.

Fumonisins are a type of mycotoxin produced by Fusarium spp., mainly F. proliferatum and F. vertieilliodes, and represent a potential hazard to the health of animals and human beings. The toxicity and mechanism of action of fumonisins is ambiguous, and it is unclear whether fumonisins are toxic to insect cells. This study examines the toxicity of fumonisin B1 (FB1) and its mechanism of action in the Spodoptera frugiperda Sf9 cell line. We found that FB1 inhibited Sf9 cellular proliferation and arrested cell growth at the G2/M phase. Morphological observation showed that FB1 induced swelling, vacuole formation, and loss of adhesion in Sf9 cells. Flow cytometry analysis showed that FB1 caused depolarization of the cell membrane potential and hyperpolarization of the mitochondrial membrane potential. To uncover potential genes associated with the molecular mechanisms of FB1, 41 differentially expressed genes were identified by transcriptome analyses after FB1 treatment. These genes are putatively involved in detoxification metabolism, insect hormone regulation, cell apoptosis, and other related processes. Finally, six differentially expressed genes were chosen and validated by quantitative real-time PCR (QRT-PCR). Our test could provide a reference for other kinds of insect cells studies on FB1 stress. At the same time, our studies try to provide a possible for FB1 as a precursor compounds of biological insecticide.

Superb Microvascular Imaging-A new vascular detecting ultrasonographic technique for avascular breast masses: A preliminary study.

OBJECTIVES: Superb Microvascular Imaging (SMI) is a new vascular imaging technique detecting a slower velocity that color Doppler flow image (CDFI) cannot. The aim of this study is to evaluate the clinical value of SMI for detecting penetrating vessels (PVs) in avascular breast lesions. METHODS: Seventy-nine patients with 82 breast lesions were examined by conventional ultrasound and diagnosed as Breast Imaging Reporting and Data System (BI-RADS) level 3 or 4. CDFI detected no PVs; subsequently, Power Doppler (PD), Advanced Dynamic Flow (ADF), and SMI were performed to detect any PVs in the breast lesions. RESULTS: Compared with PD or ADF, SMI revealed significantly (P<0.01) higher median numbers of PVs in breast lesions. The area under the receiver operating characteristic curve was 0.914 before the corrected classification versus 0.947 after the corrected classification (P<0.05). CONCLUSIONS: SMI was helpful in the differential diagnosis of benign versus malignant in avascular breast lesions, especially those in BI-RADS category 4.