Meta-analysis of the GALAD model for diagnosing primary hepatocellular carcinoma.

BACKGROUND: Ever since the GALAD (gender-age-Lens culinaris agglutinin-reactive alpha-fetoprotein-alpha-fetoprotein-des-gamma-carboxy prothrombin) logistic regression model was established to diagnose hepatocellular carcinoma (HCC), there has been no high-level evidence that evaluates and summarizes it. OBJECTIVE: This meta-analysis was performed to assess the diagnostic ability of the GALAD model. METHODS: The following databases were systematically searched for original diagnostic studies on HCC: PubMed, Embase, Medline, the Web of Science, Cochrane Library, China National Knowledge Infrastructure Wanfang (China), Wiper and the Chinese BioMedical Literature Database. After screening the search results according to our criteria, the Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the methodologic qualities, and statistical software were used to output the statistics. RESULTS: Ultimately, 10 studies were included and analyzed. The results revealed the pooled sensitivity and specificity of the GALAD model to be 0.86 (95% confidence interval [CI]: 0.82, 0.90) and 0.90 (95% CI: 0.87, 0.92), respectively, for all-stage HCC. The area under the curve (AUC) was 0.94. For early-stage HCC, the pooled sensitivity and specificity of the GALAD model were 0.83 (95% CI: 0.78, 0.87) and 0.81 (95% CI: 0.78, 0.83), respectively. The AUC was 0.90. CONCLUSION: This meta-analysis confirmed that the GALAD model has excellent diagnostic performance for early-stage and all-stage HCC and can maintain high sensitivity and specificity in early-stage HCC. Therefore, the GALAD model is qualified for screening early-stage canceration from chronic liver disease.

Computed tomography-based radiomics to predict early recurrence of hepatocellular carcinoma post-hepatectomy in patients background on cirrhosis.

BACKGROUND: The prognosis for hepatocellular carcinoma (HCC) in the presence of cirrhosis is unfavourable, primarily attributable to the high incidence of recurrence. AIM: To develop a machine learning model for predicting early recurrence (ER) of post-hepatectomy HCC in patients with cirrhosis and to stratify patients' overall survival (OS) based on the predicted risk of recurrence. METHODS: In this retrospective study, 214 HCC patients with cirrhosis who underwent curative hepatectomy were examined. Radiomics feature selection was conducted using the least absolute shrinkage and selection operator and recursive feature elimination methods. Clinical-radiologic features were selected through univariate and multivariate logistic regression analyses. Five machine learning methods were used for model comparison, aiming to identify the optimal model. The model's performance was evaluated using the receiver operating characteristic curve [area under the curve (AUC)], calibration, and decision curve analysis. Additionally, the Kaplan-Meier (K-M) curve was used to evaluate the stratification effect of the model on patient OS. RESULTS: Within this study, the most effective predictive performance for ER of post-hepatectomy HCC in the background of cirrhosis was demonstrated by a model that integrated radiomics features and clinical-radiologic features. In the training cohort, this model attained an AUC of 0.844, while in the validation cohort, it achieved a value of 0.790. The K-M curves illustrated that the combined model not only facilitated risk stratification but also exhibited significant discriminatory ability concerning patients' OS. CONCLUSION: The combined model, integrating both radiomics and clinical-radiologic characteristics, exhibited excellent performance in HCC with cirrhosis. The K-M curves assessing OS revealed statistically significant differences.

Multimodal imaging diagnosis for bone fibrous dysplasia malignant transformation: A case report.

Fibrous dysplasia of bone (FDB) is a rare benign condition in which fibrous tissue replaces normal bone architecture. FDB rarely undergoes malignant transformation, but there are reports of locally aggressive fibrous dysplasia with cortical destruction and soft tissue extension. Diagnosis of FDB malignant transformation is not easy, especially in monostotic form, because of the overlap in imaging features of locally aggressive fibrous dysplasia and fibrous dysplasia with malignant transformation. The present case study reports a rare case of FDB in a 23-year-old man with polyostotic fibrous dysplasia arising in the left side of the pelvis and lower limb bones with partial transformation to fibrosarcoma. This study explored the multimodal imaging features of FDB malignant transformation, to achieve early detection and improve diagnostic accuracy of local FDB aggressiveness and its malignant transformation.

Diosgenin inhibits the expression of NEDD4 in prostate cancer cells.

Prostate cancer is the second most common malignancy among men and causes a myriad of health problem for males that are diagnosed with the cancer. Although the 5-year relative survival rate of prostate cancer patients has been significantly increased due to prostate-specific antigen testing and treatment advances, patients that develop metastatic castrate-resistant prostate cancer continue to have poor survival rates. Thus, it is critical to discover new therapeutics to treat prostate cancer. Diosgenin is a steroidal saponin from Trigonella foenum graecum, which has been previously identified to exert anti-tumor properties. Neural precursor cell expressed developmentally down-regulated protein 4 (NEDD4) is an E3 ligase that degrades multiple different proteins, and plays an oncogenic role in human cancer. In this study, we explore the molecular mechanism by which diosgenin mediates anti-tumor effects in prostate cancer cells. We found that diosgenin treatment led to cell growth inhibition, apoptosis and cell cycle arrest. Notably, we found that diosgenin inhibited the expression of NEDD4 in prostate cancer cells. Furthermore, overexpression of NEDD4 overcame the diosgenin-mediated anti-tumor activity, while downregulation of NEDD4 promoted the diosgenin-induced anti-cancer function in prostate cancer cells. Our findings indicate that diosgenin is a potential new inhibitor of NEDD4 in prostate cancer cells.

Two new flavans from the roots of Dianella ensifolia (L.) DC.

Two new flavans, named (2S)-2',4'-dihydroxy-7-methoxy-8-methylflavan (1) and (2S)-2'-hydroxy-4',7-dimethoxy-8-methylflavan (2) were isolated from the roots of Dianella ensifolia. Their structures were elucidated by extensive spectroscopic measurements and comparison with data reported in literatures. Compounds 1 and 2 displayed cytotoxic effects against cancer cell lines MDA-MB-231, B16-F10, HCT116 and A549.

Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy.

OBJECTIVE: To provide appropriate evidence for treatment planning of patients with an impacted proximal ureteral stones ≥1.5 cm in size, by analyzing the therapeutic outcomes for those undergoing minimally invasive percutaneous antegrade ureterolithotripsy and retrograde ureterolithotripsy. PATIENTS AND METHODS: From September 2010 to November 2011, eligible patients with impacted proximal ureteral stones ≥1.5 cm in size referred to our institute were considered for this study. The closed envelope method was used to randomize the enrolled patients to mini-PCNL (30) or retrograde ureterolithotripsy (29). The efficiency quotient (EQ) was calculated to specifically address the efficiency for both the techniques. All preoperative and postoperative data for both groups were recorded. RESULTS: The initial stone-free rate was 93.3% in the mini-PCNL group and 41.4% in the URSL group (p < 0.001). However, the overall stone-free rate at the 1-month follow-up visit after initial treatment was 100% in the mini-PCNL group and 89.7% in the URSL group (p = 0.07). The EQs for the mini-PCNL and URSL groups were 0.83 and 0.50, respectively. CONCLUSIONS: Our study shows that mini-PCNL removal of large impacted proximal ureteral calculi can achieve higher stone-free rates and safe.

Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study.

We performed a randomized, prospective study to assess the possible role of combined naftopidil and tolterodine for facilitating the spontaneous expulsion of intramural ureteral stones. A total of 76 patients with intramural ureter stones were included in the study from December 2007 to February 2011. Patients were randomized to one of three treatment groups. Group A patients received naftopidil 25 mg/day, group B patients received naftopidil 25 mg/day plus tolterodine 2 mg (twice a day), and group C patients received tolterodine 2 mg (twice a day). Both groups were followed up for 2 weeks. The stone expulsion rate and time and the number of pain episodes were obtained. Subjects rated the urgency associated with each micturition using the Urinary Sensation Scale (USS). Pain descriptions were recorded by the patients using the visual analog scale (VAS). A significant difference was shown for the expulsion rate between the group C and the other two groups (P < 0.001 by log rank test). In groups A, B and C, the mean number of pain episodes was 2.25 ± 0.90, 1.38 ± 1.37 and 1.54 ± 1.18, respectively. The USS score for groups A, B and C at 3 days was 2.32 ± 0.55, 1.4 ± 0.58 and 1.34 ± 0.49, respectively. It was 1.75 ± 0.44, 1.2 ± 0.41 and 1.22 ± 0.42, respectively, at 7 days. On the other hand, a statistically significant difference was found between groups A and B, and groups A and C in relation to the visual analog scale score on days 3 and 7, respectively. Treatment with naftopidil and tolterodine appears to be beneficial in intramural ureteral stones clearance, particularly in the intramural ureter with symptoms of vesical irritability.

Comparing efficacy of α1D-receptor antagonist naftopidil and α1A/D-receptor antagonist tamsulosin in management of distal ureteral stones.

PURPOSE: To compare the efficacy of α(1)D-receptor antagonist Naftopidil and α(1)A/D-receptor antagonist Tamsulosin in management of distal ureteral stones. MATERIALS AND METHODS: A total of 131 patients with distal ureteral stones were included in the study from December 2008 to September 2010. The patients were randomized to 3 groups: group 1 (43 patients), those receiving 10 mg naftopidil once daily; group 2 (45 patients), those receiving 0.4 mg tamsulosin once daily; and group 3 (43 patients) were given a watchful waiting and served as control group. All patients were followed up for 2 weeks. Ultrasonography and kidney-ureters-bladder (KUB) were performed on day 7 and 14. At the end of the follow-up period, patients who failed to expel the stone were scheduled to undergo ESWL or ureteroscopy. RESULTS: Stone expulsion was observed in 31 patients in group 1 (72.1%), 37 patients in group 2 (82.2%), and 13 patients in group 3 (30.2%). A statistically significant difference was noted with Chi-square testing between groups 1 and 3, and groups 2 and 3 (P = 0.000 and P = 0.000, respectively). Average time to expulsion was 7.6 ± 2.26 days (range 1-12 days) in group 1, 7.7 ± 1.94 days (range 2-11 days) in group 2, and 9.4 ± 2.48 days (range 6-14 days) in group 3. A statistically significant difference was observed in time to expulsion between groups 1 and 3, and groups 2 and 3 (P = 0.000, P = 0.001, respectively) by ANOVA testing. The side effects encountered in the study groups were generally mild and did not require cessation of therapy in any patient. CONCLUSIONS: Naftopidil could significantly increase spontaneous passage of distal ureteral stones with low side effects. The stone expulsion rate is similar for the tamsulosin.

[A modified rat model for infection-induced stone formation].

OBJECTIVE: To employ a newly modified rat model for infection-induced bladder stone formation. METHODS: 24 adult male Sprague Dawley rats were divided into 3 groups, model group (n=12), sham operation group (n=8) and control group (n=4). The surgical procedures were performed aseptically under anesthesia (25% Ultane 1.0 g/kg). The bladder in model group was exposed through a short lower midline abdominal incision, the puncture needle (G18) with guideline was inserted aseptically into bladder, a metal wire, which have been contaminated by the Proteus mirabilis, was put into the puncture canal, then implanted into the bladder lumen through the guideline. In the sham operated group the puncture needle (G18) with guideline was inserted into bladder without metal wire implanted into the bladder. There was no any operation in control group. The rats were sacrificed by excessive anesthesia at 21 days post challenge. The bladder were removed aseptically and inspected for evidence of urolithiasis. RESULTS: On Day 2 after surgery, two rats died in model group, no rats died in other groups. Twenty-one days after surgery, all of rats in model group developed various-sized bladder stones. There was no stone formation in sham operation group and control group. All stones were verified by infrared spectroscopy and optical crystallography. These stone were struvite stone. CONCLUSION: This model has a less trauma, faster recovery and excellent stone formation so that it may be used for the study of infection stone.

[Clinical value of CK34BE12 combining the expression of protein P53 gene and prostate specific antigen for the differential diagnosis of prostate carcinoma].

OBJECTIVE: To improve the level of clinical diagnosis and differential diagnosis of benign and malignant prostate lesions. METHODS: One hundred and nine cases of prostate cancer and prostate hyperplasia were evaluated by the expression of high molecular weight cytokeratin (CK34BE12), prostate specific antigen (PSA) and protein P53 gene using the immunohistochemical technique. RESULTS: The basal-cells in all of the benign lesions were stained with the CK34BE12 and PSA, while it had not immunoreactivity with P53. In contrast, the prostate carcinoma were not stained or partly stained with the CK34BE12 and PSA, but P53 show significant immunoreactivity with the tissue. CONCLUSION: Based on the routine histological studies with the expression of CK34BE12 and PSA together, they can indicate the existence of basal-cell distinctly and show indirectly whether the basal-cell is integrated. Combining the expression of P53 to determine the existence of cancer gene, it can help to distinguish benign and malignant prostate lesions.