Relationship between Circle of Willis Variations and Cerebral or Cervical Arteries Stenosis Investigated by Computer Tomography Angiography and Multitask Convolutional Neural Network.

Circle of Willis (CoW) is the most critical collateral pathway that supports the redistribution of blood supply in the brain. The variation of CoW is closely correlated with cerebral hemodynamic and cerebral vessel-related diseases. But what is responsible for CoW variation remains unclear. Moreover, the visual evaluation for CoW variation is highly time-consuming. In the present study, based on the computer tomography angiography (CTA) dataset from 255 patients, the correlation between the CoW variations with age, gender, and cerebral or cervical artery stenosis was investigated. A multitask convolutional neural network (CNN) was used to segment cerebral arteries automatically. The results showed the prevalence of variation of the anterior communicating artery (Aco) was higher in the normal senior group than in the normal young group and in females than in males. The changes in the prevalence of variations of individual segments were not demonstrated in the population with stenosis of the afferent and efferent arteries, so the critical factors for variation are related to genetic or physiological factors rather than pathological lesions. Using the multitask CNN model, complete cerebral and cervical arteries could be segmented and reconstructed in 120 seconds, and an average Dice coefficient of 78.2% was achieved. The segmentation accuracy for precommunicating part of anterior cerebral artery and posterior cerebral artery, the posterior communicating arteries, and Aco in CoW was 100%, 99.2%, 94%, and 69%, respectively. Artificial intelligence (AI) can be considered as an adjunct tool for detecting the CoW, particularly related to reducing workload and improving the accuracy of the visual evaluation. The study will serve as a basis for the following research to determine an individual's risk of stroke with the aid of AI.

Prevalence and drug resistance of nontuberculous mycobacteriain Zhejiang Province / 预防医学

Objective@#To learn the prevalence and drug resistance of nontuberculous mycobacteria ( NTM ) in Zhejiang Province, so as to provide evidence for NTM prevention and control.@*Methods@#A total of 2 878 clinical mycobacterium isolates in Zhejiang Province were collected from the drug resistance surveillance in 2008-2009, 2013-2014 and 2018-2019, PNB/TCH growth tests were used to preliminarily identify the NTM in these mycobacterium-positive isolates. 16SrRNA, rpoB, ITS and hsp65 gene sequencing analysis were used to confirm strains initially identified as NTM. Proportional method was applied to detect drug susceptibility of NTM isolates.@*Results @# Finally, 135 strains were confirmed as NTM and the isolation rate was 4.69%. The isolation rates of NTM in 2008-2009, 2013-2014 and 2018-2019 were 1.85%, 4.56% and 7.84%, respectively, with an increasing trend ( P<0.05 ). Thirteen species were identified and the top two species were M. intracellulare ( 82, 60.74% ) and M. kansassi ( 18, 13.33% ). The NTM isolates showed the highest drug resistance rate to isoniazid ( 97.78% ), followed by p-aminosalicylic acid ( 94.87% ) and streptomycin ( 94.81% ).@*Conclusions@#The isolation rates of NTM showed an upward trend in the drug resistance surveillance in 2008-2019,2013-2014 and 2018-2019 in Zhejiang Province. M. intracellulare and M. kansassi were the main strains isolated. The NTM isolates showed high resistance against both first and second-line antituberculosis drugs.

Antipruritic effects of electroacupuncture on morphine-induced pruritus model mice through the TLR2/4-MyD88-NF-κB pathway.

Pruritus is one of the common side effects of intrathecal or epidural injection of opioids. The aim of this study was to test the antipruritic effect of acupuncture and its possible mechanism. We used electroacupuncture (EA), toll-like receptor (TLR)2/4 antagonist sparstolonin B (SsnB), and TLR2/4 agonist peptidoglycan (PGN) to precondition female wild-type BALB/c mice, and then prepared a morphine-induced pruritus model. The mRNA and protein expression levels of TLR2, TLR4, MyD88, and NF-κB were detected by RT-PCR and western blotting. The contents of interleukin (IL)-1, IL-6, IL-12, IL-10, and tumor necrosis factor-α in serum were measured by ELISA assays. Flow cytometry was performed to analyze the ratio of M1-phenotype to M2-phenotype macrophages. Our results showed that EA preconditioning improved pruritus; reduced the expressions of TLR2, TLR4, MyD88, and NF-κB both at the mRNA and protein levels (P<0.05); reduced the expression of proinflammatory cytokines IL-1, IL-6, IL-12, and tumor necrosis factor-α; and increased the expression of anti-inflammatory cytokine IL-10 (P<0.05). EA promoted M2-phenotype macrophage differentiation. Moreover, these results showed no significant difference between the SsnB group and the EA+SsnB group (P>0.05), but showed a significant difference between the PGN group and the EA+PGN group (P<0.05). Therefore, we propose that EA may be involved in the remission of pruritus in morphine-induced pruritus model mice through the TLR2/4-MyD88-NF-κB pathway. EA is a potential therapeutic treatment for pruritus.

Phenotypic and genotypic characterization of pyrazinamide resistance among multidrug-resistant Mycobacterium tuberculosis isolates in Zhejiang, China.

To explore the phenotypic and genotypic characterization of pyrazinamide (PZA) resistance among multidrug-resistant Mycobacterium tuberculosis (MDR-TB) isolates in Zhejiang province, a total of 274 MDR-TB isolates were collected. Drug susceptibility testing and spoligotyping were performed on all clinical isolates. In addition, the mutated features of PZA-resistant loci, including pncA and rpsA, were also analyzed by DNA sequencing. Our results showed that the prevalence of PZA resistance among MDR-TB strains in Zhejiang province was 43.07% and that PZA resistance was associated with concomitant resistance to streptomycin. The majority of PZA-resistant MDR-TB isolates belonged to the Beijing family. Mutations within pncA, not rpsA, constituted the primary mechanism of PZA resistance. Among 118 PZA-resistant isolates, 53 different mutations were observed in pncA, and most of them were point mutations. Compared with the phenotypic data, DNA sequencing of pncA has sensitivity and specificity of 77.97% and 96.79%, respectively. Analysis of pncA provided a robust tool for rapid detection of PZA drug resistance.

Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy.

AIM: To present computed tomography (CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy. METHODS: From January 2009 to November 2011, 56 patients were collected through the histopathology and Picture Archiving and Communication Systems records, which revealed 5 basal cell adenoma (BCA), 16 pleomorphic adenoma (PA), 25 Warthin's tumor (War-T), 3 Kimura's disease (KD) and 7 parotid carcinoma (PCa) cases. All the CT images were retrospectively analyzed by two radiologists in consensus, based on their description of morphology (location, number, size, margin and fibrous capsule) and enhancement patterns of masses. In addition, the diagnostic efficiency of diagnostic strategy is tested. RESULTS: War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years; the significant difference was seen in War-T vs PA and BCA vs PA. About 40% of War-Ts presented with bilateral multifocal lesions, a higher ratio than others. Seventy two percent of War-Ts were limited to the superficial lobe, followed by BCA 60% and PA 40%. Vessel facing sign and enlarged lymph nodes were both frequent in War-T, which respectively accounts for 84% and 76% of cases. Rapid contrast enhancement and decreases were unique for War-T. BCA and PA showed obvious delayed enhancement. The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency, with high accuracy, sensitivity and specificity. CONCLUSION: Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data. A diagnostic strategy with high diagnostic efficiency was established.

[Study on mRNA and protein expressions of organic anion transporting polypeptide (oatp2b1) in rats with high fat diet and overstrain induced Pi deficiency syndrome].

OBJECTIVE: To explore roles of mRNA and protein expressions of organic anion transporting polypeptide (oatp2b1) of rats with high fat diet and overstrain induced Pi deficiency syndrome in the transporting of damp turbidity. METHODS: Totally 24 SD rats were randomly divided into three groups, i.e., the normal group, the overstrain group, and the high fat diet group, 8 in each group. After successful modeling, one piece of tissues such as spleen, kidney, liver, lung, stomach, small intestine, and large intestine was taken from each rat. Rats of the overstrain group were bonded by specially made bondage cylinder, 3 h each time on odd days, and forced to swim in cold water (10 +/- 1) degrees C for 7 min on even days alternatively for twelve weeks. Rats in the model group and the normal group were fed with standard routine granular forage for 12 weeks. Rats in the high fat diet group were fed with high fat forage for twelve weeks. All rats drank and ate freely. The mRNA and protein expressions of oatp2b1 were detected in the seven tissues using RT-PCR and Western blot. RESULTS: The mRNA expression of oatp2b1 in liver and kidney tissues of rats in the high fat diet group was higher when compared with that of the normal group and the overstrain group (P < 0.01, P < 0.05). The oatp2b1 mRNA expression in the normal group was sequenced from high to low as liver > lung > spleen > larger intestine > small intestine > kidney > stomach. The oatp2b1 mRNA expression in the overstrain group was sequenced from high to low as liver > lung > larger intestine > spleen > kidney > stomach > small intestine. The oatp2b1 mRNA expression in the high fat diet group was sequenced from high to low as liver > lung > spleen > small intestine > kidney > larger intestine > stomach. The oatp2b1 protein expression in the lung tissue was sequenced from high to low as the overstrain group > the normal group > the high fat diet group (P > 0.05). The oatp2b1 protein expression in the spleen tissue was sequenced from high to low as the high fat diet group > the normal group > the overstrain group (P > 0.05). The oatp2b1 protein expression in the kidney tissue was sequenced from high to low as the normal group > the overstrain group > the high fat diet group (P > 0.05). The oatp2b1 protein expression in the liver tissue was sequenced from high to low as the normal group > the high fat diet group > the overstrain group (P > 0.05). Of them, the oatp2b1 protein expressed extremely less in the stomach, large intestine, and small intestine. The oatp2b1 protein expression in the normal group was sequenced from high to low as lung >spleen > liver, kidney > stomach, larger intestine, and small intestine. The oatp2b1 protein expression in the overstrain group was sequenced from high to low as lung > spleen > kidney > liver > stomach, larger intestine, and small intestine. The oatp2b1 protein expression in the high fat diet group was sequenced from high to low as spleen > lung > kidney > liver > stomach, larger intestine, and small intestine. However, there was no statistical significance among the three groups by pair-wise comparison (P > 0.05). CONCLUSIONS: Kidney and liver might play important roles in the transportation and transformation of damp under the state of Pi deficiency syndrome. Oatp2b1 may be one of the material bases involved in the transportation and transformation of damp turbidity. Pi's function of governing transportation and transformation of damp might not only include the functions of the gastrointestinal tract, but also include partial liver and kidney functions.

Uterine intravenous leiomyomatosis with cardiac extension: Imaging characteristics and literature review.

Intravenous leiomyomatosis (IVL), showing unusual growth patterns of uterine leiomyoma, is a rare neoplasm characterized by intravascular proliferation of a histologically benign-looking smooth muscle cell tumor mass, but not invading the tissue. To date, less than 300 cases have been reported and fewer than 100 cases with cardiac involvement. Imaging characteristics of IVL are still not clear so it is usually misdiagnosed before surgery. A 36-year-old woman, who had undergone hysterectomy due to hysteromyoma, presented with shortness of breath after activities. Imaging showed IVL with mass involvement of the left ovarian vein, left renal vein, left external and common iliac vein, as well as within the inferior vena cava (IVC), extending into the right atrium. The operation demonstrated that the mass had no stalk and had well-demarcated borders with the wall of the right atrium and IVC. The patient underwent a one-stage combined multidisciplinary thoraco-abdominal operation under general anesthetic. Subsequently, the pathology report confirmed IVL. IVL should be considered in a female patient presenting with an extensive mass in the right side of the heart. Imaging technology, such as echocardiogram, contrast-enhanced computed tomography and magnetic resonance imaging, can provide important information to reveal the mass, the range and path of the lesion, and relates to the surgical plan decision. Consequently, perfect and exact image examination is very necessary pre-operation.

[Organic anion transporting polypeptide (oatp4a1) mRNA and protein expressions in high fat and over-fatigue impairing Pi rats].

OBJECTIVE: To study organic anion transporting polypeptide (OATP) superfamily member 4a1 (oatp4a1) mRNA expression in the Pi deficiency model rats, thus exploring its mechanism for transporting and transforming the dampness. METHODS: Six SD rats of SPF grade were used to prepare over-fatigue impairing Pi model. Another 12 SD rats were randomly divided into the blank control group and the high fat diets group, 6 in each. The special binding tube was used for the over-fatigue impairing Pi model group on the odd day, 3 h each time. Then the rats were forced to swim in the cold water (10 degrees C +/- 1 degrees C) for 7 min on the even day, for 2 successive weeks. Rats in the model group and the blank control group were granulated feed for 12 weeks, while rats in the high fat group were fed with high fat diet for 12 weeks. All rats were free to take food and drink water. The mRNA and protein expressions of oatp4al were detected in the Fei, Pi, Gan, Shen, Wei, Xiaochang, and Dachang using Real-time fluorescent quantitative polymerase chain reaction (FQ-PCR) and Western blot. RESULTS: Rats in the model group were idled together with lousy defecate and coarse skin. They ate and drank less, and lost body weight (P<0.05). They were consistent with clinical manifestations of Pi deficiency syndrome, indicating that the over-fatigue impairing Pi animal model was successfully established. Rats in the high fat group started to have poor appetite and languish spirit, move lazily and addict to sleep, have coarse, dark, and colorless hair 9 weeks later, indicating phlegm dampness syndrome. Compared with the blank control group, the average body weight increased in the high fat group at the 9th week (P<0.05). The oatp4a1 mRNA expressed in the Fei, Pi, Gan, Shen, Wei, Xiaochang, and Dachang. There was no statistical difference in the oatp4al mRNA expression among all tissues (P>0.05). The oatp4al mRNA expressions were higher in the Fei and Shen of the high fat group than in the Gan (P<0.05). CONCLUSIONS: oatp4al might be one of the basic substances in the transportation and transformation of phlegm dampness. Of them, Fei, Shen, and Dachang might play important roles in the transportation and transformation of phlegm dampness.

Human umbilical mesenchymal stem cell and its adipogenic differentiation: Profiling by nuclear magnetic resonance spectroscopy.

AIM: To study the metabolic profile of human umbilical mesenchymal stem cells (HUMSC) and adipogenic differentiation by nuclear magnetic resonance (NMR) spectroscopy. METHODS: HUMSC isolated from human umbilical cord stroma were induced to adipocytes over 2 wk by adding dexamethasone, 3-isobutyl-1-methylxanthine, indomethacin, and insulin to the culture medium. Adipogenic differentiation was confirmed by Red O staining and transcription-polymerase chain reaction. Perchloric acid extracts of the HUMSCs and adipocytes (about 7 × 10(6)) were characterized for metabolites by using in vitro high resolution 9.4T NMR spectroscopy. RESULTS: Several major metabolites, such as: choline, creatine, glutamate and myo-inositol, acetate, and some fatty acids/triglycerides, were observed in the MR spectroscopic pattern of HUMSCs and their adipogenic differentiation. HUMSCs are characterized by an unusually low number of NMR-detectable metabolites, high choline, acetate, glutamate and creatine content. However, the metabolic profiles of adipogenic differentiation demonstrated considerably higher methionine and fatty acids, and non-detectable creatine. CONCLUSION: The biomarkers of HUMSCS and adipocytes were obtained and assigned. NMR spectroscopy will be a promising tool for monitoring stem cell differentiation.

Clinical observation on the acupuncture treatment in patients with urinary retention after radical hysterectomy.

OBJECTIVE: To observe the acupuncture therapy effect on the urinary retention after radical: hysterectomy. METHODS METHODS: Eighty cases of urinary retention after radical hysterectomy were randomly assigned to: the treatment group and control group according to the random number table method, 40 cases in each group. From the 15th day post operation, the patients in the two groups started to be treated and 7 days as a course with 5 days treatment and 2 days interval. The treatment group applied acupuncture with modalities of common needling on Zusanli (ST36) bilaterally, electroacupuncture on Sanyinjiao (SP6), Shuidao (ST28), and Scalp Reproduction Area bilaterally, moxibustion on Shenque (CV8). The control group applied acupoint injection with vitamin B B12 12, and Sanyinjiao and Zusanli were selected. Take turns on both sides. The courses for the recovery, of bladder function and residual urine volume for those who had voluntary micturition more than 200 mL after the first and second course of treatment were compared between the two groups. RESULTS: Within 1 course and 2: courses of treatment, the patients with bladder function recovery in the treatment group were 21 (21/40) and 36 (36/40), and those in the control group were 12 (12/40) and 29 (29/40), both with a significant difference (P<0.05). After the first course and second course, residual urine volume for those who had voluntary micturition more than 200 mL in the treatment group was 91.7 ± 17.5 mL and 93.5 ± 15.5 mL, in the control group 102.4 ± 13.7 mL and 102.5 ± 15.7 mL, both with a significant difference (P<0.05). CONCLUSIONS: Combination of acupuncture: modalities was better than acupoint injection for the recovery of bladder function in urinary retention after radical hysterectomy. It would shorten the course of treatment and get a better recovery, decrease urinary retention cases of refractoriness, and extending the treatment could raise the healing rate of urinary retention.

[Effects of electroacupuncture on urinary bladder function after radical hysterectomy].

OBJECTIVE: To observe the effect of electroacupuncture on recovery of urinary bladder function after radical hysterectomy. METHODS: One hundred and ten cases were randomly divided into an electroacupuncture (EA) group and a control group, 55 cases in each group. In the control group, the urinary tube was placed and kept with routine method and the urinary bladder was rinsed, and from the eighth day the abdomen was radiated with TDP, 30 min each day, for 5 days. In the EA group, on the basis of treatment in the control group EA was given at Sanyinjiao (SP 6), Zusanli (ST 36), Waiguan (TE 5), Shuidao (ST 28), Guilai (ST 29), etc. from the eighth day to twelfth day after operation. The recovery time of urinary bladder function after radical hysterectomy, urine dynamic indexes and hospitalization days were compared between the two groups. RESULTS: The cases of the bladder function recovery, retention of urine, urinary incontinence were 51(51/55), 4(4/55), 0 on the 14 th day after operation and 53(53/55), 2(2/55), 0 on the 28 th day in the EA group, and 27(27/55), 25(25/55), 3(3/55) on the 14 th day and 43(43/55), 11(11/55), 1(1/55) on the 28th day in the control group, respectively, with a very significant difference between the two groups (P < 0.01); the EA group in residual urine volume, bladder volume, mean urinary flowing rate was better than the control group on the 14 th day after operation (P < 0.01 or P < 0.05); the hospitalization days after operation was (21.1 +/- 3.3) days in the EA group and (25.5 +/- 3.5) days in the control group, the former being shorter than the later (P < 0.01). CONCLUSION: EA can promote recovery of bladder function, shorten the keeping time of urinary tube after radical hysterectomy, which is benefit to decreasing incidence rate of urinary system infection and shortening hospitalization days.

[The effect of gengnianningshentang on treating 72 patients with female climacteric syndrome of fever due to yin-deficiency].

OBJECTIVE: To observe the clinical effect of gengnianningshentang on the treatment of the climacteric syndrome of fever due to yin-deficiency. METHODS: 108 patients with climacteric syndrome of fever due to yin-deficiency were divided randomly into treatment group (76 cases)and control group (32 cases). Treatment group was treated by gengnianningshentang, and control group was treated by Vitamin E for 3 months. Level of serum E2, LH and FSH were determined, while the variation of symptom scores of climacteric syndrome was observed. RESULTS: Level of serum E2 in treatment group increased significantly and serum LH and FSH decreased significantly after treatment (p < 0.01). The post treatment total scores of climacteric syndrome in the treament group were significantly improved (p < 0.01). CONCLUSION: Gengnianningshentang can significantly improve the levels of E2, FSH and LH, and climacteric syndrome in patients of fever due to yin-deficiency. The total effect of gengnianningshentang is much better than western medicine.

Inflammatory myofibroblastic tumours of the spleen and liver.

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm. Generally, these lesions have a benign behaviour, but the possibility of malignant transformation exists. We report the rare case of a 43-year-old woman with metachronous IMTs in the spleen and the liver. The patient was treated with laparoscopic splenectomy and partial hepatectomy. The patient recovered uneventfully. This case emphasizes the difficulties in diagnosis and the possibility of a metachronous occurrence.