Comparison of vonoprazan bismuth-containing triple therapy with quadruple therapy in Helicobacter pylori-infected treatment-naive patients: a prospective multicenter randomized controlled trial.

BACKGROUND AND AIM: Helicobacter pylori infection is linked to various gastrointestinal conditions, such as chronic active gastritis, peptic ulcers, and gastric cancer. Traditional treatment options encounter difficulties due to antibiotic resistance and adverse effects. Therefore, the aim of this study was to explore the effectiveness of a new treatment plan that combines vonoprazan (VPZ), amoxicillin, and bismuth for the eradication of H. pylori. METHODS: A total of 600 patients infected with H. pylori were recruited for this multicenter randomized controlled trial. Patients treated for H. pylori elimination were randomly assigned at a 1:1 ratio to receive 14 days of vonoprazan-based triple therapy (vonoprazan + amoxicillin + bismuth, group A) or standard quadruple therapy (esomeprazole + clarithromycin + amoxicillin + bismuth, group B). Compliance and adverse effects were tracked through daily medication and side effect records. All patients underwent a 13C/14C-urea breath test 4 weeks after treatment completion. RESULTS: Intention-to-treat (ITT) and per-protocol (PP) analyses revealed no substantial differences in H. pylori eradication rates between groups A and B (ITT: 83.7% vs 83.2%; PP: 90.9% vs 89.7%). However, significant differences were observed in the assessment of side effects (13.7% vs 28.6%, P < 0.001). Specifically, group A had significantly fewer "bitter mouths" than group B did (3.7% vs 16.2%, P < 0.001). CONCLUSION: Triple therapy comprising vonoprazan (20 mg), amoxicillin (750 mg), and bismuth potassium citrate (220 mg) achieved a PP eradication rate ≥90%, paralleling standard quadruple therapy, and had fewer adverse events and lower costs (¥306.8 vs ¥645.8) for treatment-naive patients.

The differential diagnosis of lung precursor glandular lesions, micro-invasive adenocarcinoma, and invasive adenocarcinoma using low dose spectral computed tomography perfusion imaging.

Background: Few studies about the association between computed tomography (CT) perfusion imaging parameters and invasiveness in lung adenocarcinoma (LUAD) have been conducted using low dose spectral CT perfusion imaging. The purpose of this study was to investigate application of spectral revolution CT low-dose perfusion imaging in the differential diagnosis of different pathological subtypes of LUAD. Methods: This was a cross-sectional study based on historical data from January 2018 to May 2019 in Peking University Cancer Hospital & Institute. A total of 62 cases were enrolled, including 2 cases of atypical adenomatous hyperplasia (AAH), 3 cases of adenocarcinoma in situ (AIS), 4 cases of minimally invasive adenocarcinoma (MIA), and 53 cases of invasive adenocarcinoma (IAC), all confirmed with pathology. The inclusion and exclusion criteria were regulated. Using Revolution low-dose CT perfusion imaging (GE, USA), the CT perfusion parameters of hemodynamics were obtained: blood flow (BF), blood volume (BV), impulse residue function time of arrival (IRF TO), maximum slope of increase (MSI), mean transit time (MTT), permeability surface area product (PS), positive enhancement integral (PEI), and maximum enhancement time (Tmax). Univariate analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the differences of CT perfusion quantitative parameters among AAH, AIS, MIA, and IAC. Mann-Whitney test was used to compare the difference of CT perfusion imaging parameters between preinvasive lesions (AAH and AIS) and invasive lung cancer (MIA and IAC). Results: Statistically significant differences in IRF TO were observed in LUAD with different invasiveness, namely, among AIS, MIA, and IAC groups (0.56±0.74 vs. 0.54±1.08 vs. 4.39±2.19, P=0.004). Statistically significant differences in IRF TO were also observed between pre-invasive lesions group (AAH and AIS) and invasive lung cancer group (MIA and IAC) (1.12±1.27 vs. 3.75±2.79, P=0.031), and between AAH + AIS + MIA groups and IAC group (0.83±1.13 vs. 4.12±2.69, P<0.001). There were no statistically significant differences in other CT perfusion parameters of hemodynamics among different pathological subtypes of LUAD (P>0.05). Conclusions: The low-dose perfusion parameter IRF TO of revolution CT has the potential to be employed in the differential diagnosis of different pathological subtypes of LUAD.

Optimal selection of b-values for differential diagnosis of mediastinal lymph nodes using diffusion-weighted imaging.

This study proposed to investigate the optimal selection of b-values in diffusion-weighted imaging for distinguishing malignant from benign mediastinal lymph nodes. Diffusion-weighted imaging with six b-values was performed on 35 patients at 1.5 T. Image quality score, signal-to-noise ratio, and relative contrast ratio of lymph node to chest muscle were compared between the diffusion-weighted images with a b-value up to 800 and 1000 s/mm2. Using a lower and an upper b-value in the range of 0-1000 s/mm2, eight apparent diffusion coefficient maps were obtained from a mono-exponential model. Receiver operating characteristic analysis was employed to evaluate the performance of the apparent diffusion coefficients for distinguishing malignant from benign mediastinal lymph nodes by using the area under the curve as a criterion. The mean image quality score and the relative contrast ratio showed no difference between b-values of 800 and 1000 s/mm2. In the receiver operating characteristic analysis, the areas under the curve of apparent diffusion coefficient with b-value pairs of (0, 800), (0, 1000), and (50, 800) s/mm2 were significantly higher than those from the other b-value pairs. No significant difference was observed among the three b-value pairs. Apparent diffusion coefficient obtained from b-value pairs of (0, 800), (0, 1000), and (50, 800) s/mm2 showed superior diagnostic performance compared to the other b-value combinations. Based on several practical considerations, the b-value pair of (50, 800) s/mm2 is recommended for differential diagnosis of mediastinal lymph nodes.

Preoperative Patient and Lesion Features Are Valuable for Predicting the Prognosis of Resectable Peripheral Non-Small Cell Lung Cancer.

OBJECTIVE: The aim of the study was to investigate the preoperative factors affecting the survival of patients with resectable peripheral non-small cell lung cancer (NSCLC) to improve the management of NSCLC. METHODS: One hundred ninety-nine patients with peripheral NSCLC diagnosed clinically without lymph node metastasis were enrolled. The preoperative computed tomography characteristics of the tumors were retrospectively analyzed and the preoperative clinical data were collected. The size of the solid components for lung adenocarcinomas containing ground-glass opacity (GGO) component were measured. Kaplan-Meier method with log-rank test was used to compare overall survival (OS) between groups. Univariate and multivariate cox regression analyses were used to identify prognostic factors. RESULTS: Survival analysis showed that the OS of the group with a tumor of 3 cm or less was longer than that of the group with a tumor greater than 3 cm, the OS of the group with GGO component was superior to that of the group without GGO component, and the OS of the group with elevated carcinoembryonic antigen (CEA) levels was inferior to that of the group with normal CEA levels. Multivariate Cox regression analysis showed that tumor size, density, and preoperative CEA level were independent factors affecting OS, with hazard ratios of 2.401, 0.457, and 1.948, respectively. The analysis of lung adenocarcinomas with GGO component demonstrated that the mean size of the solid component in the nonsurviving group was significantly larger than that in the surviving group (mean, 23 ± 6.4 vs 8.6 ± 7.0 mm). The area under the receiver operating characteristic curve of the solid component size of lung cancer containing GGO component to predict postoperative death was 0.932. CONCLUSIONS: Tumor size, density, and preoperative CEA level were independent prognostic factors of patients with resectable peripheral NSCLCs. Preoperative computed tomography findings can be valuable for predicting the prognosis of patients with NSCLC after surgery.

Low-dose spectral CT perfusion imaging of lung cancer quantitative analysis in different pathological subtypes.

BACKGROUND: To explore the value of the quantitative parameters of low-dose computed tomography (CT) perfusion in the diagnosis of lung cancers of different pathological types. METHODS: Eighty-five patients with lung cancer confirmed by pathology underwent enhanced spectral CT imaging with a General Electric (GE) Revolution Xtream CT scanner, including 7 patients with lung squamous cell carcinoma, 8 patients with small cell carcinoma, 67 patients with lung adenocarcinoma, and 3 patients with other pathologies. The low-dose CT perfusion parameters [blood flow (BF), blood volume (BV), time of arrival (IRF TO), maximum slope of increase (MSI), mean transit time (MTT), positive enhancement integral (PEI), time to peak (TTP) and time to maximum (Tmax)] were calculated and compared among the first three groups. One-way analysis of variance (ANOVA) or the Kruskal-Wallis test was used to compare the quantitative parameters among the three groups, and the Bonferroni method was used to correct for multiple comparisons. RESULTS: Among the quantitative parameters, MSI was significantly different among the three lung cancers (adenocarcinoma vs. squamous cell carcinoma vs. small cell carcinoma: 11.37±8.74 vs. 2.35±0.88 vs. 1.40±0.26, respectively; P=0.016). The MSI of lung adenocarcinoma was lower than that of non-adenocarcinoma (P=0.001), and the MSI of small cell carcinoma was lower than that of non-small cell carcinoma (P=0.014). There were no significant differences in the other parameters among these three groups (P>0.05). CONCLUSIONS: Low-dose CT perfusion parameters may have a certain value in classifying the pathological type of lung cancer.

Is there any correlation between spectral CT imaging parameters and PD-L1 expression of lung adenocarcinoma?

BACKGROUND: The aim of this study was to explore whether spectral computed tomography (CT) imaging parameters are associated with PD-L1 expression of lung adenocarcinoma. METHODS: Spectral CT imaging parameters (iodine concentrations [IC] of lesion in arterial phase [ICLa] and venous phase [ICLv], normalized IC [NICa/NICv]-normalized to the IC in the aorta, slope of the spectral HU curve [λHUa/λHUv] and enhanced monochromatic CT number [CT40keVa/v, CT70keVa/v] on 40 and 70 keV images) were analyzed in 34 prospectively enrolled lung adenocarcinoma patients with common molecular pathological markers including PD-L1 expression detected with immunohistochemistry. Patients were divided into two groups: positive PD-L1 expression and negative PD-L1 expression groups. Two-sample Mann-Whitney U test was used to test the difference of spectral CT imaging parameters between the two groups. RESULTS: The CT40keVa (127.03 ± 37.92 vs. -54.69 ± 262.04), CT40keVv (124.39 ± 34.71 vs. -45.73 ± 238.97), CT70keVa (49.56 ± 11.76 vs. -136.51 ± 237.08) and CT70keVv (46.13 ± 15.81 vs. -133.10 ± 230.72) parameters in the positive PD-L1 expression group of lung adenocarcinoma were significantly higher than the negative PD-L1 expression group (all P < 0.05). There was no difference detected in IC, NIC and λHU of the arterial and venous phases between both groups (all P > 0.05). CONCLUSION: CT40keVa, CT40keVv, CT70keVa and CT70keVv were increased in positive PD-L1 expression. These parameters may be used to distinguish the PD-L1 expression state of lung adenocarcinoma.

Can spectral computed tomography imaging improve the differentiation between malignant and benign pulmonary lesions manifesting as solitary pure ground glass, mixed ground glass, and solid nodules?

BACKGROUND: This study quantitatively assessed the efficacy of spectral computed tomography (CT) imaging parameters for differentiating the malignancy and benignity of solitary pulmonary nodules (SPNs) manifesting as ground glass nodules (GGNs) and solid nodules (SNs). METHODS: The study included 114 patients with SPNs (61 GGNs, and 53 SNs) who underwent CT plain and enhanced scans in the arterial (a) and venous (v) phases using the spectral imaging mode. The spectral CT imaging parameters included: iodine concentrations (IC) of lesions in the arterial (ICLa) and venous (ICLv) phases; normalized IC (NICa/NICv, normalized to the IC in the aorta); the slope of the spectral Hounsfield unit (HU) curve (λHUa/λHUv); and monochromatic CT number (CT40keVa/v, CT70keVa/v) enhancement on 40 and 70 keV images. The two-sample Mann-Whitney U test was used to compare quantitative parameters between malignant and benign SPNs, SNs, and GGNs. RESULTS: Pathology revealed 75 lung cancer cases, 3 metastatic nodules, 14 benign nodules, and 22 inflammatory nodules. Among the 53 SNs there were 37 malignant and 16 benign nodules. Among the 61 GGNs there were 41 malignant and 20 benign nodules. Overall, the CT40keVa, λHUa, CT40keVv, λHUv, and ICLv of benign SPNs were all greater than those of malignant SPNs (all P < 0.05). For GGNs, CT40keVa/v, CT70keVa/v, λHUa/λHUv, and ICLv of malignant GGNs were all lower than those of benign GGNs. CONCLUSION: Spectral CT imaging is a more promising method for distinguishing malignant from benign nodules, especially in nodules manifesting as GGNs in contrast-enhanced scanning.

Conventional MRI to detect the differences between mass-like tuberculosis and lung cancer.

BACKGROUND: The aim of this study was to investigate differences in the imaging features of mass-like tuberculosis and lung cancer on conventional MR sequences to improve the diagnostic ability for pulmonary masses. METHODS: Thirty patients with suspicious pulmonary lesions were enrolled and diagnosed with tuberculosis by pathology or comprehensive clinical diagnoses. Twenty-six cases of lung cancer were retrospectively analyzed. Transverse fat-suppressed T2-weighted (T2W) imaging and T1-weighted (T1W) imaging were obtained at 1.5 Tesla. The imaging characteristics of lesions on the T2W and T1W images were compared between the two groups. The imaging features of enlarged mediastinal lymph nodes on T2W images were studied and compared. RESULTS: On T2W images, there was a higher percentage of lesions containing hypointensity in the tuberculosis group (GTB) than in the lung cancer group (GLC) (P=0.004).The incidence of lesions demonstrating heterogeneous intensity was significantly greater in the GTB than in the GLC (70.0% vs. 7.7%, P=0.001). Approximately 92.3% of the lung cancer cases showed hyperintensity, a proportion substantially greater than that in the GTB (6.7%). On T1W images, more cases showed hyperintensity in the GTB than in the GLC (43.3% vs. 7.7%, P=0.003). The signal intensity ratios (SIRs) of the lesion to rhomboid muscle on T2W and T1W images were significantly different between the two groups. The mean intrasubject standard deviation (SD) of lesions in the GTB was markedly greater than that in the GLC on both T2W and T1W images. Benign mediastinal lymph nodes in the GTB showed a variety of signals on T2W images, whereas 80% of metastatic mediastinal lymph nodes displayed slight homogeneous hyperintensity, and this difference between the two groups was statistically significant. CONCLUSIONS: Conventional MR sequences can reveal the essential differences between mass-like tuberculosis and lung cancer and may be helpful for discriminating pulmonary masses.

Effect of low molecular weight heparin on venous thromboembolism disease in thoracotomy patients with cancer.

BACKGROUND: Much attention has been given to venous thromboembolism (VTE) disease, and many guidelines for prophylaxis have been published. However, there are few published data on patients who underwent thoracotomy. This study is to compare the effect of low molecular weight heparin (LMWH) combined mechanical approaches with mechanical approaches alone in prevention of VTE in the post thoracotomy cancer patients. METHODS: This study used a prospective, randomized-controlled design. Patients with cancer who were scheduled for thoracotomy were divided into two groups: group A and group B. In group A, patients were given intermittent pneumatic compression (IPC) and elastic stockings (ES) postoperatively. Additionally, at 24 hours post-operation, patients were subcutaneously injected with LMWH calcium (nadroparin calcium; GlaxoSmithKline, China) for 7 days. In group B, patients were only given postoperative IPC and ES. The primary end points were incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), and the PE severity index (PESI) of PE patients. The secondary end points were hemoglobin (HGB), platelet (PLT), D-dimer, the PO2/FiO2 ratio (P/F) at postoperative day (POD) 7, the chest drainage time (CDT) and the length of stay (LOS) in hospital after operation. RESULTS: A total of 90 patients were included in the final data analysis (40 patients in group A and 50 patients in group B). At POD7, the incidence of PE, DVT and PESI was 17.50%, 5.00% and 102.14±9.87, respectively, in group A. And 8.00%, 8.00% and 97.00±4.24, respectively, in group B. There were no significant differences between two groups (all P values were >0.05). There were no significant differences of HGB, PLT, D-dimer and P/F between two groups at the 7th day post operation (all P value >0.05). CONCLUSIONS: LMWH combined mechanical prophylaxis did not significant reduced the rate of VTE in thoracotomy cancer patients.

Discrimination of Malignant versus Benign Mediastinal Lymph Nodes Using Diffusion MRI with an IVIM Model.

OBJECTIVES: To investigate the value of an intravoxel incoherent motion (IVIM) diffusion model for discriminating malignant versus benign mediastinal lymph nodes (MLN). METHODS: Thirty-five subjects with enlarged MLN were scanned at 1.5 Tesla. Diffusion-weighted imaging was performed with eight b-values. IVIM parameters D, D*, and f, as well as apparent diffusion coefficient (ADC) from a mono-exponential model were obtained. 91 nodes (49 malignant and 42 benign) were analysed with pathologic (n=90) or radiologic (n=1) confirmations. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance. RESULTS: The mean values of D, ADC, and f for the malignant group were significantly lower than those for the benign group (p<0.001), while D* showed no significant difference (p=0.281). In the ROC analysis, the combination of D and f produced the largest area under the curve (0.953) compared to ADC or other individual IVIM parameters, leading to the best specificity (92.9%) and diagnostic accuracy (90.1%). CONCLUSION: This study demonstrates that the combination of IVIM parameters can improve differentiation between malignant and benign MLN as compared to using ADC alone. KEY POINTS: • Diffusion MRI is useful for non-invasively discriminating malignant versus benign lymph nodes. • A mono-exponential model is not adequate to characterise diffusion process in lymph nodes. • IVIM model is advantageous over mono-exponential model for assessing lymph node malignancy. • Combination of IVIM parameters improves differentiation of malignant versus benign lymph nodes.

Multivariate Analysis of Pleural Invasion of Peripheral Non-Small Cell Lung Cancer-Based Computed Tomography Features.

OBJECTIVE: The aim of this study was to comprehensively analyze computed tomography features to improve the diagnostic accuracy of visceral pleural invasion of peripheral non-small cell lung cancer. METHODS: The computed tomography features of 205 non-small cell lung cancer patients were retrospectively studied. The lesion's relation to the pleura was classified into 5 grades. A multivariate logistic regression analysis was conducted to identify independent factors predicting pleural invasion. RESULTS: The multivariate logistic regression analysis showed that sex (odds ratio [OR], 1.822; P = 0.080), pleural indentation (OR, 4.111; P < 0.001), tumor density (OR, 2.735; P = 0.008), and distance between the lesion and pleura (OR, 1.981; P = 0.048) were independent predictors of pleural invasion. A patient with a score of 10.6 had an 80% risk of pleural invasion, whereas a score lower than 2 was associated with a lower (20%) risk of pleural invasion. CONCLUSIONS: Comprehensive consideration of these factors of pleural indentation, sex, tumor density, and distance between the lesion and pleura might improve the diagnosis of pleural invasion.

Spectral CT in the Demonstration of the Pancreatic Arteries and Their Branches: A Comparison With Conventional CT.

The aim of this study was to investigate the performance of monochromatic images of spectral computed tomographic (CT) in the visualization of the pancreatic arteries compared with polychromatic CT images. We conducted a case-control study in a group of 26 consecutive patients with monochromatic CT and contrasted the results against a control group of 26 consecutive patients with polychromatic CT. The CNR (contrast-to-noise ratio), SIR (signal intensity ratio), SNR (signal to noise ratio), and image noise were measured. A 5-score classification system was used to evaluate the branch order of pancreatic arteries. The course of pancreatic arteries was compared. Compared with polychromatic images, the CNR, SIR, and SNR obtained by monochromatic images were increased by 64.74%, 23.99%, and 39.50%. Branch visualization of PSPDA (posterior superior pancreaticoduodenal artery), ASPDA (anterior superior pancreaticoduodenal artery), and DPA (dorsal pancreatic artery) was better at monochromatic images than at polychromatic images. The display rate was significantly better in monochromatic images for the second and third segments of PSPDA, total course of ASPDA, and artery of uncinate process. Compared with polychromatic images, monochromatic images can improve the visualization of pancreatic arteries.

Association between the ABCA1-565C/T gene promoter polymorphism and coronary heart disease severity and cholesterol efflux in the Chinese Han population.

BACKGROUND: ABCA1 -565C/T gene promoter variants have been associated with the severity of coronary artery disease in Western populations. The purpose of our study was to investigate the association between the -565C/T gene polymorphism and coronary artery disease severity and cholesterol efflux in the Chinese Han population. METHODS: A cohort of 298 acute coronary syndrome (ACS) patients and 541 healthy controls was genotyped using the highly sensitive ligase detection reaction. ABCA1 -565C/T genotype was correlated with the clinical features of 164 acute myocardial infarction (AMI) patients. Monocytes from patients with various -565C/T gene polymorphisms were isolated and differentiated into foam cells by coincubation with [(3)H]-labeled acetyl-low-density lipoprotein cholesterol. ABCA1 mRNA and protein expression levels were evaluated, as well as cellular cholesterol efflux. RESULTS: The frequency of the TT genotype in the -565C/T polymorphism of ACS patients was significantly increased when compared with controls (0.211 vs. 0.162, p<0.05). The TT genotype, but not the CT or CC genotypes, in the -565C/T gene polymorphism correlated with the severity of the coronary lesion observed in AMI patients. Patients with the TT homozygote genotype also exhibited significantly lower cellular cholesterol efflux (TT [6.37%±0.554%]) levels than controls and also had the lowest levels of ABCA1 mRNA and protein expression among the group of variants. In contrast, cholesterol efflux levels in AMI patients with CT [11.35%±3.975%] and CC ([15.32%±6.293%]) genotypes were not significantly different from controls. CONCLUSIONS: Impaired ABCA1-mediated cholesterol efflux in macrophages may be associated with the severity of the coronary lesions in AMI patients with the TT genotype at the -565C/T gene polymorphism.

Diffusion-weighted images (DWI) without ADC values in assessment of small focal nodules in cirrhotic liver.

OBJECTIVE: To assess if diffusion-weighted magnetic resonance (MR) imaging without apparent diffusion coefficient (ADC) values provides added diagnostic value in combination with conventional MR imaging in the detection and characterization of small nodules in cirrhotic liver. METHODS: Two observers retrospectively and independently analyzed 86 nodules (≤3 cm) certified pathologically in 33 patients with liver cirrhosis, including 48 hepatocellular carcinoma (HCC) nodules, 13 high-grade dysplastic nodules (HDN), 10 low-grade dysplastic nodules (LDNs) and 15 other benign nodules. All these focal nodules were evaluated with conventional MR images (T1-weighted, T2-weighted and dynamic gadolinium-enhanced images) and breath-hold diffusion-weighted images (DWI) (b=500 s/mm(2)). The nodules were classified by using a scale of 1-3 (1, not seen; 3, well seen) on DWI for qualitative assessment. These small nodules were characterized by two radiologists. ADC values weren't measured. The diagnostic performance of the combined DWI-conventional images and the conventional images alone was evaluated using receiver operating characteristic (ROC) curves. The area under the curves (Az), sensitivity and specificity values for characterizing different small nodules were also calculated. RESULTS: Among 48 HCC nodules, 33 (68.8%) were graded as 3 (well seen), 6 (12.5%) were graded as 2 (partially obscured), and 9 weren't seen on DWI. Among 13 HDNs, there were 3 (23.1%) and 4 (30.8%) graded as 3 and 2 respectively. Five (50%) of 10 benign nodules were partially obscured and slightly hyperintense. For 86 nodules, the average diagnostic accuracy of combined DWI-conventional images was 82.56%, which was increased significantly compared with conventional MR images with 76.17%. For HCC and HDN, the diagnostic accuracy of combined DWI-conventional images increased from 78.69% to 86.07%. CONCLUSIONS: Diffusion-weighted MR imaging does provide added diagnostic value in the detection and characterization of HDN and HCC, and it may not be helpful for LDN and regenerative nodule (RN) in cirrhotic liver.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function.

OBJECTIVE: Both decreased glomerular filtration rate (GFR) and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. METHODS: In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR ≥ 60 mL/min per 1.73 m(2) estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity (PWVcf) and carotid-radial PWV (PWVcr) using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes (AIx-75) was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. RESULTS: The mean estimated GFR (eGFR) of the study group was 100.05 ± 23.26 mL/minute per 1.73 m(2). Subjects were grouped by tertiles of eGFR level. PWVcf and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AIx-75. CONCLUSIONS: In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.

[Mesenchymal stem cells release membrane microparticles in the process of apoptosis].

Though mesenchymal stem cells (MSC) have been clinically used to repair a variety of damaged tissues, the underlying mechanisms remain elusively as the majority of the ex vivo expanded MSC die shortly after transplantation. To explore the mechanism in which the death cells play tissue repair effect, apoptosis of rat bone marrow MSC was induced by culturing cells in the conditions of hypoxia or/and serum-free medium, and the subcellular structures in the supernatants were analyzed. The results showed that apoptosis occurred in the presence of either hypoxia or serum-free condition as well, and the apoptotic proportion reached up to (17.44 ± 2.15) after the cells were treated by hypoxia plus serum free culture for 72 hours. The flow cytometric analysis of the sub-cellular substances harvested by ultracentrifugation of the supernatants found that the MSC released substantial amount of membrane microparticles into the supernatants, which expressed CD29, CD44A and Annexin-V-binding phosphatidylserine. It is concluded that the MSC can release membrane microparticles after induction, the amount of these membrane microparticles was around 15-fold of the parent cell numbers. The membrane microparticles is the mediators in the cross-talk between the transplanted cells and their surrounding tissues. This study provides some novel information for the mechanisms of MSC therapy.

A polymorphism in the ABCG1 promoter is functionally associated with coronary artery disease in a Chinese Han population.

OBJECTIVE: In this study, we examine the association of single nucleotide polymorphisms (SNPs) of the human ATP binding cassette transporter G1 (ABCG1) gene with atherosclerotic coronary artery disease (CAD) in a Chinese Han population. METHODS: 1021 patients with CAD and 1013 unaffected control subjects were enrolled. PCR-based ligation detection reaction (PCR-LDR) method was used to genotype four SNPs of ABCG1, three (rs2234714, rs2234715 and rs57137919) in the promoter region and one (rs1044317) in the 3'-untranslated region (UTR). RESULTS: The human ABCG1 -367G>A polymorphism (rs57137919) showed a significantly decreased risk for CAD and myocardial infarction (MI) in a dominant model (adjusted OR = 0.73, p = 0.033 for CAD, and adjusted OR = 0.65, p = 0.014 for MI, respectively). The rs57137919 also showed an association with angiographic severity of CAD (multi-vessel vs. single-vessel CAD, adjusted OR = 0.40, p = 0.005). The findings were further supported by luciferase reporter assay, in which the polymorphism impaired reporter gene expression. The ABCG1 -768G>A polymorphism (rs2234714) showed an association with CAD in a recessive model (adjusted OR = 0.64, p = 0.015), but did not demonstrate a functional influence on reporter gene expression in the luciferase reporter assay. CONCLUSIONS: The SNP rs57137919 in the ABCG1 promoter region is functionally associated with a reduced risk of CAD in a Chinese Han population.

Early evaluation of cancer response by a new functional biomarker: apparent diffusion coefficient.

OBJECTIVE: The purpose of this article is to investigate whether apparent diffusion coefficient (ADC) might be used as a universal biomarker for response evaluation in different tumors. SUBJECTS AND METHODS: Twenty-one patients with lung cancer, 12 patients with esophageal cancer, 19 patients with liver metastases, 24 patients with gastric cancer, and 26 patients with rectal cancer were recruited to the study. Percentage changes in the ADC and changes in the size of responding and nonresponding lesions of different tumors after treatment were analyzed using repeated measures analysis of variance. RESULTS: There was no significant difference among the percentage ADC changes of different tumors (F = 1.57; p = 0.192). Clear differences were seen in the percentage ADC changes between responding and nonresponding tumors (F = 21.62; p < 0.001), which were significant at every time point after the start of treatment (early time point, F = 19.75 and p < 0.001; middle time point, F = 11.23 and p = 0.001; and later time point, F = 15.98 and p < 0.001). The percentage size changes after treatment between responding and nonresponding tumors were significantly different (F = 19.38; p < 0.001). However, at the early time point after treatment, the difference was not statistically significant (F = 0.02; p = 0.894). CONCLUSION: The ADC changes correlated with treatment response in five types of body tumor but were independent of the tumor's location. Early increases in ADC during treatment indicate good response to treatment. ADC change is a promising biomarker for detecting therapeutic responses at an early stage that could be widely used.

Gastrointestinal stromal tumors treated with imatinib mesylate: apparent diffusion coefficient in the evaluation of therapy response in patients.

PURPOSE: To prospectively investigate the use of the apparent diffusion coefficient (ADC) as an early response indicator in patients with gastrointestinal stromal tumors (GISTs) treated with imatinib mesylate. MATERIALS AND METHODS: This study was approved by the institutional review board and written informed consent was obtained from all patients. Diffusion-weighted magnetic resonance (MR) imaging was performed in 32 patients with GISTs before and 1, 4, and 12 weeks after treatment with a tyrosine kinase inhibitor, imatinib mesylate. The measurable lesions were classified as having responded well or poorly according to size alterations at clinical evaluation following the first round of treatment (3 months). A linear mixed-effects model was applied to analyze changes in the ADCs of tumors during treatment and to compare the variation and slopes of the time-dependent ADC curves between the good- and poor-response groups. RESULTS: There were 56 lesions in the good-response group and 35 in the poor-response group. An early (1 week after therapy) noticeable and statistically significant (P < .001) increase in the ADC was observed in the good-response group (median ADC increase, 44.8%) but not in the poor-response group (median ADC increase, 1.5%). The time-dependent ADC variation was significantly different between the good- and poor-response groups, with a sharper median ADC increase displayed in the former (week 1: 44.8% vs 1.5%; week 4: 80.4% vs 7.8%; week 12: 89.6% vs 16.7%; F = 25.78, P < .001). The largest difference in the weekly percentage increase in ADC between the good- and poor-response groups was observed at 1 week after therapy (week 0-1: 44.8% vs 1.5%; week 1-4: 7.0% vs 2.8%; week 4-12: 1.6% vs 0.7%). The pretherapy mean ADC (± standard deviation) of lesions in the good-response group (1.06 [×10(-3) mm(2)/sec] ± 0.27) was significantly lower than that in the poor-response group (1.24 [×10(-3) mm(2)/sec] ± 0.32) (F = 8.34, P = .005). CONCLUSION: Comparatively low pretherapy ADC and marked ADC increase at 1 week after therapy is associated with good response to imatinib mesylate in patients with GISTs.

[Association of CT image changes and prognosis in gastrointestinal stromal tumor after targeted therapy].

OBJECTIVE: To investigate the association between CT image changes and the prognosis in gastrointestinal stromal tumors (GIST) after targeted therapy. METHODS: A total of 35 patients with GIST were treated by imatinib mesylate from April 2003 to June 2008. The longest diameter (LD) and mean enhanced CT values (HU) of tumors were measured on axial images. The CT classifying (number, location, liver metastasis, hemorrhage,cystic degeneration) and quantitative indices (pre- and 2-6 months post-treatment LD, HU, and their change rate) were compared between those with and without progress in two years. RESULTS: During follow-up (median:285 months) 13 cases had tumor progress. The progress rate was higher in the group with extensive tumor involvement (> or = 5 lesions and > or = 2 parts), and that without hemorrhage demonstrated. The mean change rate was -14.29% (range, -67%, 11%) for LD and -12.25% (range, -55%, 39%) for HU in non-progressive group, while the mean change rate was 15.09%(range, -45%, 191%) for LD and 9.91% (-27%, 135%) for HU in progressive group. The differences were significantly different (P<0.01). The accuracies of predicting 2-year progress by LD and HU change rates were moderate, with area under ROC curve being 0.790 and 0.797, respectively. CONCLUSIONS: The 2-year progress rate of GIST after targeted therapy is higher in extensively involved tumors. Higher decrease rates of LD and HU predict less 2-year progress, which possess moderate prediction accuracy and can be used as valuable indicators in the evaluation of targeted therapy for GIST.