Cobalt phthalocyanine promoted copper catalysts toward enhanced electro reduction of CO_(2)to C_(2):Synergistic catalysis or tandem catalysis?

The activity and selectivity of electrocatalytic CO_(2)reduction reaction(CO_(2)RR)to C_(2)products on metal catalysts can be regulated by molecular surfactants.However,the mechanism behind it remains elusive and debatable.Herein,copper nanowires(Cu NWs)were fabricated and decorated with cobalt phthalocyanine(CoPc).The electronic interaction between the Cu NWs,CoPc,CO_(2) and CO_(2)RR intermediates were explored by density functional theory(DFT)calculations.It was found that the selectivity and activity of CO_(2)RR towards C_(2)products on Cu NWs were considerably enhanced from 35.2%to 69.9%by surface decoration of CoPc.DFT calculations revealed that CO_(2)RR can proceed in the interphase between Cu substrate and CoPc,and the CO_(2)RR intermediates could synergistically bond with both Cu and Co metal centre in CuNWs-CoPc,which favours the adsorption of CO_(2),CO and CO_(2)RR intermediates,thus reducing the free energy for CO-COcoupling towards C_(2)products.The synergistic interaction was further extended to phthalocyanine(Pc)and other metal phthalocyanine derivatives(MPc),where a relatively weaker synergistic interaction of COintermediates with MPc and Cu substrate and only a slight enhancement of CO_(2)RR towards C_(2) products were observed.This study demonstrates a synergistic catalysis pathway for CO_(2)RR,a novel perspective in interpreting the role of CoPc in enhancing the activity and selectivity of CO_(2)RR on Cu NWs,in contrast to the conventional tandem catalysis mechanism.

Research and Application of Caideng Model Rendering Technology for Virtual Reality

With the development of virtual reality (VR) technology, more and more industries are beginning to integrate with VR technology. In response to the problem of not being able to directly render the lighting effect of Caideng in digital Caideng scenes, this article analyzes the lighting model. It combines it with the lighting effect of Caideng scenes to design an optimized lighting model algorithm that fuses the bidirectional transmission distribution function (BTDF) model. This algorithm can efficiently render the lighting effect of Caideng models in a virtual environment. And using image optimization processing methods, the immersive experience effect on the VR is enhanced. Finally, a Caideng roaming interactive system was designed based on this method. The results show that the frame rate of the system is stable during operation, maintained above 60 fps, and has a good immersive experience.

Pannexins in the musculoskeletal system:new targets for development and disease progression

During cell differentiation,growth,and development,cells can respond to extracellular stimuli through communication channels.Pannexin(Panx)family and connexin(Cx)family are two important types of channel-forming proteins.Panx family contains three members(Panx1-3)and is expressed widely in bone,cartilage and muscle.Although there is no sequence homology between Panx family and Cx family,they exhibit similar configurations and functions.Similar to Cxs,the key roles of Panxs in the maintenance of physiological functions of the musculoskeletal system and disease progression were gradually revealed later.Here,we seek to elucidate the structure of Panxs and their roles in regulating processes such as osteogenesis,chondrogenesis,and muscle growth.We also focus on the comparison between Cx and Panx.As a new key target,Panxs expression imbalance and dysfunction in muscle and the therapeutic potentials of Panxs in joint diseases are also discussed.

The changes in the annual distribution of mountain runoff during the period of 1965-2018 in Hexi Corridor,Northwest China

The annual distribution characteristics of river runoff in arid regions have significant implications for water resource stability and management.Based on the mountain runoff data from 1965 to 2018,this study examines the annual change characteristics of monthly runoff of the Shiyang River Basin,Heihe River Basin,and Shule River Basin in the Hexi Corridor,Northwest China.Many indexes are used and analyzed,including the coefficient of variance,the complete regulation coefficient,the concentration degree and concentration period,the magnitude of change,the skewness coefficient,and the kurtosis coefficient of the annual distribution curves.The results reveal the following:(1)The inhomogeneity of annual runoff distribution in the Taolai River and the rivers to the west of it,except the Shiyou River,show an increasing trend.Conversely,the inhomogeneity of the rivers to the east of the Taolai River generally show a downward trend,but the coefficient of variance value is still very high.(2)In the Shiyang River Basin,the annual distribution of the concentration period is characterized by a relatively discrete pattern.Conversely,the Heihe River Basin exhibits a relatively concentrated pattern,and the distribution pattern of the Shule River Basin is quite different.Notably,all concentration periods in the three basins have shifted backward after the 2000s.(3)The Shiyang River Basin exhibits disordered annual distribution curves of runoff in different years.In contrast,the Heihe River Basin presents a typical‘single-peak’pattern with a prominent right-skewed.The Shule River Basin has regular distribution curves,with a gradually significant‘double-peak’pattern from east to west.Overall,there has been a slight change in runoff in the Shiyang River Basin,while the Heihe River Basin and Shule River Basin have experienced significant increases in runoff.The annual distribution curves of runoff in the Liyuan River and the rivers to the east of it exhibit a gentle peak pattern,and the appearance probability of extreme runoff during the year is low.Conversely,the rivers to the west of the Liyuan River,excluding the Danghe River,display a sharp peak and thick tail pattern,indicating that the appearance probability of extreme runoff during the year is high.These findings have practical implications for the planning and management of water resources in the Hexi Corridor.Moreover,they provide a solid foundation for predicting future changes in regional water resources.

Advancing the understanding and management of blastic plasmacytoid dendritic cell neoplasm:Insights from recent case studies

We specifically discuss the mechanisms of the pathogenesis,diagnosis,and management of blastic plasmacytoid dendritic cell neoplasm(BPDCN),a rare but aggressive haematologic malignancy characterized by frequent skin manifestations and systemic dissemination.The article enriches our understanding of BPDCN through detailed case reports showing the clinical,immunophenotypic,and histopathological features that are critical for diagnosing this disease.These cases highlight the essential role of pathologists in employing advanced immunophenotyping techniques to accurately identify the disease early in its course and guide treatment decisions.Furthermore,we explore the implications of these findings for management strategies,emphasizing the use of targeted therapies such as tagraxofusp and the potential of allogeneic haematopoietic stem cell transplantation in achieving remission.The editorial underscores the importance of interdisciplinary approaches in managing BPDCN,pointing towards a future where precision medicine could significantly improve patient outcomes.

Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection:A case report

BACKGROUND Spontaneous visceral artery dissection(SVAD)is a rare condition that affects the visceral arteries,such as the celiac,superior mesenteric,and inferior mesenteric arteries,without involving the aorta.Organ ischemia or hemorrhage from vessel rupture can occur in SVAD;therefore,prompt detection and management is essential.Contrast-enhanced computed tomography(CECT)has been used to diagnose most of the previous cases,but few studies have explored the potential of contrast-enhanced ultrasound(CEUS)for early detection of this disease.CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months.He had previously undergone transabdominal splenectomy,esophagogastric devascularization,and cholecystectomy for gallstones and severe portal hypertension.Liver ultrasound was performed in our department to assess liver status.An abnormal hepatic artery spectrum was observed,and dissection involving both the celiac artery and the common hepatic artery was observed.A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen,and dissection was subsequently confirmed by CECT.The patient was asymptomatic;therefore,treatment to control the blood pressure was provided,and follow-up was recommended.After 6 months of follow-up,the celiac artery was found to be dilated with an adherent thrombus visible in the wall,and the common hepatic artery was occluded with the presence of collateralization.Despite these findings,no significant changes in liver function were observed.CONCLUSION Multi-modal imaging is effective in diagnosing SVAD,and conservative treatment is a choice for asymptomatic patients.

Therapeutic role of growth factors in treating diabetic wound

Wounds in diabetic patients,especially diabetic foot ulcers,are more difficult to heal compared with normal wounds and can easily deteriorate,leading to amputation.Common treatments cannot heal diabetic wounds or control their many complications.Growth factors are found to play important roles in regulating complex diabetic wound healing.Different growth factors such as transforming growth factor beta 1,insulin-like growth factor,and vascular endothelial growth factor play different roles in diabetic wound healing.This implies that a therapeutic modality modulating different growth factors to suit wound healing can significantly improve the treatment of diabetic wounds.Further,some current treatments have been shown to promote the healing of diabetic wounds by modulating specific growth factors.The purpose of this study was to discuss the role played by each growth factor in therapeutic approaches so as to stimulate further therapeutic thinking.

Value of contrast-enhanced ultrasound in deep angiomyxoma using a biplane transrectal probe:A case report

BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.

Validation of the Chinese Version of the Affective Exercise Experiences Questionnaire (AFFEXX-C)

Despite the well-established benefits of regular physical activity(PA)on health,a large proportion of the world population does not achieve the recommended level of regular PA.Although affective experiences toward PA may play a key role to foster a sustained engagement in PA,they have been largely overlooked and crudely measured in the existing studies.To address this shortcoming,the Affective Exercise Experiences(AFFEXX)questionnaire has been developed to measure such experiences.Specifically,this questionnaire was developped to assess the following three domains:antecedent appraisals(e.g.,liking vs.disliking exercise in groups),core affective exercise experiences(i.e.,pleasure vs.displeasure,energy vs.tiredness,and calmness vs.tension),and exercise motivation(i.e.,attraction vs.antipathy toward exercise).The current study aimed to validate a Chinese version of the AFFEXX questionnaire(AFFEXX-C).In study 1,722 Chinese college students provided data for analyses of factorial,convergent,discriminant,criterion validity,and test-retest reliability of the AFFEXX-C.In addition,1,300 college students were recruited in study 2 to further validate its structural model.Results showed that the AFFEXX-C demonstrates a goodfit and reliability.Additionally,results further supported the hypothesized model based on previous research:antecedent appraisals predicted core affective exercise experiences,which in turn predicted attraction-antipathy toward physical exercise.The AFFEXX-C was found to be a reliable and valid measure of affective exercise experiences in a population of Chinese college students.

Fibromatosis-like metaplastic carcinoma of the breast:Two case reports

BACKGROUND Fibromatosis-like metaplastic carcinoma is classified as a rare type of metaplastic carcinoma of the breast by the 2012 WHO pathological and genetic classification criteria for breast tumors,which takes hyperplastic spindle cells as the main component and is often misdiagnosed as benign stromal proliferative lesions or benign mesenchymal tumors of the breast because of its mild morphology.Here,we collected the clinical data of 2 cases of fibromatosis-like metaplastic carcinoma of the breast and performed pathomorphological observation and immunohistochemical staining of the surgically resected specimens.According to the clinical features,imaging features,immunophenotype,diagnosis and differential diagnosis of 2 cases of fibromatosis-like metaplastic carcinoma of the breast,it was further differentiated.CASE SUMMARY Case 1:A 56-year-old postmenopausal female was admitted due to"right breast mass for over 1 year and local ulceration for over 1 mo".Physical examination showed a mass with a diameter of 4.5 cm×5.5 cm palpable at 2.5 cm from the nipple at 1 o'clock in the right breast.The skin on the surface of the mass ruptured about 3 cm,with a small amount of exudation and bleeding,less clear boundary,hard texture,fair activity,without obvious tenderness.No obvious abnormality was palpable in the left breast.No enlarged lymph nodes were palpable in the bilateral axillae and bilateral supraclavicular region.After removing the mass tissue,it was promptly sent to the pathology department for examination.Case 2:Female,52-years-old,premenopausal,admitted due to"right breast mass for more than 3 mo".Physical examination showed a 4.0 cm×4.0 cm diameter mass palpable at 2.0 cm of the nipple in the lower outer 7 o'clock direction of the right breast,with less clear boundary,hard texture,fair activity,no significant tenderness,no palpable significant abnormalities in the left breast,and no palpable enlarged lymph nodes in the bilateral axillae and bilateral supraclavicular region.The mass was resected and sent for pathological examination.Postoperative pathological examination revealed fibromatosis-like metaplastic carcinoma of the breast in both patient 1 and patient 2.No systemic therapy and local radiotherapy were performed after surgery,and no tumor recurrence or metastasis was observed.CONCLUSION Fibromatosis-like metaplastic carcinoma of the breast is a rare subtype of metaplastic carcinoma that is often misdiagnosed,and the diagnosis relies on medical history collection,complete sampling,and full use of immunohistochemical assessment.The risk of lymph node and distant metastasis is low,and the current treatment is based on complete surgical resection.The efficacy of systemic radiotherapy and chemotherapy is not clear.

角膜塑形镜联合0.01%阿托品滴眼液对青少年中低度近视的控制疗效

目的:探究角膜塑形镜联合0.01%阿托品滴眼液对青少年近视控制的疗效及安全性。方法:前瞻性非随机对照研究。选择2017-10/2018-11我院收治的青少年近视患者120例120眼为研究对象,对照组60眼采用角膜塑形镜治疗,联合组60眼采用角膜塑形镜联合0.01%阿托品治疗。治疗前和治疗1a测定患者最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、屈光度、眼轴、调节幅度、亮瞳直径、暗瞳直径、泪膜脂质层厚度(LLT)、泪膜破裂时间(BUT),观察不良反应发生情况。结果:两组患者治疗前后BCDVA和BCNVA组内和组间均无差异(P>0.05)。与治疗前相比,治疗后联合组和对照组等效球镜度均明显进展(P<0.01),分别进展0.21(0.03,0.53)、0.40(0.15,0.74)D;治疗后联合组和对照组眼轴长度均显著增加(P<0.01),分别增加0.13±0.19、0.22±0.21mm。治疗前后对照组调节幅度、亮瞳和暗瞳直径均未见明显差异(P>0.05),但治疗后联合组调节幅度显著下降,亮瞳和暗瞳直径显著增加(均P<0.01),且治疗后联合组调节幅度低于对照组,而亮瞳和暗瞳直径高于对照组(均P<0.01)。治疗后两组患者LLT、BUT均显著降低(P<0.01),且降低幅度均无差异(P>0.05)。治疗期间,联合组和对照组总不良反应发生率无差异(26.7%vs 15.0%,P>0.05)。结论:角膜塑形镜联合0.01%阿托品可协同增强青少年的近视控制效果,并且具有良好的安全性。

Ginsenoside modified lipid-coated perfluorocarbon nanodroplets: A novel approach to reduce complement protein adsorption and prolong in vivo circulation

Lipid-coated perfluorocarbon nanodroplets(lp-NDs)hold great promise in bio-medicine as vehicles for drug delivery,molecular imaging and vaccine agents.However,their clinical utility is restricted by limited targeted accumulation,attributed to the innate immune system(IIS),which acts as the initial defense mechanism in humans.This study aimed to optimize lp-ND formulations to mini-mize non-specific clearance by the IIS.Ginsenosides(Gs),the principal components of Panax ginseng,possessing complement inhibition ability,structural similarity to cholesterol,and comparable fat solubi-lity to phospholipids,were used as promising candidate IIS inhibitors.Two different types of ginsenoside-based Ip-NDs(Gs Ip-NDs)were created,and their efficacy in reducing IS recognition was examined.The Gs p-NDs were observed to inhibit the adsorption of C3 in the protein corona(PC)and the generation of SC5b-9.Adding Gs to Ip-NDs reduced complement adsorption and phagocytosis,resulting in a longer blood circulation time in vivo compared to lp-NDs that did not contain Gs.These results suggest that Gs can act as anti-complement and anti-phagocytosis adjuvants,potentially reducing non-specific clear-ance by the IS and improving lifespan.

飞秒激光辅助角膜原位磨镶术与角膜塑形镜治疗中低度近视的视觉质量对比研究

目的比较飞秒激光辅助角膜原位磨镶术(FS-LASIK)与角膜塑形镜(OK)治疗中低度近视患者的长期视觉质量变化。方法选取2018年10月—2019年8月广西壮族自治区人民医院收治的中低度数成人近视患者86例,分为FS-LASIK组和OK组,各43例,均选取右眼为研究对象。在治疗前和治疗后1个月、3个月、6个月、12个月,分别采集两组的裸眼视力(UCVA)、球镜、柱镜,采用双通道系统视觉质量分析仪(OQAS)检查客观视觉质量,包括散射指数(OSI)、调制传递函数(MTF)、斯特列尔比(SR)、不同对比度下OQAS值(OV100%、OV20%、OV9%)。结果 FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的UCVA在不同时间点有差异(P <0.05),组间及变化趋势上无差异(P>0.05)。FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的球镜和柱镜比较:(1)不同时间点的球镜和柱镜有差异(P <0.05);(2)两组间的球镜无差异(P>0.05),而柱镜有差异(P <0.05);(3)两组球镜变化趋势无差异(P>0.05),而柱镜变化趋势有差异(P <0.05)。FS-LASIK组与OK组治疗前和治疗后1个月、3个月、6个月、12个月的MTF、OSI、SR、OV100%、OV20%、OV9%比较:(1)不同时间点MTF、OSI、SR、OV100%、OV20%、OV9%有差异(P <0.05);(2)两组MTF、OSI、SR、OV100%、OV20%、OV9%有差异(P <0.05);(3)两组MTF、SR、OV100%、OV20%、OV9%变化趋势无差异(P>0.05),而OSI变化趋势有差异(P <0.05)。结论 FS-LASIK和OK镜治疗后患者早期均出现客观视觉质量下降,但随着时间延长有改善趋势。FS-LASIK和OK镜对中低近视患者的裸眼视力改善无明显差异,但FS-LASIK的柱镜矫正及客观视觉质量更好。

基于蓝墨云班课的高职院校汽车类课程有效课堂建设研究——以“汽车保养与维护”课程为例

本文在信息化快速发展的时代背景下,以扬州工业职业技术学院针对传统汽车检测与维修专业制定的“汽车保养与维护”课程标准为依据,以手机为主导,以蓝墨云班课APP为软件支撑应用于课堂前的学生自学、课堂中的教师导学、课堂后的答疑与复习3个环节理论与实践的学习。利用任务驱动教学方法,教师通过蓝墨云班课软件中的课堂互动、学生反馈、课堂激励和多元评价功能及时有效地把握学生学习动态,总结出教与学的教学案例,激发学生学习兴趣,增强学生学习的积极性、主动性和创新性。

汽车PEPS系统综述

简要地介绍了PEPS系统的组成,以大众MQB平台的PEPS系统为例,详细讲解了无钥匙进入系统和一键启动系统的工作原理,阐述了PEPS系统的工作形态,并分析了PEPS系统的发展趋势。

Vascular complications after adult living donor liver transplantation:Evaluation with ultrasonography

Living donor liver transplantation(LDLT) has beenwidely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrastenhanced ultrasound(CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional grayscale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.

Effect of Glycyrrhiza uralensis Fisch polysaccharide on growth performance and immunologic function in mice in Ural City,Xinjiang

Objective:To discuss the effect of Glycyrrhiza uralensis(G.uralensis) Fisch polysaccharide on growth performance and immunologic function in mice in Ural City,Xinjiang and to provide important data supporting the application of Glycyrrhiza polysaccharide.Methods:A total of100 Kunming mice aged 3 weeks old were randomly divided into 5 groups with 20 mice in each group(10 were females and 10 were males).About 0.5 mL normal saline was given to the mice of control group every day and 0.5 mL G.uralensis Fisch polysaccharide was given to the mice of other groups at the concentration of 1,20,50 and 100 mg/mL respectively.The growth performance(average body weight,average daily feed intake and feed efficiency),immune organ indexes(spleen index and thymus index) and immunologic function(serum IL-2,CD4^+/CD8^+ and the activity of NK cells) of mice in each group were detected continuously.Results:The average body weight,feed efficiency,serum IL-2,CD4^+/CD8^+ and the activity of NK cells of mice were increased with the increase of administrated time after administrating G.uralensis Fisch polysaccharide and were reached up the largest level on Day 28.At the same time,each index was proportional to the given dose and was significantly higher than those of control group and reached up the largest level at the administrated dose of 100 mg/mL.After administrating G.uralensis Fisch polysaccharide,the spleen index and thymus index of mice were increased with the increase of administrated dose and the spleen index and thymus index of mice administrated with the dose of 100 mg/mL were maximum which was more than 1.51 times and 1.43 times of that in control group respectively and the comparative differences showed statistical significance(P<0.05).The average daily feed intake of mice in each group was increased with the passage of lime and at the same time,the comparison of average daily feed intake of mice in each group was not significantly different(P>0.05).Conclusions:G.uralensis Fisch polysaccharide can significantly improve the growth performance and immunologic function of mice and laid a research basis for the clinical application of G.uralensis Fisch polysaccharide.

Regional stress field in Yunnan revealed by the focal mechanisms of moderate and small earthquakes

We determined focal mechanism solutions of 627 earthquakes of magnitude M ≥ 3.0 in Yunnan from January 2008 to May 2018 by using broadband waveforms recorded by 287 permanent and temporary regional stations. The results clearly revealed predominantly strike-slip faulting characteristics for earthquakes in Yunnan, with focal depths concentrated in the top 10 km of the crust. The earthquake mechanisms obtained were combined with the global centroid moment tensor solutions of 80 additional earthquakes from 1976 to 2016 to invert for the regional variations of stress field orientation by using a damped regional-scale stress inversion scheme.Results of the stress field inversion confirmed that the Yunnan region is under a strike–slip stress regime, with both maximum and minimum stress axes being nearly horizontal. The maximum compressional axes are primarily oriented in a northwest-southeast direction, and they experience a clockwise rotation from north to south, whereas the maximum extensional axes are oriented largely northeast-southwest. The maximum compressional axes are in line with the global positioning system–inferred horizontal velocity field and the southeastward escape of the Sichuan–Yunnan Rhombic Block, whereas the maximum extensional axes are consistent with anisotropy derived from SKS splitting. Against the strike–slip background, normal faulting stress regimes can be seen in the Tengchong volcanic area as well as in other areas with complex crisscrossing fault zones.

Contrast-enhanced ultrasound:Improving the preoperative staging of hepatocellular carcinoma and guiding individual treatment

AIM: To investigate the clinical role of contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging to improve the preoperative staging of hepatocellular carcinoma (HCC) and guide surgical decision-making. METHODS: Sixty-nine patients who underwent liver resection for HCC in our center were enrolled prospectively in the study. CEUS and CE-CT/MRI were performed before surgery. Intraoperative ultrasound (IOUS) was carried out after liver mobilization. Lesions depicted by each imaging modality were counted and mapped. To investigate the impact of tumor size on the study, we divided the patients into two groups, the 'Smaller group'(S-group, <= 5 cm in diameter) and the 'Largergroup' (L-group, > 5 cm in diameter). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CE-CT/MRI, CEUS, IOUS, CEUS+CE-CT/MRI and the tumor node metastasis staging of tumors were calculated and compared. Changes in the surgical strategy as a result of CEUS and IOUS were analyzed. RESULTS: One hundred and twenty-seven nodules, comprising 94 HCCs confirmed by histopathology and 33 benign lesions confirmed by histopathology and follow-up, were identified in 69 patients. The overall diagnostic sensitivity rates of CE-CT/MRI, CEUS, IOUS and CEUS+ CE-CT/MRI were 78.7%, 89.4%, 89.4% and 89.4%, respectively. There was a significant difference between CEUS + CE-CT/MRI and CE-CT/MRI (P = 0.046). Combining CEUS with CT or MRI increased, the diagnostic specificity compared with CT/MRI, CEUS and IOUS, and this difference was statistically significant (100%, 72.7%, 97.0%, and 69.7%, P = 0.004, P = 0.002, P = 0.002, respectively). The diagnostic accuracy was significantly higher for CEUS + CT/MRI compared with CT/MRI (92.1% vs 77.2%, P = 0.001). The TNM staging of tumors based on CEUS + CE-CT/MRI approximated to the final pathological TNM staging (P = 0.977). There was a significant difference in the accuracy of TNM staging when comparing CEUS + CECT/MRI with CE-CT/MRI (P = 0.002). Before surgery, strategies were changed in 15.9% (11/69) of patients as a result of CEUS. Finally, only 5.7% (4/69) of surgical strategies were changed because of IOUS findings. In the S-group, CEUS revealed 12 false positive lesions, including seven false positive lesions that were diagnosed by preoperative imaging examinations and five by IOUS. In contrast, in the L-group, IUOS revealed eight new malignant lesions; six of these lesions were true HCCs that were also identified by preoperative CEUS. CONCLUSION: CEUS combined with CT or MRI improves the accuracy of preoperative staging for hepatocellular carcinoma and may help to guide individualized treatment for patients with HCC. CEUS may better identify non-malignant lesions in patients with small tumors and discover new malignant lesions in patients with large tumors. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Contrast-enhanced ultrasound in association with serum biomarkers for differentiating combined hepatocellular-cholangiocarcinoma from hepatocellular carcinoma and intrahepatic cholangiocarcinoma

BACKGROUND Combined hepatocellular-cholangiocarcinoma(CHC)is a rare type of primary liver cancer.Due to its complex histopathological characteristics,the imaging features of CHC can overlap with those of hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).AIM To investigate the possibility and efficacy of differentiating CHC from HCC and ICC by using contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Data System(LI-RADS)and tumor biomarkers.METHODS Between January 2016 and December 2019,patients with histologically confirmed CHC,ICC and HCC with chronic liver disease were enrolled.The diagnostic formula for CHC was as follows:(1)LR-5 or LR-M with elevated alphafetoprotein(AFP)and carbohydrate antigen 19-9(CA19-9);(2)LR-M with elevated AFP and normal CA19-9;or(3)LR-5 with elevated CA19-9 and normal AFP.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve were calculated to determine the diagnostic value of the criteria.RESULTS After propensity score matching,134 patients(mean age of 51.4±9.4 years,108 men)were enrolled,including 35 CHC,29 ICC and 70 HCC patients.Based on CEUS LI-RADS classification,74.3%(26/35)and 25.7%(9/35)of CHC lesions were assessed as LR-M and LR-5,respectively.The rates of elevated AFP and CA19-9 in CHC patients were 51.4%and 11.4%,respectively,and simultaneous elevations of AFP and CA19-9 were found in 8.6%(3/35)of CHC patients.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under the receiver operating characteristic curve of the aforementioned diagnostic criteria for discriminating CHC from HCC and ICC were 40.0%,89.9%,58.3%,80.9%,76.9%and 0.649,respectively.When considering the reported prevalence of CHC(0.4%-14.2%),the positive predictive value and NPV were revised to 1.6%-39.6%and 90.1%-99.7%,respectively.CONCLUSION CHCs are more likely to be classified as LR-M than LR-5 by CEUS LI-RADS.The combination of the CEUS LI-RADS classification with serum tumor markers shows high specificity but low sensitivity for the diagnosis of CHC.Moreover,CHC could be confidently excluded with high NPV.