Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging for predicting histological grade of hepatocellular carcinoma:Comparison with conventional diffusion-weighted imaging

AIM To compare intravoxel incoherent motion(IVIM)-derived parameters with conventional diffusion-weighted imaging(DWI) parameters in predicting the histological grade of hepatocellular carcinoma(h CC) and to evaluate the correlation between the parameters and the histological grades.METHODS A retrospective study was performed. Sixty-two patients with surgically confirmed h CCs underwent diffusion-weighted magnetic resonance imaging with twelve b values(10-1200 s/mm^2). The apparent diffusion coefficient(ADC), pure diffusion coefficient(D), pseudo-diffusion coefficient(D*), and perfusion fraction(f) were calculated by two radiologists. The IVIM and conventional DWI parameters were compared among the different grades by using analysis of variance(ANOVA) and the Kruskal-Wallis test. Receiver operating characteristic(ROC) analysis was performed to evaluate the diagnostic efficiency of distinguishing between low-grade(grade 1, G1) and high-grade(grades 2 and 3, G2 and G3) hC C. The correlation between the parameters and the histological grades was assessed by using the Spearman correlation test. Bland-Altman analysis was used to evaluate the reproducibility of the two radiologists' measurements.RESULTS The differences in the ADC and D values among the groups with G1, G2, and G3 histological grades of HCCs were statistically significant(P < 0.001). The D* and f values had no significant differences among the different histological grades of h CC(P > 0.05). The ROC analyses demonstrated that the D and ADC values had better diagnostic performance in differentiating the low-grade h CC from the high-grade h CC, with areas under the curve(AUCs) of 0.909 and 0.843, respectively, measured by radiologist 1 and of 0.911 and 0.852, respectively, measured by radiologist 2. The following significant correlations were obtained between the ADC, D, and D~* values and the histological grades: r =-0.619(P < 0.001), r =-0.628(P < 0.001), and r =-0.299(P = 0.018), respectively, as measured by radiologist 1; r =-0.622(P < 0.001), r =-0.633(P < 0.001), and r =-0.303(P = 0.017), respectively, as measured by radiologist 2. The intra-class correlation coefficient(ICC) values between the two observers were 0.996 for ADC, 0.997 for D, 0.996 for D*, and 0.992 for f values, which indicated excellent interobserver agreement in the measurements between the two observers.CONCLUSION The IVIM-derived D and ADC values show better diagnostic performance in differentiating high-grade hC C from low-grade hC C, and there is a moderate to good correlation between the ADC and D values and the histological grades.

Palliative Local Radiotherapy in the Treatment of Tumor-stage Cutaneous T-cell Lymphoma/ Mycosis Fungoides

Objective To determine the efficacy of palliative radiotherapy in treating tumor-stage cutaneous T-cell lymphoma/mycosis fungoides(MF).Methods From January 2008 to January 2013,a total of 11 patients with tumor-stage MF were treated with local radiation therapy in Peking Union Medical College Hospital.The median age of these patients was 53.36±14.45 years.Female-male ratio was 1:1.2.The average course of disease was 10.82±3.37 years.All the patients were treated with local electronic beam irradiation with a total median dosage of 48.55±9.51(40-74) Gy in an average of 24.55±5.57(20-40) fractions,5 fractions per week.Results The median follow-up time was 55.27±29.3(13-103) months.No severe acute or chronic side effects of irradiation were observed.Complete clinical response(CR) rate of the radiated sites was 54.5%(6/11),partial response(PR) rate was 36.4%(4/11),and the overall response rate(CR+PR) was 90.9%.One patient showed no response.Conclusion Local radiotherapy with psolaren plus ultraviolet A and/or interferon maintaining treatment is an effective palliative therapy in the treatment of tumor-stage MF patients.

En bloc resection for treatment of refractory pre-auricular fistula

Objective:To report a surgical method for the treatment of pre-auricular fistula to lower post-operative recurrence rate. Methods:Clinical data of 187 patients with pre-auricular fistula who underwent en bloc resection at the Affiliated Hospital of Luzhou Medical College from August 2006 to November 2012 were retrospectively reviewed. Factors that might affect the prognosis following En bloc fistula resection bordered by the superficial temporalis fascia, helix perichondrium and auriculocephalic sulcus were investigated. Results: Of the 187 patients, 181 achieved primary healing and 6 ended up with delayed healing. During the follow-up period (one to seven years), there were 4 cases of recurrence (2.1%). Conclusions:Clear demarcation of surgical resection can facilitate easy and thorough resection of preauricular fistula and lead to low recurrence rate. Proper timing and careful search for potential fistula branches are the two crucial factors affecting prognosis. Copyright ? 2016, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

蓬乱蛋白2干扰和过表达慢病毒载体的构建及其在hUVECs中的表达

目的获得蓬乱蛋白2(DVL2)基因干扰和过表达慢病毒表达系统,并在人脐静脉内皮细胞中(h UVECs)稳定表达。方法 (1)聚合酶链反应扩增目的基因,设计合成sh RNA,以慢病毒表达质粒为基础构建DVL2干扰和过表达载体,酶切电泳、实时荧光定量聚合酶链反应(q RT-PCR)和测序技术鉴定载体构建是否成功;(2)以3质粒系统在HEK293T细胞中包装病毒,通过荧光显微镜观察计数并计算病毒滴度;以嘌呤霉素筛选稳定转染的h UVECs,通过荧光显微镜观察计数获得转染效率。将感染好的细胞分为BC组(h UVECs空白对照)、NC组(HBLV-GFP-PURO阴性对照)、干扰组(pHB-shRNA-HDVL2)及过表达组(pHBLV-HDVL2)。(3)通过q RT-PCR与Western blotting检测分别从m RNA和蛋白表达水平验证目的基因的干扰和过表达水平。结果 (1)插入慢病毒表达载体的基因片段与目的基因的碱基序列完全一致。干扰序列峰形图为单峰,无突变。(2)病毒包装后,NC组、干扰组、过表达组滴度分别为2×108、2×108和1×108 TU/ml,感染人脐静脉内皮细胞的感染效率达98%。(3)干扰组DVL2的表达较BC组降低,差异有统计学意义(P <0.05),过表达组较BC组升高,差异有统计学意义(P <0.05),其中干扰效率为61%,蛋白质过表达水平为BC组的2.7倍。结论 DVL2基因干扰和过表达慢病毒载体构建成功,并能够在原代h UVECs中稳定表达。

COMPARISON BETWEEN IMMUNOFLUORESCENCE AND PCR IN DETECTING HUMAN PAPILLOMA VIRUS IN CONDYLOMA ACUMINATA

Objective To compare the effectiveness of immunofluorescence and polymerase chain reaction (PCR) in detecting human papilloma virus (HPV) in condyloma acuminata (CA). Methods HPVs in CA tissues from 60 patients were detected by immunofluorescence and PCR, respectively. Different subtypes of HPVs were also identified with restriction fragment length polymorphism (RFLP). Results The positive detective rates of immunofluorescence and PCR were 56.67% (34/60) and 96.67% (58/60), respectively (P<0.01). RFLP results showed HPV6 and HPV11 were the main subtypes in the detected virus, which accounted for 98.28%. Conclusion The sensibility of PCR is superior to that of immunofluorescence.

Dermoscopic features of morphea and extragenital lichen sclerosus in Chinese patients

Morphea and extragenital lichen sclerosus(ELS)are chronic inflammatory dermatoses that can be clinically similar.Morphea is typically characterized by successive development of erythematous patches,central hypopigmented sclerosis,and atrophic plaques.ELS manifests as blue-whitish papules,coalescing or enlarging into shiny,sclerotic,scar-like plaques.The differentiation between morphea and ELS can be difficult,especially in an early stage or in atypical cases.Moreover,coexistence of these two conditions can be observed,and biopsy is often necessary to distinguish them.Dermoscopy,as a non-invasive technology,is effective in assisting the diagnosis of cutaneous tumors and non-neoplastic dermatoses.Studies reporting the use of dermoscopy for the diagnosis of morphea and ELS in Caucasian patients have been published in succession.[1,2,3,4,5]We designed this prospective study to analyze and compare the dermoscopic features of morphea and ELS in Chinese patients.

A Transcriptomic Analysis of Physiological Significance of Hypoxia-inducible Factor-1α in Myogenesis and Carbohydrate Metabolism of Genioglossus in Mice

Background： Chronic intermittent hypoxia is the most remarkable feature of obstructive sleep apnea/hypopnea syndrome and it can induce the change of hypoxia-inducible factor-1α （H IF-1α） expression and contractile properties in the genioglossus. To clarify the role of HIF-lot in contractile properties of the genioglossus, this study generated and compared high-throughput RNA-sequencing data from genioglossus between HIF-1α conditional knockout （KO） mice and littermate wild-type （WT） mice. Methods： KO mice were generated with cre-loxP strategy. Gene expression profile analysis was performed using gene enrichment analysis. Gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analyses of differently expressed messenger RNAs were performed to identify the related pathways and biological lhnctions. Six differentially expressed genes （DEGs） were validated by qualitative reverse transcription polymerase chain reaction. Results： A total of 142 （77 upregulated and 65 downregulated） transcripts were found to exhibit statistically significant difference between the HIF-la-KO and WT mice. GO and KEGG analyses indicated that DEGs included genes involved in ＂skeletal muscle cell differentiation,＂ ＂muscle organ development,＂ ＂glucose metabolic process,＂ ＂glycogen biosynthetic and metabolic process,＂ etc. Conclusion： This study might provide evidence that H IF-lot affects the expression of multiple genes involved in the myogenesis, muscle developrnent, and carbohydrate metabolism through transcriptome analysis in conditional HIE-1α-KO mice.

Hailey-Hailey disease with lichenoid lesions around the anus

To the Editor: Hailey-Hailey disease (HHD), first discovered by the brothers Howard and Hugh Hailey,[1]is a genodermatosis at intertriginous sites. Mutation of ATP2C1 on chromosome 3q21-2 coding a calciumdependent ATPase gives rise to calcium dysfunction within keratinocytes, resulting in acantholysis due to a signal transduction disorder.[2] It has been suggested that this gene mutation combined with irritation such as frequent friction, cold, and ultraviolet exposure leads to the development of HHD.[3]

Unilateral Axillary Pseudochromhidrosis-like Lesion Caused by Pediculosis Pubis

To the Editor： A 55-year-old homosexual man presented with complaints of right axillary redness for one week. He has been sexually active with a male partner during his travel to South China in hot weather about a month ago. Physical examination revealed redness in his right axillary area, which stained his white clothing [Figure 1 a]. A lot of mobile Pthirus pubis insects were visible on his axillary hair in the affected area [Figure 1 b and 1 c].

Pityriasis Lichenoides et Varioliformis Acuta and Psoriasis Vulgaris： Mere Coincidence or a Rare Association？

To the Editor： A 23-year-old otherwise healthy male presented with diffuse, erythematous, nonpruritic papules on the trunk and extremities, which gradually developed over 1 month [Figure 1a and 1b]. The patient was afebrile and had no other systemic symptoms. His personal and family histories were unremarkable. He denied any drug intake or episode of infection before the onset. Head, hands, feet, and mucosa were spared. No lymphadenopathies were detected. Histopathological examination revealed full-thickness epidermal necrosis, parakeratosis, vacuolization of the basal layer, and superficial perivascular infiltration of lymphocytes and histiocytes in the dermis. Exocytosis was prominent, and intraepidermal red blood cells could be seen [Figure 1c]. A diagnosis ofpityriasis licbenoides et varioliformis acuta （PLEVA） was established. He was prescribed with oral prednisolone （30mg/d） for 2 weeks, and complete remission was obtained. A follow-up visit at 3 years later showed no evidence of recurrence of PLEVA.

Sporadic Porphyria Cutanea Tarda Induced by Alcohol Abuse

To the Editor： A 50-year-old man presented with recurrent episodes of bullae, erosions, and crust on sun-exposed areas for 1 year. Lesions healed with scarring and hyperpigmentation. The skin lesions were aggravated after sun exposure. The patient had a 30-year alcohol abuse （100-200 ml/day） history. Family heredity history was unremarkable. Physical examination revealed multiple erosions with erythema, hyperpigmentation, bullae, and crusting on his lace, neck, and dorsum of the hands [Figure 1a].