INTRODUCTION:This study aims to characterize the polypeptide expression profiles in omental metastasis of Ovarian Cancer (OC) and explore their potential applications in the treatment of OC metastasis. METHODS:Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) was employed to analyze the polypeptide profiles of primary OC tissues, omental metastatic tissues, and normal omental tissues from three OC patients. Differentially expressed polypeptides were screened using bioinformatics, and three polypeptides were synthesized to investigate their functional mechanisms in OC. RESULTS:LC-MS/MS analysis revealed 127 differentially expressed polypeptides in omental metastatic tissues compared to primary OC tissues, and 171 differentially expressed polypeptides compared to normal omental tissues. Notably, a polypeptide derived from alpha-2-macroglobulin (pAHSG) was significantly downregulated in omental metastatic tissues compared to both normal omental tissues and primary OC tissues. In vitro experiments demonstrated that pAHSG inhibited the proliferation and invasion of OC cells in a concentration-dependent manner. Flow cytometry further indicated an increase in G1 phase cells and a reduction in S phase cells following pAHSG treatment. Pull-down assays combined with mass spectrometry identified 40 proteins interacting with pAHSG, and KEGG pathway analysis revealed their involvement in aminoacyl-tRNA biosynthesis and cancer-related pathways. Collectively, these findings suggest that the downregulation of pAHSG is closely associated with omental metastasis in OC. DISCUSSION:The polypeptide expression profiles of omental metastatic tissues in OC exhibit significant alterations. The pAHSG effectively suppresses the malignant behaviors of OC cells, providing a novel potential target for the prevention and treatment of OC metastasis. CONCLUSION:Compared with primary OC tissues and normal omental tissues, the polypeptide expression profiles of omental metastatic tissues exhibit significant alterations. Notably, pA-HSG, whose level is significantly changed in metastatic tissues, can effectively inhibit the malignant behaviors of OC cells, thereby providing a novel potential target for the treatment of OC metastasis.

Bifenthrin (BF) is a widely used pyrethroid pesticide recognized as an endocrine-disrupting chemical (EDC). Previous studies have confirmed that chronic exposure to BF is associated with various health risks. However, its potential association with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) remains unclear. In this study, the potential targets of BF were identified using several databases, including the Comparative Toxicogenomics Database (CTD), TargetNet, GeneCards, SwissTargetPrediction, and STITCH. Differentially expressed genes (DEGs) associated with RIF were obtained from bulk RNA-seq datasets in the GEO database. Candidate targets were identified by intersecting the predicted BF-related targets with the RIF-associated DEGs, followed by functional enrichment analysis using the DAVID and g:Profiler platforms. Subsequently, hub genes were identified based on the STRING database and Cytoscape. A diagnostic model was then constructed based on these hub genes in the RIF cohort and validated in an independent recurrent pregnancy loss (RPL) cohort. Additionally, we performed single-cell type distribution analysis and immune infiltration profiling based on single-cell RNA-seq and bulk RNA-seq data, respectively. Molecular docking analysis using AutoDock Vina was conducted to evaluate the binding affinity between BF and the four hub proteins, as well as several hormone-related receptors. Functional enrichment results indicated that the candidate genes were mainly involved in apoptotic and oxidative stress-related pathways. Ultimately, four hub genes—BCL2, HMOX1, CYCS, and PTGS2—were identified. The diagnostic model based on these genes exhibited good predictive performance in the RIF cohort and was successfully validated in the RPL cohort. Single-cell transcriptomic analysis revealed a significant increase in the proportion of myeloid cells in RPL patients, while immune infiltration analysis showed a consistent downregulation of M2 macrophages in both RIF and RPL. Moreover, molecular docking analysis revealed that BF exhibited high binding affinity to all four hub proteins and demonstrated strong binding potential with multiple hormone receptors, particularly pregnane X receptor (PXR), estrogen receptor α (ESRα), and thyroid hormone receptors (TR). In conclusion, the association of BF with four hub genes and multiple hormone receptors suggests a potential link to immune and endocrine dysregulation observed in RIF and RPL. However, in vivo and in vitro experimental evidence is currently lacking, and further studies are needed to elucidate the mechanisms by which BF may contribute to RIF and RPL.

Background Ovarian cancer (OC) is the most fatal gynaecological malignancy and has a poor prognosis. Glycosylation, the biosynthetic process that depends on specific glycosyltransferases (GTs), has recently attracted increasing importance due to the vital role it plays in cancer. In this study, we aimed to determine whether OC patients could be stratified by glycosyltransferase gene profiles to better predict the prognosis and efficiency of immune checkpoint blockade therapies (ICBs).Methods We retrieved transcriptome data across 420 OC and 88 normal tissue samples using The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases, respectively. An external validation dataset containing 185 OC samples was downloaded from the Gene Expression Omnibus (GEO) database. Knockdown and pathway prediction of B4GALT5 were conducted to investigate the function and mechanism of B4GALT5 in OC proliferation, migration and invasion.Results A total of 50 differentially expressed GT genes were identified between OC and normal ovarian tissues. Two clusters were stratified by operating consensus clustering, but no significant prognostic value was observed. By applying the least absolute shrinkage and selection operator (LASSO) Cox regression method, a 6-gene signature was built that classified OC patients in the TCGA cohort into a low- or high-risk group. Patients with high scores had a worse prognosis than those with low scores. This risk signature was further validated in an external GEO dataset. Furthermore, the risk score was an independent risk predictor, and a nomogram was created to improve the accuracy of prognostic classification. Notably, the low-risk OC patients exhibited a higher degree of antitumor immune cell infiltration and a superior response to ICBs. B4GALT5, one of six hub genes, was identified as a regulator of proliferation, migration and invasion in OC.Conclusion Taken together, we established a reliable GT-gene-based signature to predict prognosis, immune status and identify OC patients who would benefit from ICBs. GT genes might be a promising biomarker for OC progression and a potential therapeutic target for OC.

Objectives Chromosomal microarray analysis (CMA) has been widely applied to genetic diagnosis in miscarriages in clinical practice. However, the prognostic value of CMA testing of products of conception (POCs) after the first clinical miscarriage remains unknown. The aim of this study was to evaluate the reproductive outcomes after embryonic genetic testing by CMA in SM couples. Methods In this retrospective study, a total of 1142 SM couples referred for embryonic genetic testing by CMA, and 1022 couples were successfully followed up after CMA. Results Among 1130 cases without significant maternal cell contamination, pathogenic chromosomal abnormalities were detected in 680 cases (60.2%). The subsequent live birth rate did not differ significantly between couples with chromosomally abnormal and normal miscarriage (88.6% vs. 91.1%, p = .240), as well as the cumulative live birth rate (94.5% vs. 96.7%, p = .131). Couples with partial aneuploid miscarriage had a higher likelihood of spontaneous abortion both in the subsequent pregnancy (19.0% vs. 6.5%, p = .037) and cumulative pregnancies (19.0% vs. 6.8%, p = .044) when compared with couples with chromosomally normal miscarriage. Conclusions SM couples with chromosomally abnormal miscarriage manifested with a similar reproductive prognosis to couples with chromosomally normal miscarriage. Key messages CMA testing of POCs could provide an accurate genetic diagnosis for couples with SM. The live birth rate of couples with partial aneuploid miscarriage was as high as couples with chromosomally normal miscarriage, despite a higher risk of adverse pregnancy event. Among couples with the most common single aneuploid miscarriage, the cumulative live birth rates of couples with trisomy 16, sex chromosomal abnormalities and trisomy 22 were 94.1%, 95.8% and 84.0%, respectively.

目的:比较基于超声(ultrasound,US)、超声造影(contrast-enhanced ultrasound,CEUS)和MRI的BI-RADS分类在鉴别诊断乳腺良恶性钙化性病变中的价值.方法:对60例乳腺钙化性病变患者行US、CEUS和MRI检查,分析US及MRI图像特征并根据第五版BI-RADS标准进行相应分类得到US-BI-RADS和MRI-BI-RADS,根据乳腺病变的US-BI-RADS分类结合CEUS图像特征重新分类得到CEUS-BI-RADS分类.将3种技术的3、4A类病变判定为良性,4B类及以上病变判定为恶性,以组织病理学为金标准,构建受试者工作特征(receiver operating characteristic,ROC)曲线评估比较3种影像学方法对乳腺良恶性钙化性病变的诊断效能.结果:在60例乳腺钙化性病变中,良性37例(61.67％),恶性23例(38.33％).US-BI-RADS、MRI-US-RADS和CEUS-BI-RADS的误诊率分别为18.3％、15.0％和8.3％.CEUS-BI-RADS对4A和4B病变的诊断准确性高于US-BI-RADS和MRI-BI-RADS.CEUS-BI-RADS在鉴别乳腺良恶性钙化性病变的诊断性能方面显示:灵敏度和AUC(91.3％、0.915)高于US-BI-RADS (87.0％、0.819)和MRI-BI-RADS (87.0％、0.851),但差异均无统计学意义(P＞0.05);CEUS-BI-RADS的特异度和约登指数(91.9％、0.832)高于US-BI-RADS (78.4％、0.654)和MRI-BI-RADS (83.8％、0.708),差异均有统计学意义(P＜0.05).结论:CEUS和MRI对乳腺良恶性钙化性病变的鉴别诊断均有重要价值,CEUS的诊断效能优于MRI.

目的:探讨染色体微阵列分析(CMA)技术在偶发自然流产(SA)遗传学诊断中的应用价值.方法:选取2011年8月至2021年3月在南京医科大学附属妇产医院就诊的3070例自然流产病例,包括1854例SA和1216例复发性自然流产(RM),行CMA检测.结果:排除74例(2.4％,74/3070)重度母体细胞污染样本,共2996例病例(1815例SA和1181例RM)纳入最终研究.SA组和RM组的总体致病性染色体异常率比较,差异无统计学意义(61.0％vs 59.4％,P=0.380).SA病例中检出异倍体876例(48.3％),多倍体148例(8.2％),大片段结构异常60例(3.3％),致病性微缺失/微重复17例(0.9％),单亲二倍体7例(0.4％).SA病例中,孕妇年龄≥35岁组的异倍体发生率显著高于<35岁组(64.3％vs 45.2％,P<0.01);孕周<13周组中异倍体发生率显著高于≥13周组(49.3％vs 36.4％,P<0.01).结论:CMA具有检测成功率高、分辨率高、检测周期短等优势,在SA病因学研究中具有重要临床价值,能为再次生育提供精准的遗传学信息.

胎盘部位滋养细胞肿瘤(PSTT)是妊娠滋养细胞肿瘤(GTN)的一种罕见类型,发生率约为1/10万次妊娠.PSTT起源于胎盘种植部位的中间滋养层细胞,相关分子或免疫因素的介导可破坏滋养层正常的侵袭过程,进而导致PSTT的发生,但具体发病机制尚不完全清楚.停经和阴道流血是PSTT最常见的临床表现.PSTT患者血清人绒毛膜促性腺激素(HCG)轻度升高,彩色多普勒超声是最初步的影像学检查手段,同时结合其他影像学检查进一步评估原发灶或转移灶的大小、位置、囊实性和浸润深度等,可以明确临床分期,或尽早发现复发病灶;病理学检查是诊断PSTT的金标准;大多数患者细胞核分裂数低,半数可累及子宫深肌层,免疫组化常表现为人胎盘泌乳素强阳性,HCG仅为弱阳性或局灶阳性,Ki-67为8％～20％.子宫切除术是PSTT首选的治疗方式,病灶局限且无不良预后影响因素的患者在充分评估后可行保留生育能力的治疗;FIGOⅡ～Ⅳ期及伴有高危病理特征的Ⅰ期患者术后应加行辅助性化疗;近年来,PD-1/PD-L1抑制剂帕博利珠单抗已成为耐药性或难治性PSTT新的治疗策略.FIGO分期尤其Ⅳ期是PSTT独立的预后影响因素;大多数患者预后良好,存活率在90％以上,伴有转移病灶者治愈率相对低(50％～60％).

目的 探讨颈部血管超声在颈动脉支架成形术(carotid artery stenting,CAS)和颈动脉内膜切除术(carotid endarterectomy,CEA)术前评估中的应用价值,为临床手术方式的选择提供客观依据.方法 回顾性分析2017年1月-2021年7月无锡市人民医院血管外科因动脉粥样硬化斑块导致颈动脉狭窄单侧行CSA或CEA的患者71例,所有患者术前均经过血管超声的评估,分析两组患者的术前临床一般资料、斑块的大小、形态及超声特征的差异.结果 50例行CAS和21例行CEA,两组患者在术前临床一般资料、责任斑块的位置、长度以及直径狭窄率之间无统计学差异(P>0.05).两组斑块的形态、回声特性及钙化部位之间有统计学差异(P<0.05),CEA组中不规则型斑块、低回声斑块及表面钙化型斑块在组内所占比例均较CAS组比例高,基底部钙化斑块比例CAS组较CEA组高.结论 术前颈部血管超声检查评估引起颈动脉狭窄的动脉粥样硬化斑块的形态、超声特征等情况,有助于临床医生制定个体化的治疗方案.

第10号染色体同源丢失性磷酸酶—张力蛋白基因(PTEN)是一种可以调节多种生理和病理过程的抑癌基因,通过调节丝裂原活化蛋白激酶(MAPK)/细胞外信号调节激酶(ERK)、磷脂酰肌醇3-激酶(PI3K)/丝氨酸/苏氨酸蛋白激酶(AKT)/哺乳动物雷帕霉素靶蛋白(mTOR)、IκB激酶(IKK)/核因子-κB(NF-κB)途径参与了多种疾病的发生与发展;MAPK/ERK途径不仅调控了细胞增殖,侵袭和转移过程,而且参与了细胞外基质降解和血管生成的过程;PI3K/AKT/mTOR途径促进细胞增殖和抗凋亡能力,并调节由血管内皮生长因子介导的血管生成;IKK/NF-κB途径可通过影响炎症因子的表达从而使盆腔微环境失衡.子宫内膜异位症是一种具有恶性行为的良性疾病,目前仍无有效的治疗手段,仅可通过药物或手术治疗缓解症状;异位内膜细胞中PTEN表达显著降低,促进了异位内膜的增殖和抗凋亡能力,并因其盆腔微环境失衡而使异位内膜细胞易于种植与存活;PTEN对血管生成的调节作用在异位内膜细胞的存活中亦发挥了重要的作用.

目的 探讨超声在肿瘤的最大垂直切面纵横比值对于诊断乳腺肿瘤的价值.方法 前瞻性纳入乳腺肿瘤患者114例(126个肿瘤).分别测量肿瘤最大切面水平直径和与其垂直的直径、最大垂直切面最大水平直径和与其垂直的直径.以穿刺或手术组织病理学为诊断金标准.比较最大切面及其垂直切面的纵横比对于诊断乳腺肿瘤的价值.结果 良性组45个肿瘤,恶性组81个肿瘤.最大切面纵横比和垂直切面纵横比在良恶性组间差异均有统计学意义(P＜0.001).两者ROC曲线下面积分别为0.740和0.934,差异有统计学意义(Z=4.721,P＜0.001).Youden's指数最大值对应诊断界值分别为0.638和0.844.以该界值诊断乳腺肿瘤的灵敏度分别为60.5％、84.0％,特异度分别为77.8％、91.1％.两者诊断乳腺肿瘤的灵敏度差异有统计学意义(P＜0.001),特异度差异无统计学意义(P=0.344).结论 在肿瘤最大垂直切面上,以纵横比0.844为界值可有效鉴别乳腺良恶性肿瘤.

Objective:To investigate the value of margin features in the coronal plane of automated breast volume scanner (ABVS) for the diagnosis of solid breast tumors in women.Methods:The preoperative data on handheld ultrasound (HHUS) and ABVS of 206 female breast mass patients with 230 nodes were retrospectively analyzed. HHUS focused on the margins, morphology, growth orientation, calcification, internal echogenic features, posterior echogenic features, color blood flow and Doppler spectrum features of the mass. SPSS 20.0 software was used for statistical analysis, ±s used for the mean of quantitative data, paired chi-square test was used for comparison of sensitivity and specificity. Kappa test was used for consistency testing.Results:The sensitivities of the malignant marginal features of HHUS, all features of HHUS, the malignant marginal features of ABVS coronal plane, and the malignant marginal features of ABVS combined with all features of HHUS for the diagnosis of solid breast tumors were 62.40%, 71.40%, 72.93%, and 88.72%, respectively, the specificities were 80.41%, 76.29%, 77.32%, and 75.26%, respectively. The sensitivity of the malignant marginal features of the ABVS coronal plane was higher than that of the HHUS, the difference had statistics significance (P < 0.001), the Kappa was 0.762 in the consistency test. The sensitivity of the malignant marginal features of the ABVS coronal plane combined with all features of the HHUS was higher than that of the HHUS alone in the diagnosis of solid breast tumors, the difference had statistics significance (P = 0.001), the Kappa was 0.778 in the consistency test.Conclusions:ABVS coronal plane can provide more marginal features of breast tumors. The sensitivity of diagnosing malignant tumors of female breast will be improved when combined with HHUS.

OBJECTIVE:To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis.METHODS:The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB.RESULTS:The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively.CONCLUSIONS:SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.

目的:探讨类风湿性关节炎(rheumatoid arthritis,RA)的超声评分与DAS-28评分相关性.方法:对83例RA患者病情活动性进行DAS-28评分,应用高频超声对DAS-28评分对应关节的滑膜增生、滑膜炎能量多普勒(power Doppler,PD)及骨侵蚀情况进行超声评分,各受累关节的评分相加为超声最终得分;常规检测患者类风湿因子(RF)、血沉(ESR)、C反应蛋白(CRP)、抗环瓜氨酸肽抗体(A-CCP),分析超声总评分与DAS-28评分及实验室指标的相关性.结果:超声总评分与DAS-28评分呈正相关(r=0.434,P＜0.01),超声总评分、DAS-28评分与ESR呈正相关(P均＜0.05);DAS-28评分与滑膜增生、滑膜炎PD评分及骨侵蚀评分均有相关性:与滑膜增生及滑膜炎PD评分的相关性高于骨侵蚀.滑膜增生、滑膜炎PD评分与ESR、CRP有相关性,骨侵蚀评分与ESR、CRP无相关性,其中滑膜炎PD评分与ESR相关性最高(r=0.303,P＜ 0.01);滑膜增生、滑膜炎PD及骨侵蚀评分与RFA-CCP均无相关性.结论:超声评分与DAS-28评分呈正相关,超声评分法可以客观评估类风湿关节炎的活动性,联合应用DAS-28评分及超声评分可较为客观地反映RA的临床活动性.

Background LINC01234, a long noncoding RNA (lncRNA), is overexpressed in several cancers, including colorectal cancer (CRC). We investigated the role of LINC01234 in CRC development and confirmed its correlation with Krüppel-like factor 6 (KLF6), a tumor suppressor gene that is dysregulated in CRC. Methods We tested mRNA levels using quantitative reverse transcription PCR (qRT-PCR). Tissue samples from patients with CRC, inflammatory bowel disease (IBD), hyperplastic polyp, and adenoma were included. Correlations between clinicopathological parameters, overall survival (OS) rate, and LINC01234 were analyzed using Kruskal-Wallis H test. Additionally, cell proliferation, apoptosis, and tumor formation in nude mice were tested to investigate the mechanism of LINC01234. Western blotting was used to determine protein levels. Results LINC01234 expression was significantly upregulated in CRC tissues and CRC cell lines than in non-tumor tissues and normal epithelial cells, respectively. LINC01234 was associated with high tumor stage, larger tumor size, and metastasis. Patients with higher LINC01234 expression showed reduced OS. Cell proliferation was inhibited by LINC01234 knockdown, whereas apoptosis was enhanced. Mice injected with SW480 cells with LINC01234 knockdown displayed decreased tumor volume, weight, and Ki-67 levels compared with those injected with control cells. KLF6 was negatively regulated by LINC01234. Overexpression of KLF6 showed effects similar to those observed following LINC01234 knockdown on cell proliferation and apoptosis. Conclusions LINC01234 could be a prognostic biomarker in CRC patients. Upregulation of LINC01234 in CRC promotes tumor development through negative regulation of KLF6.

目的 探讨三阴性乳腺癌的灰阶CEUS特征及其诊断价值.方法 回顾性分析37例三阴性乳腺癌(TNBC)患者(TNBC组)及74例非三阴性乳腺癌(NTNBC)患者(NTNBC组),观察灰阶CEUS肿块内造影剂到达时间、达峰时间,测量造影剂达峰时病灶最大径.记录11项灰阶造影增强特征,包括内部强化特征、边缘强化特征、形态、边界、内部回声、周边放射状血管、内部充盈缺损及充盈缺损数量、强化方式、内部及周边扭曲或穿入血管、造影剂滞留.结果 TNBC组病灶最大径较NTNBC组明显增大[(25.26±10.33)mm vs(18.64±6.11)mm,t=4.445,P＜0.001],且2组间病灶边缘强化特征(x2 =6.518,P=0.011)、形态(x2=15.686,P＜0.001)、边界(x2=12.727,P＜0.001)、周边放射状血管(x2=50.825,P＜0.001)、内部充盈缺损(x2=5.556,P=0.018)及充盈缺损数量(x2=13.096,P＜0.001)、强化方式(x2=13.072,P＜0.001)、造影剂滞留(x2=17.731,P＜0.001)差异均有统计学意义,其余灰阶CEUS特征指标在2组间差异均无统计学意义(P均＞0.05).结论 TNBC病灶较大且灰阶CEUS表现具有一定特征,有助于与NTNBC鉴别.

目的 评价超声剪切波弹性成像(SWE)对于超声引导下空芯针穿刺活检诊断为乳腺导管内原位癌(DCIS)的患者组织学升级为浸润性癌的预测价值.方法 选取2013年1月至2019年2月在南京医科大学附属无锡人民医院经超声引导下空芯针穿刺活检诊断为单纯性DCIS患者159例.对患者行常规超声检查、SWE检查及组织病理学检查,记录患者临床病理特征(年龄、空芯针直径、钼靶腺体厚度、病理级别、手术方式)、常规超声图像特征(肿块最大直径、形态、回声、微钙化等)以及SWE图像特征[最大杨氏模量(Emax)值和平均杨氏模量(Emean值)].采用多因素Logistic回归分析穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的影响因素.结果 159例患者术后病理诊断为单纯性DCIS者(单纯DCIS组)105例,诊断为DCIS伴浸润性癌成分者(浸润性癌组)54例,组织学升级率为34.0％(54/159).浸润性癌组与单纯DCIS组肿块可触及、超声测量肿块最大直径、超声显示微钙化位置、超声乳腺影像报告和数据系统(BI-RADS)分级、Emean值及Emax值差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,Emean值是穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的独立预测因素(OR=1.254,95％CI:1.029～1.827,P<0.05).Emean值预测组织学升级的ROC曲线下面积为0.923(95％CI:0.825～1.000),最佳临界值为102.4 kPa,敏感性为94.9％,特异性为83.3％.结论 SWE测量得到的Emean值是术前预测超声引导下穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的有效辅助手段.

Vasculogenic mimicry (VM) is a novel mechanism of tumor blood supply distinct from endothelial vessel (EV). VM is associated with malignancy, invasion, metastasis, and poor prognosis. Hitherto a noninvasive method for the assessment of VM in vivo has been lacking. Contrast-enhanced ultrasound (CEUS) was performed to evaluate the quantitative parameters of tumors in mice. CD31 immunohistochemistry-Periodic Acid-Schiff double staining was conducted to identify the VM or EV in tumor tissues. Correlations between perfusion parameters and VM density was analyzed by Pearson correlation test. By the 15th day after tumor inoculation, the EV and VM density was 31.15 ± 7.14 and 14.11 ± 2.99 per 200× field. The maximal intensity (IMAX) was 301.19 ± 191.56%, and the rise time (RT), time to peak (TTP) and mean transit time (mTT) were 17.38 ± 7.82 s, 20.27 ± 9.61 s and 58.09 ± 26.44 s, respectively. VM density positively correlated to RT (r = 0.3598, P = 0.0226), TTP (r = 0.3733, P = 0.0177) and mTT(r = 0.6483, P <  0.0001), whereas EV density positively correlated to IMAX (r = 0.4519, P = 0.0034). The vascular diameter of VM was substantially larger than that of EV (43.81 ± 5.88 μm vs 11.21 ± 4.13 μm). Three quantitative parameters related to VM were obtained and the relationships between CEUS and VM were established. CEUS might thus provide a novel noninvasive method to assess VM in vivo.

目的 总结药物流产后宫腔少量绒毛残留的声像图特征及其与病理的相关性.方法 选取病理证实为少量绒毛残留的药物流产患者52例,回顾性分析患者药流后至清宫前不同时间的超声声像图特征及血人绒毛膜促性腺激素β亚单位(TBHCG)水平,并与病理对照分析.结果 52例患者,孕囊排出后1周内首次超声检查无异常发现21例,宫腔局部回声不均匀19例,宫腔小片状高回声12例;彩色多普勒血流显像(CDFI)显示宫腔局部点状血流信号29例,无血流信号23例.至清宫术前超声检查平均3.5次/人,宫腔残留声像图随时间延长呈多种回声改变,无明显规律性,清宫术前超声检查宫腔内异常回声呈高回声区16例、混合回声区25例、低回声区11例,范围11～39 mm;随时间延长残留血流信号从无到有,从有到丰富,多普勒频谱特征为滋养层样血流,阻力指数(RI)0.38～0.56,其中17例见血流信号向肌层延伸.患者血TBHCG 3.70～135.41 ng/ml.所有患者均行清宫治疗,宫腔刮出物病理检查均可见蜕变的早孕绒毛,残留呈高回声患者病理成分为少量蜕变的早孕绒毛及坏死的蜕膜组织或伴分泌期内膜、呈低回声患者多伴增生期内膜、混合回声患者多伴纤维素样出血坏死物及炎性细胞浸润.结论 药物流产后少量绒毛残留声像图随时间延长而呈多种回声改变,主要与病理成分不同有关,残留局部彩色血流信号随时间延长而增多,血TBHCG在低水平波动.