To address issues of pesticide resistance and environmental pollution in the chemical control of ginseng black spot (caused by Alternaria panax) and the unstable efficacy of traditional biological control, this study developed chitosan nanoparticles (CSNPs) coloaded with antimicrobial berberine (BR) and immune-activating salicylic acid (SA), referred to as BR/SA@CSNPs, based on the Traditional Chinese Medicine theory of “eliminating pathogens and reinforcing vital qi” (Qu Xie Fu Zheng), aiming to simultaneously suppress pathogens and activate plant resistance. BR/SA@CSNPs were prepared via optimized ionic cross-linking, and the physicochemical properties and stability were characterized. Efficacy was evaluated through in vitro antifungal activity (EC 50 ) and ginseng antioxidant enzyme activity assays. Optimized BR/SA@CSNPs exhibited uniform particle size (162.4 ± 2.5 nm), good dispersity (polydispersity index = 0.149 ± 0.041), environmental stability, and pH-responsive release. In vitro assays demonstrated significant pathogen inhibition (EC 50 = 55.28 μg/ml), mycelial membrane disruption, and induction of oxidative damage. In vivo tests showed that BR/SA@CSNPs induced ginseng to activated antioxidant enzymes and suppressed lipid peroxidation. BR/SA@CSNPs successfully integrated the “eliminating pathogens and reinforcing vital qi” theory: BR directly suppressed pathogens (eliminating pathogens), SA activated SAR to enhance resistance (reinforcing vital qi), and the multifunctional CS carrier provided synergistic effects, offering a novel strategy for efficient and green nanopesticide control of ginseng black spot.

BackgroundPhacoemulsification combined with intraocular lens (IOL) implantation is the standard treatment for cataract. A proportion of patients still experience suboptimal visual outcomes or postoperative complications. This study aimed to investigate the roles of Interleukin-20 (IL-20) and Apelin-13 as biomarkers for assessing visual outcomes and predicting postoperative prognosis following phacoemulsification with IOL implantation.MethodsIn this retrospective study, 193 cataract patients who underwent phacoemulsification combined with IOL implantation between January 2023 and December 2024 were included. Based on the best-corrected visual acuity (BCVA) and complication status at 3 months postoperatively, patients were categorized into good (n = 138) and poor (n = 55) outcome groups. Clinical baseline data, levels of IL-20, Apelin-13 in preoperative serum and intraoperative aqueous humor were compared between two groups. Univariate and multivariate logistic regression analyses were employed to identify factors influencing postoperative outcomes. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of IL-20 and Apelin-13.ResultsThere were significant differences in diabetes history, CRP, and IL-6 levels (p < 0.05). Patients in the poor outcome group exhibited significantly higher IL-20 and lower Apelin-13 levels in both aqueous humor and serum (p < 0.05). Multivariate logistic regression analysis confirmed higher levels of IL-20 and lower levels of Apelin-13 in aqueous humor and serum were independent predictors of poor postoperative outcomes. ROC curve analysis indicated that levels of IL-20 and Apelin-13, as well as the IL-20/Apelin-13 ratio in aqueous humor effectively predicted postoperative outcomes.ConclusionIL-20 and Apelin-13 are significantly associated with the efficacy of cataract surgery. Apelin-13 serves as a protective factor for favorable outcomes, whereas IL-20 is a risk factor. Their ratio shows strong predictive value for adverse prognosis. These biomarkers offer potential for preoperative risk assessment and personalized treatment strategies, with significant clinical implications for improving postoperative outcomes.

Background/Objectives: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is commonly considered as a hepatic manifestation of metabolic syndrome, posing considerable public health and economic challenges due to its high prevalence. This study investigates the diagnostic potential of serum galectin-1 levels in MASLD patients. Methods: A total of 128 participants were analyzed for this study, comprising 68 healthy controls and 60 MASLD patients. The hepatic steatosis index (HSI) and fatty liver index (FLI) were calculated to evaluate the liver steatosis. Serum galectin-1 levels were measured using an enzyme-linked immunosorbent assay. We additionally conducted a comparative analysis of galectin-1 mRNA and protein expression levels in the liver tissue between the mouse models of MASLD, including ob/ob mice (n = 6), high-fat diet-fed C57 mice (n = 6), and the control group (n = 6). Results: Average serum galectin-1 levels significantly differed between groups, with lower values in the controls (p < 0.01). The frequency of MASLD increased with higher quartiles of galectin-1 levels (p < 0.01). The correlation analysis showed a positive relationship between serum galectin-1 and both HSI and FLI (p < 0.01). The multivariate logistic regression indicated that elevated galectin-1 was associated with an increased risk of MASLD (p < 0.01), yielding an area under the receiver operating characteristic curve for predicting MASLD at 0.745 (95% CI: 0.662-0.829). Hepatic galectin-1 levels were also elevated in the MASLD mouse model at both transcript and protein levels (p < 0.01). Conclusions: Serum galectin-1 can be used as a potential biomarker to help diagnose MASLD.

Introduction:This study assessed the safety and efficacy of B cell- and anti-PLA2R antibody-targeted low-dose rituximab therapy in patients with idiopathic membranous nephropathy (IMN). Methods:This was a multicenter, investigator-initiated, open-label, prospective cohort study. Patients were recruited from 10 hospitals in the east coastal region of China between November 1st, 2019 and June 15th, 2023. Enrolled patients were assigned to individualized rituximab therapy (guided by peripheral B cells and anti-PLA2R antibody levels) or standard rituximab therapy (1,000 mg × 2 or 375 mg/m² × 3-4): the individualized group (n = 78) and the standard group (n = 62). Odds ratios (ORs) and 95% confidence intervals (CIs) for response were estimated using multivariate logistic regression models, adjusting for key confounders, with inverse probability of treatment weighting (IPTW) applied to balance demographic and clinical characteristics. The primary outcome was a composite of complete or partial remission of proteinuria. Results:A total of 140 patients were included in the sta tistical analysis, which was completed on June 10th, 2024. After IPTW, baseline characteristics were well balanced between the two groups. Patients were followed every 2 months for 1 year after the first rituximab injection. At 12 months, 57 of 78 patients (73.1%) in the individualized therapy group and 40 of 62 patients (64.5%) in the standard therapy group achieved complete or partial remission [the adjusted risk difference and 95% CI were 0.1 (-0.05 to 0.26); p = 0.001 for noninferiority]. In the weighted cohort, 74.1% in the individualized group and 70.5% in the standard group achieved remission (p = 0.5). The median (interquartile range) total rituximab dose per patient at 1 year was 800 mg (600-1,100 mg), with a total cost of RMB 16,227.5 (13,148-23,536) per unit utility in the individualized group, which was markedly lower than in the standard group. Anti-PLA2R autoantibody negativity at 6 months post-treatment predicted a higher probability of remission. The frequency of adverse events differed significantly between groups (6.4% vs. 12.9%, P = 0.02). Discussion:B cell- and anti-PLA2R antibody-targeted rituximab therapy may be a cost-effective and safe alternative for patients with IMN. Randomized controlled trials with larger samples are needed to confirm these findings. Clinical Trial Registration:https://www.chictr.org.cn/showproj.html?proj=42793, identifier ChiCTR1900026382.

The exostosin 1 and 2 (EXT1/2) complex was recently identified as a potential antigen associated with systemic autoimmunity in PLA2R-negative membranous nephropathy patients. There are currently no reports of circulating antiEXT1/2 antibodies and no clinical studies of EXT1/2-positive membranous nephropathy in the Chinese population.

INTRODUCTION:To evaluate the alterations in the peripapillary retinal thickness and its risk factors in dry-type high myopia (HM). METHODS:One hundred and twenty eyes in 69 HM subjects were collected from March 2023 to July 2023 with the age, refractive diopter, axial length (AL), posterior scleral staphyloma, type of myopic maculopathy, and peripapillary retinal thickness. Divided into three groups according to the international photo-graphic classification system: Category 0 (C0) with no myopic retinal degenerative lesions, Category 1 (C1) with tessellated fundus, and Category 2 (C2) with diffuse chorioretinal atrophy. Peripapillary retinal thickness was assessed using swept-source optical coherence tomography (SS-OCT) B-scans. All data were analyzed with the SPSS software version 23.0 by one-way ANOVA test among three groups. Linear regression and pearson correlation analysis were used to determine the relationships among measurements. RESULTS:The retinal thickness of the peripapillary was measured from the superior, nasal, inferior, and temporal directions around the optic disc. The superior, nasal, and inferior peripapillary retinal thickness in the C2 group decreased significantly in all three groups. The retinal thicknesses decreased significantly with the increase of AL in the superior, nasal, and inferior. The retinal thicknesses increased significantly with the increase of refractive diopter, except for the temporal sector. The retinal thickness decreased significantly with the increase of age in dry-type HM. There was no significant difference between peripapillary retinal thickness and the wide macular staphyloma. CONCLUSIONS:Individuals in the C2 group had a thinner peripapillary retinal thickness than other groups, except for the temporal sector. The retinal thicknesses of the peripapillary decreased significantly with the increase of AL and increased significantly with the increase of refractive diopter, except for the temporal sector. With the increase of age, the retinal thickness of the peripapillary decreased significantly. Ophthalmologists and HM patients should pay attention to changes in the thickness of the peripapillary retina and the growth of age.

Abstract Background and Aims The exostosin 1 and 2 (EXT1/2) complex was recently identified as a potential antigen associated with systemic autoimmunity in PLA2R-negative membranous nephropathy patients. There are currently no reports of circulating anti-EXT1/2 antibodies and no clinical studies of EXT1/2-positive membranous nephropathy in the Chinese population. Method Immunohistochemical staining for PLA2R, THSD7A and NELL-1 was performed in 1442 consecutive patients with biopsy-proven MN from January 2011 to December 2019 at Beijing Anzhen Hospital. A total of 201 MN patients were PLA2R-, THSD7A- and NELL-1-negative and enrolled in the study. Patient medical records were reviewed for clinical data, including demographics, laboratory tests, treatment, and follow-up. The glomerular expression of EXT1 and EXT2 was screened. The anti-EXT1 and anti-EXT2 antibodies were also detected in the sera of patients with EXT1/2–positive membranous nephropathy by western blot, ELISA and immunoprecipitation separately. Clinical and pathologic features were comparable between PLA2R-, THSD7A- and NELL-1-negative patients with EXT1/2 or without EXT1/2 positive. Results Among these 201 patients, 19 of 83 (22.9%) with lupus membranous nephropathy (class 5 and class 5+3/4), and 13 of 118 (11.0%) with nonlupus membranous nephropathy exhibited positive EXT1/2 staining. Thirteen patients with EXT1/2-positive non-LMN had no definitive secondary cause, but 7 patients (53.8%, 7/13) were seropositive for ANA. Baseline anti–double-stranded DNA antibody and serum antinuclear antibody positivity were independent predictors of glomerular EXT1/2-positive expression in patients with lupus membranous nephropathy (pure class 5, class 5 + 3/4) and nonlupus membranous nephropathy, respectively. In 32 patients with EXT1/2-positive MN, 22 patients with available serum samples collected at the time of biopsy were tested for anti-EXT1 and anti-EXT2 antibodies. Sixteen patients were positive for antibodies. According to the molecular weight of positive bands, we speculated that 5 patients were positive for both anti-EXT1 and anti-EXT2 antibodies, 11 patients were positive only for anti-EXT1 antibodies, and no patients were positive only for anti-EXT2 antibodies. There were no significantly differences between the characteristics of 22 EXT1/2-positive MN patients with or without antibody seropositivity. Two patients with EXT1/2-positive membranous nephropathy underwent repeated renal biopsies. When the pathological type changed to lupus nephritis (LN) or the LN worsened clinically, the renal tissue staining intensity of EXT1/2 increased. Renal EXT1/2 staining positivity occurred earlier than the diagnosis of lupus. Conclusion This is the first study to detect circulating anti-EXT1/2 antibodies, and the functional significance should be further studied. The renal EXT1/2 staining positive was earlier than diagnosis of lupus. whether the level of serum EXT1/2 antibody can be used as a predictor for disease progression and prognosis needs to be further evaluated in larger sample studies.

BACKGROUND:To investigate the alterations in the retinal vasculature and microstructure in dry-type high myopia.METHODS:One hundred and eighty-nine dry-type high myopia eyes were classified into three groups. Group 1 consisted of 86 eyes with no myopic retinal degenerative lesion (C0). Group 2 consisted of 71 eyes with tessellated fundus (C1). Group 3 consisted of 32 eyes with diffuse chorioretinal atrophy (C2). Retinal vascular density and retinal thickness were measured with optical coherence tomography angiography. The scanning area was a 3 × 3 mm2 ring with the fovea of the macular. All data were analyzed with the SPSS 23.0 by one-way ANOVA test among comparison groups. Pearson's correlation analysis was used to determine the relations among measurements. Univariate linear regression showed a correlation between the vascular densities and retinal thicknesses.RESULTS:The microvessel density significantly decreased and significant thinning of the superior and temporal macular thickness in the C2 group. The vascular densities of macular decreased significantly with the increase of axial length (AL) and refractive diopter in the C2 group. The retinal thicknesses of the macular fovea increased significantly with the increase of vascular densities in the C0 group and C1 group.CONCLUSIONS:The impairment of retinal microstructure is more likely related to reduced oxygen and nutrients due to microvessel density decreases.

Ovarian cancer is one of the most harmful gynecological diseases. Detecting ovarian tumors in early stage with computer-aided techniques can efficiently decrease the mortality rate. With the improvement of medical treatment standard, ultrasound images are widely applied in clinical treatment. However, recent notable methods mainly focus on single-modality ultrasound ovarian tumor segmentation or recognition, which means there still lacks researches on exploring the representation capability of multi-modality ultrasound ovarian tumor images. To solve this problem, we propose a Multi-Modality Ovarian Tumor Ultrasound (MMOTU) image dataset containing 1469 2d ultrasound images and 170 contrast enhanced ultrasonography (CEUS) images with pixel-wise and global-wise annotations. Based on MMOTU, we mainly focus on unsupervised cross-domain semantic segmentation task. To solve the domain shift problem, we propose a feature alignment based architecture named Dual-Scheme Domain-Selected Network (DS2Net). Specifically, we first design source-encoder and target-encoder to extract two-style features of source and target images. Then, we propose Domain-Distinct Selected Module (DDSM) and Domain-Universal Selected Module (DUSM) to extract the distinct and universal features in two styles (source-style or target-style). Finally, we fuse these two kinds of features and feed them into the source-decoder and target-decoder to generate final predictions. Extensive comparison experiments and analysis on MMOTU image dataset show that DS2Net can boost the segmentation performance for bidirectional cross-domain adaptation of 2d ultrasound images and CEUS images. Our proposed dataset and code are all available at https://github.com/cv516Buaa/MMOTU_DS2Net.

Automatic and precise polyp segmentation is crucial for the early diagnosis of colorectal cancer. Existing polyp segmentation methods are mostly based on convolutional neural networks (CNNs), which usually utilize the global features to enhance local features through well-designed modules, thereby dealing with the diversity of polyps. Although CNN-based methods achieve impressive results, they are powerless to model explicit long-range relations, which limits their performance. Different from CNN, Transformer has a strong capability of modeling long-range relations owing to self-attention. However, self-attention always spreads attention to unexpected regions and the Transformer's ability of local feature extraction is insufficient, resulting in inaccurate localization and fuzzy boundary. To address these issues, we propose PPFormer for accurate polyp segmentation. Specifically, we first adopt a shallow CNN encoder and a deep Transformer encoder to extract rich features. In the decoder, we present the PP-guided self-attention that uses prediction maps to guide self-attention to focus on the hard regions so as to enhance the model's perception of polyp boundary. Meanwhile, the Local-to-Global mechanism is designed to encourage the Transformer to capture more information in the local-window for better polyp localization. Extensive experiments on five challenging datasets show that PPFormer outperforms other advanced methods and achieves state-of-the-art results with six metrics, i.e. mean Dice and mean IoU.

The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x2 = 5.223, p=0.022). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

BACKGROUND The diagnostic specificity of conventional ultrasound for breast non-mass lesions (NMLs) is low at approximately 21%-43%. Shear wave elastography (SWE) can distinguish benign from malignant lesions by evaluating the internal and peripheral stiffness. SWE has good reproducibility and high diagnostic efficacy. However, there are very few independent studies on the diagnostic value of SWE in breast NMLs. AIM To determine the value of SWE in the differential diagnosis of breast NMLs. METHODS This study enrolled a total of 118 patients with breast NMLs who underwent SWE examinations in the Beijing Shijitan Hospital Affiliated to Capital Medical University and The Second Hospital of Shandong University from January 2019 to January 2020. The internal elastic parameters of the lesions were recorded, including maximum (Emax), mean (Emean) and minimum elastic values and the standard deviation. The following peripheral parameters were noted: Presence of a "stiff rim" sign; Emax, and Emean elasticity values within 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm from the edge of NMLs. The receiver operating characteristic curve of each parameter was drawn, and the areas under the curve were calculated. RESULTS Emax, Emean and elastic values, and the standard deviation of the internal elastic values in malignant NMLs were significantly higher than those in benign NMLs (P< 0.05). The percentage with the "stiff rim" sign in malignant NMLs was significantly higher than that in the benign group (P< 0.05), and Emax and Emean at the shell of 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm in the malignant group were all higher than those in the benign group (P< 0.05). Of the surrounding elasticity values, Emax of the shell at 2.5 mm in malignant NMLs had maximum areas under the curve of 0.900, and the corresponding sensitivity and specificity were 94.57% and 85.86%, respectively. CONCLUSION The "stiff rim" sign and multiple quantitative elastic values within and around the lesion had good diagnostic performance in the differential diagnosis of breast NMLs. Emax in peripheral tissue had better diagnostic efficiency than other parameters.

We reported a large Chinese family diagnosed with autosomal dominant tubulointerstitial kidney disease caused by MUC1 mutation (ADTKD-MUC1). Cytosine duplication within a string of 7 cytosines in the variable-number tandem repeats (VNTR) region of the MUC1 gene was detected by long-read single-molecule real-time (SMRT) sequencing. MUC1 frameshift protein (MUC1fs) was found to be expressed in renal tubules and urinary exfoliated cells by pathological examination. The family, which consisted of 5 generations including 137 individuals, was followed for 5 years. Genetic testing was performed in thirty-four individuals, 17 of whom carried MUC1 mutations. The ADTKD-MUC1-affected individuals had an elevated incidence of hyperuricaemia without gout attack. Within five years, higher baseline levels of urinary α1-microglobulin were detected in affected individuals with rapidly progressing renal failure than in affected individuals with stable renal function, and the increases manifested even before increases in serum creatinine. This study demonstrates that SMRT sequencing is an effective method for the identification of MUC1 mutations. The pathological examination of MUC1fs expression in renal tissue and urinary exfoliated cells can contribute to early screening of family members suspected to be affected. It is suggested that affected individuals with elevated urinary α1-microglobulin levels should be closely monitored for renal function.

ObjectivesTo explore the relationships between resting energy expenditure (REE) according to indirect calorimetry, fetal biometric parameters by ultrasound, and birthweight in gestational diabetes mellitus (GDM).MethodsSixty‐five women with GDM and 60 in the control group were enrolled. The REE, birthweight, and fetal biometric parameters according to ultrasound, including biparietal diameter, head circumference, abdominal circumference (AC), and femur length, were measured.ResultsThe AC at 29 to 32 weeks and 37 to 40 weeks was larger in the GDM than in the control group (P < 0.01), birthweight was higher in the GDM than in the control group (P < 0.01), and women in the GDM group had higher REE than those in the control group at all stages of pregnancy (P < 0.01). In the control group, all fetal biometric parameters were correlated with birthweight at 37 to 40 weeks (r= 0.418, 0.678, 0.741, and 0.635 for biparietal diameter, head circumference, AC, and femur length, respectively,P < 0.05); however, in the GDM group, only AC was correlated with birthweight at 37 to 40 weeks (r= 0.707;P < 0.05). In the GDM group, REE was correlated with birthweight at all three stages of pregnancy (r= 0.369, 0.381, and 0.446 for 21 to 24, 29 to 32, and 37 to 40 weeks, respectively,P < 0.05), and REE was correlated with AC at 37 to 40 weeks (r= 0.431;P < 0.05).ConclusionsREE is correlated with birthweight in women with GDM from the middle to the end of pregnancy. REE by indirect calorimetry might be potential index for medical nutrition therapy in GDM.

BACKGROUND Breast non-mass-like lesions (NMLs) account for 9.2% of all breast lesions. The specificity of the ultrasound diagnosis of NMLs is low, and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System (BI-RADS). Contrast-enhanced ultrasound (CEUS) can help to differentiate and classify breast lesions but there are few studies on NMLs alone. AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography (US), color Doppler flow imaging (CDFI) and CEUS, and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs. METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019. All lesions were examined by US, CDFI and CEUS, and their features from those examinations were analyzed. With pathology as the gold standard, binary logic regression was used to analyze the independent risk factors for malignant breast NMLs, and a regression equation was established to calculate the efficiency of combined diagnosis. Based on the regression equation, the combined diagnostic efficiency of US combined with CEUS (US + CEUS) was determined. The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS, and the diagnostic efficiency of CEUS combined with BI-RADS (CEUS + BI-RADS) was calculated based on the results. ROC curves were drawn to compare the diagnostic values of the three methods, including US, US + CEUS, and CEUS + BI-RADS, for benign and malignant NMLs. RESULTS Microcalcification, enhancement time, enhancement intensity, lesion scope, and peripheral blood vessels were significantly different between benign and malignant NMLs. Among these features, microcalcification, higher enhancement, and lesion scope were identified as independent risk factors for malignant breast NMLs. When US, US + CEUS, and CEUS + BI-RADS were used to identify the benign and malignant breast NMLs, their sensitivity rates were 82.6%, 91.3%, and 87.0%, respectively; their specificity rates were 71.4%, 89.2%, and 92.9%, respectively; their positive predictive values were 70.4%, 87.5%, and 90.9%, respectively; their negative predictive values were 83.3%, 92.6%, and 89.7%, respectively; their accuracy rates were 76.5%, 90.2%, and 90.2%, respectively; and their corresponding areas under ROC curves were 0.752, 0.877 and 0.903, respectively. Z tests showed that the area under the ROC curve of US was statistically smaller than that of US + CEUS and CEUS + BI-RADS, and there was no statistical difference between US + CEUS and CEUS + BI-RADS. CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs. The adjustment of the BI-RADS classification according to the features of contrast-enhanced US of NMLs enables the diagnostic results to be simple and intuitive, facilitates the management of NMLs, and effectively reduces the incidence of unnecessary biopsy.

Objective The current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP). Methods A retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed. Results CEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group. Conclusions CEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

Objective: To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). Methods: CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. Results: Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. Conclusion: CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.

Podocyte injury critically contributes to the pathogenesis of obesity-related glomerulopathy (ORG). Recently, lipid accumulation and inflammatory responses have been found to be involved in podocyte injury. This study is to explore their role and relationship in podocyte injury of ORG. In animal experiments, the ORG mice developed proteinuria, podocyte injury, and hypertriglyceridemia, accompanied with deregulated lipid metabolism, renal ectopic lipid deposition, activation of NOD-like receptor protein 3 (NLRP3) inflammasome, and secretion of IL-1β of the kidney. The expression of adipose differentiation-related protein (ADRP), CD36, sterol regulatory element-binding protein 1 (SREBP-1), and peroxisome proliferator-activated receptor α (PPARα) in renal tissue were increased. In in vitro cell experiments, after cultured podocytes were stimulated with leptin, similar to ORG mice, we found aggravated podocyte injury, formatted lipid droplet, increased expression of ADRP and CD36, activated NLRP3 inflammasome, and released IL-1β. In addition, after blocking CD36 with inhibitor sulfo-N-succinimidyl oleate (SSO) or CD36 siRNA, activation of NLRP3 inflammasome and release of IL-1β are downregulated, and podocyte injury was alleviated. However, after blocking NLRP3 with MCC950, although podocyte injury was alleviated and release of IL-1β was decreased, there was no change in the expression of CD36, ADRP, and intracellular lipid droplets. Taken together, our study suggests that CD36-mediated lipid accumulation and activation of NLRP3 inflammasome may be one of the potential pathogeneses of ORG podocyte injury.

Background/Aims . It is known that chronic low-grade inflammation contributes to the initiation and development of both diabetes and diabetic nephropathy (DN), so we designed this study to investigate the role of P2X7R and NLRP3 inflammasome in DN pathogenesis and the antagonistic effects of artificially cultivated Ophiocordyceps sinensis (ACOS). Methods . A rat model of DN caused by high-fat-diet feeding and low-dose streptozotocin injection and a mouse podocyte injury model induced by high-glucose (HG) stimulation were established, and the intervention effects of ACOS on them were observed. The biological parameters of serum and urine and the pathological manifestations of kidney tissue were examined. The expression of mRNA and protein of P2X7R and NLRP3 inflammasome (NLRP3, ASC, and caspase-1) and downstream effectors (IL-1 β and IL-18), as well as podocyte-associated molecules, was determined by real-time quantitative PCR and Western blot assay, respectively. Results . The DN rats showed to have developed insulin resistance, elevated fasting blood glucose, increased urinary protein excretion, and serum creatinine level as well as corresponding glomerular pathological alterations including podocyte damages. ACOS significantly antagonized the above changes. The experiments in vivo and in vitro both displayed that the mRNA and protein expression of P2X7R, NLRP3, ASC, caspase1 (procaspase-1 mRNA in the gene level and active caspase-1 subunit P10 in the protein level), IL-1 β , and IL-18 was significantly upregulated and the mRNA and protein expression of podocyte-associated molecules was significantly changed (downregulation of nephrin, podocin, and WT-1 expression and upregulation of desmin expression) indicating podocyte injury in the kidney tissue of DN rats and in the HG-stressed mouse podocytes, respectively. ACOS also significantly antagonized all the above changes. Conclusion . Our research work suggests that P2X7R and NLRP3 inflammasome are involved in the pathogenesis of DN, and ACOS can effectively inhibit the high expression of P2X7R and the activation of NLRP3 inflammasome, which may contribute to the therapeutic effects of Ophiocordyceps sinensis .