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Background: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor in the liver. Partial hepatectomy is one of the most effective therapies for HCC but suffer from the high recurrence rate. At present, the studies of association between clinical outcomes and CT features of patients with HCCs undergoing partial hepatectomy are still limited. The purpose of this study is to determine the predictive CT features and establish a model for predicting relapse or metastasis in patients with primary hepatocellular carcinomas (HCCs) undergoing partial hepatectomy.Methods: The clinical data and CT features of 112 patients with histopathologically confirmed primary HCCs were retrospectively reviewed. The clinical outcomes were categorized into two groups according to whether relapse or metastasis occurred within 2 years after partial hepatectomy. The association between clinical outcomes and CT features including tumour size, margin, shape, vascular invasion (VI), arterial phase hyperenhancement, washout appearance, capsule appearance, satellite lesion, involvement segment, cirrhosis, peritumoral enhancement and necrosis was analyzed using univariate analysis and binary logistic regression. Then establish logistic regression model, followed by receiver operating characteristic (ROC) curve analysis.Results: CT features including tumor size, margin, shape, VI, washout appearance, satellite lesion, involvement segment, peritumoral enhancement and necrosis were associated with clinical outcomes, as determined by univariate analysis (POR=6.41 and 10.92 respectively). The logistic regression model was logit(p)=-1.55+1.86 margin +2.39 VI. ROC curve analysis showed that the area under curve of the obtained logistic regression model was 0.887(95% CI：0.827-0.947).Conclusion: Patients with ill-defined margin or VI of HCCs were independent risk predictors of poor clinical outcome after partial hepatectomy. The model as logit(p)= -1.55+1.86 margin +2.39 VI was a good predictor of the clinical outcomes.

Background To investigate whether the relative computed tomography (CT) value (rCT) of adjacent pancreatic parenchyma can distinguish focal‐type autoimmune pancreatitis (fAIP) from pancreatic ductal adenocarcinoma (PDAC). Methods A total of 13 patients with fAIP and 20 patients with PDAC were included in this study. The rCT was calculated as the ratio of the CT value of adjacent pancreatic parenchyma to that of muscle. The diagnostic performance of rCT for discriminating fAIP from PDAC was evaluated using receiver operating characteristic (ROC) analysis. Results Both fAIP and PDAC presented hyper‐fibrosis histologically and delayed enhancement on CT examination. Moreover, the pancreatic parenchyma of fAIP presented serious inflammation. The mean rCT of the parenchyma was significantly lower in fAIP than in PDAC in all phases. The best diagnostic performance of the rCT value was found in the pancreatic phase, with an area under the ROC curve of 0.912, while the areas under the ROC curve of the portal and delayed phases were 0.812 and 0.754, respectively. The optimal cut‐off value for distinguishing fAIP from PDAC was 1.62 in the pancreatic phase. Conclusions The rCT of the pancreatic parenchyma during the pancreatic phase may be a feasible CT feature for differentiating fAIP from PDAC., Similar imaging features such as regional enlargement of the pancreas and delayed enhancement became a big challenge to differentiate focal‐type autoimmune pancreatitis (fAIP) from PDAC. In this study, we found that the pancreatic parenchyma of fAIP presented severe inflammation. Moreover, the mean relative computed tomography values of the pancreatic parenchyma were lower in fAIP than that in PDAC in all phases.

Currently, the broad use of monovalent aptamers in oncology faces challenges, including insufficient recognition and internalization caused by a finite number of receptors on the cell surface, as well as a confined recognition spectrum. Herein, we describe the development of a dual-targeting circular aptamer (DTCA) that can recognize two different biomarkers on living cells to augment aptamer-receptor interactions, thus enhancing recognition of the target cells. This improvement not only boosts binding and internalization abilities, but also expands the recognition spectrum of these aptamers to different leukemia cells. Moreover, the stability of DTCA in serum can be significantly improved by an enzyme-promoted terminal ligation strategy. The chemical incorporation of 5-fluorodeoxyuridine into DTCA resulted in a pharmaceutically functional aptamer that exhibited excellent selectivity, as demonstrated by its high cytotoxicity against target cancer cells, but not to normal cells. The superiority of our newly developed strategy was further highlighted by its precise tumor-imaging capability.

OBJECTIVE. The purpose of our study was to retrospectively characterize the CT and MRI features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). MATERIALS AND METHODS. Eleven patients (10 women and one man; age range, 30-63 years) with 11 pathologically proven LELCCs were enrolled retrospectively from April 2016 to December 2018. Triphasic enhanced images were obtained of all patients: MR images of five patients, CT images of five patients, and both CT and MR images of one patient. The clinical data and CT and MRI findings were reviewed. RESULTS. All LELCC cases were associated with Epstein-Barr virus (EBV) infection. Eight of the 11 patients had hepatitis B virus (HBV) infection. The tumor diameter ranged from 1.1 to 8.7 cm. All tumors were well defined with a smooth or lobulated margin. A cystic area was noted in two of the 11 tumors. After the administration of contrast material, the tumors showed homogeneous (n = 7) or heterogeneous (n = 4) hypervascular arterial enhancement and gradual washout, delayed central scar or irregular enhancement (n = 9), delayed circular thin or incomplete pseudocapsule enhancement (n = 7), and homogeneous hypointensity in the hepatobiliary phase (n = 2). No cirrhosis, focal dilatation of intrahepatic ducts, or satellite nodules were detected. Lymphadenopathy were detected in four patients, appearing as hypervascular enhancement and no necrosis (even in multiple nodes > 3 cm) or as moderate peripheral enhancement and necrosis. CONCLUSION. A liver mass in a middle-aged woman with EBV and HBV infection that appears on CT and MRI to have a well-defined boundary and a combination of hypervascularity, washout, delayed intratumoral enhancement, or pseudocapsule enhancement may suggest an imaging diagnosis of primary LELCC. More cases are needed to better understand this disease.

Background Infection prevention and control (IPC) measures are crucial to combat the COVID-19 pandemic. This study aimed to explore the levels and determinants of HCWs’ IPC behaviors based on the theoretical domains framework (TDF), which has been shown to be effective in guiding behavior change. Methods A cross-sectional survey was conducted in Wuhan, China in January 2020. Self-reported hand hygiene and droplet isolation behaviors (including the use of masks, gloves, goggles and gowns) were set as dependent variables. TDF domains and HCWs’ characteristics were independent variables. Negative binomial regression analyses were performed to explore their relationships. Results HCWs reported good IPC behaviors, while the compliance with goggle and gown use was relatively low (below 85%). Environmental context and resources domain was significantly related to hand hygiene (β = 0.018, p = 0.026), overall droplet isolation behaviors (β = 0.056, p = 0.001), goggle (β = 0.098, p = 0.001) and gown use (β = 0.101. p p = 0.005) and gown use (β = 0.053, p = 0.013). Emotion domain was a predictor of overall droplet isolation behaviors (β = 0.043, p = 0.016), goggle (β = 0.074, p = 0.026) and gown use (β = 0.106, p p = 0.029) and gown use (β = 0.039, p = 0.035). HCWs in high-risk departments had better behaviors of gown use (β = 0.158, p = 0.032). HCWs who had encountered confirmed or suspected patients reported worse behaviors of goggle (β = − 0.127, p = 0.050) and gown use (β = − 0.153, p = 0.003). Conclusions Adequate personal protective materials and human resources, education and training, as well as supervision and role model setting are necessary to improve IPC behaviors regarding the COVID-19 pandemic.

Background: Irrational use of antimicrobial agents for gastrointestinal diseases deserves attention, but corresponding antimicrobial stewardship programs (ASPs) are generally not a priority for managers. We conducted this study to evaluate the effectiveness of multifaceted pharmacist-led (MPL) interventions in the gastroenterology ward (GW) to provide evidence for the efficacy of ASPs in a non-priority department. Methods: This was an interventional, retrospective study implemented in China. The MPL intervention lasting 1.5 years involved daily ward rounds with physicians, regular review of medical orders, monthly indicator feedback, frequent physician training, and necessary patient education. Data on all hospitalized adults receiving antibiotics was extracted from the hospital information system over a 36-month period from January 2016 to December 2018. Segmented regression analysis of interrupted time series was performed to evaluate the effect of the MPL interventions (started in July 2017) on antibiotic use and length of hospital stay, which was calculated monthly as analytical units. Results: A total of 1763 patients receiving antibiotics were enrolled. Segmented regression models showed descending trends from the baseline in the intensity of antibiotic consumption (coefficient = -0.88, p = 0.01), including a significant decline in the level of change of the proportion of patients receiving combined antibiotics (coefficient = -9.91, p = 0.03) and average length of hospital stay (coefficient = -1.79, p = 0.00), after MPL interventions. The MPL interventions led to a temporary increase in the proportion of patients receiving antibiotics (coefficient = 4.95, p = 0.038), but this was part of a declining secular trend (coefficient = -0.45, p = 0.05). Conclusion: The MPL interventions led a statistically significant decline in the number of patients receiving antibiotics, the antibiotic consumption and the average hospital stay post-intervention compared to the pre-intervention phase of the study. Health policymakers should actively practice MPL interventions by clinical pharmacists in ASPs in those departments that are not included in priority management.

To explore the relationship between osteosclerotic changes and chemotherapy response in non-small-cell lung cancer (NSCLC) patients with bone metastases (BM). Fifty-two NSCLC patients with BM were enrolled from 1 January 2010–31 June 2015 and divided into two groups based on their CT features: an osteosclerotic change (OC) group and a no-osteosclerotic change (NOC) group. The disease control rate (DCR) was evaluated, and progression-free survival (PFS) was analysed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were performed to analyse the factors that could affect PFS. Osteosclerotic changes were observed in 35/52 patients. The median interval when osteosclerotic changes occurred was 2 months (range 1–3 months) after chemotherapy. The OC group had a significantly higher 3-month DCR than the NOC group (p < 0.001). The OC group had a higher 1-year PFS rate than the NOC group (1-year PFS: 74.9% vs. 30.2%, p < 0.001). Univariate Cox regression analysis indicated that pathological subtype (HR = 4.419; 95% CI = 1.635–11.941, p = 0.003) and osteosclerotic changes (HR = 0.199; 95% CI = 0.083–0.477, p < 0.001) were significant predictors of PFS. Early osteosclerotic changes predict chemotherapy response in NSCLC patients with BM. • Osteosclerotic changes were prevalent CT features after chemotherapy in NSCLC patients. • Osteosclerotic changes were positively related to increased 3-month DCR. • Osteosclerotic changes were positively related to increased 1-year PFS rate.

To investigate the predictive clinical and imaging factors associated with pulmonary metastasis in pulmonary nodules (PNs) ≤10 mm in patients with primary extrapulmonary malignancy (PEPM) on initial CT as well as the inter-nodular imaging features in the non-solitary PNs patients, to make a more reliable diagnosis and appropriate management of the PNs at an earlier stage after detection. 161 patients with PNs ≤10 mm were reviewed from April 2013 to December 2013. The nature of PNs were determined on the interval change in imaging features on serial CT images (158 patients) and histologically proven (three patients). Independent predictors of changed PNs on initial CT were examined by multivariate regression analysis. 36.6% of patients developed interval change in nodules size. The average interval of the first change was 65.0 days (29–144 days). Tumor staging of III (P = 0.011) and IV (P

Background COVID-19 arise global attention since their first public reporting. Infection prevention and control (IPC) is critical to combat COVID-19, especially at the early stage of pandemic outbreak. This study aimed to measure level of healthcare workers’ (HCW’) self-reported IPC behaviors with the risk of COVID-19 emerges and increases. Methods A cross-sectional study was conducted in two tertiary hospitals. A structured self-administered questionnaire was delivered to HCWs in selected hospitals. The dependent variables were self-reported IPC behavior compliance; and independent variables were outbreak risk and three intent of infection risk (risk of contact with suspected patients, high-risk department, risk of affected area). Chi-square tests and multivariable negative binomial regression models were employed. Results A total of 1386 participants were surveyed. The risk of outbreak increased self-reported IPC behavior on each item (coefficient varied from 0.029 to 0.151). Considering different extent of risk, HCWs from high-risk department had better self-reported practice in most IPC behavior (coefficient ranged from 0.027 to 0.149). HCWs in risk-affected area had higher self-reported compliance in several IPC behavior (coefficient ranged from 0.028 to 0.113). However, HCWs contacting with suspected patients had lower self-reported compliance in several IPC behavior (coefficient varied from − 0.159 to − 0.087). Conclusions With the risk of COVID-19 emerges, HCWs improve IPC behaviors comprehensively, which benefits for better combat COVID-19. With the risk (high-risk department and affected area) further increases, majority of IPC behaviors achieved improvement. Nevertheless, under the risk of contact with suspected patients, HCWs show worse IPC behaviors. Which may result from higher work load and insufficient supplies and resources among these HCWs. The preparedness system should be improved and medical assistance is urgently needed.

In this article, an ambient mass spectrometric method with molecularly imprinted polymer (MIP)-coated wooden tips was developed for sensitive analysis of trace macrolide antibiotics in complex food samples. A novel solid-phase microextraction (SPME) probe was prepared, via the modification of a layer MIP coating (with roxithromycin as template molecule) on the surface of wooden tips. The obtained MIP-coated wooden-tip SPME probe can be applied directly to enrich trace macrolide antibiotics from complex food samples, with enrichment factors of 244–1604, 72–370, and 12–82 folds for analysis of five investigated macrolide antibiotics in drinking water, honey, and milk samples, respectively. After extraction, a high voltage and some spray solvent were applied on the loaded SPME probe to desorb and ionize analytes enriched on the probe surface for electrospray ionization mass spectrometric (ESI-MS) analysis under ambient and open-air conditions. The method showed good linearity, with correlation coefficient values (r2) no less than 0.9904, and the calibration function was verified via Mandel's fitting test (p > 0.063). The limits of detection were in the range of 0.003–0.05, 1.1–5.1, and 1.9–15.8 ng/g for analysis of drinking water, honey, and milk samples, respectively. Recoveries of the five targeted macrolide antibiotics in honey and milk samples ranged from 73.4% to 98.1%, with the standard deviations no higher than 8.6%. As a result, MIP-coated wooden-tip ESI-MS method could be feasibly used as a sensitive method for determination of trace macrolide antibiotics in complex food samples.

To investigate the optimal monochromatic energy for artifacts reduction from 125I seeds as well as image improvement in the vicinity of seeds on monochromatic images with and without metal artifacts reduction software (MARS) and to compare this with traditional 120-kVp images, so as to evaluate the application value of gemstone spectral imaging for reducing artifacts from 125I seeds in liver brachytherapy. A total of 45 tumors from 25 patients treated with 125I seed brachytherapy in the liver were enrolled in this study. Multiphasic spectral computed tomography (CT) scanning was performed for each patient. After a delay time of 15 s of portal vein phase, a traditional 120-kVp scan was performed, focusing on several planes of 125I seeds only. The artifact index (AI) in the vicinity of seeds and the standard deviation (SD) of the CT density of region of interest in the outside liver parenchyma were calculated. Artifact appearance was evaluated and classified on reconstructed monochromatic S and 120-kVp images. Image quality in the vicinity of seeds of three data sets were evaluated using a 1–5 scale scoring method. The Friedman rank-sum test was used to estimate the scoring results of image quality. The greatest noise in monochromatic images was found at 40 keV (SD = 27.38, AI = 206.40). The optimal monochromatic energy was found at 75 keV, which provided almost the least image noise (SD = 10.01) and good performance in artifact reduction (AI = 102.73). Image noise and AI reduction at 75 keV was decreased by 63.44 and 50.23 %, compared with at 40 keV. Near-field thick artifacts were obvious in all 45 lesions, in 120-kVp images, and 75-keV images, but basically reduced in 75 keV MARS images and artifacts completely invisible in 7 lesions. The number of diagnosable images (score ≥3) was significantly more in the 75-keV MARS group (28/45), and the 75-keV group (22/45) than in the 120-kVp group (11/45) (p

Interest is growing in the interventional surgery training system used before the treatment of vessel diseases. As one of the elementary component of the simulator, an accurate reconstruction of blood vessel obtaining from cross-sectional images is ugly needed. Digital Subtraction Angiography (DSA) data is used as a criterion for reconstruction result of blood vessel. In this paper, an improved threshold method is proposed to segment blood vessel from medical images. Firstly, with optimization characteristic, the genetic algorithm is used to determine the pre-segmentation greyscale from best histogram entropy. Secondly, we enlarge greyscale around the best greyscale to adjust image intensity value which can greatly singularize the region of interest. And then, classical threshold method (Otsu algorithm) is used to determine the best threshold value which can separate blood vessel from background. To test the improved method, comparative trial was set to testify the improvement. Finally, a series of DSA images were obtained to demonstrate this method and the final experimental results showed the effectiveness of the improved method.

The chemokines eotaxin-1 (CCL11) and eotaxin-2 (CCL24), belonging to the CC chemokines family, play key roles in the inflammatory response, allergic asthma and other diseases. When expressed in Escherichia coli, chemokines are prone to form inclusion bodies devoid of biological activity, and it is hard to refold them properly. Here an expression and purification protocol for high-level production of soluble and biologically active CCL11 and CCL24 in E. coli has been established. A final yield of 8.7 mg/l for CCL11 and 3.9 mg/l for CCL24 has been obtained and the purified proteins were characterized with SDS-PAGE, mass spectrometry and circular dichroism. High binding affinity of purified chemokines with C C chemokine receptor type 3 (CCR3) has been confirmed with surface plasmon resonance (SPR) and the KD values are 3.7 × 10−7 M and 3.0 × 10−7 M, respectively, for CCL11 and CCL24. This report provides a straightforward strategy for the efficient production of soluble and biologically active chemokines in E. coli.

To retrospectively evaluate risk factors related to incomplete computed tomography (CT)-guided radiofrequency (RF) ablation of metastatic and primary lung tumors.This study included 93 patients with 147 tumors: 70 men, 23 women; median age 54 y (range, 19-81 y); 24 cases of primary lung tumors, 69 cases of metastases; average largest diameter of tumors, 1.8 cm ± 1.2 (range, 0.3-6.0 cm). Local efficacy was evaluated based on CT follow-up scans. Complete ablation rates (CARs) for tumors were calculated according to several variables; independent risk factors for local tumor progression (LTP) were examined by binary logistic regression analysis.CAR of tumors was 60.54% within first 6 months after lung RF ablation; median interval of LTP was 1.5 months (mean, 1.3 months ± 1.0; range, 0 days to 3 months). Compared with tumors3 cm, CAR of tumors ≤ 3 cm was significantly higher (68.55% vs 17.39%, P.001). CAR of tumors with complete ablation margin (AM) was dramatically higher compared with tumors with incomplete AM (74.77% vs 16.67%, P.001). Among tumors with complete AM, CAR of tumors with shortest distance between outer edge of tumor and AM (ablative margin D) ≥ 5 mm was compared with tumors with ablative margin D 1-4 mm (85.96% vs 62.96%, P = .005). Multivariate regression analysis showed that lobulation and/or spicules, contact with blood vessels, and ablative margin D5 mm were independent risk factors for incomplete lung RF ablation. LTP was likely to develop at the edge of ablated lesions and especially the site of incomplete AM or shortest AM.RF ablation for lung cancers should be individualized based on tumor size, morphology, and tumor type to obtain an adequate AM.

A novel mixed micelle made of Tween 80 and soybean phospholipids (S80) was prepared and used as the delivery system for paclitaxel (PTX), with the purpose of improving the stability, therapeutic index, and security of PTX in comparison with Taxol® injection. The micelle size, morphological features, dilution stability, and critical micelle concentration (CMC) were measured. The in vitro antitumor activity, pharmacokinetics, and hemolysis effect of the optimal PTX-loaded mixed micelles (PTX-M) were evaluated and compared with Taxol®. The results showed that PTX-M was more stable than Taxol® upon dilution. PTX-M had a higher antitumor efficacy against HeLa and A549 cells than that of Taxol®. The plasma AUC of PTX-M was 1.3-fold higher than that of Taxol® and the hemolysis test revealed that PTX-M was safe for intravenous injection. In conclusion, PTX-M had a higher dilution stability and antitumor efficacy than Taxol®, but significantly reduced the toxicity while improving the bioavailability of PTX. Therefore, Tween 80-S80 mixed micelles could be a promising drug carrier for intravenous administration of PTX.

Poly(methacrylic acid-grafted-poly(ethylene glycol)) (P(MAA-g-EG)) hydrogel nanoparticles (HNPs) were prepared by a thermally-initiated free radical dispersion polymerization method. The effects of various reaction parameters on the preparation of HNPs were investigated, including the quantity of monomer, temperature, initiator dosage, crosslinker dosage, and co-stabilizer concentration. The reaction temperature at 75 °C was found to be suitable for preparing stable and small P(MAA-g-EG) HNPs. By adding a little amount of polyvinyl alcohol in the reaction media, P(MAA-g-EG) HNPs with narrow size distribution could be obtained. The effects of pH and the crosslinker dosage on the equilibrium swelling behavior of P(MAA-g-EG) HNPs were also studied. The P(MAA-g-EG) HNPs perform pH-responsive swelling behavior, which is strongly influenced by the crosslinker dosage.

The aim of this study was to develop a new phospholipid complex self-emulsifying drug delivery system (PC-SEDDS) to enhance bioavailability of oral etoposide, a drug with poor water solubility.Etoposide-phospholipid complex (EPC) was prepared by reacting etoposide and phospholipid in tetrahydrofuran and confirmed as a phospholipid compound by differential scanning calorimetry (DSC). Solubility of EPC and etoposide was determined in various vehicles. Pseudoternary phase diagrams were constructed to identify the efficient self-emulsification region of EPC-SEDDS, and the effects of oil concentration, drug loading, and aqueous media on droplet size were investigated.The optimal formulation of EPC-SEDDS was EPC:octyl and decyl monoglyceride (ODO):Cremopher EL:PEG-400 (1:20:48:32) (w/w/w/w). Compared with etoposide-phospholipid complex suspension (EPCS) and etoposide suspension (ES), cumulative release of etoposide from EPC-SEDDS increased by 1.31 and 2.65 fold at 24 hours, respectively. Compared with ES, relative bioavailability of EPC-SEDDS, E-SEDDS, and EPCS after oral administration in rats was enhanced by 60.21-, 44.9-, and 8.44- fold, respectively.The synergistic effect between PC and SEDDS contributed to the enhanced bioavailability of etoposide. It was concluded that PC-SEDDS proved to be a potential system for delivering orally administered hydrophobic compounds including etoposide.