Background: The diagnosis performance of B-mode ultrasound (US) for focal liver lesions (FLLs) is relatively limited. We aimed to develop a deep convolutional neural network of US (DCNN-US) for aiding radiologists in classification of malignant from benign FLLs. Materials and methods: This study was conducted in 13 hospitals and finally 2143 patients with 24,343 US images were enrolled. Patients who had non-cystic FLLs with pathological results were enrolled. The FLLs from 11 hospitals were randomly divided into training and internal validations (IV) cohorts with a 4:1 ratio for developing and evaluating DCNN-US. Diagnostic performance of the model was verified using external validation (EV) cohort from another two hospitals. The diagnosis value of DCNN-US was compared with that of contrast enhanced computed tomography (CT)/magnetic resonance image (MRI) and 236 radiologists, respectively. Findings: The AUC of Model LBC for FLLs was 0.924 (95% CI: 0.889À0.959) in the EV cohort. The diagnostic sensitivity and specificity of Model LBC were superior to 15-year skilled radiologists (86.5% vs 76.1%, p = 0.0084 and 85.5% vs 76.9%, p = 0.0051, respectively). Accuracy of Model LBC was comparable to that of contrast enhanced CT (both 84.7%) but inferior to contrast enhanced MRI (87.9%) for lesions detected by US. Interpretation: DCNN-US with high sensitivity and specificity in diagnosing FLLs shows its potential to assist less-experienced radiologists in improving their performance and lowering their dependence on sectional imaging in liver cancer diagnosis.

The fatality of avian influenza A(H7N9) infection in humans was over 30%. To identify human genetic susceptibility to A(H7N9) infection, we performed a genome-wide association study (GWAS) involving 102 A(H7N9) patients and 106 heavily-exposed healthy poultry workers, a sample size critically restricted by the small number of human A(H7N9) cases. To tackle the stringent significance cutoff of GWAS, we utilized an artificial imputation program SnipSnip to improve the association signals. In single-SNP analysis, one of the top SNPs was rs13057866 of LGALS1. The artificial imputation (AI) identified three non-genotyped causal variants, which can be represented by three anchor/partner SNP pairs rs13057866/rs9622682 (AI P = 1.81 × 10−7), rs4820294/rs2899292 (2.13 × 10−7) and rs62236673/rs2899292 (4.25 × 10−7) respectively. Haplotype analysis of rs4820294 and rs2899292 could simulate the signal of a causal variant. The rs4820294/rs2899292 haplotype GG, in association with protection from A(H7N9) infection (OR = 0.26, P = 5.92 × 10−7) correlated to significantly higher levels of LGALS1 mRNA (P = 0.050) and protein expression (P = 0.025) in lymphoblast cell lines. Additionally, rs4820294 was mapped as an eQTL in human primary monocytes and lung tissues. In conclusion, functional variants of LGALS1 causing the expression variations are contributable to the differential susceptibility to influenza A(H7N9).

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. The data on this syndrome in a Chinese community are limited. Methods: A community-based cross-sectional survey was undertaken. Cluster-randomized sampling was used. Female residents of Chengdu aged between 12 and 44 were included according to the constituent ratio of the female population of Sichuan province. We used three diagnostic criteria to determine the prevalence: the National Institutes of Health diagnostic criteria of PCOS (NIH-1990), the revised Rotterdam diagnostic criteria of PCOS (Rott-2003), and the recommended diagnostic criteria of PCOS by the Androgen Excess Society (AES-2006). Results: 1,645 participants were included. The prevalence of PCOS in women aged between 12 and 44 was 7.1, 11.2 and 7.4%, respectively, according to the three different criteria. After the onset of puberty, the prevalence of PCOS increased rapidly from 12 to 14 years of age, peaked between 15 and 24 and decreased gradually thereafter and reached its lowest point before menopause. Conclusions: The prevalence of PCOS in this study was in the PCOS prevalence range from existing studies. According to the trend of prevalence, PCOS might be a temporary condition.

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An evaluation of the effects of a traditional Chinese herbal medicine, Hochu-ekki-to (Bu-zong-yi-qi-tang) on endometrial carcinogenesis was performed in experiments with female mice. In the short-term experiment, dietary exposure of Hochu-ekki-to (0.2% for 2 weeks) decreased the estradiol-17ß (E2)-stimulated expression levels of c-jun (P<0.001), tumor necrosis factor (TNF)-• (P<0.005), estrogen receptors (ER)-• (P<0.001) and ER-ß (P<0.005), as determined by reverse transcription-polymerase chain reaction and a Southern blot analysis in the uteri of the ovarectomized mice. In the long-term experiment, the mice were given N-methyl-N-nitrosourea (MNU) solution (1 mg/100 g body weight) and normal saline (as controls) into their left and right uterine corpora, respectively, and then were divided into four groups. Group 1 (25 mice) was given a diet with Hochu-ekki-to and 5 ppm E2. Group 2 (25 mice) was given a diet with E2 alone. Group 3 (25 mice) was given a diet with Hochu-ekki-to alone. Group 4 (25 mice) was kept on the basal diet alone and treated as a control. The incidence of uterine endometrial cancer in the group with Hochu-ekki-to treatment was substantially lower than of the control group. The inhibitory effect of Hochu-ekki-to on endometrial carcinogenesis is thus suggested to decrease the expressions of c-jun, TNF-•, ER-• and-ß.

PurposeThis study aimed to investigate the value of shear wave elastography (SWE) for characterization of breast masses in a Chinese population.Patients and methodsTwo thousand two hundred seventy-three women consented to be prospectively enrolled for the characterization of breast masses with ultrasound and SWE. Breast masses were known from symptoms, palpability, and/or previous imaging screening with mammography and/or ultrasound. Correlation of SWE qualitative and quantitative features with malignancy risk and impact on diagnostic performance of combining SWE features were assessed, and the Breast Imaging Reporting and Data System (BI-RADS) scoring was calculated using histopathology as reference.ResultsData of 2,262 masses (median size: 13 mm; range: 1.3–50) from 2,262 patients (median age: 43 years; range: 18–91) were investigated, of which 752 (33.3%) were malignant. Sensitivity and specificity of BI-RADS diagnosis were 97.5% (733/752) and 54.8% (827/1,510), respectively. By logistic regression, the combination of maximum elasticity (Emax) measurements with BI-RADS assessments increased the area under the receiver operating characteristic curve from 0.908 (95% CI: 0.896–0.920) to 0.954 (95% CI: 0.944–0.962). Using Emax of 30 kPa or lower to selectively downgrade BI-RADS 4a masses to follow-up, and Emax of 160 kPa or higher to selectively upgrade BI-RADS 3 lesions to biopsy, specificity significantly increased from 54.8% (827/1,510) to 66.1% (998/1,510) (P<0.001) while sensitivity decreased nonsignificantly from 97.5% (733/752) to 96.9% (729/752) (P=0.2891). Positive predictive value for biopsy recommendation increased from 51.7% (733/1,417) to 58.7% (729/1,241) (P<0.001).ConclusionAdding SWE maximum stiffness to BI-RADS 3 and BI-RADS 4a breast masses in a Chinese population increased significantly the specificity of breast ultrasonography, without significant change in sensitivity.

There is limited evidence that the addition of CHM to clomiphene is associated with improved clinical pregnancy outcomes and no other evidence of any other effect. The methodology of RCTs was not adequately reported by primary studies.

Abstract. We have previously reported on the inhibitory effect of Glycyrrhizae radix (Gl radix) on mouse endometrial carcinogenesis. The present study was performed to clarify the effects of Gl radix and glycyrrhizin (GL), the main part of Gl radix, on estradiol (E 2 )-related endometrial carcinogenesis. Both Gl radix and GL exerted a significant decrease in the COX-2, IL-1· and TNF-· mRNA expressions. GL generated a significant decrease in the incidence of endometrial adenocarcinoma. Accordingly, the preventive effects of Gl radix may be attributable to GL, thus being related with the suppression of COX-2, IL-1· and TNF-·. Gl radix and GL could therefore be a promising formula for the chemoprevention of human endometrial cancer. IntroductionGlycyrrhizin (GL), a major constituent of Glycyrrhizae radix (Gl radix) which is ~10% of the dry weight of Gl radix extract, is the calcium and potassium salt of glycyrrhizinic acid. GL glycoside loses its sweet taste and upon hydrolysis is then converted to aglycone glycyrrhetinic acid plus two molecules of glucuronic acid. GL has an anti-estrogenic as well as an estrogenic effect (1). There is some evidence that GL has a protective effect on the skin (2,3) or liver carcinogenesis (4,5).It is known that Gl radix is widely used as a Kampo medicine in Asian countries and ~75% of traditional Japanese and Chinese medicines contain this agent. We have previously reported that Gl radix has a preventive effect on endometrial carcinogenesis in mice, and this effect is related to the inhibition of the expression of estrogen-stimulated genes c-fos/jun mRNA and proteins (6). We also proved that the herbal complex containing Gl radix suppresses cell proliferation in a chemo-endocrine resistant cancer cell line (7). In general, the anti-estrogenic effects are considered to have a protective effect against the occurrence of estrogendependent cancers. Such effects are confirmed in animal models of uterine endometrial cancer (8).Cyclooxygenase (COX), an enzyme that activates the production of prostaglandins from arachidonic acid, has two isoforms. COX-2 has attracted considerable attention in connextion with carcinogenesis in organs such as the large bowel, mammary glands and breast carcinogenesis (9-11). There is evidence that the COX activity is related to the promotion and progression in the tumorigenesis of the prostatic gland, stomach and lung (12)(13)(14). It remains unclear whether COX-2 is involved in E 2 related mouse endometrial carcinogenesis, although a high expression level of COX-2 has been confirmed in human endometrial carcinomas (15). In this study, we examined the possible association of the preventive effects of GL on E 2 -induced mouse endometrial carcinogenesis with COX-2 activity.We have reported that the expression of internal cytokines, interleukin (IL)-1· and tumor necrosis factor (TNF)-·, increase after E 2 treatment (16). Such an increase of the internal cytokines is suggested to contribute to both tumor promotion and progression (17)(18)(19). Such circumstances ...