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Purpose: To assess the long-term results after Rex bypass (RB) shunt and Rex transposition (RT) shunt and determine the optimal approach., Methods: Between 2010 and 2019, traditional RB shunt was performed in 24 patients, and modified RT shunt was performed in 23 children with extrahepatic portal hypertension (pHTN). A retrospective study was conducted based on comparative symptoms, platelet counts, color Doppler ultrasonography and computed tomographic portography of the portal system, and gastroscopic gastroesophageal varices postoperatively. The portal venous pressure was evaluated intraoperatively., Results: The operation in the RB group was notably more time-consuming than that in the RT group (P < 0.05). Compared to RT shunt, the reduction in gastroesophageal varix grading, the increases in platelets, and the caliber of the bypass were greater in the RB group (P < 0.05). Although not statistically significant, higher morbidity of surgical complications was found after RT shunt (17.4%) compared with RB shunt (8.3%) with patency rates of 82.6 and 91.7%, respectively. Additionally, patients exhibited a lower rate of rebleeding under the RB procedure (12.5%) than under the RT procedure (21.7%)., Conclusions: The RT procedure is an alternative option for the treatment of pediatric extrahepatic pHTN, and RB shunt is the preferred procedure in our center.

OBJECTIVE. Pulmonary intravascular metastasis is a special type of pulmonary metastasis of malignancies; however, few relevant studies have been performed. This study aimed to determine the characteristics of pulmonary intravascular metastasis and improve understanding of the disease by retrospective analysis of FDG PET/CT and thin-layer high-resolution CT (HRCT) imaging of the chest in patients with tumors. MATERIALS AND METHODS. We identified all patients who underwent FDG PET/CT at two hospitals between January 2016 and February 2019 and conducted a comparative analysis of HRCT and PET/CT images. In total, 84 patients (38 women and 46 men) ranging in age from 35 to 82 years old (mean age, 54.7 ± 14.5 [SD] years) participated in the study. Patient characteristics were summarized, and diagnosis was confirmed by chest CT or PET/CT follow-up. RESULTS. A total of 260 pulmonary intravascular metastases were found, which were classified as type I (no significant abnormality, n = 5), type II (abrupt and uneven thickening of the pulmonary vessel, n = 118), type III (simultaneous invasion of adjacent pulmonary vessel, n = 121), and type IV (large strip-shaped high-density mass, n = 16). The majority were located in peripheral pulmonary vessels (94.2% [245/260]). FDG up-take was increased in 252 lesions, and the mean SUV max was 4.6 ± 2.5. CONCLUSION. The combination of PET/CT and chest HRCT is an effective approach for detecting pulmonary intravascular metastasis. The linear pattern of FDG uptake, abnormal pulmonary blood vessel morphology, and location (below the lung segment) are specific indicators for the diagnosis of pulmonary intravascular metastasis and should be recognized by clinicians and radiologists.

Background: The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein (CTPV) in children that creates a bypass between the superior mesenteric vein and the intrahepatic left portal vein (LPV). This procedure can relieve portal hypertension and restore physiological hepatopetal flow. However, the modified procedure is technically demanding because it is difficult to make an end-to-end anastomosis of a bypass to a hypoplastic LPV. Many studies reported using a recanalized umbilical vein as a conduit to resolve this problem. However, the feasibility of umbilical vein recanalization for a Rex shunt has not been fully investigated., Aim: To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children by ultrasonography., Methods: A total of 47 children who were diagnosed with CTPV with prehepatic portal hypertension in the Second Hospital, Cheeloo College of Medicine, Shandong University, were enrolled in this study. Fifteen children received a recanalized umbilical vein as a conduit for a Rex shunt surgery and were enrolled in group I. Thirty-two children received the classic Rex shunt surgery and were enrolled in group II. The sonographic features of the two groups related to intraoperative and postoperative variation in terms of bypass vessel and the LPV were compared., Results: The patency rate of group I (60.0%, 9/15) was significantly lower than that of group II (87.5%, 28/32) 7 d after (on the 8 th d) operation ( P < 0.05). After clinical anticoagulation treatment for 3 mo, there was no significant difference in the patency rate between group I (86.7%, 13/15) and group II (90.6%, 29/32) ( P > 0.05). Moreover, 3 mo after (at the beginning of the 4 th mo) surgery, the inner diameter significantly widened and flow velocity notably increased for the bypass vessels and the sagittal part of the LPV compared to intraoperative values in both shunt groups ( P < 0.05). However, there was no significant difference between the two surgical groups 3 mo after surgery ( P > 0.05)., Conclusion: For children with hypoplastic LPV in the Rex recessus, using a recanalized umbilical vein as a conduit for a Rex shunt may be an effective procedure for CTPV treatment., Competing Interests: Conflict-of-interest statement: The authors state that they have nothing to disclose., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

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 5 th 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., Competing Interests: Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Aim: To explore the value of Omniview (OV) technology in assessing the fetus corpus callosum., Material and Methods: For the ultrasound examination of 189 fetuses (gestational week range 19-28 weeks), two-dimensional (2D) ultrasound imaging and Omniview technology were used by two physicians (A and B). The acquisition time and the quality of images were recorded., Results: The acquisition time of Omniview technology was shorter comparing with the aquisition time of 2D ultrasound imaging (A2D vs. AOV: 159.44±27.09 s vs. 73.90±18.99 s, p<0.01; B2D vs. BOV: 120.22±21.89 s vs. 74.19±14.86 seconds, p<0.01). 2D ultrasound examination was performed in a longer time by the junior physician, compared with the senior physician (A2D vs. B2D: 159.44±27.09 s vs. 120.22±21.89 s, p<0.01). The intra- and inter-observer reliability of acquisition time using Omniviewtechnology was good (LoA: ‒11.8 to +12.4s, and ‒41.9 to +43.3s, respectively). The success rate of junior and senior physicians with the Omniview technique was 76.2% and 80.4%, respectively. There was good consistency between the Omniview technique and 2D ultrasound imaging in terms of image quality (Kappa = 0.782, 95% CI: 0.586-0.977)., Conclusion: Omniview technique can not only obtain corpus callosum images more effectively but also can achieve better quality images. Therefore, it is a reliable method to image the fetal corpus callosum.

Objective: Ovarian cancer is the most lethal gynecologic cancer worldwide, since most patients are diagnosed at an advanced stage. To improve the early diagnosis and treatment of ovarian cancer, we performed a integrated analysis of transcription profile and genetic variations to study on the molecular pathogenesis in ovarian cancer., Methods: mRNA expression profiles of ovarian cancer and normal controls downloaded from ArrayExpress database were applied to identify differentially expressed genes (DEGs). The chromosomal distributions of these DEGs were established using DAVID. Then, DNASeq data from the Cancer Genome Atlas (TCGA) were extracted to analyze gene mutational information including the number of mutations (mut), the number of mutational genes (mutG) and chromosomal distributions of mutations. Statistical method was offered to carrying on correlation analysis of gene mutations and differential expression., Results: A total of 1732 DEGs were identified, and the chromosomal distributions of 97 genes were unknown. These DEGs were most significantly distributed on chromosome 4 with p value = 1.34E-7. Chromosome 1 enriched the most DEGs (11.56%). Statistical algorithm showed that DEGs presented significantly positive correlation with mut (p = 0.000009) and mutG (p = 0.00001). In 48.7% DEGs, gene mutations were found., Conclusions: We conducted scientific analysis on integration of DEGs in expression profiles and genetic mutations in ovarian cancer, displayed the correlation of differential expression and genetic variations. The result indicated that expression profiles were significantly correlated to genotype.

This study aimed to evaluate the effects of cantharidins, a traditional Chinese medicine, in chemotherapy for the treatment of hepatoma. From August 2011 to December 2012, 96 patients with hepatoma, who were eligible for transcatheter hepatic arterial chemoembolization and received cantharidins, were selected for comparison with the control group of 95 patients without cantharidins. The treatment effect, clinical symptoms and adverse effects were analyzed. The results of the study showed that the cantharidins group had a higher overall efficient rate than the control group (p < 0.001). The improvement rate of the Karnofsky score in the cantharidins group was significantly higher than that of the control group (p = 0.014). In the cantharidins group, there was a decrease in white blood cell (WBC) count and gastrointestinal response rates were lower than those of the control group (p < 0.05). Therefore, the traditional Chinese medicine cantharidins showed effects of easing the progress of liver cancer, relieving side effects of chemotherapy and improving the quality of life in the treatment of hepatoma.

Background: Treatment for breast cancer is mainly performed by surgical resection of primary tumors and chemotherapy. However, after tumor invasion and metastases, breast cancer is hard to control. Clarification of the pathogenic mechanisms would be helpful to the prognosis or therapy for the breast cancer. The aim of this study is to investigate the clinical and prognostic implications of legumain protein Materials and Methods: In this study, we examined mastectomy specimens from 114 breast cancer and matching, 26 adjacent non-cancerous tissues using immunohistochemistry., Results: The results indicated that positive expression of legumain protein in breast cancer was 51.8 % (59/114) and the positive expression of legumain protein in adjacent non-cancerous tissue was 11.5% (3/26). It appeared to be related with lymph node metastasis of breast cancer (p=0.02) and correlation analysis indicated that legumain expression was correlated positively with the estrogen receptor (ER) and mutant-type p53 expression (both p<0.05). Positive legumain expression was significantly associated with shorter overall survival time in breast cancer patients (log-rank p<0.01). Multivariate survival analysis suggested that the positive legumain expression was an independent predictor of poorer overall survival in patients with breast cancer (HR=0.24; 95%CI 0.11-0.65, p=0.03)., Conclusions: Legumain might be a new potential biomarker for breast cancer, which may reflect the prognosis and overall survival.

Objective: To explore the functional brain localization with magnetic resonance imaging (MRI) after acupuncturing the Yuan-Source and He-Sea acupoints of Stomach Meridian of Foot-Yangming (ST)., Methods: The study was performed in 30 healthy volunteers who underwent acupuncture at Yuan-Source acupoint (Chongyang, ST42) and He-Sea acupoint (Zusanli, ST36) (ST group). Ten of these were also underwent acupuncture at the non-acupoints as the control group. Blood oxygenation level dependent functional MRI was performed., Results: In the ST group, signal increasing areas were demonstrated in bilateral superior temporal gyri (Broadmann 22), bilateral supramarginal gyri (Broadmann 40), bilateral cerebellar hemispheres, bilateral cingulate gyri and isthmus of cingulate gyri (Broadmann 32, 30), bilateral superior parietal lobules (Broadmann 7); signal decreasing areas were shown in bilateral orbital gyri (Broadmann 11), bilateral temporal pole (Broadmann 38), right inferior frontal gyrus (Broadmann 47) and right medial occipitotemporal gyrus (Broadmann 36). In the control group, signal increases areas were demonstrated in superior temporal gyri, precentral gyri, cingulate gyri, thalamus, insula and cerebellum. The size, signal intensity and number of increasing areas in control group are less than in ST group., Conclusion: Combined acupuncture of Yuan-Source and He-Sea acupoints of ST can activate and decrease the multiple brain regions of "splanchnic brain" and thus reach a new functional balance to relieve pain.