1.Locally producing antibacterial peptide to deplete intratumoral pathogen for preventing metastatic breast cancer.
Shizhen GENG ; Tingting XIANG ; Yaru SHI ; Mengnian CAO ; Danyu WANG ; Jing WANG ; Xinling LI ; Haiwei SONG ; Zhenzhong ZHANG ; Jinjin SHI ; Junjie LIU ; Airong LI ; Ke SUN
Acta Pharmaceutica Sinica B 2025;15(2):1084-1097
Metastatic dissemination is the major cause of death from breast-cancer (BC). Fusobacterium nucleatum (F.n) is widely enriched in BC and has recently been identified as one of the high-risk factors for promoting BC metastasis. Here, with an experimental model, we demonstrated that intratumoral F.n induced BC aggressiveness by transcriptionally activating Epithelial-mesenchymal transition-associated genes. Therefore, the F.n may be a potential target to prevent metastasis. Given the fact that cancer-associated fibroblasts (CAFs) are abundant in BC and located near blood vessels, we report an optogenetic system that drives CAF to in situ produce human antibacterial peptide LL37, with the characteristics of biosafety and freely intercellular trafficking, for depleting intratumoral F.n, leading to a 72.1% reduction in lung metastatic nodules number without affecting the balance of the systemic flora. Notably, mild photothermal treatment was found that could normalize CAF, contributing to synergistically inhibiting BC metastasis. In addition, the system can also simultaneously encode a gene of TNF-related apoptosis-inducing ligand to suppress the primary tumor. Together, our study highlights the potential of local elimination of tumor pathogenic bacteria to prevent BC metastasis.
2.Jiedu-shengji ointment promotes wound repair in diabetic rats through inhibiting excessive endoplasmic reticulum stress and regulating PERK/IRE1/NLRP3 signaling pathway
Liu YANG ; Yarong DING ; Meijin HE ; Xubing WANG ; Shuangxi YANG ; Li-angying LIAO ; Xinling HUANG ; Zhongzhi ZHOU
Chinese Journal of Pathophysiology 2025;41(5):945-952
AIM:This study aims to investigate the effects of Jiedu-Shengji ointment(JDSJG)on wound healing in diabetic rats by modulating the protein kinase R-like endoplasmic reticulum kinase(PERK)/inositol-requiring enzyme 1(IRE1)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)pathway in the context of endoplasmic reticulum stress(ERS).METHODS:Male Sprague-Dawley rats were randomly assigned to four groups:control group,model group,detoxification muscle ointment group,and sulfadiazine silver cream group.All groups,except the control,were administered an intraperitoneal injection of 45 mg/kg streptozotocin to induce diabetes.The control and model groups received daily applications of normal saline,while the detoxification myogen ointment and sulfadiazine silver cream groups received their respective treatments daily.After dressing changes,wounds were bandaged with sterile gauze.Following 14 d of continuous treatment,wound healing was assessed and healing rates calculated.Histopathologi-cal changes in wound tissues were analyzed using HE staining.Transmission electron microscopy was utilized to observe the number,morphology,and swelling of endoplasmic reticulum in the wound tissues.The expression and distribution of PERK,IRE1 and thioredoxin interacting protein(TXNIP)was assessed by immunohistochemistry,while Western blot was used to measure the levels of apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),TXNIP and NLRP3.ELISA was conducted to quantify the inflammatory cytokines interleukin-18(IL-18)and IL-1β.RE-SULTS:After 14 d of intervention,significant differences were observed in wound tissue parameters across the groups.The model group exhibited a significantly lower wound healing rate compared to the control group(P<0.01),with in-creased wound exudation,poor granulation tissue growth,and elevated the protein levels of PERK,IRE1,TXNIP,CHOP,NLRP3 and ASC(P<0.01),as well as significantly higher levels of IL-1β and IL-18(P<0.01).In contrast,the detoxification muscle ointment group showed a marked improvement in wound healing rate(P<0.01),reduced inflamma-tory exudation,improved granulation tissue growth,and significant decreases in TXNIP expression(P<0.01),along with lower levels of PERK,IRE1,CHOP,ASC and NLRP3(P<0.01).Additionally,the IL-1β and IL-18 were significantly reduced(P<0.01).CONCLUSION:Jiedu Shengji ointment alleviates excessive ERS and mitigates chronic inflammato-ry responses,thereby promoting the healing of diabetic wounds.These effects may be attributed to the inhibition of exces-sive activation of the PERK/IRE1/NLRP3 pathway.
3.Exploring the causal relationship between gut microbiota and gout: a Mendelian randomization study
Xinling LIU ; Zewen WU ; Ruonan WU ; Jingxuan LI ; Li ZHAO ; Qianyu GUO ; Liyun ZHANG
Chinese Journal of Rheumatology 2025;29(9):780-787
Objective:Using Mendelian randomization analysis to investigate the unidirectional causal effects of gut microbiota on gout and serum uric acid levels.Methods:The Mendelian randomization analysis was conducted using summary statistics from genome-wide association studies (GWAS). The gut microbiota was used as the exposure factor, with gout and serum uric acid levels as the outcomes, utilizing the MiBioGen Consortium, FinnGen GWAS, and CKDGen Consortium meta-analysis databases. The analysis was performed using inverse variance weighted (IVW) method, MR-Egger, and weighted median (WM) approach. Additionally, sensitivity analysis was conducted by excluding heterogeneity and horizontal pleiotropy. This study used RStudio 4.3.1 software for analysis.Results:The IVW results confirmed that 17 microbiota taxa were associated with gout, including class Verrucomicrobiaceae [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], family Verrucomicrobiaceae [ OR(95% CI)=1.161(1.004, 1.344), P=0.044], genus Akkermansia [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], genus Collinsella [ OR(95% CI)=1.257(1.043, 1.516), P=0.016], genus Eubacterium hallii group [ OR(95% CI)=1.226(1.022, 1.471), P=0.027], genus Howardella [ OR(95% CI)=1.094(1.001, 1.195), P=0.046], genus Ruminococcaceae UCG010 [ OR(95% CI)=1.317(1.089, 1.593), P=0.004], order Clostridiales [ OR(95% CI)=1.182(1.007,1.387), P=0.041], order Verrucomicrobiales [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], class Melainabacteria [ OR(95% CI)=0.894(0.804, 0.994), P=0.038], family Streptococcaceae [ OR(95% CI)=0.851(0.727, 0.996), P=0.044], unknown family [ OR(95% CI)=0.890(0.800, 0.989), P=0.030], genus Streptococcus [ OR(95% CI)=0.836(0.710, 0.983), P=0.030], unknown genus [ OR(95% CI)=0.890(0.800, 0.989), P=0.030], genus Victivallis [ OR(95% CI)=0.857(0.736, 0.998), P=0.046], order Gastranaerophilales [ OR(95% CI)=0.890(0.800,0.989), P=0.030], and phylum Bacteroidetes [ OR(95% CI)=0.827(0.692, 0.989), P=0.037]. Additionally, 5 microbiota taxa were associated with serum uric acid levels: phylum Actinobacteria [ OR(95% CI)=0.963(0.925, 0.992), P=0.027], family ⅩⅢ [ OR(95% CI)=0.965(0.932, 1.008), P=0.035], genus Escherichia Shigella [ OR(95% CI)=1.047(1.005,1.089), P=0.034], genus Lachnospiraceae FCS020 group [ OR(95% CI)=0.974(0.941, 1.003), P=0.028], and genus Lachnospiraceae NC2004 group [ OR(95% CI)=0.966(0.943, 0.995), P=0.018]. No abnormalities in SNPs were found in the sensitivity analysis. Conclusion:An increase in the levels of class Verrucomicrobiae, family Verrucomicrobiaceae, genus Akkermansia, and genus Escherichia Shigella is associated with an increased risk of gout or serum uric acid levels, while an increase in the levels of class Melainabacteria, family Streptococcaceae, unknown family, phylum Actinobacteria, and family ⅩⅢ is associated with a decreased risk of gout or serum uric acid levels.
4.Correlation of T-lymphocyte subsets in peripheral blood with progression of Alzheimer′s disease
Yanmei LIU ; Dan LI ; Haizhe MA ; Yujie ZHANG ; Yan ZHANG ; Xinling MENG
Chinese Journal of Neurology 2025;58(1):46-54
Objective:To explore the correlation between the level of T-lymphocyte subsets in peripheral blood and the progression of Alzheimer′s disease (AD).Methods:A cross-sectional study was conducted, including 30 cases of amnestic mild cognitive impairment (aMCI; aMCI group), 30 cases of mild AD (Mi-D; Mi-D group), 30 cases of moderate AD (Mo-D; Mo-D group), who were diagnosed in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from January to December 2023, and 30 normal controls (normal control group) matched by age and gender. The levels of T cell subsets in peripheral blood were detected by flow cytometry, and the subpopulations of CD4 +T cells, Th cells, were examined. Binary Logistic regression was used to explore the correlation between factors affecting patients′ cognitive function and the onset of AD, and Spearman′s correlation analysis was applied to assess the association between the level of peripheral blood immune cells and the severity of AD. Results:There were no statistically significant differences in peripheral blood CD4 +T cells ( F=1.762, P=0.158), CD8 +T cells ( F=0.370, P=0.775), CD4 +/CD8 +ratios ( F=1.976, P=0.121), and regulatory T cells (Tregs) levels ( F=0.232, P=0.874) among the aMCI group, Mi-D group, Mo-D group, and normal control group in the intergroup comparisons (all P>0.05). The study subjects were stratified according to gender, age, body mass index, and years of education affecting the cognitive function of AD patients, and the peripheral blood CD4 +T cells, CD8 +T cells, CD4 +/CD8 + ratios and Tregs levels showed no statistically significant differences among groups (all P>0.05). The results of binary Logistic regression analysis showed that the peripheral blood CD8 +T-cell level ( OR=1.131, 95% CI 1.009-1.268, P=0.035) was a risk factor for the onset of AD. Further analysis of peripheral blood CD4 +T cell subsets revealed that Th1 cell levels were lower in the aMCI group compared to the Mi-D group ( t=-2.354, P=0.036), and the Mo-D group ( t=-2.079, P=0.026). The results of the Spearman′s correlation analysis showed that peripheral blood Th1 cell level was positively correlated with AD progression ( r=0.192, P<0.05). Conclusions:AD patients show peripheral immune imbalance, peripheral blood CD8 +T-cell level is a risk factor for the onset of AD, and peripheral Th1 cell level is positively correlated with the severity of AD. Monitoring the changes in peripheral blood Th1 cell level may have a predictive value for the progression of AD.
5.Chondrodysplasia complicated with infantile early-onset epilepsy and medial temporal lobe dysgenesis caused by the FGFR3 gene mutation: a case report and literature review
Shanying WEI ; Xinling TENG ; Li WANG ; Guangfei SUN ; Ruihan LIU ; Qinliang ZHENG ; Yanchao TIAN ; Qiubo LI
Chinese Journal of Applied Clinical Pediatrics 2025;40(7):537-541
The clinical data of an infant with chondrodysplasia accompanied by early-onset epilepsy and medial temporal lobe dysgenesis due to the FGFR3 gene mutation, who was treated in the Affiliated Hospital of Jining Medical University in March 2024 were retrospectively analyzed.The 9-day-old male infant presented with frequent apnea at 5 hours after birth and experienced first seizure at 24 hours after birth.Physical examination revealed short limbs.Magnetic resonance imaging (MRI) showed abnormal changes in bilateral temporal lobes, hippocampal structure and bilateral lateral ventricular temporal angles, so cerebral developmental abnormalities were considered in this child.Whole exome sequencing confirmed a heterozygous variation in the FGFR3 gene [c.1620C>A(p.Asn540Lys)].After receiving Phenobarbital monotherapy, the child still had frequent seizures, but the seizure was completely controlled after the additional use of Lvetiracetam.To August 2024, a total of 14 patients with achondroplasia, epilepsy, and medial temporal lobe dysplasia caused by FGFR3 gene mutations were identified.These patients typically experienced frequent seizures in early infancy, which could be accompanied by apnea and psychomotor retardation.MRI consistently showed abnormal development of bilateral temporal lobes and hippocampus.Seizures were hardly controlled by anti-seizure medications, and Phenobarbital was effective in some cases.Whole exome sequencing revealed gene variations of c.1620C>A or c. 1620C>G (p.Asn540Lys).Patients with achondroplasia caused by FGFR3 gene mutations may present with early-onset epilepsy and medial temporal lobe dysplasia.Early seizures are frequent and difficult to control, and Phenobarbital is effective in some cases.
6.Jiedu-shengji ointment promotes wound repair in diabetic rats through inhibiting excessive endoplasmic reticulum stress and regulating PERK/IRE1/NLRP3 signaling pathway
Liu YANG ; Yarong DING ; Meijin HE ; Xubing WANG ; Shuangxi YANG ; Li-angying LIAO ; Xinling HUANG ; Zhongzhi ZHOU
Chinese Journal of Pathophysiology 2025;41(5):945-952
AIM:This study aims to investigate the effects of Jiedu-Shengji ointment(JDSJG)on wound healing in diabetic rats by modulating the protein kinase R-like endoplasmic reticulum kinase(PERK)/inositol-requiring enzyme 1(IRE1)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)pathway in the context of endoplasmic reticulum stress(ERS).METHODS:Male Sprague-Dawley rats were randomly assigned to four groups:control group,model group,detoxification muscle ointment group,and sulfadiazine silver cream group.All groups,except the control,were administered an intraperitoneal injection of 45 mg/kg streptozotocin to induce diabetes.The control and model groups received daily applications of normal saline,while the detoxification myogen ointment and sulfadiazine silver cream groups received their respective treatments daily.After dressing changes,wounds were bandaged with sterile gauze.Following 14 d of continuous treatment,wound healing was assessed and healing rates calculated.Histopathologi-cal changes in wound tissues were analyzed using HE staining.Transmission electron microscopy was utilized to observe the number,morphology,and swelling of endoplasmic reticulum in the wound tissues.The expression and distribution of PERK,IRE1 and thioredoxin interacting protein(TXNIP)was assessed by immunohistochemistry,while Western blot was used to measure the levels of apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC),TXNIP and NLRP3.ELISA was conducted to quantify the inflammatory cytokines interleukin-18(IL-18)and IL-1β.RE-SULTS:After 14 d of intervention,significant differences were observed in wound tissue parameters across the groups.The model group exhibited a significantly lower wound healing rate compared to the control group(P<0.01),with in-creased wound exudation,poor granulation tissue growth,and elevated the protein levels of PERK,IRE1,TXNIP,CHOP,NLRP3 and ASC(P<0.01),as well as significantly higher levels of IL-1β and IL-18(P<0.01).In contrast,the detoxification muscle ointment group showed a marked improvement in wound healing rate(P<0.01),reduced inflamma-tory exudation,improved granulation tissue growth,and significant decreases in TXNIP expression(P<0.01),along with lower levels of PERK,IRE1,CHOP,ASC and NLRP3(P<0.01).Additionally,the IL-1β and IL-18 were significantly reduced(P<0.01).CONCLUSION:Jiedu Shengji ointment alleviates excessive ERS and mitigates chronic inflammato-ry responses,thereby promoting the healing of diabetic wounds.These effects may be attributed to the inhibition of exces-sive activation of the PERK/IRE1/NLRP3 pathway.
7.Chondrodysplasia complicated with infantile early-onset epilepsy and medial temporal lobe dysgenesis caused by the FGFR3 gene mutation: a case report and literature review
Shanying WEI ; Xinling TENG ; Li WANG ; Guangfei SUN ; Ruihan LIU ; Qinliang ZHENG ; Yanchao TIAN ; Qiubo LI
Chinese Journal of Applied Clinical Pediatrics 2025;40(7):537-541
The clinical data of an infant with chondrodysplasia accompanied by early-onset epilepsy and medial temporal lobe dysgenesis due to the FGFR3 gene mutation, who was treated in the Affiliated Hospital of Jining Medical University in March 2024 were retrospectively analyzed.The 9-day-old male infant presented with frequent apnea at 5 hours after birth and experienced first seizure at 24 hours after birth.Physical examination revealed short limbs.Magnetic resonance imaging (MRI) showed abnormal changes in bilateral temporal lobes, hippocampal structure and bilateral lateral ventricular temporal angles, so cerebral developmental abnormalities were considered in this child.Whole exome sequencing confirmed a heterozygous variation in the FGFR3 gene [c.1620C>A(p.Asn540Lys)].After receiving Phenobarbital monotherapy, the child still had frequent seizures, but the seizure was completely controlled after the additional use of Lvetiracetam.To August 2024, a total of 14 patients with achondroplasia, epilepsy, and medial temporal lobe dysplasia caused by FGFR3 gene mutations were identified.These patients typically experienced frequent seizures in early infancy, which could be accompanied by apnea and psychomotor retardation.MRI consistently showed abnormal development of bilateral temporal lobes and hippocampus.Seizures were hardly controlled by anti-seizure medications, and Phenobarbital was effective in some cases.Whole exome sequencing revealed gene variations of c.1620C>A or c. 1620C>G (p.Asn540Lys).Patients with achondroplasia caused by FGFR3 gene mutations may present with early-onset epilepsy and medial temporal lobe dysplasia.Early seizures are frequent and difficult to control, and Phenobarbital is effective in some cases.
8.Correlation of T-lymphocyte subsets in peripheral blood with progression of Alzheimer′s disease
Yanmei LIU ; Dan LI ; Haizhe MA ; Yujie ZHANG ; Yan ZHANG ; Xinling MENG
Chinese Journal of Neurology 2025;58(1):46-54
Objective:To explore the correlation between the level of T-lymphocyte subsets in peripheral blood and the progression of Alzheimer′s disease (AD).Methods:A cross-sectional study was conducted, including 30 cases of amnestic mild cognitive impairment (aMCI; aMCI group), 30 cases of mild AD (Mi-D; Mi-D group), 30 cases of moderate AD (Mo-D; Mo-D group), who were diagnosed in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from January to December 2023, and 30 normal controls (normal control group) matched by age and gender. The levels of T cell subsets in peripheral blood were detected by flow cytometry, and the subpopulations of CD4 +T cells, Th cells, were examined. Binary Logistic regression was used to explore the correlation between factors affecting patients′ cognitive function and the onset of AD, and Spearman′s correlation analysis was applied to assess the association between the level of peripheral blood immune cells and the severity of AD. Results:There were no statistically significant differences in peripheral blood CD4 +T cells ( F=1.762, P=0.158), CD8 +T cells ( F=0.370, P=0.775), CD4 +/CD8 +ratios ( F=1.976, P=0.121), and regulatory T cells (Tregs) levels ( F=0.232, P=0.874) among the aMCI group, Mi-D group, Mo-D group, and normal control group in the intergroup comparisons (all P>0.05). The study subjects were stratified according to gender, age, body mass index, and years of education affecting the cognitive function of AD patients, and the peripheral blood CD4 +T cells, CD8 +T cells, CD4 +/CD8 + ratios and Tregs levels showed no statistically significant differences among groups (all P>0.05). The results of binary Logistic regression analysis showed that the peripheral blood CD8 +T-cell level ( OR=1.131, 95% CI 1.009-1.268, P=0.035) was a risk factor for the onset of AD. Further analysis of peripheral blood CD4 +T cell subsets revealed that Th1 cell levels were lower in the aMCI group compared to the Mi-D group ( t=-2.354, P=0.036), and the Mo-D group ( t=-2.079, P=0.026). The results of the Spearman′s correlation analysis showed that peripheral blood Th1 cell level was positively correlated with AD progression ( r=0.192, P<0.05). Conclusions:AD patients show peripheral immune imbalance, peripheral blood CD8 +T-cell level is a risk factor for the onset of AD, and peripheral Th1 cell level is positively correlated with the severity of AD. Monitoring the changes in peripheral blood Th1 cell level may have a predictive value for the progression of AD.
9.Exploring the causal relationship between gut microbiota and gout: a Mendelian randomization study
Xinling LIU ; Zewen WU ; Ruonan WU ; Jingxuan LI ; Li ZHAO ; Qianyu GUO ; Liyun ZHANG
Chinese Journal of Rheumatology 2025;29(9):780-787
Objective:Using Mendelian randomization analysis to investigate the unidirectional causal effects of gut microbiota on gout and serum uric acid levels.Methods:The Mendelian randomization analysis was conducted using summary statistics from genome-wide association studies (GWAS). The gut microbiota was used as the exposure factor, with gout and serum uric acid levels as the outcomes, utilizing the MiBioGen Consortium, FinnGen GWAS, and CKDGen Consortium meta-analysis databases. The analysis was performed using inverse variance weighted (IVW) method, MR-Egger, and weighted median (WM) approach. Additionally, sensitivity analysis was conducted by excluding heterogeneity and horizontal pleiotropy. This study used RStudio 4.3.1 software for analysis.Results:The IVW results confirmed that 17 microbiota taxa were associated with gout, including class Verrucomicrobiaceae [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], family Verrucomicrobiaceae [ OR(95% CI)=1.161(1.004, 1.344), P=0.044], genus Akkermansia [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], genus Collinsella [ OR(95% CI)=1.257(1.043, 1.516), P=0.016], genus Eubacterium hallii group [ OR(95% CI)=1.226(1.022, 1.471), P=0.027], genus Howardella [ OR(95% CI)=1.094(1.001, 1.195), P=0.046], genus Ruminococcaceae UCG010 [ OR(95% CI)=1.317(1.089, 1.593), P=0.004], order Clostridiales [ OR(95% CI)=1.182(1.007,1.387), P=0.041], order Verrucomicrobiales [ OR(95% CI)=1.162(1.004, 1.344), P=0.044], class Melainabacteria [ OR(95% CI)=0.894(0.804, 0.994), P=0.038], family Streptococcaceae [ OR(95% CI)=0.851(0.727, 0.996), P=0.044], unknown family [ OR(95% CI)=0.890(0.800, 0.989), P=0.030], genus Streptococcus [ OR(95% CI)=0.836(0.710, 0.983), P=0.030], unknown genus [ OR(95% CI)=0.890(0.800, 0.989), P=0.030], genus Victivallis [ OR(95% CI)=0.857(0.736, 0.998), P=0.046], order Gastranaerophilales [ OR(95% CI)=0.890(0.800,0.989), P=0.030], and phylum Bacteroidetes [ OR(95% CI)=0.827(0.692, 0.989), P=0.037]. Additionally, 5 microbiota taxa were associated with serum uric acid levels: phylum Actinobacteria [ OR(95% CI)=0.963(0.925, 0.992), P=0.027], family ⅩⅢ [ OR(95% CI)=0.965(0.932, 1.008), P=0.035], genus Escherichia Shigella [ OR(95% CI)=1.047(1.005,1.089), P=0.034], genus Lachnospiraceae FCS020 group [ OR(95% CI)=0.974(0.941, 1.003), P=0.028], and genus Lachnospiraceae NC2004 group [ OR(95% CI)=0.966(0.943, 0.995), P=0.018]. No abnormalities in SNPs were found in the sensitivity analysis. Conclusion:An increase in the levels of class Verrucomicrobiae, family Verrucomicrobiaceae, genus Akkermansia, and genus Escherichia Shigella is associated with an increased risk of gout or serum uric acid levels, while an increase in the levels of class Melainabacteria, family Streptococcaceae, unknown family, phylum Actinobacteria, and family ⅩⅢ is associated with a decreased risk of gout or serum uric acid levels.
10.Comparison of diagnostic performance of adding value of transabdominal and transvaginal contrast-enhanced ultrasound to Ovarian-Adnexal Reporting and Data System Ultrasound risk stratification in the evaluation of adnexal masses
Manli WU ; Manting SU ; Ruili WANG ; Xiaofeng SUN ; Rui ZHANG ; Liang MU ; Li XIAO ; Hong WEN ; Tingting LIU ; Xiaotao MENG ; Xinling ZHANG
Chinese Journal of Ultrasonography 2024;33(5):385-391
Objective:To compare and explore the diagnostic performance of adding value of transabdominal and transvaginal contrast-enhanced ultrasound (CEUS) to Ovarian-Adnexal Reporting and Data System (O-RADS US) risk stratification and management system in differential diagnosis of adnexal masses.Methods:A total of 180 adnexal masses with solid components in 175 women were enrolled retrospectively between September 2021 and November 2022. All patients underwent routine Doppler ultrasound examinations and CEUS examinations. Among these masses, 107 masses underwent with transabdominal CEUS, 58 masses underwent with transvaginal CEUS, and 15 masses underwent both transvaginal and transabdominal CEUS. All patients were scheduled for surgery and pathological results served as the reference standard. Routine Doppler ultrasound and CEUS images and video were reviewed by a subspecialty radiologist using Vuebox software. The O-RADS US was downgraded or upgraded according to the CEUS characteristics of the masses. The diagnostic accuracy was assessed using ROC curve analysis. The area under the ROC curve (AUC) was calculated to compare the diagnostic performance of adding value of transabdominal and transvaginal CEUS to O-RADS US.Results:The diagnostic performance of adding transabdominal and transvaginal CEUS to O-RADS US were both significantly higher than of O-RADS US alone (transabdominal CEUS: AUC 0.83 vs 0.76, P=0.018; transvaginal CEUS: AUC 0.92 vs 0.81, P=0.013). Combination of transvaginal CEUS and O-RADS US was superior to that of combination of transabdominal and O-RADS US in the differential diagnosis of adnexal masses ( P=0.047). When the maximal diameter of adnexal masses ≤40 mm, transabdominal combined with O-RADS US presented the lowest diagnostic performance, with an AUC of 0.73. Conclusions:Combination of transvaginal CEUS and O-RADS US was superior to that of combination of transabdominal and O-RADS US in assessing adnexal masses with solid components. When the maximal diameter of adnexal masses ≤40 mm, transvaginal CEUS examination was recommended.

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