A Generalizable Causal-Invariance-Driven Segmentation Model for Peripancreatic Vessels.

Segmenting peripancreatic vessels in CT, including the superior mesenteric artery (SMA), the coeliac artery (CA), and the partial portal venous system (PPVS), is crucial for preoperative resectability analysis in pancreatic cancer. However, the clinical applicability of vessel segmentation methods is impeded by the low generalizability on multi-center data, mainly attributed to the wide variations in image appearance, namely the spurious correlation factor. Therefore, we propose a causal-invariance-driven generalizable segmentation model for peripancreatic vessels. It incorporates interventions at both image and feature levels to guide the model to capture causal information by enforcing consistency across datasets, thus enhancing the generalization performance. Specifically, firstly, a contrast-driven image intervention strategy is proposed to construct image-level interventions by generating images with various contrast-related appearances and seeking invariant causal features. Secondly, the feature intervention strategy is designed, where various patterns of feature bias across different centers are simulated to pursue invariant prediction. The proposed model achieved high DSC scores (79.69%, 82.62%, and 83.10%) for the three vessels on a cross-validation set containing 134 cases. Its generalizability was further confirmed on three independent test sets of 233 cases. Overall, the proposed method provides an accurate and generalizable segmentation model for peripancreatic vessels and offers a promising paradigm for increasing the generalizability of segmentation models from a causality perspective. Our source codes will be released at https://github.com/SJTUBME-QianLab/PC_VesselSeg.

MRI-based deep learning and radiomics for prediction of occult cervical lymph node metastasis and prognosis in early-stage oral and oropharyngeal squamous cell carcinoma: a diagnostic study.

INTRODUCTION: The incidence of occult cervical lymph node metastases (OCLNM) is reported to be 20%-30% in early-stage oral cancer and oropharyngeal cancer. There is a lack of an accurate diagnostic method to predict occult lymph node metastasis and to help surgeons make precise treatment decisions. AIM: To construct and evaluate a preoperative diagnostic method to predict occult lymph node metastasis (OCLNM) in early-stage oral and oropharyngeal squamous cell carcinoma (OC and OP SCC) based on deep learning features (DLFs) and radiomics features. METHODS: A total of 319 patients diagnosed with early-stage OC or OP SCC were retrospectively enrolled and divided into training, test and external validation sets. Traditional radiomics features and DLFs were extracted from their MRI images. The least absolute shrinkage and selection operator (LASSO) analysis was employed to identify the most valuable features. Prediction models for OCLNM were developed using radiomics features and DLFs. The effectiveness of the models and their clinical applicability were evaluated using the area under the curve (AUC), decision curve analysis (DCA) and survival analysis. RESULTS: Seventeen prediction models were constructed. The Resnet50 deep learning (DL) model based on the combination of radiomics and DL features achieves the optimal performance, with AUC values of 0.928 (95% CI: 0.881-0.975), 0.878 (95% CI: 0.766-0.990), 0.796 (95% CI: 0.666-0.927) and 0.834 (95% CI: 0.721-0.947) in the training, test, external validation set1 and external validation set2, respectively. Moreover, the Resnet50 model has great prediction value of prognosis in patients with early-stage OC and OP SCC. CONCLUSION: The proposed MRI-based Resnet50 deep learning model demonstrated high capability in diagnosis of OCLNM and prognosis prediction in the early-stage OC and OP SCC. The Resnet50 model could help refine the clinical diagnosis and treatment of the early-stage OC and OP SCC.

Integrated Single-cell and Bulk RNA Sequencing Analysis Cross Talk between Ferroptosis-related Genes and Prognosis in Oral Cavity Squamous Cell Carcinoma.

BACKGROUND: Ferroptosis is a new type of programmed apoptosis and plays an important role in tumour inhibition and immunotherapy. OBJECTIVE: In this study, we aimed to explore the potential role of ferroptosis-related genes (FRGs) and the potential therapeutic targets in oral cavity squamous cell carcinoma (OCSCC). METHODS: The transcription data of OCSCC samples were obtained from the Cancer Genome Atlas (TCGA) database as a training dataset. The prognostic FRGs were extracted by univariate Cox regression analysis. Then, we constructed a prognostic model using the least absolute shrinkage and selection operator (LASSO) and Cox analysis to determine the independent prognosis FRGs. Based on this model, risk scores were calculated for the OCSCC samples. The model's capability was further evaluated by the receiver operating characteristic curve (ROC). Then, we used the GSE41613 dataset as an external validation cohort to confirm the model's predictive capability. Next, the immune infiltration and somatic mutation analysis were applied. Lastly, single-cell transcriptomic analysis was used to identify the key cells. RESULTS: A total of 12 prognostic FRGs were identified. Eventually, 6 FRGs were screened as independent predictors and a prognostic model was constructed in the training dataset, which significantly stratified OCSCC samples into high-risk and low-risk groups based on overall survival. The external validation of the model using the GSE41613 dataset demonstrated a satisfactory predictive capability for the prognosis of OCSCC. Further analysis revealed that patients in the highrisk group had distinct immune infiltration and somatic mutation patterns from low-risk patients. Mast cell infiltrations were identified as prognostic immune cells and played a role in OCSCC partly through ferroptosis. CONCLUSION: We successfully constructed a novel 6 FRGs model and identified a prognostic immune cell, which can serve to predict clinical prognoses for OCSCC. Ferroptosis may be a new direction for immunotherapy of OCSCC.

Mutational landscape of head and neck cancer and cervical cancer in Chinese and Western population.

BACKGROUND: We aimed to unbiasedly map the genetic mutation profile of HNSC and CESC associated with HPV status in the Chinese population (SYSU-cohort) and compare them with Western population (TCGA-cohort). METHODS: Fifty-one HNSC patients (SYSU-HNSC) and 38 CESC patients (SYSU-CESC) were enrolled in this study. Genomic alterations were examined, and the profile was produced using the YuanSuTM450 gene panel (OrigiMed, Shanghai, China). The altered genes were inferred and compared to Western patients from TCGA cohorts. RESULTS: Compared to the TCGA-HNSC cohort, FGFR3 mutation was identified as a novel target in SYSU-HNSC with therapeutic potential. Compared to the TCGA-CESC cohort, some epigenetic regulation-associated genes were frequently mutated in SYSU-CESC cohort (KMT2C, KMT2D, KDM5C, KMT2A). CONCLUSION: In summary, our study provides unbiased insights into the genetic landscape of HNSC and CESC in the Chinese population and highlights potential novel therapeutic targets that may benefit Chinese patients.

Clinical value of cognitive behavioral nursing model to patients with congenital glaucoma.

BACKGROUND: There have been studies on the use of cognitive behavioral nursing intervention (CBNI) but the main subjects were patients with secondary glaucoma and there are fewer studies on the care of congenital glaucoma. OBJECTIVE: To explore the clinical value of cognitive behavioral nursing model in patients with congenital glaucoma. METHODS: One hundred and fifty-three postoperative patients with congenital glaucoma treated in our hospital between January 2021 and December 2022 were prospectively selected for the study and randomly divided into a control group (n= 77) and an observation group (n= 76). The control group was given routine nursing, and the observation group was given cognitive behavioral nursing mode on the basis of the control group. Anxiety self-assessment scale (SAS), depression self-assessment scale (SDS), Connor-Davidson toughness scale, and treatment adherence evaluation scale were used to evaluate the psychological state, mental toughness, treatment adherence, treatment effect and nursing care satisfaction in the two groups before and after 2 weeks of intervention. The efficacy of the treatment was also assessed by determining the visual acuity (VA), intraocular pressure (IOP), and mean defective (MD) value of the visual field of the two groups of patients. RESULTS: After nursing, the SDS score (46.33 ± 6.16 versus 53.21 ± 5.94) and SAS score (44.41 ± 5.6 versus 52.82 ± 6.31) in the observation group were lower than those in the control group (P< 0.05). The scores of optimism (11.55 ± 1.90 versus 8.20 ± 1.95), self-improvement (22.05 ± 3.60 versus 17.60 ± 4.30), tenacity (37.45 ± 3.10 versus 28.90 ± 4.55) and total score (71.35 ± 8.00 versus 56.85 ± 8.50) in the observation group were higher than those in the control group (P< 0.05). After care, the VA of the observation group (0.95 ± 0.22) was greater than that of the control group (0.84 ± 0.16), and the IOP (14.25 ± 0.58 versus 15.89 ± 0.67) and the MD (5.42 ± 0.46 versus 6.68 ± 0.49) of the observation group were less than that of the control group. The difference between the two groups was statistically significant (P< 0.05). The compliance (96.05% versus 85.71%) and nursing satisfaction (96.10% versus 85.71%) of the observation group were higher than those of the control group (P< 0.05). CONCLUSION: Cognitive-behavioural nursing care for glaucoma patients can improve patients' mental toughness, improve visual acuity, reduce intraocular pressure and mean visual field defect values, and have a positive effect on enhancing patients' treatment adherence and nursing satisfaction.

Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors.

RATIONALE AND OBJECTIVES: To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs). MATERIALS AND METHODS: 101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff), electron density (Rho), double energy index (DEI), and the slope of the spectral Hounsfield unit curve (λHU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance. RESULTS: Attenuation, Zeff, DEI, IC, NIC, and λHU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p < 0.001-0.047). λHU in VP and Zeff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Zeff, DEI, IC, NIC, and λHU in the AP and VP of MTs were higher than those of PAs (p < 0.001-0.047). Zeff and NIC in AP and λHU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Zeff, DEI, IC, NIC, and λHU in AP; and the Rho in the VP of PAs were lower than those of WTs (p < 0.001-0.03). Rho in the precontrast phase and attenuation in AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Zeff, DEI, IC, NIC, and λHU in VP and lower Rho in the precontrast phase compared with WTs (p < 0.001-0.04); but no independent predictors were found. CONCLUSION: DECT quantitative parameters can help to differentiate PGTs.

Detecting lesion-specific ischemia in patients with coronary artery disease with computed tomography fractional flow reserve measured at different sites.

OBJECTIVES: Whether a stenosis can cause hemodynamic lesion-specific ischemia is critical for the treatment decision in patients with coronary artery disease (CAD). Based on coronary computed tomography angiography (CCTA), CT fractional flow reserve (FFRCT) can be used to assess lesion-specific ischemia. The selection of an appropriate site along the coronary artery tree is vital for measuring FFRCT. However the optimal site to measure FFRCT for a target stenosis remains to be adequately determined. The purpose of this study was to determine the optimal site to measure FFRCT for a target lesion in detecting lesion-specific ischemia in CAD patients by evaluating the performance of FFRCT measured at different sites distal to the target lesion in detecting lesion-specific ischemia with FFR measured with invasive coronary angiography (ICA) as reference standard. METHODS: In this single-center retrospective cohort study, a total of 401 patients suspected of having CAD underwent invasive ICA and FFR between March 2017 and December 2021 were identified. 52 patients having both CCTA and invasive FFR within 90 days were enrolled. Patients with vessels 30%-90% diameter stenosis as determined by ICA were referred to invasive FFR evaluation, which was performed 2-3 cm distal to the stenosis under the condition of hyperemia. For each vessel with 30%-90% diameter stenosis, if only one stenosis was present, this stenosis was selected as the target lesion; if serial stenoses were present, the stenosis most distal to the vessel end was chosen as the target lesion. FFRCT was measured at four sites: 1 cm, 2 cm, and 3 cm distal to the lower border of the target lesion (FFRCT-1 cm, FFRCT-2 cm, FFRCT-3 cm), and the lowest FFRCT at the distal vessel tip (FFRCT-lowest). The normality of quantitative data was assessed using the Shapiro-Wilk test. Pearson's correlation analysis and Bland-Altman plots were used for assessing the correlation and difference between invasive FFR and FFRCT. Correlation coefficients derived from Chi-suqare test were used to assess the correlation between invasive FFR and the cominbaiton of FFRCT measred at four sites. The performances of significant obstruction stenosis (diameter stenosis ≥ 50%) at CCTA and FFRCT measured at the four sites and their combinations in diagnosing lesion-specific ischemia were evaluated by receiver-operating characteristic (ROC) curves using invasive FFR as the reference standard. The areas under ROC curves (AUCs) of CCTA and FFRCT were compared by the DeLong test. RESULTS: A total of 72 coronary arteries in 52 patients were included for analysis. Twenty-five vessels (34.7%) had lesion-specific ischemia detected by invasive FFR and 47 vesseles (65.3%) had no lesion-spefifice ischemia. Good correlation was found between invasive FFR and FFRCT-2 cm and FFRCT-3 cm (r = 0.80, 95% CI, 0.70 to 0.87, p < 0.001; r = 0.82, 95% CI, 0.72 to 0.88, p < 0.001). Moderate correlation was found between invasive FFR and FFRCT-1 cm and FFRCT-lowest (r = 0.77, 95% CI, 0.65 to 0.85, p < 0.001; r = 0.78, 95% CI, 0.67 to 0.86, p < 0.001). FFRCT-1 cm + FFRCT-2 cm, FFRCT-2 cm + FFRCT-3 cm, FFRCT-3 cm + FFRCT-lowest, FFRCT-1 cm + FFRCT-2 cm + FFRCT-3 cm, and FFRCT-2 cm + FFRCT-3 cm + FFRCT-lowest were correatled with invasive FFR (r = 0.722; 0.722; 0.701; 0.722; and 0.722, respectively; p < 0.001 for all). Bland-Altman plots revealed a mild difference between invasive FFR and the four FFRCT (invasive FFR vs. FFRCT-1 cm, mean difference -0.0158, 95% limits of agreement: -0.1475 to 0.1159; invasive FFR vs. FFRCT-2 cm, mean difference 0.0001, 95% limits of agreement: -0.1222 to 0.1220; invasive FFR vs. FFRCT-3 cm, mean difference 0.0117, 95% limits of agreement: -0.1085 to 0.1318; and invasive FFR vs. FFRCT-lowest, mean difference 0.0343, 95% limits of agreement: -0.1033 to 0.1720). AUCs of CCTA, FFRCT-1 cm, FFRCT-2 cm, FFRCT-3 cm, and FFRCT-lowest in detecting lesion-specific ischemia were 0.578, 0.768, 0.857, 0.856 and 0.770, respectively. All FFRCT had a higher AUC than CCTA (all p < 0.05), FFRCT-2 cm achieved the highest AUC at 0.857. The AUCs of FFRCT-2 cm and FFRCT-3 cm were comparable (p > 0.05). The AUCs were similar between FFRCT-1 cm + FFRCT-2 cm, FFRCT-3 cm + FFRCT-lowest and FFRCT-2 cm alone (AUC = 0.857, 0.857, 0.857, respectively; p > 0.05 for all). The AUCs of FFRCT-2 cm + FFRCT-3 cm, FFRCT-1 cm + FFRCT-2 cm + FFRCT-3 cm, FFRCT-and 2 cm + FFRCT-3 cm + FFRCT-lowest (0.871, 0.871, 0.872, respectively) were slightly higher than that of FFRCT-2 cm alone (0.857), but without significnacne differences (p > 0.05 for all). CONCLUSIONS: FFRCT measured at 2 cm distal to the lower border of the target lesion is the optimal measurement site for identifying lesion-specific ischemia in patients with CAD.

Nitroglycerin improves the visibility of fibula-free flap perforators on computed tomography angiography in patients with oral or maxillofacial lesion.

PURPOSE: To investigate the improvement of image quality and visualization of fibula-free flap (FFF) perforators on computed tomography angiography (CTA) after administration of sublingual nitroglycerin (NTG) tablets. METHODS: A total of 60 patients with oral or maxillofacial lesions before CTA of the lower extremity were randomly divided into two groups (NTG group and non-NTG group). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), overall image quality and grading of vessels were evaluated and compared. The lumen diameters of the major arteries and the proximal and distal peroneal perforators were measured. The number of visible perforators in muscular clearance and muscular layer was also counted and compared between the two groups. RESULTS: The CNR of posterior tibial artery and overall image quality of CTA images in the NTG group was significantly higher than that in the non-NTG group (p < 0.05), although the SNR and CNR of other arteries did not show significant differences (p > 0.05). The lumen diameters of the peroneal artery and its perforators, anterior tibial artery, and posterior tibial artery were significantly larger in the NTG group (p < 0.001), while no significant difference prevailed in the diameter of the popliteal artery between the two groups (p = 0.298). Compared with the non-NTG group, a significant increase in the number of visible perforators was noted in the NTG group (p < 0.001). CONCLUSIONS: The administration of sublingual NTG in CTA of the lower extremity can improve the image quality and visualization of perforators, which aids to surgeons select the optimum FFF.

Fluidic Spatial-Confinement Scaffold Affords a Multicomponent DNA Reaction with Improved Efficiency and Accelerated Kinetics.

Enzyme-free nucleic acid amplification reactions with the capability of signal catalytic amplification have been widely used in biosensors. However, these multicomponent, multistep nucleic acid amplification systems often suffer from low reaction efficiency and kinetics. Herein, inspired by the natural cell membrane system, we utilized the red blood cell membrane as a fluidic spatial-confinement scaffold to construct a novel accelerated reaction platform. By simply modifying with cholesterol, DNA components can be efficiently integrated into the red blood cell membrane through hydrophobic interactions, which greatly increases the local concentration of DNA strands. Moreover, the fluidity of the erythrocyte membrane improves the collision efficiency of DNA components in the amplification system. Based on the increased local concentration and improved collision efficiency, the fluidic spatial-confinement scaffold significantly improved the reaction efficiency and kinetics. Taking catalytic hairpin assembly (CHA) as a model reaction, an RBC-CHA probe based on the erythrocyte membrane platform enables a more sensitive detection of miR-21 with a sensitivity that is 2 orders of magnitude higher than the free CHA probe and a fast reaction rate (about 3.3-fold). The proposed strategy provides a new idea for the construction of a novel spatial-confinement accelerated DNA reaction platform.

Improving visualization of free fibula flap perforators and reducing radiation dose in dual-energy CT angiography.

Background: The precise assessment of the perforators of the fibula free flap (FFF) is crucial for minimizing procedure-related complications when harvesting the FFF in patients with maxillofacial lesions. This study aims to investigate the utility of virtual noncontrast (VNC) images for radiation dose saving and to determine the optimal energy level of virtual monoenergetic imaging (VMI) reconstructions in dual-energy computed tomography (DECT) for visualization of the perforators of the fibula free flap (FFF). Methods: Data from 40 patients with maxillofacial lesions who received lower extremity DECT examinations in the noncontrast and arterial phase were collected in this retrospective, cross-sectional study. To compare VNC images from the arterial phase with true non-contrast images in a DECT protocol (M_0.5-TNC) and to compare VMI images with 0.5 linear images blending from the arterial phase (M_0.5-C), the attenuation, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality were assessed in different arteries, muscles, and fat tissues. Two readers evaluated the image quality and visualization of the perforators. The dose-length product (DLP) and CT volume dose index (CTDIvol) were used to determine the radiation dose. Results: Objective and subjective analyses showed no significant difference between the M_0.5-TNC and VNC images in the arteries and muscles (P>0.09 to P>0.99), and VNC imaging could reduce 50% of the radiation dose (P<0.001). Compared with those of the M_0.5-C images, the attenuation and CNR of VMI reconstructions at 40 kiloelectron volt (keV) and 60 keV were higher (P<0.001 to P=0.04). Noise was similar at 60 keV (all P>0.99) and increased at 40 keV (all P<0.001), and the SNR in arteries was increased at 60 keV (P<0.001 to P=0.02) in VMI reconstructions compared with those in the M_0.5-C images. The subjective scores in VMI reconstructions at 40 and 60 keV was higher than those in M_0.5-C images (all P<0.001). The image quality at 60 keV was superior to that at 40 keV (P<0.001), and there was no difference in the visualization of the perforators between 40 and 60 keV (P=0.31). Conclusions: VNC imaging is a reliable technique for replacing M_0.5-TNC and provides radiation dose saving. The image quality of the 40-keV and 60-keV VMI reconstructions was higher than that of the M_0.5-C images, and 60 keV provided the best assessment of perforators in the tibia.

Selective In Situ Analysis of Mature microRNAs in Extracellular Vesicles Using a DNA Cage-Based Thermophoretic Assay.

Mature microRNAs (miRNAs) in extracellular vesicles (EVs) are involved in different stages of cancer progression, yet it remains challenging to precisely detect mature miRNAs in EVs due to the presence of interfering RNAs (such as longer precursor miRNAs, pre-miRNAs) and the low abundance of tumor-associated miRNAs. By leveraging the size-selective ability of DNA cages and polyethylene glycol (PEG)-enhanced thermophoretic accumulation of EVs, we devised a DNA cage-based thermophoretic assay for highly sensitive, selective, and in situ detection of mature miRNAs in EVs with a low limit of detection (LoD) of 2.05 fM. Our assay can profile EV mature miRNAs directly in serum samples without the interference of pre-miRNAs and the need for ultracentrifugation. A clinical study showed that EV miR-21 or miR-155 had an overall accuracy of 90 % for discrimination between breast cancer patients and healthy donors, which outperformed conventional molecular probes detecting both mature miRNAs and pre-miRNAs. We envision that our assay can advance EV miRNA-based diagnosis of cancer.

Comparison of image quality and quantitative parameters in intravoxel incoherent motion imaging at 3-T based on turbo spin-echo and echo-planar imaging in patients with oral cancer.

PURPOSE: To compare the image quality, apparent diffusion coefficient (ADC), and intravoxel incoherent motion- (IVIM) derived parameters of IVIM imaging based on turbo spin-echo (TSE) and echo-planar imaging (EPI) of patients with oral cancer and to assess the equivalence of the ADC and IVIM-derived parameters. METHODS: Thirty patients with oral cancer underwent TSE-IVIM and EPI-IVIM imaging using a 3.0-T system. The distortion ratio (DR), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), qualitative evaluations of image quality, ADC, pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were compared between the two sequences. The consistency of the quantitative parameters in oral cancer between the TSE and EPI sequences was evaluated using a Bland-Altman analysis. RESULTS: TSE-IVIM had a significantly smaller DR than EPI-IVIM (P < 0.001). The CNR of EPI-IVIM on most of the anatomical sites was significantly higher than that of TSE-IVIM (P < 0.05), while the SNR was not significantly different (P > 0.05). TSE-IVIM had significantly higher image quality, less distortion and artifacts, and lower image contrast compared with EPI-IVIM (P < 0.05). The lesion-edge sharpness and diagnostic confidence of EPI-IVIM were lower than that of TSE-IVIM, although no significant differences existed (P > 0.05). The ADC and D of TSE-IVIM had better reproducibility (intraclass correlation coefficient > 0.9). Although no significant difference existed for the ADC and IVIM-derived parameters of lesions between the two sequences (P > 0.05), wide limits of agreement were found in the Bland-Altman plots. CONCLUSION: TSE-IVIM could be used as an alternative technique to EPI-IVIM for patients with oral cancer because of its better image quality. Furthermore, TSE-IVIM can provide more accurate quantitative parameters. However, the quantitative parameters derived from the two IVIM techniques cannot be used as equivalent parameters for patients with oral cancer.

Improving the Visualization of the Adrenal Veins Using Virtual Monoenergetic Images from Dual-Energy Computed Tomography before Adrenal Venous Sampling.

(1) Background: This study explored the optimal energy level in advanced virtual monoenergetic images (VMI+) from dual-energy computed tomography angiography (DE-CTA) for adrenal veins visualization before adrenal venous sampling (AVS). (2) Methods: Thirty-nine patients were included in this prospective single-center study. The CT value, noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured in both adrenal veins and abdominal solid organs and were then compared between VMI+ within the range of 40-80 kiloelectron volt (keV). The visualization rate of the adrenal veins and the overall image quality of solid organs were subjectively compared among different keV VMI+. The AVS success rate was recorded for 20 patients. (3) Results: For the adrenal veins, 40 keV VMI+ had the peak CT value, noise and CNR (p < 0.05). Subjectively, the visualization rate was the highest at 40 keV (100% for the right adrenal vein, and 97.4% for the left adrenal vein) (p < 0.05). For solid organs, the CT value, noise and CNR at 50 keV were lower than those at 40 keV (p < 0.05), but the SNR was similar between 40 keV and 50 keV. The overall subjective image quality of solid organs at 50 keV was the best (p < 0.05). The AVS success rate was 95%. (4) Conclusions: For VMI+, 40 keV was the preferential energy level to obtain a high visualization rate of the adrenal veins and a high success rate of AVS, while 50 keV was the favorable energy level for the depiction of abdominal organs.

The Critical Shoulder Angle Can be Accurately and Reliably Determined from Three-Dimensional Computed Tomography Images.

OBJECTIVE: Anteroposterior (AP) radiographs do not necessarily offer the optimal approach to measuring the critical shoulder angle (CSA) due to the malposition of the scapula. Three-dimensional computed tomography (3D-CT) may offer some advantages, including the ability to rotate the scapula for position alignment and pre-operative planning for reducing CSA. This study aimed to investigate the accuracy and reliability of CSA measurement in 3D-CT and to determine whether there is an association between CSA and rotator cuff tears (RCTs). METHODS: In this retrospective study we identified 200 patients who received shoulder arthroscopy from 2019 to 2021, including 142 patients (81 females, 61 males) with RCTs and 58 patients (14 females, 44 males) with non-RCTs. For each participant, CSA was measured from standard shoulder AP radiographs and anterior views of 3D-CT of the scapula by two independent assessors. Inter- and intra-observer agreements were assessed by the intraclass correlation coefficient (ICC). The relationship between the two measurement methodologies was determined by Spearman's correlation coefficient and Bland-Altman plots. Discriminative capacity was calculated by using receiver operating curve (ROC) analyses in the whole cohort and age sub-groups above and below 45 years. RESULTS: We found perfect inter-observer (ICC >0.96) and intra-observer (ICC >0.97) reliabilities for CSA measurements obtained from the standard AP radiographs and the 3D-CT. There was a strong correlation between the two methods (r = 0.960, P < 0.001). The mean CSA was 31.7° ± 4.2° in the standard AP radiographs and 31.8° ± 4.4° in the 3D-CT (mean difference 0.02°, P = 0.940; bias 0.02°, limits of agreement -2.29° to +2.33°). ROC analysis of the whole cohort showed that the CSA measured in the standard AP radiographs (area under the ROC curve [AUC] = 0.812, P < 0.001) and the 3D-CT (AUC = 0.815, P < 0.001) predicted RCT with high confidence. ROC analysis of patients aged ≥45 years showed that the CSA measured from the standard AP radiographs (AUC = 0.869, P < 0.001) and the 3D-CT (AUC = 0.870, P < 0.001) were very good at predicting RCTs. CONCLUSION: CSA measured from standard AP radiographs and 3D-CT showed high consistency, and the CSA could be accurately and reliably measured using 3D-CT. CSAs measured from standard AP radiographs and 3D-CT could predict RCTs, especially in patients aged ≥45 years.

PtSnBi Nanoplates Enable Photoacoustic Imaging-Guided Highly Efficient Photothermal Tumor Ablation.

The development of photothermal agents (PTAs) with robust photostability and high photothermal conversion efficiency is of great importance for cancer photothermal therapy. Herein, a novel PTA was created using two-dimensional intermetallic PtSnBi nanoplates (NPs), which demonstrated excellent photostability and biocompatibility with a high photothermal conversion efficiency of ∼61 % after PEGylation. More importantly, PtSnBi NPs could be employed as photoacoustic imaging contrast agents for tumor visualization due to their strong absorbance in the NIR range. In addition, both in vitro and in vivo experiments confirmed that PtSnBi NPs had a good photothermal efficacy under NIR laser irradiation. Therefore, the remarkable therapeutic characteristics of PtSnBi NPs make them a most promising candidate for cancer theranostics.

Effects of hyperbaric oxygen on Notch signaling pathway after severe carbon monoxide poisoning in mice.

Demyelination of the cerebral white matter is the most common pathological change after carbon monoxide (CO) poisoning. Notch signaling, the mechanism underlying the differentiation of astrocytes and oligodendrocytes, is critical to remyelination of the white matter after brain lesion. The purpose of this work was to determine the effects of hyperbaric oxygen (HBO) on Notch signaling pathway after CO poisoning for the explanation of the protective effects of HBO on CO-poisoning-related cerebral white matter demyelination. The male C57 BL/6 mice with severe CO poisoning were treated by HBO. And HBO therapy shortened the escape latency and improved the body mass after CO poisoning. HBO therapy also significantly suppressed protein and mRNA levels of Notch1 and Hes5 after CO poisoning. Our findings suggested that HBO could suppress the activation of Notch signaling pathway after CO poisoning, which is the mechanism underlying the neuroprotection of HBO on demyelination after severe CO poisoning.

Hydrogen exerts neuroprotective effects by inhibiting oxidative stress in experimental diabetic peripheral neuropathy rats.

Diabetic peripheral neuropathy (DPN) is a complex disorder caused by long-standing diabetes. Oxidative stress was considered the critical creed in this DPN pathophysiology. Hydrogen has antioxidative effects on diabetes mellitus and related complications. However, there is still no concern on the beneficial effects of hydrogen in DPN. This paper aimed to evaluate the effects of exogenous hydrogen to reduce the severity of DPN in streptozotocin-induced diabetic rats. Compared with hydrogen-rich saline treatment, hydrogen inhalation significantly reduced blood glucose levels in diabetic rats in the 4th and 8th weeks. With regard to nerve function, hydrogen administration significantly attenuated the decrease in the velocity of motor nerve conduction in diabetic animals. In addition, hydrogen significantly attenuated oxidative stress by reducing the level of malondialdehyde, reactive oxygen species, and 8-hydroxy-2-deoxyguanosine and meaningfully enhanced the antioxidant capability by partially restoring the activities of superoxide dismutase. Further studies showed that hydrogen significantly upregulated the expression of nuclear factor erythroid-2-related factor 2 and downstream proteins such as catalase and hemeoxygenase-1 in the nerves of diabetic animals. Our paper showed that hydrogen exerts significant protective effects in DPN by downregulating oxidative stress via the pathway of nuclear factor erythroid-2-related factor 2, which suggests its potential value in clinical applications.

The myth of aortic valve annulus changes in aortic valve disease.

Background: The characteristics of aortic annulus changes in aortic regurgitation (AR) patients are poorly understood, and predictive factors among aortic valve disease are yet to be established. Objective: This study seeks to elucidate the pattern of annular size fluctuations across different cardiac phases in AR patients and to identify predictors for annular enlargement during either systole or diastole in aortic valve diseases. Methods: A retrospective analysis was conducted on 55 patients with severe aortic valve diseases, including 26 patients with aortic stenosis (AS) and 29 with AR, to discern the two groups' contrasting and analogous patterns of annular changes. The patient sample was expanded to 107 to investigate the factors influencing the size of the annulus during different cardiac phases. Based on our findings, patients were then divided into two groups: those with an annulus that is larger during systole (83 patients) and those where the annulus is larger during diastole (24 patients). Results: Typically, AR patients exhibit a dynamic annulus, with both perimeter and area being largest during mid-systole. These dimensions diminish progressively and then increase again in early diastole, a pattern consistent with observations in AS patients. Among 107 patients, 21% had diastolic enlargement. Systolic measurements would lead to prosthesis undersizing in 17% of these. Male gender and lower systolic annulus minimum relative to body surface area (AnMin index) were predictors of diastolic enlargement, with ROC curve areas of 0.70 and 0.87 for AR and AS, respectively. Conclusions: Systolic measurements are recommended for AR patients. Gender and the AnMin index are significant predictors, particularly potent in AS patients.

RNF186/EPHB2 Axis Is Essential in Regulating TNF Signaling for Colorectal Tumorigenesis in Colorectal Epithelial Cells.

The receptor tyrosine kinase EPHB2 (EPH receptor B2) is highly expressed in many human cancer types, especially in gastrointestinal cancers, such as colorectal cancer. Several coding mutations of the EPHB2 gene have been identified in many cancer types, suggesting that EPHB2 plays a critical role in carcinogenesis. However, the exact functional mechanism of EPHB2 in carcinogenesis remains unknown. In this study, we find that EPHB2 is required for TNF-induced signaling activation and proinflammatory cytokine production in colorectal epithelial cells. Mechanistically, after TNF stimulation, EPHB2 is ubiquitinated by its E3 ligase RNF186. Then, ubiquitinated EPHB2 recruits and further phosphorylates TAB2 at nine tyrosine sites, which is a critical step for the binding between TAB2 and TAK1. Due to defects in TNF signaling in RNF186-knockout colorectal epithelial cells, the phenotype of colitis-propelled colorectal cancer model in RNF186-knockout mice is significantly reduced compared with that in wild-type control mice. Moreover, we find that a genetic mutation in EPHB2 identified in a family with colorectal cancer is a gain-of-function mutation that promoted TNF signaling activation compared with wild-type EPHB2. We provide evidence that the EPHB2-RNF186-TAB2-TAK1 signaling cascade plays an essential role in TNF-mediated signal transduction in colorectal epithelial cells and the carcinogenesis of colorectal cancer, which may provide potential targets for the treatment of colorectal cancer.

ADC and kinetic parameter of primary tumor: Surrogate imaging markers for fertility-sparing vaginal radical trachelectomy in patients with stage IB cervical cancer.

PURPOSE: To investigate the role of ADC and kinetic parameters derived from DCE-MRI in selecting eligible candidates for fertility-sparing vaginal radical trachelectomy (VRT). METHOD: Female patients with FIGO stage IB cervical cancers between March 2019 and January 2022 were retrospectively included. All patients underwent hysterectomy and bilateral lymphadenectomy. According to the surgical pathology, the study population was divided into VRT-eligible group and VRT-ineligible group. ADC, semi-quantitative and quantitative kinetic parameters of the primary tumor were compared between the two groups. Logistic regression analysis was used to determine the independent predictors for VRT eligibility and ROC curve was used to evaluate the predictive performance. RESULTS: 19 patients were deemed eligible for VRT and 50 were ineligible. Compared with VRT-eligible group, time to peak and ADC were significantly lower in VRT-ineligible group (P = 0.004 and 0.001, respectively) while volume fraction of plasma (Vp) was higher in VRT ineligible group (P = 0.001). ADC and Vp were independent predictors for VRT eligibility. Combining Vp and ADC yielded the highest area under the ROC curve of 0.853 compared with that of 0.766 for Vp and 0.764 for ADC, though marginal differences were found (P = 0.109 and 0.078, respectively). CONCLUSIONS: ADC and the kinetic DCE-MRI parameter Vp can be used as surrogate markers to select eligible candidates for fertility-sparing VRT.