Renal function after ureteral reconstruction surgery in patients with solitary kidney.

Background: Ureteral strictures (US) could lead to impaired kidney function, which was alleviated by ureteral reconstruction surgery. However, solitary kidney (SK) patients with US were more complicated to treat. This study aimed to evaluate the impact of reconstruction surgery on renal function based on estimated glomerular filtration rate (eGFR) in patients with SK. Methods: We retrospectively enrolled patients who underwent reconstruction surgery between April 2014 to March 2022. eGFR was measured pre- and postoperatively. The 'static renal function' was defined as a change in eGFR of 20% or less at the last follow-up, and the 'worsening renal function group' was defined as a decrease of greater than 20%. Results: A total of 61 SK patients were involved. The success rate of ureteral reconstruction surgery was 90.16% (55/61). The median follow-up time was 20.8 months (range, 3.7-109.2 months). The median eGFR was 65.5 (range, 15.1-99.9) and 65.3 (range, 3.8-123.4) mL/min/1.73 m2 at the baseline and the last follow-up. No statistically significant difference in eGFR was observed between the preoperative baseline and last follow-up visits (P=0.58). However, in patients with baseline renal dysfunction [chronic kidney disease (CKD) stage 3-5], the eGFR significantly improved at the last follow-up compared to the baseline (P=0.02). Three patients developed a 'worsening renal function' (4.92%). Besides, the systolic blood pressures (SBP) at follow-up significantly reduced compared to the preoperative baseline (P=0.002). Conclusions: Ureteral reconstruction surgery is an effective treatment to preserve renal function, which also achieves a high success rate and is associated with the reduction of SBP for SK patients with US.

Needle-perc-assisted endoscopic surgery versus retrograde intrarenal surgery for the treatment of 1- to 2-cm lower-pole renal stones in patients with unfavorable infundibulopelvic anatomy: a matched-pair analysis.

PURPOSE: To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy. METHODS: Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. RESULTS: The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups. CONCLUSION: Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate.

Application of machine learning in the analysis of multiparametric MRI data for the differentiation of treatment responses in breast cancer: retrospective study.

OBJECTIVE: The objective of this study is to develop and validate a multiparametric MRI model employing machine learning to predict the effectiveness of treatment and the stage of breast cancer. METHODS: The study encompassed 400 female patients diagnosed with breast cancer, with 200 individuals allocated to both the control and experimental groups, undergoing examinations in Shenzhen, China, during the period 2017-2023. This study pertains to retrospective research. Multiparametric MRI was employed to extract data concerning tumor size, blood flow, and metabolism. RESULTS: The model achieved high accuracy, predicting treatment outcomes with an accuracy of 92%, sensitivity of 88%, and specificity of 95%. The model effectively classified breast cancer stages: stage I, 38% ( P = 0.027); stage II, 72% ( P = 0.014); stage III, 50% ( P = 0.032); and stage IV, 45% ( P = 0.041). CONCLUSIONS: The developed model, utilizing multiparametric MRI and machine learning, exhibits high accuracy in predicting the effectiveness of treatment and breast cancer staging. These findings affirm the model's potential to enhance treatment strategies and personalize approaches for patients diagnosed with breast cancer. Our study presents an innovative approach to the diagnosis and treatment of breast cancer, integrating MRI data with machine learning algorithms. We demonstrate that the developed model exhibits high accuracy in predicting treatment efficacy and differentiating cancer stages. This underscores the importance of utilizing MRI and machine learning algorithms to enhance the diagnosis and individualization of treatment for this disease.

A deep-learning model for intracranial aneurysm detection on CT angiography images in China: a stepwise, multicentre, early-stage clinical validation study.

BACKGROUND: Artificial intelligence (AI) models in real-world implementation are scarce. Our study aimed to develop a CT angiography (CTA)-based AI model for intracranial aneurysm detection, assess how it helps clinicians improve diagnostic performance, and validate its application in real-world clinical implementation. METHODS: We developed a deep-learning model using 16 546 head and neck CTA examination images from 14 517 patients at eight Chinese hospitals. Using an adapted, stepwise implementation and evaluation, 120 certified clinicians from 15 geographically different hospitals were recruited. Initially, the AI model was externally validated with images of 900 digital subtraction angiography-verified CTA cases (examinations) and compared with the performance of 24 clinicians who each viewed 300 of these cases (stage 1). Next, as a further external validation a multi-reader multi-case study enrolled 48 clinicians to individually review 298 digital subtraction angiography-verified CTA cases (stage 2). The clinicians reviewed each CTA examination twice (ie, with and without the AI model), separated by a 4-week washout period. Then, a randomised open-label comparison study enrolled 48 clinicians to assess the acceptance and performance of this AI model (stage 3). Finally, the model was prospectively deployed and validated in 1562 real-world clinical CTA cases. FINDINGS: The AI model in the internal dataset achieved a patient-level diagnostic sensitivity of 0·957 (95% CI 0·939-0·971) and a higher patient-level diagnostic sensitivity than clinicians (0·943 [0·921-0·961] vs 0·658 [0·644-0·672]; p<0·0001) in the external dataset. In the multi-reader multi-case study, the AI-assisted strategy improved clinicians' diagnostic performance both on a per-patient basis (the area under the receiver operating characteristic curves [AUCs]; 0·795 [0·761-0·830] without AI vs 0·878 [0·850-0·906] with AI; p<0·0001) and a per-aneurysm basis (the area under the weighted alternative free-response receiver operating characteristic curves; 0·765 [0·732-0·799] vs 0·865 [0·839-0·891]; p<0·0001). Reading time decreased with the aid of the AI model (87·5 s vs 82·7 s, p<0·0001). In the randomised open-label comparison study, clinicians in the AI-assisted group had a high acceptance of the AI model (92·6% adoption rate), and a higher AUC when compared with the control group (0·858 [95% CI 0·850-0·866] vs 0·789 [0·780-0·799]; p<0·0001). In the prospective study, the AI model had a 0·51% (8/1570) error rate due to poor-quality CTA images and recognition failure. The model had a high negative predictive value of 0·998 (0·994-1·000) and significantly improved the diagnostic performance of clinicians; AUC improved from 0·787 (95% CI 0·766-0·808) to 0·909 (0·894-0·923; p<0·0001) and patient-level sensitivity improved from 0·590 (0·511-0·666) to 0·825 (0·759-0·880; p<0·0001). INTERPRETATION: This AI model demonstrated strong clinical potential for intracranial aneurysm detection with improved clinician diagnostic performance, high acceptance, and practical implementation in real-world clinical cases. FUNDING: National Natural Science Foundation of China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Terrain effect on atmospheric process in seasonal ozone variation over the Sichuan Basin, Southwest China.

Terrain effect is challenging for understanding atmospheric environment changes under complex topography. This study targets the Sichuan Basin (SCB), a deep basin isolated by plateaus and mountains in Southwest China, by employing WRF-Chem with integrated process rates (IPR) analysis to characterize the terrain-driven seasonal variations of tropospheric ozone (O3) with atmospheric physical and chemical processes. Results show that the basin terrain exerts reversed impacts on regional air quality changes by aggravating summertime and alleviating wintertime near-surface O3 with the relative contributions oscillating seasonally between -40% and 40% in SCB. Similarly, a seasonal shift of vertical O3 structures is dominated by summertime positive and wintertime negative changes in the lower troposphere induced by basin terrain. The key contributions of atmospheric process to near-surface O3 are identified with vertical and horizontal transport, which is dominated by basin terrain with intensifying seasonal and diurnal variations. With the existence of basin, the daytime O3 productions at the near-surface layer are elevated in months of warm seasons (April and July) but inhibited in the cold seasons (October and January), presenting a seasonal transition of primary factor from meteorology to aerosol-radiation forcing on photochemical reactions. Driven by plateau-basin thermodynamic forcing, horizontal O3 transport between the SCB and eastern TP is enhanced by mountain-plains solenoid (MPS), and even nocturnal O3-rich layers contribute to the impacts of vertical exchange on near-surface O3 levels. The terrain effects of deep basin under the interaction of Asian monsoons and westerlies could jointly change atmospheric physical and chemical processes to construct the seasonal and diurnal O3 evolution patterns over the SCB region.

Jackstone in the renal calyx: A rare case report.

BACKGROUND: Jackstone is a rare entity of calculi in urinary tracts and has the characteristic appearance resembling toy jacks. They are nearly always reported to occur in the urinary bladder, we first report a rare case of jackstone located in the obstructed renal calyx. CASE SUMMARY: We report a 46-year-old man presenting with intermittent, painless gross hematuria and left flank pain. Urinary computed tomography revealed staghorn stones and secondary hydronephrosis. A jackstone with radiating branches was found in one of the dilated renal calyx. Percutaneous nephrolithotomy was performed and endoscopic images were recorded during the operation. Postoperative stone composition analysis revealed it as calcium oxalate monohydrate stones. CONCLUSION: Jackstones can occur in the renal collecting system besides the bladder. The unique appearance and imaging manifestations are the most important factors in the diagnosis of jackstones, and further exploration of the formation mechanism is required.

Adaptive parameter estimation for the expanded sandwich model.

An expanded-sandwich system is a nonlinear extended block-oriented system in which memoryless elements in conventional block-oriented systems are displaced by memory submodels. Expanded-sandwich system identification has received extensive attention in recent years due to the powerful ability of these systems to describe actual industrial systems. This study proposes a novel recursive identification algorithm for an expanded-sandwich system, in which an estimator is developed on the basis of parameter identification error data rather than the traditional prediction error output information. In this scheme, a filter is introduced to extract the available system information based on miserly structure layout, and some intermediate variables are designed using filtered vectors. According to the developed intermediate variables, the parameter identification error data can be obtained. Thereafter, an adaptive estimator is established by integrating the identification error data compared with the classic adaptive estimator based on the prediction error output information. Thus, the design framework introduced in this research provides a new perspective for the design of identification algorithms. Under a general continuous excitation condition, the parameter estimation values can converge to the true values. Finally, experimental results and illustrative examples indicate the availability and usefulness of the proposed method.

Evaluation of a continuous-time random-walk diffusion model for the differentiation of malignant and benign breast lesions and its association with Ki-67 expression.

The purpose of the current study was to evaluate the performance of a continuous-time random-walk (CTRW) diffusion model for differentiating malignant and benign breast lesions and to consider the potential association between CTRW parameters and the Ki-67 expression. Sixty-four patients (46.2 ± 11.4 years) with breast lesions (29 malignant and 35 benign) were evaluated with the CTRW model, intravoxel incoherent motion model, and diffusion-weighted imaging. Echo planar diffusion-weighted imaging was conducted using 13 b-values (0-3000 s/mm2 ). Three CTRW model parameters, including an anomalous diffusion coefficient Dm , and two parameters related to temporal and spatial diffusion heterogeneity, α and ß, respectively, were obtained, and had MRI b-values of 0-3000 s/mm2 . Receiver operating characteristic (ROC) analysis was conducted to determine the sensitivity, specificity, and diagnostic accuracy of CTRW parameters for differentiating malignant from benign breast lesions. In malignant breast lesions, the CTRW parameters Dm , α, and ß were significantly lower than the corresponding parameters of benign breast lesions. In the malignant breast lesion group, the CTRW parameter Dm was significantly lower in high Ki-67 expression than in low Ki-67 expression. In ROC analysis, the combination of CTRW parameters (Dm , α, ß) demonstrated the highest area under the curve value (0.985) and diagnostic accuracy (94.23%) in differentiating malignant and benign breast lesions. The CTRW model effectively differentiated malignant from benign breast lesions. The CTRW diffusion model offers a new way for noninvasive assessment of breast malignancy and better understanding of the proliferation of malignant lesions.

Differentiation of Small Gastrointestinal Stromal Tumor and Gastric Leiomyoma with Contrast-Enhanced CT.

Objective: The value of multiphase contrast-enhanced CT in differentiating gastrointestinal stromal tumors (GISTs) and gastric leiomyomas (GLMs) which were ≤3 cm was evaluated using machine learning. Methods: A retrospective analysis was conducted on 45 cases of small gastric wall submucosal tumors (including 22 GISTs and 23 GLMs) with pathologically confirmed diameter ≤3 cm and completed multiphase CT-enhanced scan images. The CT features including tumor location, maximum diameter, shape, margins, growth pattern, plain/enhanced CT value, cystic degeneration, calcification, ulcer, progressive reinforcement, perilesional lymph nodes, and the CT value ratio of the tumor to the aorta at the same level in the enhanced phase III scan of the two groups were evaluated. Tumor location and maximum diameter were automatically evaluated by machine learning. Results: The GISTs and GLMs with a diameter ≤3 cm showed clear margins, uniform density on plain scan CT, and progressive homogeneous enhancement. The age of the GISTs is greater than that of the GLMs group. The plain scan CT value of the GISTs group was lower than that in the GLMs group. In the GISTs group, the lesions were mostly located in the fundus (68.18%), showing a mixed growth pattern (54.55%), and in the GLMs group, most lesions were located in the cardia (47.82%), showing an intraluminal growth pattern (95.65%). The abovementioned differences were statistically significant. Conclusions: Contrast-enhanced CT has limited value in differentiating small GISTs from GLMs, which are ≤3 cm. Older age (>49.0 years), a low plain CT value (<42.5 Hu), mixed growth inside and outside the cavity, and noncardiac location tended to be the criteria for the diagnosis of small GISTs of the gastric wall.

Myocardial First-Pass Perfusion With Increased Anatomic Coverage at 3 T Using Autocalibrated Multiband Imaging.

BACKGROUND: Myocardial first-pass perfusion (FPP) imaging is a useful cardiac MRI method for the diagnosis of coronary artery disease. However, conventional 2D multislice FPP acquisitions usually have gaps between myocardium slices, which limits the overall assessment of myocardial ischemia. PURPOSE: To increase the anatomic coverage of myocardial FPP imaging at 3 T by implementing both autocalibrated multiband (MB) acquisition and k-t space acceleration with compress sensing (CS) reconstruction, without the need for additional reference scans. STUDY TYPE: Phantom and prospective human studies. PHANTOM/SUBJECTS: A T1MES (T1 Mapping and ECV Standardization in cardiovascular magnetic resonance) phantom and 20 subjects (12 healthy subjects and 8 patients, 10 males, age 42 ± 16 years). FIELD STRENGTH/SEQUENCE: A 3 T/saturation recovery prepared gradient echo sequence with contrast administration. ASSESSMENT: Phantom experiments were performed to compare the performance of autocalibrated MB-FPP with k-t acceleration using slice-GRAPPA and CS reconstructions. In vivo experiments were performed to compare the performance of conventional FPP (2.5× acceleration) with autocalibrated MB + CS-FPP (6× acceleration). In phantom experiments, the error maps were calculated. In in vivo experiments, the contrast ratio (CR) and blurring were quantitatively measured, while image quality, perceived signal-to-noise ratio (SNR), and artifact level were qualitatively graded by three cardiologists on a 4-point scale. STATISTICAL TESTS: Wilcoxon signed-rank test, paired t-test. A P value <0.05 was considered statistically significant. RESULTS: In phantom experiments, residual artifact was reduced using the MB + CS-FPP reconstruction method compared with using the MB + slice-GRAPPA reconstruction method. In in vivo experiments, the proposed autocalibrated MB + CS-FPP method demonstrated significantly higher CR (3.52 ± 0.78 vs 2.91 ± 0.81) and had significantly better perceived SNR (2.69 ± 0.29 vs 2.48 ± 0.31) compared to the conventional sequence. Compared with conventional FPP, MB + CS-FPP doubled the spatial coverage (MB + CS-FPP vs conventional FPP) without compromising the image quality (2.69 ± 0.26 vs 2.60 ± 0.30) or increasing the artifact level (2.60 ± 0.26 vs 2.52 ± 0.31). CONCLUSION: Autocalibrated MB + CS-FPP improved the myocardial coverage and achieved comparable image quality with the same spatial resolution and scan time as conventional FPP and is a promising technique for clinical myocardial perfusion imaging. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

Application value of T2 fluid-attenuated inversion recovery sequence based on deep learning in static lacunar infarction.

BACKGROUND: Regular monitoring of static lacunar infarction (SLI) lesions plays an important role in preventing disease development and managing prognosis. Magnetic resonance imaging is one method used to monitor SLI lesions. PURPOSE: To evaluate the image quality of the T2 fluid-attenuated inversion recovery (T2-FLAIR) sequence using artificial intelligence-assisted compressed sensing (ACS) in detecting SLI lesions and assess its clinical applicability. METHODS: A total of 42 patients were prospectively enrolled and scanned by T2-FLAIR. Two independent readers reviewed the images acquired with accelerated modes 1D (acceleration factor 2) and ACS (acceleration factors 2, 3, and 4). The overall image quality and lesion image quality were analyzed, as were signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and number of lesions between groups. RESULTS: The subjective assessment of overall brain image quality and lesion image quality was consistent between the two readers. The lesion display quality and the overall image quality were better with the traditional 1D acceleration method than with the ACS accelerated method. There was no significant difference in the SNR of the lacunar infarction in the images between the groups. The CNR of the images with the 1D acceleration mode was significantly lower than that of images with the ACS acceleration mode. Images with the 1D, ACS2, and ACS3 acceleration modes showed no significant differences in terms of detecting lesions but scan time can be reduced by 40% (1D vs. ACS3). CONCLUSION: ACS acceleration mode can greatly reduce the scan time. In addition, the images have good SNR, high CNR, and strong SLI lesion detection ability.

Mirabegron for medical expulsive therapy of ureteral stones: a systematic review and meta-analysis.

Objective: To systematically review and quantitively evaluate the efficacy and safety of mirabegron as a medical expulsive therapy for ureteral stones. Methods: We performed an extensive search of the EMBASE and PubMed databases for studies examining the use of mirabegron as a medical expulsive therapy for ureteral stones. The primary outcome measure assessed was the stone expulsion rate (SER), while the secondary outcomes evaluated were the stone expulsion interval (SEI) and the occurrence of pain episodes during follow-up. Risk ratios (RRs) and mean differences (MDs) with their respective 95% CIs were calculated. Results: We included a total of seven studies involving 728 participants. Our analysis revealed a significant increase in the stone expulsion rate (SER) with mirabegron (RR = 1.40; 95% CI = 1.17-1.67; p < 0.001) and a reduction in the frequency of pain episodes (MD = -0.80; 95% CI = -0.39 to -0.21; p = 0.008) compared to the control group. No significant difference was found in SEI between the two groups (MD = -3.04; 95% CI = -6.33 to 0.25; p = 0.07). Subgroup analysis revealed that the increased SER was significant for distal ureteral stones, but not for proximal and middle ureter stones. Compared to tamsulosin or silodosin, mirabegron showed no significant difference in SER, SEI, or pain episode frequency. The adverse effects of mirabegron were relatively rare and mild. Conclusion: Mirabegron appears to be a promising candidate for the MET of distal ureteral stones rather than proximal and middle ureteral stones, as it significantly increases SER and reduces pain episode frequency. Further well-designed randomised controlled trials are needed to validate and affirm these findings. Systematic Review Registration: PROSPERO (CRD42022341603).

Endoscopic treatment of urothelial encrusted pyelo-ureteritis disease: A case series.

BACKGROUND: Urothelial encrusted pyelo-ureteritis disease is an infrequent condition and there is no unified surgical treatment and reference standard to consult. We have used a minimally invasive endoscopic method to treat three such cases, which yielded excellent results. CASE SUMMARY: The first case was a 45-year-old man who had unilateral ureteropelvic junction (UPJ) atresia and contralateral stenosis and was treated by double endoscopic surgery using an anterograde percutaneous nephroscope coupled with a rigid retrograde ureteroscope. The second case was a 12-year-old boy who received a percutaneous nephroscopy on one side and a percutaneous nephroscopy with a rigid ureteroscope on the other side due to the presence of bilateral UPJ stenosis. The third case was a 32-year-old woman with bilateral lower ureteral stricture treated using a rigid retrograde ureteroscope. Endoscopic surgeries were successfully performed on all the three patients. Varying degrees of encrustation and erosion of the urothelium were observed during the operation. The calcified layer composition analysis showed magnesium ammonium phosphate or carbonate apatite. Two patients achieved a good prognosis. CONCLUSION: Minimally invasive endoscopic treatment for urothelial encrusted pyelo-ureteritis disease can yield better results.

High-fidelity photonic quantum logic gate based on near-optimal Rydberg single-photon source.

Compared to other types of qubits, photon is one of a kind due to its unparalleled advantages in long-distance quantum information exchange. Therefore, photon is a natural candidate for building a large-scale, modular optical quantum computer operating at room temperature. However, low-fidelity two-photon quantum logic gates and their probabilistic nature result in a large resource overhead for fault tolerant quantum computation. While the probabilistic problem can, in principle, be solved by employing multiplexing and error correction, the fidelity of linear-optical quantum logic gate is limited by the imperfections of single photons. Here, we report the demonstration of a linear-optical quantum logic gate with truth table fidelity of 99.84(3)% and entangling gate fidelity of 99.69(4)% post-selected upon the detection of photons. The achieved high gate fidelities are made possible by our near-optimal Rydberg single-photon source. Our work paves the way for scalable photonic quantum applications based on near-optimal single-photon qubits and photon-photon gates.

Ultrasound-guided renal access and balloon dilation for PCNL in the prone position: results of a multicenter prospective observational study.

PURPOSE: To investigate the safety and efficacy of ultrasound-guided renal access and tract dilation using balloon dilators, as well as to identify suitable patients for this technique. METHODS: Consecutive patients undergoing ultrasound-guided PCNL using balloon dilators between December 2019 and June 2020 in seven large medical centers from China were prospectively enrolled. Demographic and perioperative parameters of the patients were collected. Logistic regression analysis was used to analyze factors that would affect the success rate of tract establishment using ultrasound-guided renal access and balloon dilation. RESULTS: A total of 170 patients were included in this study, among whom, 91.18% of the (155/170) patients had a successful tract establishment under ultrasound guidance on the first attempt. The stone-free rate was 83.5% and postoperative complications occurred in 14 patients (8.23%). In univariate analysis, history of ipsilateral surgery (p = 0.026), and stone diameter (p = 0.01) were significantly associated with tract establishment failure, while a larger width of the target calyx (p = 0.016) and the presence of hydronephrosis (p = 0.001) were significantly associated with a successful tract establishment. In multivariate analysis, only hydronephrosis in target calyx (p = 0.027) was a favorable factor for successful tract establishment, and the history of ipsilateral renal surgery (p = 0.012) was the only independent risk factor for failure of tract establishment. CONCLUSION: It was safe and effective to establish percutaneous renal access with balloon dilation under whole-process ultrasound monitoring during PCNL. Furthermore, patients with a hydronephrotic target calyx and without history of ipsilateral renal surgery were most suited to this technique. Trial registration CHiCTR1800014448.

High-resolution NMR metabolomics of patients with subjective cognitive decline plus: Perturbations in the metabolism of glucose and branched-chain amino acids.

BACKGROUND: "Subjective cognitive decline plus" (SCD plus) increases the risk of Alzheimer's disease (AD), and this may be an early stage of AD that precedes amnestic mild cognitive impairment (aMCI). We examined alterations of serum metabolites and metabolic pathways in SCD plus subjects using 1H-magnetic resonance spectroscopy (1H NMR) metabolomics. METHODS: Serum samples from subjects with SCD plus (n = 32), aMCI (n = 33), and elderly controls (ECs, n = 41) were analyzed using an 800MHz NMR spectrometer. Multivariate analyses were used to identify serum metabolites, and two machine-learning methods were used to evaluate the diagnostic power of these metabolites in distinguishing SCD plus subjects, aMCI subjects, and ECs. RESULTS: Eight metabolites differentiated SCD plus from EC subjects. A random forest (RF) model discriminated SCD plus from EC subjects with an accuracy of 0.883 and an area under the receiver operating characteristic curve (AUROC) of 0.951. A support vector machine (SVM) model had an accuracy of 0.857 and an AUROC of 0.946. Nine other metabolites distinguished SCD plus from aMCI subjects. An RF model discriminated SCD plus from aMCI subjects (accuracy: 0.975, AUROC: 0.998) and an SVM model also discriminated these two groups (accuracy: 0.955, AUROC: 0.991). Disturbances of glucose and branched-chain amino acid (BCAA) metabolism were the most striking features of SCD plus subjects, and valine was positively correlated with Auditory Verbal Learning Test delayed-recall score. CONCLUSIONS: Serum metabolomics using 1H NMR provided noninvasive identification of perturbations in glucose and BCAA metabolism in subjects with SCD plus.

Genipin protects against mitochondrial damage of the retinal pigment epithelium under hyperglycemia through the AKT pathway mediated by the miR-4429/JAK2 signaling axis.

Background: To investigate the protective effect and mechanism of genipin (GE) on mitochondrial damage in retinal pigment epithelial (RPE) cells induced by high glucose. Methods: Differential genes of GE in the treatment of diabetic retinopathy (DR) were screened by the Gene Expression Omnibus (GEO) database. Differential genes located in the AKT pathway were obtained. TargetScan, miRDB, and DIANA databases were used to predict the targeted microRNAs (miRNAs) of differential genes. A high-fat diet combined with streptomycin (STZ) intraperitoneal injection were used to establish a diabetic mouse model. Diabetic mice were treated with GE by intragastric administration. The functional and molecular changes of the retina were detected by electroretinogram (ERG) and reverse transcription-polymerase chain reaction (RT-PCR). ARPE-19 cells were cultured under hyperglycemic conditions with AKT and JAK2 inhibitors. MiR-4429 was knocked down/overexpressed to detect changes in cell function, activity, and mitochondrial function. The dual luciferase reporter assay confirmed the targeted binding of miR-4429 with JAK2. Results: Bioinformatics analysis finally yielded JAK2 as the research target gene. miR-4429 was predicted to be the targeted miRNA of JAK2 by online databases. The results of animal experiments showed that the retinal function of mice recovered after GE administration (P<0.05), the expression of AKT and miR-4429 in RPE cells was significantly increased (P<0.05), and the expression of JAK2 was significantly decreased (P<0.05). The results of cell experiments showed that the functions of cells and mitochondria recovered after the addition of GE under hyperglycemia (P<0.05). Cell and mitochondrial functions were decreased after the addition of AKT inhibitor (P<0.05). Overexpression of miR-4429 or inhibition of JAK2 increased cell activity and mitochondrial function (P<0.05). The results of the dual luciferase reporter assay showed that miR-4429 had a targeted binding site with JAK2. Conclusions: GE protects ARPE-19 cell functional activity, inflammatory responses, and mitochondrial damage by promoting the AKT signaling pathway and regulating the expression of the miR-4429/JAK2 signaling axis.

Value of Intravoxel Incoherent Motion (IVIM) Imaging for Differentiation between Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma.

Efficient noninvasive imaging techniques in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) are very important because of their different management and prognosis. Our purpose was to evaluate the difference of parameters extracted from intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the two groups and their performance for the differentiation, as well as the significance of perfusion information. IVIM studies (9 b-values) in 41 patients with either ICC or HCC were reviewed retrospectively by two observers. Diffusion coefficient (D), pseudodiffusion coefficient (D∗), perfusion fraction (f), ADC, and the mean percentage of parenchymal enhancement (MPPE) at 30 s after contrast-enhancement were calculated and compared between ICC and HCC. The relationship between D∗, f values, and MPPE was evaluated by Spearman's correlation test. The diagnostic efficacy of all parameters was analyzed by the receiver operating characteristic (ROC) curve. Interobserver and intraobserver agreements were analyzed. The parameters (D and ADC) of ICC were distinctly higher than those of HCC; whereas the parameters (f and MPPE of arterial phase) were distinctly lower (all false discovery rate [FDR]-corrected P < 0.05). The metric D∗ value of ICC was slightly higher than that of HCC (71.44 vs 69.41) with FDR-corrected P > 0.05. Moreover, the value of parameter D was significantly lower than that of ADC (FDR-corrected P < 0.05). The parameters (D and f values) extracted from IVIM showed excellent diagnostic efficiency in the identification, and the diagnostic efficiency of D value was significantly higher than that of the ADC. There were positive correlations between perfusion-related parameters (D∗, f values) and MPPE. Interobserver and intraobserver agreements were excellent or perfect in measurements of all parameters. Parameters derived from IVIM were valuable for distinguishing ICC and HCC. Moreover, the D value showed better diagnostic efficiency for the differential diagnosis than monoexponential fitting-derived ADC value. Meanwhile, the significant correlation between perfusion-related parameters and MPPE demonstrates that specific IVIM metrics may serve as a noninvasive indicator for the vascular perfusion information of ICC and HCC.

PCNL Combined with 3D Printing Technology for the Treatment of Complex Staghorn Kidney Stones.

Objective: To explore the clinical application value of percutaneous nephrolithotripsy (PCNL) combined with 3D printing technology in the treatment of complex staghorn kidney stones. Methods: From January 2018 to February 2020, a total of 72 patients with complex staghorn kidney stones admitted to our center were divided into experimental group (3D printing group) and control group (computed tomography, CT, imaging group)) according to the random block method, and a prospective cohort study was conducted. Preoperative computed tomography urography (CTU) examination was performed on all patients in the two groups, and the original CT scan Digital Imaging and Communications in Medicine (DICOM) data of patients in the experimental group were separately extracted for three-dimensional reconstruction and 3D model printing and designed a doctor-patient communication evaluation score table. The two groups were compared in score table, puncture location time, total operation time, consistency between estimated calyx and target calyx, incidence of surgical complications, stone free rate, postoperative recovery, and other aspects. Results: Both groups completed preoperative CTU examination and showed good kidney and stone morphology. In the experimental group, all 3D printed models were completed and the internal anatomical structure could be clearly displayed. Simulation puncture and relevant measurement parameters could be obtained. The experimental group was significantly better than the control group in doctor-patient communication evaluation score, puncture location time, target calyx consistency, and stone free rate (p < 0.05), and there was no statistical difference in total operation time, postoperative complications, and postoperative recovery. Conclusions: Individualized 3D printing technology can fully evaluate and design percutaneous renal access and stone clearing strategies before surgery. Compared with traditional preoperative imaging evaluation, 3D printing makes PCNL more accurate and efficient in the treatment of complex staghorn shaped kidney stones, with a high stone free rate at the first stage and better doctor-patient communication satisfaction.

Impact of deep basin terrain on PM2.5 distribution and its seasonality over the Sichuan Basin, Southwest China.

The terrain effect on atmospheric environment is poorly understood in particular for the polluted region with underlying complex topography. Therefore, this study targeted the Sichuan Basin (SCB), a deep basin with severe PM2.5 pollution enclosed by the eastern Tibetan Plateau (TP), Yunnan-Guizhou Plateaus (YGP) and mountains over Southwest China, and we investigated the terrain effect on seasonal PM2.5 distribution and the meteorological mechanism based on the WRF-Chem simulation with stuffing the basin topography. It is characterized that the three-dimensional distribution of topography-induced PM2.5 concentrations over the SCB with the seasonal shift of regional PM2.5 averages from approximately 30 µg m-3 in summer to 90 µg m-3 in winter at surface layer and from summertime 10 µg m-3 to wintertime 30 µg m-3 in the lower free troposphere. Such basin-forced PM2.5 changes presented the vertically monotonical declines concentrated within the lower troposphere below 3.6 km in spring, 2.3 km in summer, 2.6 km in autumn and 4.8 km in winter. Impacts of deep basin aggravated PM2.5 accumulation within the SCB and transport toward the surrounding plateaus contributing approximately 50-90% to PM2.5 levels over the regions of eastern TP and northern YGP. In the SCB, atmospheric thermal structure in the lower troposphere could build a vertical convergence layer between the boundary layer and free troposphere, acting as a lid inhibiting air diffusion, which was regulated by the terrain effects on interactions of westerlies and Asian monsoons, especially the wintertime strong warm lid deteriorating air pollution in the SCB. Furthermore, warm and humid air conditions within the basin prompted sulfur oxidation ratio by +0.02 and nitrogen oxidation ratio by +0.22 effectively producing the secondary PM2.5 in atmospheric environment.