Classification of coronary artery disease severity based on SPECT MPI polarmap images and deep learning: A study on multi-vessel disease prediction.

Background: Coronary artery disease (CAD) is a global health concern. Conventional single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is a noninvasive method for assessing the severity of CAD. However, it relies on manual classification by clinicians, which can lead to visual fatigue and potential errors. Deep learning techniques have displayed promising results in CAD diagnosis and prediction, providing efficient and accurate analysis of medical images. Methods: In this study, we explore the application of deep learning methods for assessing the severity of CAD and identifying cases of multivessel disease (MVD). We utilized the EfficientNet-V2 model in combination with DeepSMOTE to evaluate CAD severity using SPECT MPI images. Results: Utilizing a dataset consisting of 254 patients (176 with MVD and 78 with single-vessel disease [SVD]), our model achieved an accuracy rate of 84.31% and area under the receiver operating characteristic curve (AUC) value of 0.8714 in predicting cases of MVD. These results underline the promising potential of our approach in MVD prediction, offering valuable diagnostic insights and the prospect of reducing medical costs. Conclusion: This study emphasizes the feasibility of employing deep learning techniques for predicting MVD based on SPECT MPI images. The integration of Efficient-Net-V2 and DeepSMOTE methods effectively evaluates CAD severity and distinguishes MVD from SVD. Our research presents a practical approach to the early prediction and diagnosis of MVD, ultimately leading to enhanced patient outcomes and reduced healthcare costs.

Isolation and evaluation of the pathogenicity of a hybrid shiga toxin-producing and Enterotoxigenic Escherichia coli in pigs.

BACKGROUND: Porcine pathogenic Escherichia coli (E. coli), the globally recognized important pathogen, causes significant economic loss in the field. Enterotoxigenic E. coli (ETEC) causes porcine neonatal and post-weaning diarrhea (PWD), frequently carrying F4 adhesin, F18 adhesin, Heat-Stable toxin (ST), and Heat-Labile toxin (LT). Shiga Toxin-Producing E. coli (STEC) produces F18 adhesin and Shiga toxin type 2e (stx2e), majorly leading to systemic endothelial cell damage and edema disease. In this study, hemolytic pathogenic hybrid STEC/ETEC strains carrying ST and LT genes of ETEC and the Stx2e gene of STEC isolated from pigs with PWD in Taiwan were identified. The pathogenicity of a Taiwan hybrid STEC/ETEC strain was evaluated by oral inoculation in post-weaning pigs. RESULTS: Next generation sequencing and multilocus sequence typing of two hybrid Taiwan porcine STEC/ETEC isolates indicated that these two isolates were closely related to the ST88 porcine hybrid STEC/ETEC isolated from pigs with watery diarrhea. Furthermore, the two hybrid Taiwan porcine STEC/ETEC isolates also displayed combinations of multiple resistance genes encoding mechanisms for target modification and antibiotic inactivation. Animal experiments confirmed that the Taiwan hybrid STEC/ETEC could cause watery diarrhea in post-weaning pigs with no signs of edema disease and minimal histopathological lesions. CONCLUSION: To the best of the authors' knowledge, the present study is the first study demonstrating intestinal pathogenicity of the hybrid STEC/ETEC in pigs. The result suggests that the hybrid STEC/ETEC should be considered as a new emerging pathogen and a new target for vaccine development.

Characterizing Genetic Susceptibility to Colorectal Cancer in Taiwan Through Genome-Wide Association Study.

We conducted the first genome-wide association study (GWAS) of colorectal cancer (CRC) in Taiwan with 5342 cases and 61,015 controls. Ninety-two SNPs in three genomic regions reached genome-wide significance (p < 5 × 10-8). The lead SNPs in these three regions were: rs12778523 (OR = 1.18, 95% CI, 1.15-1.23, p = 4.51 × 10-13), an intergenic SNP between RNA5SP299 and LINC02676 at chromosome 10p14; rs647161 (OR = 1.14, 95% CI, 1.09-1.19, p = 2.21 × 10-9), an intronic SNP in PITX1 at 5q31.1, and rs10427139 (OR = 1.20, 95% CI, 1.14-1.28, p = 3.62 × 10-9), an intronic SNP in GPATCH1 at 19q13.1. We further validated CRC susceptibility SNPs previously identified through GWAS in other populations. A total of 61 CRC susceptibility SNPs were confirmed in Taiwanese. The top validated putative CRC susceptibility genes included: POU2AF2, HAO1, LAMC1, EIF3H, BMP2, ZMIZ1, BMP4, POLD3, CDKN1A, PREX1, CDKN2B, CDH1, and LRIG1. The top enriched pathways included TGF-ß signaling, BMP signaling, extracellular matrix organization, DNA repair, and cell cycle control. We could not validate SNPs in HLA-G at 6p22.1 and in NOTCH4 at 6p21.32. We generated a weighted genetic risk score (GRS) using the 61 SNPs and constructed receiver operating characteristic (ROC) curves using the GRS to predict CRC. The area under the ROC curve (AUC) was 0.589 for GRS alone and 0.645 for GRS, sex, and age. These susceptibility SNPs and genes provide important insights into the molecular mechanisms of CRC development and help identify high-risk individuals for CRC in Taiwan.

Is multilevel MIS-TLIF with bilateral facetectomy a lordosing procedure? A retrospective cohort of 3-level MIS-TLIF.

OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a common surgery that has been extensively reported. However, publications on 3-level MIS-TLIF are sparse, and the effects of multilevel MIS-TLIF on sagittal balance remain controversial. This study aimed to analyze the outcomes and variables involved in the correction of sagittal imbalance by multilevel MIS-TLIF. METHODS: Consecutive patients who underwent 3-level MIS-TLIF were retrospectively analyzed. Demographics and clinical outcomes were evaluated. Standard radiological and spinopelvic parameters were measured pre- and postoperatively, and at the last follow-up. A linear regression model was used to examine the correlation between preoperative segmental lordosis (SL) and the degree of sagittal correction. An optimal cutoff of preoperative SL to predict the change in sagittal correction was determined by receiver operating characteristic (ROC) analysis. RESULTS: Forty-seven patients (mean follow-up 24.63 ± 12.69 months) were included. Postoperatively, all patients showed clinical improvements, demonstrated by the Oswestry Disability Index and visual analog scale. The overall SL at the last follow-up was slightly nonsignificantly increased (1.23°, p = 0.267), while the other spinopelvic parameters, including lumbar lordosis (p = 0.008), sacral slope (p < 0.001), pelvic tilt (p = 0.002), and pelvic incidence-lumbar lordosis mismatch (p = 0.006), all improved significantly compared with preoperatively. The preoperative SL was negatively correlated with the change in SL at the last follow-up (r2 = 0.2591, p = 0.0003), and the cutoff value was 26.89° (area under the ROC curve = 0.7836, p = 0.0087). The 24 patients who had a less lordotic lumbar spine (i.e., preoperative SL ≤ 27°) demonstrated significant improvement in spinopelvic parameters, whereas the other 23 patients (SL > 27°) had a slight, insignificant decrease of spinopelvic parameters. CONCLUSIONS: Multilevel MIS-TLIF improved sagittal balance and SL with satisfactory patient-reported clinical outcomes at 2 years postoperatively. Multilevel MIS-TLIF was more effective in increasing lordosis in patients whose lumbar spine had a smaller preoperative lordotic curve (SL ≤ 27°).

Characterization of primary Sjögren's syndrome in the Taiwan Han population through a genome-wide association study and polygenic risk score analysis.

BACKGROUND: Sjögren's syndrome (SS) is an autoimmune disorder that primarily affects the exocrine glands, leading to dryness of mucous membranes and systemic manifestations. This study aimed to identify genetic markers associated with primary SS (pSS) in the Taiwan Han population through a hospital-based genome-wide association study (GWAS) and polygenic risk score (PRS) analysis, addressing the lack of genetic research. RESULTS: This study included 11,390 patients diagnosed with pSS and 113,900 controls. GWAS identified one known locus and eight novel loci. Known HLA alleles, including HLA-DRB1*15:01 and HLA-DQA1*03:01, were successfully replicated in a consistent effect direction. PRS analysis revealed that several autoimmune diseases share similar genetic backgrounds with pSS, including rheumatoid arthritis and systemic lupus erythematosus. CONCLUSION: This study represents the largest cohort to date on the genetics of pSS in the Taiwan Han population. Our findings provide valuable insights into the pathogenesis of pSS and emphasize the comorbidities associated with it as an autoimmune disease.

Comparative Risk of Neuropsychiatric Adverse Events Associated With Leukotriene-Receptor Antagonists Versus Inhaled Corticosteroids.

BACKGROUND: Leukotriene-receptor antagonists (LTRA) and inhaled corticosteroids (ICS) are common controller medications for asthma, but limited studies examine their comparative risks on neuropsychiatric adverse events (NAEs) in patients with asthma. OBJECTIVE: To investigate the comparative risks of LTRA versus ICS on 7 distinct categories of NAEs in patients with asthma at a nationwide level. METHODS: We conducted a nationwide cohort study during 2010-2021. Incident NAEs and their clinical subgroups (eg, psychotic disorders, anxiety disorders, movement disorders, behavioral and emotional disorders, mood disorders, sleep-related disorders, and personality disorders) were assessed. Cox proportional hazards regressions were used to quantify the comparative risks. RESULTS: There were 1,249,897 patients with asthma aged 6 to 64 years. Incidence rates for NAEs were 25.10 per 1000 person-years among patients treated with LTRA and 23.46 per 1000 person-years among those treated with ICS. The incidence rate difference was 1.64 (95% confidence interval [CI]: 0.30-2.98) per 1000 person-years. Positive associations of NAEs and 3 clinical subgroups were found in patients treated with LTRA compared with ICS (hazard ratios [HR]: 1.06 [95% CI: 1.00-1.12] for NAEs; HR: 1.88 [95% CI: 1.24-2.84] for psychotic disorders; HR: 1.10 [95% CI: 1.01-1.20] for anxiety disorders; and HR: 1.27 [95% CI: 1.02-1.58] for behavioral and emotional disorders), but not for movement disorders, mood disorders, sleep-related disorders, and personality disorders. CONCLUSIONS: This nationwide cohort study identified heightened risks, ranging from 6% to 88%, of NAEs and 3 clinical subgroups in patients with asthma treated with LTRA compared with ICS. These findings underscore the necessity for clinicians to communicate with patients regarding potential neuropsychiatric harms when prescribing LTRA.

Thermal ablation for Bethesda III and IV thyroid nodules: current diagnosis and management.

The diagnosis and management of Bethesda III and IV thyroid nodules remain clinical dilemmas. Current guidelines from academic societies suggest active surveillance or diagnostic lobectomy. However, the extent of surgery is often inappropriate, and a considerable percentage of patients experience under- or over-treatment. Thermal ablation has gained popularity as a safe and effective alternative treatment option for benign thyroid nodules. This review explores the feasibility of thermal ablation for Bethesda III or IV thyroid nodules, aiming to preserve the thyroid organ and avoid unnecessary surgery. It emphasizes individualized management, the need to consider factors including malignancy risk, clinical characteristics, and sonographic features, and the importance of supplemental tests such as repeat fine needle aspiration cytology, core needle biopsy, molecular testing, and radioisotope imaging.

Addressing the challenges of missed parathyroid glands in ultrasonography for secondary hyperparathyroidism: a retrospective observational study.

Purpose: Preoperative localization plays an important role in secondary hyperparathyroidism (SHPT) surgery. The advantages of neck ultrasound (US) include high availability and low cost. However, the reported sensitivity of US is 54%-76%, and the reason for missed parathyroid glands (PGs) on US has been rarely addressed. Methods: Fifty-four patients who were diagnosed with renal SHPT from September 2020 to March 2022 were included in this retrospective study. Preoperative localization included surgeon-oriented US and technetium 99m-sestamibi single-photon emission CT (SPECT)/CT. Results: A total of 212 PGs were pathologically confirmed, resulting in a success rate of 96.2% (52 of 54). Using echo, 193 PGs (91.0%) were accurately localized, while 19 glands (9.0%) were not identified, including those in ectopic positions (n = 12, at thymus or intrathyroid or others), of small size (<1 cm, n = 6), or overlapping with an ipsilateral PG (n = 1). US accurately detected 4 PGs in 36 (66.7%) patients, while SPECT/CT localized 4 glands in 19 patients (35.2%). Although the number of US-detectable PGs was not associated with success rate, it showed a significant negative correlation with surgical time (rs = -0.459, P = 0.002). Conclusion: US detected 4 glands in 66% of SHPT patients with a sensitivity of 90% for localization. Ectopic position and small size were the most common reasons for the failure to detect PG on US. Complete preoperative echo localization might shorten operating time.

Pooling controls from nested case-control studies with the proportional risks model.

The standard approach to regression modeling for cause-specific hazards with prospective competing risks data specifies separate models for each failure type. An alternative proposed by Lunn and McNeil (1995) assumes the cause-specific hazards are proportional across causes. This may be more efficient than the standard approach, and allows the comparison of covariate effects across causes. In this paper, we extend Lunn and McNeil (1995) to nested case-control studies, accommodating scenarios with additional matching and non-proportionality. We also consider the case where data for different causes are obtained from different studies conducted in the same cohort. It is demonstrated that while only modest gains in efficiency are possible in full cohort analyses, substantial gains may be attained in nested case-control analyses for failure types that are relatively rare. Extensive simulation studies are conducted and real data analyses are provided using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) study.

Biocompatibility and corrosion resistance of drug coatings with different polymers for magnesium alloy cardiovascular stents.

Recently, advances in enhancing corrosion properties through various techniques, and the clinical application of biodegradable cardiovascular stents made from magnesium (Mg) alloys face challenges to corrosion resistance, blood compatibility, and biocompatibility. Drug-eluting stents (DES) offer a solution to enhance the corrosion resistance of Mg alloys while simultaneously reducing the occurrence of restenosis. In this study, WE43 Mg alloy was pretreated using electropolishing technology, and different polymers (PEG and PLLA) were used as drug-polymer coatings for the Mg alloy. At the same time, PTX, an anticoagulant, was incorporated to achieve drug coating of different polymers on WE43 Mg alloy. The corrosion resistance of different polymer-drug coatings was assessed using a plasma solution. Furthermore, in vitro and in vivo tests were used to evaluate the blood biocompatibility of these coatings. The results indicated the PTX-PEG-coated WE43 Mg alloy exhibited the highest corrosion resistance and the most stable drug release profile among the tested coatings. Its hemolysis rate of 0.6 % was within the clinical requirements (<5 %). The incorporation of PEG prevents non-specific protein adsorption and nanoparticle aggregation, enhancing the surface hemocompatibility of WE43 Mg alloy. Therefore, the PTX-PEG coating shows promising potential for application in the development of drug-coated Mg alloy.

Effectiveness of a nutrition education intervention using simulation videos and encouragement of parental involvement for elementary school students.

This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants' knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants' healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.

Pulsed sounds caused by internal oxygen transport during photosynthesis in the seagrass Halophila ovalis.

Oxygen bubbles that leak from seagrass blades during photosynthesis have been hypothesized to cause cavitation sounds in aquatic plants. Here we investigate low-amplitude sounds with regular pulse rates produced during photosynthesis in seagrass beds of Halophila ovalis (Qitou Bay, Penghu islands and Cigu Lagoon, Taiwan). Sound pulses appear in the morning when illumination exceeds 10,000 Lux, peak at midday and decrease in midafternoon on a sunny day. Frequencies peak between 1 to 4 kHz, durations range between ca. 1.8 to 4.8 ms, and sound pressure level 1 cm from the bed is 105.4 ± 0.5 dB re 1 µPa (1100 h on a cloudy day). Sounds attenuate rapidly with distance, disappearing beyond 15 cm. Blocking sunlight or administering herbicide stops ongoing sounds. Gas bubbles are not typically seen during sound production ruling out cavitation, and external force (scissor cutting or plant pressed against the substrate) applied to the patch, leaves, petioles, or rhizomes generally increases pulse rate. We suggest sound emission is caused by internal oxygen transport through pores in diaphragms (a whistle mechanism) at the leaf base and nodes of the rhizome.

Behavioral change in fruit and vegetable consumption and associated cognitive impairment among Chinese older adults.

BACKGROUND: Previous research has examined how fruit and vegetable consumption may affect cognitive impairment among older adults. However, knowledge regarding the behavioral change in fruit and vegetable consumption remains limited in the Chinese older adult population. This research aimed to fill the literature gap. METHODS: We used data from five waves of the Chinese Longitudinal Healthy Longevity Study (2005-2018, observations = 18,856 from 11,388 participants) and selected older adult participants (65 years old or above). A behavioral change was defined as a consumption change in the study sample. Cognitive impairment was measured based on the mini-mental state examination. We used the Cox multi-state model as the major statistical analysis. RESULTS: Chinese older adults who transitioned from non-daily to daily consumption of vegetables had lower odds of reporting cognitive impairment deteriorating from normal cognitive function to severe, compared with those who did not change their consumption behavior (HR [hazard ratio] = 0.88, 95% CI 0.80, 0.97; p < 0.05). All transitions in fruit consumption were negatively associated with cognitive changes from normal cognitive function to mild-moderate cognitive impairment. In our additional stratified analysis examining rural-urban disparity, we observed similar significant findings among rural older adults (Vegetable consumption change: HR = 0.83, 95% CI 0.75, 0.93; p < 0.01) but not urban older adults. CONCLUSION: Behavioral change in consumption of vegetables may affect Chinese older adults' cognitive health. Future interventions should focus on the critical role of behavioral change in vegetable consumption in reducing older adults' cognitive impairment. However, the contradictory findings of fruit consumption warrant further investigation to draw a conclusive claim regarding its benefits for cognitive health.

Insulinoma-associated protein 1 (INSM1) immunohistochemical expression in normal, hyperplastic, and neoplastic canine neuroendocrine tissues.

Insulinoma-associated protein 1 (INSM1), a recently identified neuroendocrine marker, is a transcriptional regulator with highly conserved INSM1 homologues in various species. This study investigated the immunohistochemical reactivity of the INSM1 antibody in 20 normal canine neuroendocrine tissues from various anatomical locations, 87 hyperplastic or neoplastic tissues of neuroendocrine origin, and 62 non-neuroendocrine neoplasms and compared the results with those of chromogranin A and synaptophysin in neuroendocrine neoplasms. Western blot was performed on fresh canine pituitary glands and canine parathyroid glands to confirm the specificity of the anti-INSM1 antibody. The results showed that the anti-INSM1 antibody could detect nuclear expression in normal canine neuroendocrine tissues, except for the parathyroid glands. INSM1 was detectable in 79/87 (91%) of the hyperplastic and neoplastic neuroendocrine lesions, but all parathyroid carcinomas and parathyroid adenomas (three samples each) were negative for INSM1. In contrast, INSM1 was detected in only one of 62 (2%) non-neuroendocrine neoplasms. The overall percentage of neuroendocrine neoplasms that immunolabeled positively for all three markers was 89%. In addition, the nuclear expression of INSM1 was easier to interpret than that of chromogranin A or synaptophysin. These findings confirm that INSM1 is a useful immunohistochemical marker for diagnosing canine neuroendocrine neoplasms, except for parathyroid neoplasms, and should be considered as part of immunohistochemistry panels to improve diagnostic capability.

High performance poly(lactic acid)/poly(ether-block-amide) blend-based bionanocomposites containing carbon nanotubes and/or organoclay.

High-performance poly(lactic acid) (PLA) blend-based composites were fabricated with a poly(ether-block-amide) (PEBA) elastomer acting as the blend counterpart. It was confirmed that a compatibilizer (ADR) enhanced the interaction between PLA and PEBA. Carbon nanotubes (CNTs) and organoclay (30B) were added individually and simultaneously into the blend to produce bionanocomposites. Morphological results showed that CNTs were mainly dispersed in PEBA domains, whereas 30B was mainly localized at the interfacial region of PLA and PEBA phases. The selective localization of added CNTs and 30B led to significant modification of the properties of the compatibilized PLA/PEBA blend. The brittleness and flammability of PLA were evidently improved after forming the bionanocomposites. Differential scanning calorimetry results revealed that CNTs and 30B assisted the crystallization of both PLA and PEBA in the composites, with CNTs providing superior nucleation efficiency to 30B. Thermogravimetric analysis revealed the thermal stability enhancement of the blend after adding CNTs and/or 30B, with up to 16 °C increase at 20 wt% loss with inclusion of 2 phr 30B. Addition of CNTs and/or 30B improved the blend's anti-dripping performance during burning tests, and CNT exhibited better anti-dripping efficiency. Ductility of PLA was drastically improved after forming the compatibilized blend, and further improved with incorporation of CNTs and/or 30B (increased from 9 % for neat PLA to 252 % for the hybrid composite containing CNT/30B). The impact strength of 1 phr CNTs-added composite was about 3 times that of PLA. Rheological properties indicated the (pseudo)network formation of added filler(s), leading to a significant reduction in electrical resistivity, up to six orders of magnitude with addition of 3 phr CNTs.

A stress-induced source of phonon bursts and quasiparticle poisoning.

The performance of superconducting qubits is degraded by a poorly characterized set of energy sources breaking the Cooper pairs responsible for superconductivity, creating a condition often called "quasiparticle poisoning". Both superconducting qubits and low threshold dark matter calorimeters have observed excess bursts of quasiparticles or phonons that decrease in rate with time. Here, we show that a silicon crystal glued to its holder exhibits a rate of low-energy phonon events that is more than two orders of magnitude larger than in a functionally identical crystal suspended from its holder in a low-stress state. The excess phonon event rate in the glued crystal decreases with time since cooldown, consistent with a source of phonon bursts which contributes to quasiparticle poisoning in quantum circuits and the low-energy events observed in cryogenic calorimeters. We argue that relaxation of thermally induced stress between the glue and crystal is the source of these events.

Peripheral glia and neurons jointly regulate activity-induced synaptic remodeling at the Drosophila neuromuscular junction.

In the nervous system, reliable communication depends on the ability of neurons to adaptively remodel their synaptic structure and function in response to changes in neuronal activity. While neurons are the main drivers of synaptic plasticity, glial cells are increasingly recognized for their roles as active modulators. However, the underlying molecular mechanisms remain unclear. Here, using Drosophila neuromuscular junction as a model system for a tripartite synapse, we show that peripheral glial cells collaborate with neurons at the NMJ to regulate activity-induced synaptic remodeling, in part through a protein called shriveled (Shv). Shv is an activator of integrin signaling previously shown to be released by neurons during intense stimulation at the fly NMJ to regulate activity-induced synaptic remodeling. We demonstrate that Shv is also present in peripheral glia, and glial Shv is both necessary and sufficient for synaptic remodeling. However, unlike neuronal Shv, glial Shv does not activate integrin signaling at the NMJ. Instead, it regulates synaptic plasticity in two ways: 1) maintaining the extracellular balance of neuronal Shv proteins to regulate integrin signaling, and 2) controlling ambient extracellular glutamate concentration to regulate postsynaptic glutamate receptor abundance. Loss of glial cells showed the same phenotype as loss of Shv in glia. Together, these results reveal that neurons and glial cells homeostatically regulate extracellular Shv protein levels to control activity-induced synaptic remodeling. Additionally, peripheral glia maintains postsynaptic glutamate receptor abundance and contribute to activity-induced synaptic remodeling by regulating ambient glutamate concentration at the fly NMJ.

Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound.

OBJECTIVES: This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. METHODS: From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. RESULTS: The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. CONCLUSION: This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.

Intrathoracic goiters significantly impact both cosmetic appearance and induce numerous compressive symptoms.Radiofrequency ablation brought notable volume reduction and persistent, effective alleviation of compressive symptoms.Radiofrequency ablation presents a promising therapeutic modality with long-term benefits for patients with intrathoracic goiter.

Secretory autophagy - a new paradigm regulating synaptic plasticity.

When exposed to new experiences or changes in the environment, neurons rapidly remodel their synaptic structure and function in a process called activity-induced synaptic remodeling. This process is necessary for transforming transient experiences into stable, lasting memories. The molecular mechanisms underlying acute, activity-dependent synaptic changes are not well understood, partly because processes regulating synaptic plasticity and neurodevelopment are intricately linked. By using an RNAi screen in Drosophila targeting genes associated with human nervous system function, we found that while macroautophagy (referred to as autophagy) is fundamental for both synapse development and synaptic plasticity, activity-induced synaptic remodeling does not rely on genes associated with lysosomal degradation. These findings suggest a requirement for the unconventional secretory autophagy pathway in regulating synaptic plasticity, wherein autophagosomes, instead of fusing with lysosomes for degradation, fuse with the plasma membrane to release their contents extracellularly. To test this hypothesis, we knocked down Sec22, Snap29, and Rab8, molecular components required for secretory autophagy, all of which disrupted structural and functional plasticity. Additionally, by monitoring autophagy, we demonstrated that neuronal activity suppresses degradative autophagy to shift the pathway toward secretory autophagy release. Our work unveils secretory autophagy as a novel trans-synaptic signaling mechanism crucial for activity-induced synaptic remodeling.

Novel artificial tricalcium phosphate and magnesium composite graft facilitates angiogenesis in bone healing.

BACKGROUND: Bone grafting is the standard treatment for critical bone defects, but autologous grafts have limitations like donor site morbidity and limited availability, while commercial artificial grafts may have poor integration with surrounding bone tissue, leading to delayed healing. Magnesium deficiency negatively impacts angiogenesis and bone repair. Therefore, incorporating magnesium into a synthetic biomaterial could provide an excellent bone substitute. This study aims to evaluate the morphological, mechanical, and biological properties of a calcium phosphate cement (CPC) sponge composed of tetracalcium phosphate (TTCP) and monocalcium phosphate monohydrate (MCPM), which could serve as an excellent bone substitute by incorporating magnesium. METHODS: This study aims to develop biomedical materials composed mainly of TTCP and MCPM powder, magnesium powder, and collagen. The materials were prepared using a wet-stirred mill and freeze-dryer methods. The particle size, composition, and microstructure of the materials were investigated. Finally, the biological properties of these materials, including 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay for biocompatibility, effects on bone cell differentiation by alkaline phosphatase (ALP) activity assay and tartrate-resistant acid phosphatase (TRAP) activity assay, and endothelial cell tube formation assay for angiogenesis, were evaluated as well. RESULTS: The data showed that the sub-micron CPC powder, composed of TTCP/MCPM in a 3.5:1 ratio, had a setting time shorter than 15 minutes and a compressive strength of 4.39±0.96 MPa. This reveals that the sub-micron CPC powder had an adequate setting time and mechanical strength. We found that the sub-micron CPC sponge containing magnesium had better biocompatibility, including increased proliferation and osteogenic induction effects without cytotoxicity. The CPC sponge containing magnesium also promoted angiogenesis. CONCLUSION: In summary, we introduced a novel CPC sponge, which had a similar property to human bone promoted the biological functions of bone cells, and could serve as a promising material used in bone regeneration for critical bone defects.