Detecting Muscle Invasion of Bladder Cancer: An Application of Diffusion Kurtosis Imaging Ratio and Vesical Imaging-Reporting and Data System.

BACKGROUND: Independent factors are needed to supplement vesical imaging-reporting and data system (VI-RADS) to improve its ability to identify muscle invasive bladder cancer (MIBC). PURPOSE: To assess the correlation between MIBC and diffusion kurtosis imaging (DKI) ratio, VI-RADS, and other factors (such as tumor location). STUDY TYPE: Retrospective. POPULATION: Sixty-eight patients (50 males and 18 females; age: 70.1 ± 9.5 years) with bladder urothelial carcinoma. FIELD STRENGTH/SEQUENCE: 1.5 T, conventional diffusion-weighted imaging (DWI), and DKI (single shot echo-planar sequence). ASSESSMENT: Three radiologists independently measured the diffusion parameters of each bladder cancer (BCa) and obturator internus, including the mean apparent diffusion coefficient (ADCmean), mean kurtosis (MK), and mean diffusion (MD). And the ratio of diffusion parameters between BCa and obturator internus was calculated (diffusion parameter ratio = bladder cancer:obturator internus). Based on the VI-RADS, the target lesions were independently scored. Furthermore, the actual tumor-wall contact length (ACTCL) and absolute tumor-wall contact length (ABTCL) were measured. STATISTICAL TESTS: Multicollinearity among independent variables was evaluated using the variance inflation factor (VIF). Multivariable logistic regression analysis was used to determine the independent risk factors of MIBC. The receiver operating characteristic curve was used to evaluate the efficacy of each variable in detecting MIBC. The DeLong test was used to compare the area under the curve (AUC). A P < 0.05 was considered statistically significant. RESULTS: MKratio (median: 0.62) and VI-RADS were independent risk factors for MIBC. AUCs for MKratio, VI-RADS, and MKratio combined with VI-RADS in assessing MIBC were 0.895, 0.871, and 0.973, respectively. MKratio combined with VI-RADS was more effective in diagnosing MIBC than VI-RADS alone. DATA CONCLUSIONS: MKratio has potential to assist the assessment of MIBC. MKratio can be used as a supplement to VI-RADS for detecting MIBC. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

Extracranial metastasis of glioblastoma: A case report and literature review.

INTRODUCTION: Glioblastoma (GBM) is the most common malignant tumor of the central nervous system. Extracranial metastasis is rare, accounting for only 0.4 %-0.5 % of all GBM patients. The pathways and mechanisms involved are still unclear. CASE PRESENTATION: We reported a rare case of GBM with multiple bone metastases, highly suspected of abdominal metastasis. This 20 year old woman underwent surgery in March 2017 and underwent postoperative radiotherapy and chemotherapy. In July 2018, she underwent a second surgery due to intracranial recurrence and also underwent radiotherapy and chemotherapy after the surgery. She experienced pain in the lumbosacral region in May 2019, abdominal magnetic resonance imaging (MRI) showed metastases to the ilium, sacrum, and multiple lumbar vertebrae. In August 2019, a lump was discovered at the sternum and biopsy was performed, pathological examination confirmed it as GBM. During this period, the patient's condition was briefly controlled after receiving palliative radiotherapy, chemotherapy, and targeted treatment. Surprisingly, the patient later developed highly suspected malignant ascites, and further anti-tumor treatment was refused. She died 7 months after diagnosis of extracranial metastases. CLINICAL DISCUSSION: This patient with GBM had multiple bone metastases and highly suspected abdominal metastasis after two operations. Chemotherapy, radiotherapy and Targeted therapy extend the survival period and improve the quality of life. CONCLUSION: We believe that the patient's extracranial metastases may have occurred through blood. Young "long-term survivors" who have undergone surgery seem to have a higher risk of extracranial metastasis. Timely detection and early treatment can improve the overall quality of life of the patient.

High-resolution MRI-based radiomics analysis to predict lymph node metastasis and tumor deposits respectively in rectal cancer.

PURPOSE: To establish and validate two predictive radiomics models for preoperative prediction of lymph node metastases (LNMs) and tumor deposits (TDs) respectively in rectal cancer (RC) patients. METHODS: A total of 139 RC patients (98 in the training cohort and 41 in the validation cohort) were enrolled in the present study. High-resolution magnetic resonance images (HRMRI) were retrieved for tumor segmentation and feature extraction. HRMRI findings of RC were assessed by three experienced radiologists. Two radiomics nomograms were established by integrating the clinical risk factors, HRMRI findings and radiomics signature. RESULTS: The predictive nomogram of LNMs showed good predictive performance (area under the curve [AUC], 0.90; 95% confidence interval [CI] 0.83-0.96) which was better than clinico-radiological (AUC, 0.83; 95% CI 0.74-0.93; Delong test, p = 0.017) or radiomics signature-only model (AUC, 0.77; 95% CI 0.67-0.86; Delong test, p = 0.003) in training cohort. Application of the nomogram in the validation cohort still exhibited good performance (AUC, 0.87; 95% CI 0.76-0.98). The accuracy, sensitivity and specificity of the combined model in predicting LNMs was 0.86,0.79 and 0.91 in training cohort and 0.83,0.85 and 0.82 in validation cohort. As for TDs, the predictive efficacy of the nomogram (AUC, 0.82; 95% CI 0.71-0.93) was not significantly higher than radiomics signature-only model (AUC, 0.80; 95% CI 0.69-0.92; Delong test, p = 0.71). Radiomics signature-only model was adopted to predict TDs with accuracy=0.76, sensitivity=0.72 and specificity=0.94 in training cohort and 0.68, 0.62 and 0.97 in validation cohort. CONCLUSION: HRMRI-based radiomics models could be helpful for the prediction of LNMs and TDs preoperatively in RC patients.

High resolution MRI-based radiomic nomogram in predicting perineural invasion in rectal cancer.

BACKGROUND: To establish and validate a high-resolution magnetic resonance imaging (HRMRI)-based radiomic nomogram for prediction of preoperative perineural invasion (PNI) of rectal cancer (RC). METHODS: Our retrospective study included 140 subjects with RC (99 in the training cohort and 41 in the validation cohort) who underwent a preoperative HRMRI scan between December 2016 and December 2019. All subjects underwent radical surgery, and then PNI status was evaluated by a qualified pathologist. A total of 396 radiomic features were extracted from oblique axial T2 weighted images, and optimal features were selected to construct a radiomic signature. A combined nomogram was established by incorporating the radiomic signature, HRMRI findings, and clinical risk factors selected by using multivariable logistic regression. RESULTS: The predictive nomogram of PNI included a radiomic signature, and MRI-reported tumor stage (mT-stage). Clinical risk factors failed to increase the predictive value. Favorable discrimination was achieved between PNI-positive and PNI-negative groups using the radiomic nomogram. The area under the curve (AUC) was 0.81 (95% confidence interval [CI], 0.71-0.91) in the training cohort and 0.75 (95% CI, 0.58-0.92) in the validation cohort. Moreover, our result highlighted that the radiomic nomogram was clinically beneficial, as evidenced by a decision curve analysis. CONCLUSIONS: HRMRI-based radiomic nomogram could be helpful in the prediction of preoperative PNI in RC patients.

Expression and prognostic significance of pyruvate dehydrogenase kinase 1 in bladder urothelial carcinoma.

Muscular infiltrating bladder urothelial carcinoma (MIBC) is a highly malignant disease with a poor prognosis. Radical cystectomy is the standard treatment. However, due to surgery and postoperative complications, the quality of life of patients is seriously affected. Therefore, it is increasingly important to find prognostic markers and new therapeutic targets for MIBC. Here, we investigated the expression of PDK1, a key regulator of glucose metabolism, in bladder urothelial carcinoma (BLCA) and its effect on prognosis. The expression pattern of PDK1 was examined by bioinformatics analysis and immunohistochemistry. A total of 101 cases of BLCA were selected for tissue microarrays (TMAs) that contained both tumour and paired normal tissues. We demonstrated that PDK1 expression was correlated with tumour grade and Ki67expression in our TMA cohort (all p values < 0.05). Kaplan-Meier survival analysis showed that patients with MIBC with high PDK1 expression had a worse prognosis than patients with low PDK1 expression (p = 0.016). Multifactor risk analysis showed that increased PDK1 expression was an independent prognostic factor affecting the overall survival of MIBC patients. GSEA showed that the mTOR pathway, HIF pathway, glycolysis, PI3K/AKT/mTOR signalling, etc. were differentially enriched in the PDK1 high expression phenotype. Hence, PDK1 may be a prognostic and therapeutic target for MIBC.

Expression and significance of ETFDH in hepatocellular carcinoma.

The ETFDH (electron transfer flavoprotein dehydrogenase) gene mutations are reported to be a major cause of riboflavin-responsive multiple acyl-coenzyme A dehydrogenation deficiency (MADD). However, the role of ETFDH in the prognosis of hepatocellular carcinoma (HCC) remains unclear. The aim of this study was to investigate the expression of ETFDH in HCC. Immunohistochemical staining of the 207 HCC tissue microarray showed that expression of ETFDH was significantly decreased in HCC compared with the matching noncancerous hepatic tissues (P < 0.001). Moreover, ETFDH expression levels were found to be correlated with AFP levels (P = 0.011). Intriguingly, ETFDH expression levels were significantly lower in poorly differentiated or undifferentiated HCCs as compared to the well or moderately differentiated cases (P = 0.001). Kaplan-Meier analysis revealed that low tumor expression of ETFDH was associated with a poorer overall survival in patients with HCC (P = 0.024). Furthermore, multivariate analysis showed that ETFDH (P = 0.047) was an independent predictor of overall survival. Our findings may shed new light on the identification of new prognostic marker for HCC.

The role of the Chaperonin containing t-complex polypeptide 1, subunit 8 (CCT8) in B-cell non-Hodgkin's lymphoma.

The chaperonin containing t-complex polypeptide 1 (CCT) is known to mediate folding of proteins. CCT, subunit 8 (CCT8), is the θ subunit of CCT complex chaperonin. CCT8 has been reported to be dysregulated in several tumor tissues. In this study, we investigated the role of CCT8 in B-cell non-Hodgkin's lymphoma (NHL). Clinically, the expression levels of CCT8 in reactive lymphoid hyperplasia (RLH) and B-cell NHL specimens were investigated using immunohistochemical analysis. We found that CCT8 was highly expressed in proliferating germinal center cells compared with the quiescent cells of the follicular mantle zone. Furthermore, CCT8 was highly expressed in progressive lymphomas than in indolent lymphomas. Kaplan-Meier curve showed that high expression of CCT8 was significantly associated with shorter overall survival in patients with diffuse large B-cell lymphoma. Moreover, we demonstrated that CCT8 could promote the proliferation of B-cell NHL cells. In addition, we found that CCT8 could accelerate the G1/S transition in B-cell NHL. Finally, we demonstrated that overexpression of CCT8 could reverse cell adhesion-mediated drug resistance (CAM-DR) phenotype. Our study may shed new insights into the important role of CCT8 in cancer development.

In situ high-valued utilization and transformation of sugars from Dioscorea zingiberensis C.H. Wright for clean production of diosgenin.

The industrial production of diosgenin in China generates a large amount of high-sugar wastes with low bioavailability, which causes serious pollution to the environment. In this study, a new clean and efficient process for the production of diosgenin was developed using sugars through in situ high-valued transformation. The sugar mixture from Dioscorea zingiberensis C.H. Wright contained abundant beneficial components. Nine typical microorganisms that produced intracellular products were evaluated. Saccharopolyspora spinosa was selected for recursive protoplast fusion to increase the spinosad yield by 46.3% compared with that of the wildtype. Diosgenin and spinosad co-production was conducted in a 100L bioreactor, with pH controlled by adding glucose. The biological oxygen demand of the effluent water decreased from 15,000mg/L to 450mg/L; hence, the proposed process is environment friendly.