Homotopic functional connectivity disruptions in schizophrenia and their associated gene expression.

It has been revealed that abnormal voxel-mirrored homotopic connectivity (VMHC) is present in patients with schizophrenia, yet there are inconsistencies in the relevant findings. Moreover, little is known about their association with brain gene expression profiles. In this study, transcription-neuroimaging association analyses using gene expression data from Allen Human Brain Atlas and case-control VMHC differences from both the discovery (meta-analysis, including 9 studies with a total of 386 patients and 357 controls) and replication (separate group-level comparisons within two datasets, including a total of 258 patients and 287 controls) phases were performed to identify genes associated with VMHC alterations. Enrichment analyses were conducted to characterize the biological functions and specific expression of identified genes, and Neurosynth decoding analysis was performed to examine the correlation between cognitive-related processes and VMHC alterations in schizophrenia. In the discovery and replication phases, patients with schizophrenia exhibited consistent VMHC changes compared to controls, which were correlated with a series of cognitive-related processes; meta-regression analysis revealed that illness duration was negatively correlated with VMHC abnormalities in the cerebellum and postcentral/precentral gyrus. The abnormal VMHC patterns were stably correlated with 1287 genes enriched for fundamental biological processes like regulation of cell communication, nervous system development, and cell communication. In addition, these genes were overexpressed in astrocytes and immune cells, enriched in extensive cortical regions and wide developmental time windows. The present findings may contribute to a more comprehensive understanding of the molecular mechanisms underlying VMHC alterations in patients with schizophrenia.

3D-CEUS/MRI-CEUS fusion imaging vs 2D-CEUS after locoregional therapies for hepatocellular carcinoma: a multicenter prospective study of therapeutic response evaluation.

OBJECTIVES: To compare the diagnostic accuracy of 3D contrast-enhanced ultrasound (CEUS)/MRI-CEUS fusion imaging with 2D-CEUS in assessing the response of hepatocellular carcinoma (HCC) to locoregional therapies in a multicenter prospective study. MATERIALS AND METHODS: A consecutive series of patients with HCC scheduled for locoregional treatment were enrolled between April 2021 and March 2023. Patients were randomly divided into 3D-CEUS/MRI-CEUS fusion imaging group (3D/fusion group) or 2D-CEUS group (2D group). CEUS was performed 1 week before and 4-6 weeks after locoregional treatment. Contrast-enhanced MRI (CE-MRI) 4-6 weeks after treatment was set as the reference standard. CEUS images were evaluated for the presence or absence of viable tumors. Diagnostic performance criteria, including sensitivity, specificity, accuracy, and area under the curve (AUC), were determined for each modality. RESULTS: A total of 140 patients were included, 70 patients in the 2D group (mean age, 60.2 ± 10.4 years) and 70 patients in the 3D/fusion group (mean age, 59.8 ± 10.6 years). The sensitivity of the 3D/fusion group was 100.0% (95% CI: 75.9, 100.0), higher than that of the 2D group (55.6%, 95% CI: 22.7, 84.7; p = 0.019). The specificity of the 3D/fusion group was 96.3% (95% CI: 86.2, 99.4), which was comparable to that of the 2D group (98.4%, 95% CI: 90.0, 99.9; p = 0.915). The AUC of the 3D/fusion group was 0.98 (95% CI: 0.95, 1.00), higher than that of the 2D group (0.77, 95% CI: 0.56, 0.98; p = 0.020). CONCLUSION: 3D-CEUS/MRI-CEUS fusion imaging exhibits superior diagnostic accuracy in evaluating the treatment response to locoregional therapies for HCC. CLINICAL RELEVANCE STATEMENT: 3D-CEUS/MRI-CEUS fusion imaging can be applied for post-treatment assessment of residual tumors in HCC undergoing locoregional treatment, offering potential benefits in terms of accurate diagnosis and clinical management. KEY POINTS: Evaluating for HCC recurrence following locoregional therapy is important. 3D-CEUS/MRI-CEUS fusion imaging achieved a higher sensitivity than 2D-CEUS in assessing residual tumors after locoregional therapies. 3D-CEUS/MRI-CEUS fusion imaging can help clinicians intervene early in residual HCC lesions after locoregional treatment.

Percutaneous microwave ablation versus sclerotherapy for large hepatic hemangioma: a multi-center cohort study.

OBJECTIVE: The study aimed to compare the effectiveness and safety of ultrasound-guided microwave ablation (MWA) and percutaneous sclerotherapy (PS) for the treatment of large hepatic hemangioma (LHH). METHODS: This retrospective study included 96 patients who underwent MWA (n = 54) and PS (n = 42) as first-line treatment for LHH in three tertiary hospitals from January 2016 to December 2021. Primary outcomes were technique efficacy rate (volume reduction rate [VRR] > 50% at 12 months), symptom relief rate at 12 months and local tumor progression (LTP). Secondary outcomes included procedure time, major complications, treatment sessions, cost and one-, two-, three-year VRR. RESULTS: During a median follow-up of 36 months, the MWA group showed a higher technique efficacy rate (100% vs. 90.4%, p = .018) and symptom relief rate (100% vs. 80%, p = .123) than the PS group. The MWA group had fewer treatment sessions, higher one-, two- and three-year VRR, lower LTP rate (all p < .05), longer procedure time and higher treatment costs than the PS group (both p < .001). MWA shared a comparable major complications rate (1.8% vs. 2.4%, p = .432) with PS. After multivariate analysis, the lesion's heterogeneity and maximum diameter >8.1 cm were independent risk factors for LTP (all p < .05). In the PS group, lesions with a cumulative dose of bleomycin > 0.115 mg/cm3 had a lower risk of LTP (p = .006). CONCLUSIONS: Both MWA and PS treatments for large hepatic hemangioma are safe and effective, with MWA being superior in terms of efficacy.

Safety and effectiveness of balloon catheter-assisted ultrasound-guided percutaneous microwave ablation in difficult-site liver cancer.

BACKGROUND: Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations. METHODS: Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n = 40) and non-isolation (n = 92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups. RESULTS: The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5% vs. 4.3%, P = 0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8% vs. 17.5%, P = 0.032). Balloon catheter isolation [odds ratio (OR) = 0.225, 95% confidence interval (CI): 0.085-0.595, P = 0.009] and tumor diameter (OR = 2.808, 95% CI: 1.186-6.647, P = 0.019) were identified as independent factors influencing LTR rate. The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6% vs. 7.9%, P = 0.661; 4.9% vs. 9.8%, P = 0.676, respectively). Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR = 3.445, 95% CI: 1.406-8.437, P = 0.017). CONCLUSIONS: Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficult-site liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.

Prospective assessment of pancreatic ductal adenocarcinoma diagnosis from endoscopic ultrasonography images with the assistance of deep learning.

BACKGROUND: Endosonographers are highly dependent on the diagnosis of pancreatic ductal adenocarcinoma (PDAC). The objectives of this study were to develop a deep-learning radiomics (DLR) model based on endoscopic ultrasonography (EUS) images for identifying PDAC and to explore its true clinical benefit. METHODS: A retrospective data set of EUS images that included PDAC and benign lesions was used as a training cohort (N = 368 patients) to develop the DLR model, and a prospective data set was used as a test cohort (N = 123 patients) to validate the effectiveness of the DLR model. In addition, seven endosonographers performed two rounds of reader studies on the test cohort with or without DLR assistance to further assess the clinical applicability and true benefits of the DLR model. RESULTS: In the prospective test cohort, DLR exhibited an area under the receiver operating characteristic curves of 0.936 (95% confidence interval [CI], 0.889-0.976) with a sensitivity of 0.831 (95% CI, 0.746-0.913) and 0.904 (95% CI, 0.820-0.980), respectively. With DLR assistance, the overall diagnostic performance of the seven endosonographers improved: one endosonographer achieved a significant expansion of specificity (p = .035,) and another achieved a significant increase in sensitivity (p = .038). In the junior endosonographer group, the diagnostic performance with the help of the DLR was higher than or comparable to that of the senior endosonographer group without DLR assistance. CONCLUSIONS: A prospective test cohort validated that the DLR model based on EUS images effectively identified PDAC. With the assistance of this model, the gap between endosonographers at different levels of experience narrowed, and the accuracy of endosonographers expanded.

Zero-Dimensional Hybrid Antimony Chloride with Near-Unity Broad-Band Orange-Red Emission toward Solid-State Lighting.

Zero-dimensional (0D) hybrid metal halides are attractive owing to their distinctive structure as well as photoluminescence (PL) characteristics. To discover 0D hybrid metal halides with high photoluminescence quantum yield and good stability is of great significance for white light-emitting diodes (LEDs). Herein, a novel hybrid antimony chloride (CTP)2SbCl5 is synthesized, which shows a bright broad-band orange-red emission peaking at 620 nm under the low energy excitation (365 nm), achieving an excellent photoluminescence quantum yield of 96.8%. In addition, (CTP)2SbCl5 shows an additional emission peaking at 470 nm when excited at high energy (323 nm). PL spectra and density functional theory results demonstrate that the observed dual-band emission originates from the singlet and triplet self-trapped excitons confined in isolated [SbCl5]2- square pyramids. Moreover, (CTP)2SbCl5 presents relatively superior air stability, and the PL intensity still maintains 78% of the initial PL intensity when exposed to the air for above 2 weeks. Benefiting from high-efficiency PL emission and good stability of (CTP)2SbCl5, a stable warm white LED device with a 92.3% color rendering index was prepared by coating blue phosphor BaMgAl10O17:Eu2+, green (Sr,Ba)2SiO4:Eu2+, and orange-red (CTP)2SbCl5 on a 365 nm LED chip. This work provides an efficient luminescent material and also demonstrates the potential application of 0D hybrid antimony chloride in solid-state lighting.

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions.

BACKGROUNDS: Percutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies. METHODS: Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified. RESULTS: The diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA (P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy. CONCLUSIONS: In conclusion, both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.

Deep learning radiomics based on contrast-enhanced ultrasound images for assisted diagnosis of pancreatic ductal adenocarcinoma and chronic pancreatitis.

BACKGROUND: Accurate and non-invasive diagnosis of pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP) can avoid unnecessary puncture and surgery. This study aimed to develop a deep learning radiomics (DLR) model based on contrast-enhanced ultrasound (CEUS) images to assist radiologists in identifying PDAC and CP. METHODS: Patients with PDAC or CP were retrospectively enrolled from three hospitals. Detailed clinicopathological data were collected for each patient. Diagnoses were confirmed pathologically using biopsy or surgery in all patients. We developed an end-to-end DLR model for diagnosing PDAC and CP using CEUS images. To verify the clinical application value of the DLR model, two rounds of reader studies were performed. RESULTS: A total of 558 patients with pancreatic lesions were enrolled and were split into the training cohort (n=351), internal validation cohort (n=109), and external validation cohorts 1 (n=50) and 2 (n=48). The DLR model achieved an area under curve (AUC) of 0.986 (95% CI 0.975-0.994), 0.978 (95% CI 0.950-0.996), 0.967 (95% CI 0.917-1.000), and 0.953 (95% CI 0.877-1.000) in the training, internal validation, and external validation cohorts 1 and 2, respectively. The sensitivity and specificity of the DLR model were higher than or comparable to the diagnoses of the five radiologists in the three validation cohorts. With the aid of the DLR model, the diagnostic sensitivity of all radiologists was further improved at the expense of a small or no decrease in specificity in the three validation cohorts. CONCLUSIONS: The findings of this study suggest that our DLR model can be used as an effective tool to assist radiologists in the diagnosis of PDAC and CP.

Etiology, case fatality, recurrence, and severity in pediatric acute pancreatitis: a meta-analysis of 48 studies.

For children, there are very few published reviews focusing on severe acute pancreatitis (AP). PubMed, EMBASE, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, EBSCO, and Cochrane Library were searched from inception until March 2020. Meta-regression analyses were used to estimate the etiology, case fatality, recurrence, and severity of pediatric AP in different regions (North America, Asia, South America, Europe, and Oceania). Pooled data from 47 papers (48 studies) found that main causes of pediatric AP were gallstones in Asia; trauma in Oceania; and idiopathic in Europe, North America, and South America. The case-fatality rate (CFR) of pediatric AP is 4.7% (North America), 6.2% (Europe), 2.4% (Asia), 3.1% (South America), and 7.4% (Oceania). The incidence rates of recurrent acute pancreatitis (RAP) in children who have had an episode of acute pancreatitis in North American, Asia, and Europe were 15.3, 13.1, and 13.8%, respectively. The incidence of severe acute pancreatitis (SAP) in different regions was 30.3% (Oceania), 29.2% (South America), 20.8% (Europe), 15.8% (Asia), and 13.7% (North America). It suggests that physicians should notice the etiology of pediatric AP for the initial assessment, diagnosis, prediction of relapse, and appropriate treatment at a later stage. IMPACT: It indicates the etiology of pediatric acute pancreatitis for the initial assessment, diagnosis, and prediction of relapse. Main causes of pediatric AP were gallstones in Asia; trauma in Oceania; and idiopathic in Europe, North America, and South America. The case-fatality rate of pediatric AP is diverse worldwide. It suggests that physicians noticed the etiology of pediatric AP for the initial assessment, diagnosis, prediction of relapse, and appropriate treatment at a later stage.

Comparison between spleen and liver stiffness measurements by sound touch elastography for diagnosing cirrhosis at different aminotransferase levels: a prospective multicenter study.

OBJECTIVES: To compare the performance of spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) by sound touch elastography (STE) for the diagnosis of cirrhosis at different alanine aminotransferase (ALT) levels, and to compare the applicability and repeatability of SSM with LSM performed by STE, a new two-dimensional shear wave elastography technology. METHODS: This prospective multicenter study included 25 centers and recruited chronic hepatitis B (CHB) patients with liver biopsy between May 2018 and November 2019. All patients underwent LSM and SSM by STE. Success and reliability rates were calculated and compared. Intra-observer agreement was assessed using intraclass correlation coefficients (ICCs). Differences between areas under the receiver operating characteristic curves (AUCs) of LSMs and SSMs at different ALT levels were compared using the Delong test. RESULTS: Among 603 CHB patients, the success and reliability rates of SSM were 94.53% (570/603) and 85.74% (517/603), respectively, which were similar to those of LSM (p > 0.05), respectively. The ICC for intra-observer agreements of SSM was 0.964 (p < 0.001). In the total cohort, ALT ≤ 2 × upper limit of normal (ULN) group, and A0-1 group, the AUCs of SSMs were significantly lower than those of LSMs for the diagnosis of cirrhosis (p < 0.001). In the ALT > 2 × ULN group and A2-3 group, the AUC of SSM improved and was not significantly different from that of LSM (p = 0.342, p = 0.510, respectively). CONCLUSIONS: SSM by STE achieved applicability and repeatability equivalent to those of LSM. SSM might be a good substitute to LSM in patients with high ALT levels. KEY POINTS: • Spleen stiffness measurement performed by sound touch elastography was proven to have similar applicability and repeatability to liver stiffness measurement in this prospective multicenter study. • Spleen stiffness measurement demonstrated a poorer diagnostic performance for cirrhosis compared with liver stiffness measurement in the total cohort and low ALT level group, yet it showed a similar diagnostic performance to liver stiffness measurement in patients with high ALT levels.

Clinicopathological Significance and Molecular Mechanism of AKT/GSK3ß Pathway-based Fibrillin-1 Expression in Gastric Cancer Progression.

This research was developed to explore the significance of fibrillin-1 (FBN1) in the progression of gastric cancer and its relationship with the activation of the AKT/glycogen synthase kinase-3beta (GSK3ß) pathway. For this aim, immunohistochemical assays were adopted to detect FBN1 expression in chronic superficial gastritis, chronic atrophic gastritis, gastric cancer, and normal mucosa. The expression of FBN1 in gastric cancer and adjacent tissue samples was detected by reverse transcription-quantitative (RT-q) PCR and Western blot, and the relationship between FBN1 and the clinicopathological features of gastric cancer patients was analyzed. Lentivirus was utilized to construct SGC-7901 gastric cancer cell lines stably overexpressing and silencing FBN1, and the effects on cell proliferation, colony formation, and apoptosis were analyzed. AKT, GSK3ß, and their phosphorylated proteins were detected by Western blot. Results showed that the positive expression rate of FBN1 increased successively in chronic superficial gastritis, chronic atrophic gastritis, and gastric cancer. FBN1 was up-regulated in gastric cancer tissues and correlated with the depth of tumor invasion. Overexpression of FBN1 promoted the proliferation and colony formation of gastric cancer cells, inhibited apoptosis, and promoted the phosphorylation of AKT and GSK3ß. Silencing FBN1 expression inhibited the proliferation and clonal formation of gastric cancer cells, promoted apoptosis, and inhibited the phosphorylation of AKT and GSK3ß. In conclusion, FBN1 was up-regulated in gastric cancer tissues and correlated with the depth of gastric tumor invasion. FBN1 silencing inhibited the progression of gastric cancer through the AKT/GSK3ß pathway.

Neutrophil membrane-coated nanoparticles for enhanced nanosecond pulsed electric field treatment of pancreatic cancer.

OBJECTIVE: Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Poor prognosis and low survival rates have driven the development of novel therapeutic strategies. Nanosecond pulsed electric field has emerged as a novel, minimal invasive and non-thermal treatment for solid tumors. It is of great significance to study the combination therapy of nsPEF and other treatment strategies for pancreatic cancer. METHODS: We developed neutrophil membrane-wrapped liposomal nanoparticles loaded with gemcitabine (NE/Lip-GEM) and investigated their use as a complementary agent for nsPEF treatment. RESULTS: Our results showed that neutrophil-mediated delivery of liposomal-gemcitabine (NE/Lip-GEM) efficiently inhibited the growth of pancreatic tumors in mice whose has been treated with incomplete nsPEF ablation. CONCLUSIONS: The combination of nsPEF and NE/Lip-GEM may be a promising synergistic strategy for pancreatic cancer therapy.

Esophageal wall thickness on CT scans: can it predict the T stage of primary thoracic esophageal squamous cell carcinoma?

BACKGROUND: CT is the most commonly used method to stage esophageal cancer (EC). However, the reported CT T-staging criteria for EC are controversial. PURPOSE: To determine and validate the optimal esophageal wall thickness (EWT) threshold on CT to distinguish lesions with different T stages in esophageal squamous cell carcinoma (ESCC) patients. METHODS: One thousand, one hundred-two consecutive patients with histopathologically confirmed ESCC between July 2014 and April 2020 were retrospectively reviewed. All patients underwent a preoperative CT examination and surgical treatment. The maximal EWT of the lesions on CT was measured. Patients were divided into pT1, pT2, pT3 and pT4 subgroups according to the pathologic stage. We employed the support vector machine, where linear kernels were leveraged to determine the optimal threshold to classify samples with different T stages. 90% of samples from each subgroup were randomly selected as the training set, while the remainder comprised the testing set. RESULTS: The mean EWTs of the pT1, pT2, pT3 and pT4 subgroups were 4.9 ± 2.6 mm, 8.1 ± 2.3 mm, 12.4 ± 3.6 mm, and 18.6 ± 4.4 mm, respectively. Differences in the EWT between the four subgroups or between adjacent subgroups were significant (p < 0.001), and esophageal wall became thicker with increasing pT stage. We utilized MATLAB 2020a to implement the SVM model and ran the code 10 times. The accuracy of the model was 60.29 ± 2.33%. The thresholds between samples from pT1/pT2, pT2/pT3 and pT3/pT4 lesions were 5.5 ± 0.3 mm, 10.8 ± 0.8 mm and 15.9 ± 0.5 mm, respectively. CONCLUSIONS: Possibility of predicting T stage of ESCC by EWT on CT scans was limited to 60% by model examination with large sample size.

Fusion imaging-guided radiofrequency ablation for residual hepatocellular carcinoma invisible on ultrasound after transcatheter arterial chemoembolization.

PURPOSE: This study aimed to investigate the technical efficiency and therapeutic response of fusion imaging (considered as virtual navigation) between contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) for the guidance of radiofrequency ablation (RFA) in patients with residual hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). METHODS: For this prospective study, 98 patients with residual HCC lesions after TACE treatment were enrolled between June 2017 and December 2020. All the lesions were invisible on conventional ultrasound scans. Percutaneous RFA was performed using either CEUS (CEUS group, 52 lesions) or virtual navigation (VN group, 46 lesions) guidance. The lesion display rate, disease-free survival rate, local recurrence rate, overall survival rate and complication incidence were calculated and compared. RESULTS: Fusion imaging had a significant impact on the RFA outcomes (hazard ratio, 2.629; 95% confidence interval, 1.256-5.505; p = .01). The median disease-free survival time of the VN group was significantly higher than that of the CEUS group (10.9 vs. 8.8 months; p = .007). The local recurrence rates after 3, 6 and 12 months in the VN group were significantly lower than those in the CEUS group (p = .014, .002 and .011). The minor complication rate was not significantly different between the two groups. CONCLUSIONS: CEUS-CECT/CEMRI fusion imaging for guiding RFA enables an efficient and useful therapy of inconspicuous HCC lesions after TACE. The novel solution prolongs the disease-free survival time and reduces the long-term local recurrence of residual lesions treated when using virtual-navigation (VN)-guided RFA.

Could Ultrasound-Based Radiomics Noninvasively Predict Axillary Lymph Node Metastasis in Breast Cancer?

OBJECTIVES: This work aimed to investigate whether quantitative radiomics imaging features extracted from ultrasound (US) can noninvasively predict breast cancer (BC) metastasis to axillary lymph nodes (ALNs). METHODS: Presurgical B-mode US data of 196 patients with BC were retrospectively studied. The cases were divided into the training and validation cohorts (n = 141 versus 55). The elastic net regression technique was used for selecting features and building a signature in the training cohort. A linear combination of the selected features weighted by their respective coefficients produced a radiomics signature for each individual. A radiomics nomogram was established based on the radiomics signature and US-reported ALN status. In a receiver operating characteristic curve analysis, areas under the curves (AUCs) were determined for assessing the accuracy of the prediction model in predicting ALN metastasis in both cohorts. The clinical value was assessed by a decision curve analysis. RESULTS: In all, 843 radiomics features per case were obtained from expert-delineated lesions on US imaging in this study. Through radiomics feature selection, 21 features were selected to constitute the radiomics signature for predicting ALN metastasis. Area under the curve values of 0.778 and 0.725 were obtained in the training and validation cohorts, respectively, indicating moderate predictive ability. The radiomics nomogram comprising the radiomics signature and US-reported ALN status showed the best performance for ALN detection in the training cohort (AUC, 0.816) but moderate performance in the validation cohort (AUC, 0.759). The decision curve showed that both the radiomics signature and nomogram displayed good clinical utility. CONCLUSIONS: This pilot radiomics study provided a noninvasive method for predicting presurgical ALN metastasis status in BC.

Irreversible electroporation in patients with liver tumours: treated-area patterns with contrast-enhanced ultrasound.

BACKGROUND: Familiarity with post-IRE imaging interpretation is of considerable importance in determining ablation success and detecting recurrence. CEUS can be used to assess the tumour response and characteristics of the ablation zone. It is of clinical interest to describe the ultrasonographic findings of liver tumours after irreversible electroporation (IRE) percutaneous ablation. METHODS: A prospective study of 24 cases of malignant liver tumours (22 cases of primary liver tumours and 2 cases of liver metastases) treated by IRE ablation was conducted. Two inspectors evaluated the ablation zone in a consensus reading performed immediately, 1 day, and 1 month after IRE ablation. The gold standard method, magnetic resonance imaging (MRI), was used to evaluate the effectiveness of the treatment at 1 month. RESULTS: Immediately after IRE ablation and up to 1 month later, the ablation zones gradually changed from hypo-echogenicity to hyper-echogenicity on conventional ultrasound and showed non-enhancement on contrast-enhanced ultrasound (CEUS). One month after IRE ablation, CEUS and MRI results were highly consistent (κ = 0.78, p < 0.05). CONCLUSIONS: We conclude that CEUS may be an effective tool for assessing post-IRE ablation changes after 1 month. CEUS enables the depiction of tumour vascularity in real time and serves as an easy, repeatable method.

Virtual navigation-guided radiofrequency ablation for recurrent hepatocellular carcinoma invisible on ultrasound after hepatic resection.

BACKGROUND: No reports are available on the technical efficiency and therapeutic response of virtual navigation (VN)-guided radiofrequency ablation (RFA) for patients with recurrent hepatocellular carcinoma (HCC) after hepatic resection. The aim of this study was to investigate the overall technical performance and outcome of VN-guided RFA in recurrent HCC patients. In addition, a nomogram model was developed to predict the factors influencing the overall survival (OS). METHODS: This was a prospective study on 76 recurrent HCC patients who underwent VN-guided RFA between June 2015 and February 2018. The technical feasibility, success, and efficiency, OS, local tumor progression, and complications were evaluated. A multivariate Cox regression analysis was conducted to predict the significant factors, and a nomogram including independent predictive factors was subsequently plotted to predict OS. RESULTS: The technical feasibility, success, and efficiency rates of VN-guided RFA were 86.4%, 94.7%, and 97.4%, respectively. The cumulative OS rates at 1-, 2-, and 3-year were 88.1%, 79.7%, and 71.0%, respectively. The cumulative local tumor progression rates at 1-, 2-, and 3-year were 5.5%, 8.7%, and 14.0%, respectively. In addition, the minor and major complication rates were 5.3% and 3.9%, respectively. No intervention-related deaths occurred during the follow-up period. The C-index of the OS nomogram in this study was 0.737. CONCLUSIONS: VN-guided RFA is an effective therapeutic option in recurrent HCC patients and improves the long-term outcomes especially for the lesions that cannot be detected in the two-dimensional ultrasound. Besides, the nomogram may be a useful supporting tool in predicting OS to estimate the individual survival probability, optimize treatment options, and facilitate decision-making.

An AIDS patient with urine retention.

BACKGROUND: Cryptococcal prostatitis is a rare clinical disease and has never been reported in China. CASE PRESENTATION: We report on a male HIV-infected patient with pulmonary and prostate cryptococcosis that was misdiagnosed (as tuberculosis) and delayed diagnosed. Although the patients accepted anti-fungal treatment and anti-retroviral treatment finally, the physician's mistakes reflect the rarity of this condition in China. CONCLUSION: Cryptococcal prostatitis is a rare disease that unusually presents in immunodeficient patients. Physicians should have a heightened awareness of this particular infection in the immunodeficient population.

Endoscopic Ultrasonography-Guided Versus Percutaneous Drainage for the Recurrent Pancreatic Fluid Collections.

BACKGROUND Ultrasonography-guided percutaneous drainage for pancreatic fluid collections is associated with a high recurrence rate and endoscopic ultrasonography (EUS)-guided drainage is a valuable approach. Our aim was to compare the efficacy and safety of percutaneous and EUS-guided drainage for the recurrent pancreatic fluid collections. MATERIAL AND METHODS A retrospective analysis of percutaneous-guided and EUS-guided procedures for pancreatic fluid collections drainages at a single tertiary care center between February 2017 and May 2018 was performed. Treatment success, adverse events, recurrence, need for surgery, length of hospital stays, and number of follow-up computed tomography (CT) scan were assessed. RESULTS A total of 119 pancreatic fluid collections treated with initial percutaneous drainage were included in this study and 35 patients had recurrent pancreatic fluid collections. Recurrent patients were classified based on drainage method: EUS-guided drainage (18 patients) and the second percutaneous drainage (17 patients). EUS-guided drainage revealed a shorter length of hospital stays (P<0.001), less re-intervention (P=0.047), fewer number of follow-up CT scans (P=0.006) compared with the initial percutaneous drainage. Furthermore, we also compared the clinical outcomes between the EUS-guided drainage and the second percutaneous drainage for the recurrent PFC after initially failed percutaneous drainage. EUS-guided drainage showed higher clinical success (P=0.027), shorter length of hospital stays (P<0.001), less re-intervention (P=0.012), fewer number of follow-up CT scan (P<0.001) and less recurrence P=0.027) compared to the second percutaneous drainage procedure. CONCLUSIONS EUS-guided drainage is an effective and appropriate method to treat the recurrent pancreatic fluid collections after initially failed percutaneous drainage procedure, with the advantage of higher clinical success, shorter length of hospital stays, less re-intervention, fewer number of follow-up CT scan and less recurrence compared to the percutaneous drainage.

Percutaneous Laser Ablation of Hepatic Tumors Located in the Portacaval Space: Preliminary Results.

BACKGROUND AND OBJECTIVES: Limited data have been used to evaluate the feasibility and effectiveness of percutaneous laser ablation (PLA) (a modality that has been proven to be a safe method for tumors in high-risk locations) for hepatic tumors in the space between the portal vein and inferior vena cava (IVC). The goal of this study was to investigate the characteristics and therapeutic effectiveness of ultrasound-guided PLA of hepatic tumors in the portacaval space. STUDY DESIGN/MATERIALS AND METHODS: Ten patients, who had hepatic tumors in the portacaval space (defined as tumors located in the space formed by the hepatic portal vein and IVC less than 5 mm from the margins of both vessels), receiving ultrasound-guided PLA between January 2016 and June 2017 were analyzed. Tumors in the type I portacaval space were enclosed on three sides of major vessels, and tumors in the type II portacaval space were enclosed on two sides of major vessels. The technical success, treatment response, complete tumor ablation (CTA), local tumor progression (LTP), and distant tumor recurrence (DTR) were assessed and recorded at the follow-up. RESULTS: The mean tumor diameter was 1.8 ± 0.4 cm. Technical success and initial CTA were achieved in all 10 patients without major complications. The 6-month and 12-month LTP rates were 0% and 10%, respectively. The DTR rate was 20% at both the 6- and 12-month follow-ups. CONCLUSIONS: The preliminary results showed that ultrasound-guided PLA was feasible and safe for tumors in the portacaval space, and further studies on larger populations with a longer follow-up are needed to delineate the use of PLA and evaluate its therapeutic efficacy. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.