Two-Stage Hybrid Approach for Treatment of Abdominal Aortic Pseudoaneurysm Combined with Superior Mesenteric Artery Occlusion Secondary to Vasculo-Behçet's Disease.

Behçet's disease (BD) is a chronic multisystem autoinflammatory disorder. Multiple arterial involvement in vasculo-BD was extremely rare. A 40-year-old man suffered from abdominal pain and increased lower back pain. He was diagnosed with BD 4 years ago. Computed tomography angiography indicated a 40 mm × 90 mm abdominal aortic saccular pseudoaneurysm and a proximal superior mesenteric artery (SMA) occlusion. We report here a case of successful treatment for abdominal aortic pseudoaneurysm (AAP) and SMA occlusion in a complicated vasculo-BD using 2-stage procedure, including endovascular intervention for AAP and hybrid approach with laparotomy and retrograde canalization and revascularization for SMA occlusion. Retrograde open mesenteric stenting was effective in the treatment of SMA occlusion in patients with vasculo-BD.

Endovascular Therapy of a Giant Renal Artery Aneurysm Combined With High-Flow Renal Arteriovenous Fistula Using a Patent Ductus Arteriosus Occluder.

Renal artery aneurysm (RAA) concomitant with a renal arteriovenous fistula (RAVF) is extremely rare. A 32-year-old man suffered from a giant RAA combined with high-flow RAVF. The computer tomographic angiography (CTA) demonstrated a RAA, which is 6.3 cm in length and 2.1 cm in diameter, combined with an arteriovenous fistula between the right renal artery and right renal vein (fistula area:1.05 cm × 1.0 cm). After a comprehensive preoperative assessment, a patent ductus arteriosus occluder (PDAO) was implanted. At a 1-year follow-up, the CTA study showed that the PDAO was in situ and there was no recanalization of the lesion. At a third-year follow-up, ultrasound examination showed an image of right renal atrophy. The results of long-term follow-up demonstrate that PDAO is safe and effective for the management of RAAs combined with high-flow RAVF.

Thalamocortical neural responses during hyperthermia: a resting-state functional MRI study.

The neural responses during hyperthermia, once thought of as simple physiological processes (e.g. thermal sensation and regulation), have now been recognised involving more cognitive processes, which would be of high importance to the management of those occupations during heavy heat exposure. Previous studies have demonstrated altered activity in localised subcortical clusters for thermal sensation and regulation, as well as cortical-cortical activity for behavioural tasks during hyperthermia. However, the involvement of cortical-subcortical activity during hyperthermia has not been investigated. In this study, we performed exploratory analyses comparing thalamocortical functional connectivity during whole body hyperthermic condition for an hour at 50 °C and normothermic condition at 25 °C. We found weakened functional connectivity of cortical fronto-polar/anterior cingulate cortex and prefrontal areas with the corresponding thalamic nuclei during hyperthermic versus normothermic comparisons. On the contrary, the motor/premotor, somatosensory and temporal cortical subdivisions showed increased connectivity with thalamic nuclei during hyperthermia. Thalamocortical connectivity changes in the prefrontal were identified to be correlated with the behavioural reaction time during psychomotor vigilance test after controlling for physiological variables. These distinct thalamocortical pathway alterations might reflect physiologically thermal sensation and regulation, as well as psychologically neural behaviour changes underlying cortical-subcortical activity during hyperthermia.

The effects of head-cooling on brain function during passive hyperthermia: an fMRI study.

PURPOSE: To investigate the effect of head-cooling on resting-state spontaneous brain activity during passive hyperthermia. METHODS: An environmental heat exposure was simulated on 16 healthy men under a normal control condition (NC) at 25 °C and two hot conditions at 50 °C with hyperthermia with head-cooling condition (HHC) and without hyperthermia condition (HOT) keeping the head cool, respectively. Resting-state functional MRI (fMRI) data were acquired under each condition and the values of amplitude low frequency fluctuations (ALFF) and z functional connectivity (zFC) were computed to examine regional activity and functional integration, respectively. Pearson's correlation analysis between the ALFF value and subjective sensations scores were performed. RESULTS: Brain regions with significant ALFF differences among the three conditions were found primarily in the right medial prefrontal cortex/anterior cingulate cortex (MPFC/ACC), bilateral posterior cingulate cortex/precuneus (PCC/PCu), and right fusiform gyrus. Compared to the NC or HOT condition, the HHC condition exhibited significantly increased ALFF in the bilateral PCC/PCu and decreased ALFF in the right fusiform gyrus. However, ALFF of the right MPFC/ACC showed no significant difference between the NC and HHC conditions. Positive FC between the right MPFC/ACC and bilateral PCC/PCu was significantly increased in HHC condition with respect to HOT condition. Negative FC between the right fusiform gyrus and the right MPFC/ACC, bilateral PCC/PCu was observed with a decreasing trend from the HHC condition to the HOT condition. Moreover, head-cooling also improved thermal comfort during passive hyperthermia. CONCLUSIONS: Head-cooling could substantially reduce the negative effect of hyperthermia on human brain activity as well as thermal sensation.

Reduced white matter integrity and cognitive deficits in maintenance hemodialysis ESRD patients: a diffusion-tensor study.

OBJECTIVES: The purpose of this investigation was to examine the association between cognition disorders and microstructural white matter (WM) changes in maintenance hemodialysis end-stage renal disease (ESRD) patients. METHODS: Twenty-six maintenance hemodialysis ESRD patients and 28 healthy controls underwent diffusion tensor imaging (DTI), Mini Mental State Examination (MMSE), Trial Marking Test-A&B (TMT-A&B), and white matter hyperintensity (WMH) assessment. Tract-based spatial statistics (TBSS) analyses was performed to evaluate WM changes in the patients. Relationships between behavioural performances, clinical data, and the DTI index were tested, respectively, by correlation analysis at the voxel level. RESULTS: ESRD patients showed significant decreased fractional anisotropy (FA) in 14 WM regions, and increased mean diffusivity (MD) and radial diffusivity (RD) in widespread regions. Significant positive correlations between FA values and MMSE scores were found in the right anterior corona radiata and the left anterior thalamic radiation; significant negative correlations between the TMT-B time consumption and FA values were identified in the bilateral superior longitudinal fasciculus. Positive linear relationships between MD, RD values, and the duration of hemodialysis were found in several WM regions. CONCLUSION: Structural damages to radiation and associative fibre tracts, caused by brain oedema and WM demyelination, may account for the cognitive deficits in ESRD patients.

Altered interhemispheric resting state functional connectivity during passive hyperthermia.

PURPOSE: This study examines the effect of passive hyperthermia on interhemispheric resting state functional connectivity and the correlation between interhemispheric resting state functional connectivity and efficiency of a succedent working memory task. MATERIALS AND METHODS: We performed voxel-mirrored homotopic connectivity (VMHC) analyses on resting state MRI data and a one-back task from 14 healthy subjects in both HT (hyperthermia, 50 °C) conditions and normal control (NC, 25 °C) conditions. The group analyses of the differences for VMHC between the two conditions and the correlation analysis between the VMHC and the reaction time (RT) of the one-back task were performed with the statistical parametric mapping software package and the software REST. RESULTS: Compared with NC conditions, HT conditions increased VMHC in the cuneus, the postcentral gyrus, and the fusiform gyrus. No region showed decreased VMHC in the HT group in comparison with the NC group. For NC conditions, negative correlations were demonstrated between RT of the one-back task and VMHC in bilateral superior temporal gyrus, and bilateral middle frontal gyrus; for HT conditions, negative correlations were demonstrated between RT and VMHC in bilateral inferior frontal gyrus, bilateral middle frontal gyrus, as well as cerebellum posterior lobe. CONCLUSION: Passive heat stress can impact the interhemispheric information interactions at resting state and the VMHC deficits may play an important role in cognitive dysfunction.

Impact of Elevated Core Body Temperature on Attention Networks.

OBJECTIVE AND BACKGROUND: Cognitive function can be impaired after passive heat exposure and with an elevation in core body temperature (Tcore). This study examined the dynamic correlation among passive heat exposure, Tcore, and cognition. METHODS: We gave the Attention Network Test of alerting, orienting, and executive control to five groups of five young men who were being exposed to a hyperthermic condition (50°C, 40% relative humidity) for 0, 10, 20, 30, or 40 minutes. We used the participants' reaction time, accuracy (correct responses), efficiency (accuracy÷reaction time), and Tcore to estimate optimal curve models for best fit of data. RESULTS: We could not estimate an appropriate curve model for either alerting or orienting with Tcore, change in Tcore, or duration of passive heat exposure. We estimated quadratic models for Tcore and duration (adjusted R=0.752), change in Tcore and duration (0.906), executive control score and duration (0.509), and efficiency of executive control and duration (0.293). We estimated linear models for executive control score and Tcore (0.479), efficiency of executive control and Tcore (0.261), executive control score and change in Tcore (0.279), and efficiency of executive control and change in Tcore (0.262). CONCLUSIONS: Different attentional abilities had different sensitivities to thermal stress. Executive control of attention deteriorated linearly with a rise in Tcore within the normal physiologic range, but deteriorated nonlinearly with longer passive heat exposure.

Multimodal data integration using machine learning to predict the risk of clear cell renal cancer metastasis: a retrospective multicentre study.

PURPOSE: To develop and validate a predictive combined model for metastasis in patients with clear cell renal cell carcinoma (ccRCC) by integrating multimodal data. MATERIALS AND METHODS: In this retrospective study, the clinical and imaging data (CT and ultrasound) of patients with ccRCC confirmed by pathology from three tertiary hospitals in different regions were collected from January 2013 to January 2023. We developed three models, including a clinical model, a radiomics model, and a combined model. The performance of the model was determined based on its discriminative power and clinical utility. The evaluation indicators included area under the receiver operating characteristic curve (AUC) value, accuracy, sensitivity, specificity, negative predictive value, positive predictive value and decision curve analysis (DCA) curve. RESULTS: A total of 251 patients were evaluated. Patients (n = 166) from Shandong University Qilu Hospital (Jinan) were divided into the training cohort, of which 50 patients developed metastases; patients (n = 37) from Shandong University Qilu Hospital (Qingdao) were used as internal testing, of which 15 patients developed metastases; patients (n = 48) from Changzhou Second People's Hospital were used as external testing, of which 13 patients developed metastases. In the training set, the combined model showed the highest performance (AUC, 0.924) in predicting lymph node metastasis (LNM), while the clinical and radiomics models both had AUCs of 0.845 and 0.870, respectively. In the internal testing, the combined model had the highest performance (AUC, 0.877) for predicting LNM, while the AUCs of the clinical and radiomics models were 0.726 and 0.836, respectively. In the external testing, the combined model had the highest performance (AUC, 0.849) for predicting LNM, while the AUCs of the clinical and radiomics models were 0.708 and 0.804, respectively. The DCA curve showed that the combined model had a significant prediction probability in predicting the risk of LNM in ccRCC patients compared with the clinical model or the radiomics model. CONCLUSION: The combined model was superior to the clinical and radiomics models in predicting LNM in ccRCC patients.

Altered topological patterns of large-scale brain functional networks during passive hyperthermia.

In this study, we simulated environmental heat exposure to 18 participants, and obtained functional magnetic resonance image (fMRI) data during resting state. Brain functional networks were constructed over a wide range of sparsity threshold according to a prior atlas dividing the whole cerebrum into 90 regions. Results of graph theoretical approaches showed that although brain networks in both normal and hyperthermia conditions exhibited economical small-world property, significant alterations in both global and nodal network metrics were demonstrated during hyperthermia. Specifically, a lower clustering coefficient, maintained shortest path length, a lower small-worldness, a lower mean local efficiency were found, indicating a tendency shift to a randomized network. Additionally, significant alterations in nodal efficiency were found in bilateral gyrus rectus, bilateral parahippocampal gyrus, bilateral insula, right caudate nucleus, bilateral putamen, left temporal pole of middle temporal gyrus, right inferior temporal gyrus. In consideration of physiological system changes, we found that the alterations of normalized clustering coefficient, small-worldness, mean normalized local efficiency were significantly correlated with the rectal temperature alteration, but failed to obtain significant correlations with the weight loss. More importantly, behavioral attention network test (ANT) after MRI scanning showed that the ANT effects were altered and correlated with the alterations of some global metrics (normalized shortest path length and normalized global efficiency) and prefrontal nodal efficiency (right dorsolateral superior frontal gyrus, right middle frontal gyrus and left orbital inferior frontal gyrus), implying behavioral deficits in executive control effects and maintained alerting and orienting effects during passive hyperthermia. The present study provided the first evidence for human brain functional disorder during passive hyperthermia according to graph theoretical analysis using resting-state fMRI.

Hyperthermia impaired human visual short-term memory: an fMRI study.

PURPOSE: In order to investigate the effects of hyperthermia conditions on human cognitive performance, functional magnetic resonance imaging (fMRI) was employed to investigate human brain activation during visual short-term memory (VSTM) tasks under modulated hyperthermia conditions. MATERIALS AND METHODS: A total of 38 right-handed healthy young male participants were randomly divided into control and hyperthermia groups who underwent VSTM tasks by using block design. RESULTS: Compared with that of the control group, the reaction time of the hyperthermia group was longer in VSTM tasks (p = 0.019), but there was no significant difference between the two groups for the accuracy rate (p > 0.85). The fMRI data showed that the processing advantage of the right hemisphere was notably enhanced and that activity strength of the bilateral dorsolateral prefrontal cortex and right intra-parietal sulcus were significantly enhanced in the hyperthermia group. CONCLUSIONS: These data provided neuroimaging evidence of the effect of hyperthermia conditions on the brain regions and also proved heat load decreases cognitive performance.

Uncoupling protein 2 modulates polarization and metabolism of human primary macrophages via glycolysis and the NF­κB pathway.

Metabolic abnormalities, particularly the M1/M2 macrophage imbalance, play a critical role in the development of various diseases, leading to severe inflammatory responses. The present study aimed to investigate the role of uncoupling protein 2 (UCP2) in regulating macrophage polarization, glycolysis, metabolic reprogramming, reactive oxygen species (ROS) and inflammation. Primary human macrophages were first polarized into M1 and M2 subtypes, and these two subtypes were infected by lentivirus-mediated UCP2 overexpression or knockdown, followed by enzyme-linked immunosorbent assay, reverse transcription-quantitative PCR, western blotting and flow cytometry to analyze the effects of UCP2 on glycolysis, oxidative phosphorylation (OXPHOS), ROS production and cytokine secretion, respectively. The results demonstrated that UCP2 expression was suppressed in M1 macrophages and increased in M2 macrophages, suggesting its regulatory role in macrophage polarization. UCP2 overexpression decreased macrophage glycolysis, increased OXPHOS, decreased ROS production, and led to the conversion of M1 polarization to M2 polarization. This process involved NF-κB signaling to regulate the secretion profile of cytokines and chemokines and affected the expression of key enzymes of glycolysis and a key factor for maintaining mitochondrial homeostasis (nuclear respiratory factor 1). UCP2 knockdown in M2 macrophages exacerbated inflammation and oxidative stress by promoting glycolysis, which was attenuated by the glycolysis inhibitor 2-deoxyglucose. These findings highlight the critical role of UCP2 in regulating macrophage polarization, metabolism, inflammation and oxidative stress through its effects on glycolysis, providing valuable insights into potential therapeutic strategies for macrophage-driven inflammatory and metabolic diseases.

Difference of mean Hounsfield units (dHU) between follow-up and initial noncontrast CT scan predicts 90-day poor outcome in spontaneous supratentorial acute intracerebral hemorrhage with deep convolutional neural networks.

OBJECTIVES: This study aimed to investigate the usefulness of a new non-contrast CT scan (NCCT) sign called the dHU, which represented the difference in mean Hounsfield unit values between follow-up and the initial NCCT for predicting 90-day poor functional outcomes in acute supratentorial spontaneous intracerebral hemorrhage(sICH) using deep convolutional neural networks. METHODS: A total of 377 consecutive patients with sICH from center 1 and 91 patients from center 2 (external validation set) were included. A receiver operating characteristic (ROC) analysis was performed to determine the critical value of dHU for predicting poor outcome at 90 days. Modified Rankin score (mRS) >3 or >2 was defined as the primary and secondary poor outcome, respectively. Two multivariate models were developed to test whether dHU was an independent predictor of the two unfavorable functional outcomes. RESULTS: The ROC analysis showed that a dHU >2.5 was a critical value to predict the poor outcomes (mRS >3) in sICH. The sensitivity, specificity, and accuracy of dHU >2.5 for poor outcome prediction were 37.5%, 86.0%, and 70.6%, respectively. In multivariate models developed after adjusting for all elements of the ICH score and hematoma expansion, dHU >2.5 was an independent predictor of both primary and secondary poor outcomes (OR = 2.61, 95% CI [1.32,5.13], P = 0.006; OR = 2.63, 95% CI [1.36,5.10], P = 0.004, respectively). After adjustment for all possible significant predictors (p < 0.05) by univariate analysis, dHU >2.5 had a positive association with primary and secondary poor outcomes (OR = 3.25, 95% CI [1.52,6.98], P = 0.002; OR = 3.42, 95% CI [1.64,7.15], P = 0.001). CONCLUSIONS: The dHU of hematoma based on serial CT scans is independently associated with poor outcomes after acute sICH, which may help predict clinical evolution and guide therapy for sICH patients.

LncRNA FGF7-5 and lncRNA GLRX3 together inhibits the formation of carotid plaque via regulating the miR-2681-5p/ERCC4 axis in atherosclerosis.

Atherosclerotic plaques belong to the common vascular disease in the aged, which rupture will lead to acute thromboembolic diseases, the leading cause of fatal cardiovascular events. Accumulating evidence indicates that the lncRNAs-miRNAs-mRNA regulatory network plays a critical role in atherosclerosis. Based on RNA sequencing (GSE207252), we constructed expression profiles of lncRNAs, microRNAs, and mRNA in the carotid plaque of atherosclerosis patients and analyzed differentially expressed genes (DEGs). We identified three candidate lncRNAs using two algorithms (LASSO and SVM-RFE): lnc_GLRX3, lnc_FGF7-5, and DISC1FP1). LNCipedia, TargetScan, and miRDB databases were used to predict target miRNAs of lncRNAs and target genes of miRNAs. Gene ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and Gene Set Enrichment Analysis (GSEA) analysis of DEGs was carried out using the R package clusterProfiler. A PPI network was constructed using the STRING website and visualized by Cytoscape. According to the "MCC" method of the plug-in cytoHubba in Cytoscape, ERCC4 was the top hub gene of the PPI network. We constructed a lncRNA_FGF7-5/lncRNA_GLRX3-miR-2681-5p-ERCC4 regulatory network for carotid plaque using lncRNA-miRNA and miRNA-mRNA pairs. Next, lncRNA_FGF7-5 and lncRNA_GLRX3 targeted miR-2681-5p directly to upregulate ERCC4 expression. Silencing of lncRNA_FGF7-5 and lncRNA_GLRX3 promoted apoptosis and TP53 expression in HUVECs treated with ox-LDL; however, these effects were reversed by ERCC4-overexpression. Taken together, these findings indicated that lncRNA_FGF7-5 and lncRNA_GLRX3 together reduced atherosclerosis-induced apoptosis of HUVECs via targeting miR-2681-5p to increase ERCC4 expression, thereby preventing the formation of carotid plaque and finally inhibiting atherosclerosis progression.

BACH1 regulates the differentiation of vascular smooth muscle cells from human embryonic stem cells via CARM1-mediated methylation of H3R17.

The role of BACH1 in the process of vascular smooth muscle cell (VSMC) differentiation from human embryonic stem cells (hESCs) remains unknown. Here, we find that the loss of BACH1 in hESCs attenuates the expression of VSMC marker genes, whereas overexpression of BACH1 after mesoderm induction increases the expression of VSMC markers during in vitro hESC-VSMC differentiation. Mechanistically, BACH1 binds directly to coactivator-associated arginine methyltransferase 1 (CARM1) during in vitro hESC-VSMC differentiation, and this interaction is mediated by the BACH1 bZIP domain. BACH1 recruits CARM1 to VSMC marker gene promoters and promotes VSMC marker expression by increasing H3R17me2 modification, thus facilitating in vitro VSMC differentiation from hESCs after the mesoderm induction. The increased expression of VSMC marker genes by BACH1 overexpression is partially abolished by inhibition of CARM1 or the H3R17me2 inhibitor TBBD in hESC-derived cells. These findings highlight the critical role of BACH1 in hESC differentiation into VSMCs by CARM1-mediated methylation of H3R17.

Hyperthermia exposure impaired the early stage of face recognition: an ERP study.

We investigated the effect of hyperthermia exposure on the early stages of face processing by recording event-related potentials (ERPs) elicited by faces and non-face stimuli presented in upright and inverted orientations. Across all conditions, both the peak latencies of P1 and N170 components were earlier in the hyperthermia group than in the control participants. Although no effects of P1 amplitudes were influenced by hyperthermia, the face effect (larger amplitude for faces relative to other object categories) of the N170 was modulated by hyperthermia, whereas the face effect was significant in the control group, it was minimised in the hyperthermia group. The inversion effect of faces on N170 amplitudes, however, was not affected by hyperthermia. These data suggest that the detection of faces in the visual field and their initial streaming to face-specific structural encoding mechanisms are impaired by hyperthermia. However, subsequent face-specific configural processing revealed by the N170 inversion effect is not affected by hyperthermia. In addition, hyperthermia accelerates the early stage of visual perception, regardless of faces or non-face objects.

Hyperthermia impairs the executive function using the Attention Network Test.

PURPOSE: The primary aim of this study was to examine the effect of passive hyperthermia on the human attention system using the Attention Network Test (ANT), which has been used in both healthy controls and patients. Using target contrasts between conditions within a Flanker paradigm, the ANT can isolate three essential networks in the attention system: maintaining an alert state that is receptive to stimulus input and ready for responding; orienting, which involves selection of sensory input; and executive control, which monitors for and resolves conflict in responding or other aspects of cognitive processing. MATERIALS AND METHODS: The ANT was administered to 16 right-handed subjects in a heat stress condition (50°C, 40% relative humidity) and a control condition (20°C, 40% relative humidity), for 1 hour each. Reaction time (RT) and accuracy rate as well as mean body core temperature (T-core) and body weight loss were recorded. RESULTS: Compared to the control condition, T-cores significantly increased and body weight was not significantly reduced in the heat stress condition. Overall, there were non-significant group differences for RT and accuracy rate. Although significant changes in neither alerting nor orienting effects were modulated by the simulated hyperthermia, the executive control effect on RTs was significantly larger in the heat compared to the control condition. CONCLUSIONS: Passive hyperthermia impaired executive control function, whereas alerting and orienting effects were unaffected.

Long-segment common carotid occlusion presenting with limb-shaking transient ischemic attack: Case report.

Background: Limb-shaking transient ischemic attack (LS-TIA) is a rare manifestation of carotid artery occlusion. Common carotid artery occlusion (CCAO) is a relatively rare condition, and both its natural history and recommendations for treatment are still unclear. Case description: A 67-year-old female suffered from transient episodes of unilateral limb shaking. Computer tomographic angiography (CTA) showed long-segment occlusion of the right common carotid artery. Computer tomographic perfusion (CTP) demonstrated hypoperfusion of the corpus striatum, which suggests that hemodynamic failure is a potential mechanism underlying the LS-TIA secondary to common carotid artery occlusion. The occlusion was successfully recanalized by retrograde common carotid endarterectomy, and the episodes of left limb shaking disappeared after surgery. Conclusions: The occlusion was successfully recanalized by retrograde common carotid endarterectomy, and the episodes of left limb shaking disappeared after surgery. Hypoperfusion of the corpus striatum might be a potential mechanism underlying the LS-TIA secondary to common carotid occlusion.

Case report: Chronic lymphocytic leukemia/small lymphocytic lymphoma and monomorphic epitheliotropic intestinal T-cell lymphoma: A composite lymphoma.

Background: Composite lymphomas involving B-cell and T-cell lymphomas is very rare. Case presentation: We reported a 63-year-old gentleman with composite chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL). The patient was admitted to our hospital due to abdominal pain, and was diagnosed with CLL/SLL after bone marrow (BM) biopsy, BM aspiration, and flow cytometry. Two weeks later, he was diagnosed with MEITL based on pathological analysis after intestine excision. Next gene sequencing (NGS) findings identified two hotspot mutation sites (STAT5B and DNMT3A) closely related with the pathogenesis of CLL/SLL and MEILT. Additionally, BCOR mutation was only detected in the CLL/SLL area. The likely pathogenic mutations of CLL were SETD2, NOTCH1, SF3B1, and PTPN11, while the likely pathogenic mutations related with the MEILT were TET2 and ZRSR2. Mutations of GATA3, PLCG2, and FAT1 were identified in both CLL/SLL and MEITL areas, but the clinical significance was unknown. Finally, the patient died in the 12-month follow-up after surgery. Conclusion: We report a rare case of composite CLL/SLL and MEITL that highlights the importance of careful inspection of hematologic neoplasms. We also present the results of NGS of different gene mutations in CLL and MEITL tissues.

A Pilot Study of Radiomic Based on Routine CT Reflecting Difference of Cerebral Hemispheric Perfusion.

Background: To explore the effectiveness of radiomics features based on routine CT to reflect the difference of cerebral hemispheric perfusion. Methods: We retrospectively recruited 52 patients with severe stenosis or occlusion in the unilateral middle cerebral artery (MCA), and brain CT perfusion showed an MCA area with deficit perfusion. Radiomics features were extracted from the stenosis side and contralateral of the MCA area based on precontrast CT. Two different region of interest drawing methods were applied. Then the patients were randomly grouped into training and testing sets by the ratio of 8:2. In the training set, ANOVA and the Elastic Net Regression with fivefold cross-validation were conducted to filter and choose the optimized features. Moreover, different machine learning models were built. In the testing set, the area under the receiver operating characteristic (AUC) curve, calibration, and clinical utility were applied to evaluate the predictive performance of the models. Results: The logistic regression (LR) for the triangle-contour method and artificial neural network (ANN) for the semiautomatic-contour method were chosen as radiomics models for their good prediction efficacy in the training phase (AUC = 0.869, 0.873) and the validation phase (AUC = 0.793, 0.799). The radiomics algorithms of the triangle-contour and semiautomatic-contour method were implemented in the whole training set (AUC = 0.870, 0.867) and were evaluated in the testing set (AUC = 0.760, 0.802). According to the optimal cutoff value, these two methods can classify the vascular stenosis side class and normal side class. Conclusion: Radiomic predictive feature based on precontrast CT image could reflect the difference of cerebral hemispheric perfusion to some extent.

Radiomics for predicting revised hematoma expansion with the inclusion of intraventricular hemorrhage growth in patients with supratentorial spontaneous intraparenchymal hematomas.

BACKGROUND: Previous radiomics analyses of hematoma expansion have been based on the traditional definition, which only focused on changes in intraparenchymal volume. However, the ability of radiomics-related models to predict revised hematoma expansion (RHE) with the inclusion of intraventricular hemorrhage expansion remains unclear. To develop and validate a noncontrast computed tomography (NCCT)-based clinical- semantic-radiomics nomogram to identify supratentorial spontaneous intracerebral hemorrhage (sICH) patients with RHE on admission. METHODS: In this double-center retrospective study, data from 376 patients with sICH (training set: n=299; test set: n=77; external validation cohort: n=91) were reviewed. A radiomics model, a clinical-semantic model, and a combined model were then constructed based on the logistic regression machine learning approach. Radiomics features were extracted and selected by least absolute shrinkage and selection operator (LASSO) with 5-fold cross validation. Furthermore, the classical BRAIN scoring system was also constructed to predict RHE. Discriminative performance of the models was evaluated on the training and test set with area under the curve (AUC) and decision curve analysis (DCA). RESULTS: The addition of radiomics to clinical-semantic factors significantly improved the prediction performance of RHE compared with the clinical-semantic model alone in the training (AUC, 0.94 vs. 0.81, P<0.05) and test (AUC, 0.84 vs. 0.71, P<0.05) sets, with similar results in the validation set (AUC, 0.83 vs. 0.69, P<0.05). Moreover, the discrimination efficacy of the BRAIN score was significantly lower than the other 3 models (AUC of 0.71 in the training set, P<0.05). CONCLUSIONS: The clinical-semantic-radiomics combined model had the greatest potential for discriminating RHE, and significantly outperformed the classical BRAIN scoring system.