Association between different regional lymph node metastases of papillary thyroid carcinoma in adolescents and young adults.

Adolescents and young adults (AYA) describe the demographic aged between 15-39 years diagnosed with cancer. This group is particularly at risk of papillary thyroid carcinoma (PTC) with a greater severity compared with other ages. Through comparative design, the present study aimed to quantify central lymph node metastasis (CLNM) risk in AYAs. A total of 463 AYA patients with PTC and 489 patients >39 years old with PTC from Ningbo Medical Center Lihuili Hospital (Ningbo, China) were enrolled. Details such as demographic data, serum indices and fine-needle aspiration from the Electronic Medical Records System were extracted and analyzed. AYA patients had significantly higher rates of ipsilateral Hashimoto thyroiditis, thyroid capsular invasion (TCI), CLNM, larger tumors and more positive central lymph nodes (CLN). Independent risk factors of CLNM in AYA patients were as follows: Male sex, presence of TCI, multifocality, bilateral disease and maximum tumor diameter (MTD) ≥1.0 cm. Independent risk factors of lateral lymph node metastasis in AYAs with CLNM were as follows: MTD ≥1.0 cm, maximum diameter of positive CLN ≥1.0 cm, and presence of ipsilateral nodular goiter. Furthermore, AYA patients with PTC displayed significantly greater aggression in primary tumor invasion and neck lymph node metastasis. Based on these findings, a treatment stratification chart was created to guide the PTC treatment approach for AYAs. The present study is registered at the Chinese Clinical Trials Registry (trial registration no. ChiCTR2200064921) in November 2022.

Prognostic value of 18 F-FDG PET radiomics and sarcopenia in patients with oral squamous cell carcinoma.

BACKGROUND: Oral cancer is one of the most common malignancies in the head and neck region. Approximately 90% of oral cancers are oral squamous cell carcinomas (OSCC). 18 F-FDG PET/CT has been used in OSCC patients for its high value in detecting metastatic lymph nodes and distant metastases. PET radiomics and sarcopenia can be measured on the PET and CT components of 18 F-FDG PET/CT. PURPOSE: This study aimed to investigate the prognostic value of radiomics and sarcopenia measured on the PET and CT components of pre-operation 18 F-FDG PET/CT in OSCC. METHODS: A total of 116 patients eventually enrolled in our study were randomly divided into two cohorts: training cohort (n = 58) and validation cohort (n = 58). The Cox model combined with the least absolute shrinkage and selection operator (LASSO) algorithm was applied to construct the radiomics score (Rad_score). The third lumber skeletal muscle index (L3 SMI) was calculated to identify sarcopenia. Univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors. Based on the clinical factors, the clinical model was constructed, and the combined model was developed through the combination of the clinical model and Rad_score. C index, time-dependent C-index curves, receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis were used to evaluate the performance of prediction models. RESULTS: Three radiomics features constitute the Rad_score for overall survival (OS) and progression-free survival (PFS), respectively. Multivariate Cox regression analysis revealed that Rad_score was an independent prognostic factor, whereas sarcopenia was not. The combined models showed satisfactory performance in both the training cohort (C-index: OS:0.836, PFS:0.776) and the validation cohort (C-index: OS:0.744, PFS:0.712). The combined models were visualized as nomograms. Nomogram scores can realize the risk stratification of OSCC patients. Lower nomogram score is significantly related to the poorer OS (training cohort: p < 0.0001, validation cohort: p < 0.0001, overall cohort: p < 0.0001) and PFS (training cohort: p < 0.0001, validation cohort: p = 0.00017, overall cohort: p < 0.0001). CONCLUSIONS: Rad_score, but not sarcopenia, was an independent prognostic factor for patients with OSCC. The nomograms had a satisfactory performance, which might be helpful for OSCC patients and clinicians in personalized prognostic prediction and treatment decision-making.

FDX1 inhibits thyroid cancer malignant progression by inducing cuprotosis.

Cuprotosis is a recently identified cell death form that caused by intracellular copper accumulation and regulated by FDX1. This work aimed to explore the role of cuprotosis and the pivotal regulatory gene FDX1 in thyroid cancer development. We observed that expression of FDX1 in tumor section was notably lower than that in non-tumor sections in clinical samples. Induction of cuprotosis by elesclomol (ES) significantly repressed the in vitro and in vivo growth of thyroid cancer cells, simultaneously elevated Cu level and expression of FDX1, whereas depletion of FDX1 abolished these effects. Knockdown of FDX1 decreased the lipoylation level of DLAT and DLST in thyroid cancer cells, alleviated cuprotosis-induced cell death, simultaneously upregulated the levels of PA and α-KG. These findings demonstrated that FDX1 promotes the cuprotosis of thyroid cancer cells via regulating the lipoylation of DLAT.

"Elastic stretch cavity building" system in endoscopic thyroidectomy via the axillary approach: a case series.

Background: Patients undergoing conventional endoscopic thyroidectomy via the axillary approach, which is commonly used clinically, suffered from a range of postoperative complications. This study aimed to prevent postoperative complications and evaluate patients' satisfaction with cosmetic outcomes in endoscopic thyroidectomy via the axillary with the use of "Elastic Stretch Cavity Building" System. Methods: In this retrospective case series study, the clinical data of patients who were admitted to the Thyroid Surgery Department of Ningbo Medical Centre Lihuili Hospital between December 2020 and December 2021 for endoscopic thyroidectomy via the axillary approach under the "Elastic Stretch Cavity Building" System. Results: A total of 67 patients were included, all surgeries were successfully completed. The operation time was 75.61 ± 13.67 minutes; the postoperative drainage volume was 109.97 ± 37.54 ml; the average postoperative hospital stay was 4 (2-6) days. There was no skin ecchymosis, effusion or infection, hypocalcemia, convulsions, upper extremity dyskinesia, and temporary hoarseness after the surgery. The patients were satisfied with the cosmetic effects, and the cosmetic score was 4 (3-4). Conclusion: The "Elastic Stretch Cavity Building" System in endoscopic thyroid surgery via the axillary approach might reduce the risks of complications and achieve satisfactory results with the cosmetic outcomes.

Attention guided neural ODE network for breast tumor segmentation in medical images.

Breast cancer is the most common cancer in women. Ultrasound is a widely used screening tool for its portability and easy operation, and DCE-MRI can highlight the lesions more clearly and reveal the characteristics of tumors. They are both noninvasive and nonradiative for assessment of breast cancer. Doctors make diagnoses and further instructions through the sizes, shapes and textures of the breast masses showed on medical images, so automatic tumor segmentation via deep neural networks can to some extent assist doctors. Compared to some challenges which the popular deep neural networks have faced, such as large amounts of parameters, lack of interpretability, overfitting problem, etc., we propose a segmentation network named Att-U-Node which uses attention modules to guide a neural ODE-based framework, trying to alleviate the problems mentioned above. Specifically, the network uses ODE blocks to make up an encoder-decoder structure, feature modeling by neural ODE is completed at each level. Besides, we propose to use an attention module to calculate the coefficient and generate a much refined attention feature for skip connection. Three public available breast ultrasound image datasets (i.e. BUSI, BUS and OASBUD) and a private breast DCE-MRI dataset are used to assess the efficiency of the proposed model, besides, we upgrade the model to 3D for tumor segmentation with the data selected from Public QIN Breast DCE-MRI. The experiments show that the proposed model achieves competitive results compared with the related methods while mitigates the common problems of deep neural networks.

"Elastic Stretch Cavity Building" System in Endoscopic Thyroidectomy of Giant Thyroid Tumors.

Objective: To analyze the clinical characteristics of patients with large thyroid tumors underwent endoscopic thyroidectomy using the "elastic stretch cavity builder" system. Methods: This retrospective case series study included thyroid tumor patients admitted to the Ningbo Medical Center Li Hui li Hospital between September 2017 and November 2021. The self-developed "elastic stretch cavity builder" was used to elastically lift the anterior cervical flap, combined with low-pressure (3 mmHg) high-flow CO2 inflation, and create a working cavity for endoscopic thyroidectomy. Results: This study included 13 patients for analysis. The endoscopic thyroidectomy duration was 92-170 min (mean, 123 ± 24min). The maximum transverse plane diameter of the glands was 5.0-6.2 cm (mean, 5.3 ± 0.3 cm). The maximum sagittal plane diameter was 6.8-10.0 cm (mean, 7.6 ± 0.9 cm). After the "elastic stretch cavity builder" lifted the cervical flap, the height of the subcutaneous region was increased by 1.3 ± 0.2cm without affecting cervical activity. There was no residual scar in the anterior cervical skin puncture hole. All patients were satisfied with the cosmetic with the cosmetic satisfaction score was 3.4 ± 0.5. Conclusion: The novel mixed cavity building model established by the "elastic stretch cavity builder" might provide the surgeon with additional longitudinal cervical operating space while improving the stability of the space and saving human effort.

A facile and effective strategy to develop a super-hydrophobic/super-oleophilic fiberglass filter membrane for efficient micron-scale water-in-oil emulsion separation.

In order to achieve efficient micron-scale water-in-oil emulsion separation, a facile and effective strategy is developed to prepare a super-hydrophobic/super-oleophilic fiberglass filter membrane (FGm). Methyl-trichlorosilane (MTS) is successfully cross-linked on the surface of the fiberglass filter membrane (FGm) and aggregates into a 3D nanowire array to provide low surface energy. Nano fumed hydrophobic silica (SH-SiO2) is used to construct the well-defined nanosphere structure on the surface of FGm and enhance the ability of the membrane to resist extreme conditions. The optimally modified membrane displays outstanding super-hydrophobic properties with a contact angle of 156.2°. It is impressive to find that the MTS@SH-SiO2@FGm not only demonstrates the ability to separate water-in-oil emulsions with a particle size of less than 20 µm, but also the removal efficiency of separation has reached 99.98%. More attractively, the membrane still has stable super-hydrophobic features and reusable water-in-oil emulsion separation performance even under exposure to diverse harsh conditions, including extremely acidic corrosive solutions and ultra-high temperature systems.

[Study on Automatic Plan Method for Radiotherapy after Breast-conserving Surgery Based on TiGRT System].

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.

MTANS: Multi-Scale Mean Teacher Combined Adversarial Network with Shape-Aware Embedding for Semi-Supervised Brain Lesion Segmentation.

The annotation of brain lesion images is a key step in clinical diagnosis and treatment of a wide spectrum of brain diseases. In recent years, segmentation methods based on deep learning have gained unprecedented popularity, leveraging a large amount of data with high-quality voxel-level annotations. However, due to the limited time clinicians can provide for the cumbersome task of manual image segmentation, semi-supervised medical image segmentation methods present an alternative solution as they require only a few labeled samples for training. In this paper, we propose a novel semi-supervised segmentation framework that combines improved mean teacher and adversarial network. Specifically, our framework consists of (i) a student model and a teacher model for segmenting the target and generating the signed distance maps of object surfaces, and (ii) a discriminator network for extracting hierarchical features and distinguishing the signed distance maps of labeled and unlabeled data. Besides, based on two different adversarial learning processes, a multi-scale feature consistency loss derived from the student and teacher models is proposed, and a shape-aware embedding scheme is integrated into our framework. We evaluated the proposed method on the public brain lesion datasets from ISBI 2015, ISLES 2015, and BRATS 2018 for the multiple sclerosis lesion, ischemic stroke lesion, and brain tumor segmentation respectively. Experiments demonstrate that our method can effectively leverage unlabeled data while outperforming the supervised baseline and other state-of-the-art semi-supervised methods trained with the same labeled data. The proposed framework is suitable for joint training of limited labeled data and additional unlabeled data, which is expected to reduce the effort of obtaining annotated images.

Bioinformatics Analyses Indicate That Cathepsin G (CTSG) is a Potential Immune-Related Biomarker in Oral Squamous Cell Carcinoma (OSCC).

PURPOSE: Plenty of studies showed that the immune system was associated with cancer initiation and progression. This study aimed to explore the prognostic biomarkers from immune-related genes (IRGs) in oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: RNA-seq data were downloaded from The Cancer Genome Atlas (TCGA) and IRGs and transcription factors (TFs) were extracted. Then, the co-expression network between IRGs and TFs was constructed using the "WGCNA" package in R software. Furthermore, a gene expression signature according to IRGs was constructed to predict OSCC prognosis and its accuracy was validated by survival analysis. Subsequently, correlation analyses between risk-score and immune cells level and clinical parameters were performed. Finally, immune-related biomarkers were selected and further investigated using gain-of-function assays in vitro. RESULTS: A total of 32 normal cases and 317 OSCC cases were selected in our study. Differentially-expressed analysis indicated that there were 381 differentially-expressed IRGs and 62 TFs in OSCC. Among them, 25 TFs and 21 IRGs were enrolled in the co-expression network. Furthermore, we found that gene expression signature on the basis of 10 IRGs could predict the prognosis accurately and a high-risk score based on gene expression signature meant a high T classification, terminal clinical stage, and low immune cells level in OSCC. Finally, cathepsin G (CTSG) was identified as a potential immune-related biomarker and therapeutic target in OSCC. CONCLUSION: In conclusion, IRGs were directly involved in the development and progression of OSCC. Furthermore, CTSG was identified as a potential independent biomarker and might be an immunotherapeutic target in OSCC treatment.

Deep learning combined with radiomics may optimize the prediction in differentiating high-grade lung adenocarcinomas in ground glass opacity lesions on CT scans.

PURPOSE: Adenocarcinoma (ADC) is the most common histological subtype of lung cancers in non-small cell lung cancer (NSCLC) in which ground glass opacifications (GGOs) found on computed tomography (CT) scans are the most common lesions. However, the presence of a micropapillary or a solid component is identified as an independent predictor of prognosis, suggesting a more extensive resection. The purpose of our study is to explore imaging phenotyping using a method combining radiomics with deep learning (RDL) to predict high-grade patterns within lung ADC. METHODS: Included in this study were 111 patients differentiated as having GGOs and pathologically confirmed ADC. Four different groups of methods were compared to classify the GGOs for the prediction of the pathological subtypes of high-grade lung ADCs in definitive hematoxylin and eosin stain, including radiomics with gray-level features, radiomics with textural features, deep learning method, and the RDL. RESULTS: We evaluated the performance of different models on 111 NSCLC patients using 4-fold cross-validation. The proposed RDL has achieved an overall accuracy of 0.913, which significantly outperforms the other methods (p <  0.01, analysis of variation, ANOVA). In addition, we also verified the generality and practical effectiveness of these models on an independent validation dataset of 28 patients. The results showed that our RDL framework with an accuracy of 0.966 significantly surpassed other methods. CONCLUSION: High-grade lung ADC based on histologic pattern spectrum in GGO lesions might be predicted by the framework combining radiomics with deep learning, which reveals advantage over radiomics alone.

RFDCR: Automated brain lesion segmentation using cascaded random forests with dense conditional random fields.

Segmentation of brain lesions from magnetic resonance images (MRI) is an important step for disease diagnosis, surgical planning, radiotherapy and chemotherapy. However, due to noise, motion, and partial volume effects, automated segmentation of lesions from MRI is still a challenging task. In this paper, we propose a two-stage supervised learning framework for automatic brain lesion segmentation. Specifically, in the first stage, intensity-based statistical features, template-based asymmetric features, and GMM-based tissue probability maps are used to train the initial random forest classifier. Next, the dense conditional random field optimizes the probability maps from the initial random forest classifier and derives the whole tumor regions referred as the region of interest (ROI). In the second stage, the optimized probability maps are further intergraded with features from the intensity-based statistical features and template-based asymmetric features to train subsequent random forest, focusing on classifying voxels within the ROI. The output probability maps will be also optimized by the dense conditional random fields, and further used to iteratively train a cascade of random forests. Through hierarchical learning of the cascaded random forests and dense conditional random fields, the multimodal local and global appearance information is integrated with the contextual information, and the output probability maps are improved layer by layer to finally obtain optimal segmentation results. We evaluated the proposed method on the publicly available brain tumor datasets BRATS 2015 & BRATS 2018, as well as the ischemic stroke dataset ISLES 2015. The results have shown that our framework achieves competitive performance compared to the state-of-the-art brain lesion segmentation methods. In addition, contralateral difference and skewness were identified as the important features in the brain tumor and ischemic stroke segmentation tasks, which conforms to the knowledge and experience of medical experts, further reflecting the reliability and interpretability of our framework.

Oncolytic activity of canine distemper virus in canine mammary tubular adenocarcinoma cells.

Canine distemper virus (CDV), bearing a close resemblance to measles virus, represents a promising candidate for oncolytic therapy; however, its application and underlying oncolytic mechanisms in canine mammary carcinoma cells remain to be explored. Here, we found that an attenuated canine distemper vaccine strain, CDV-L, efficiently infected and inhibited the growth of canine mammary tubular adenocarcinoma CIPp cells but not MDCK cells in vitro. Transcriptomic analysis of CDV-L-infected CIPp cells revealed substantially differentially expressed genes in apoptotic and NF-κB signalling pathways. Subsequent validations confirmed that CDV-L-induced apoptosis of CIPp cells through the caspase-8 and caspase-3 pathway. Identification of phosphorylated-IκBα, phosphorylated-p65 and the nuclear translocation of p65 confirmed the activation of the NF-κB signalling pathway. Inhibition of the NF-κB pathway abrogated CDV-L-induced cleaved-caspase-3 and cleaved-PARP. In a CIPp subcutaneous xenograft mouse model, intratumoural injections of CDV-L significantly restricted tumour growth without apparent pathology, and virus remained localized within the tumour. Taken altogether, these findings indicate that CDV-L exerts an antitumour effect in CIPp cells, and that apoptosis and the NF-κB pathway play essential roles in this process.

Drainage During Endoscopic Thyroidectomy.

BACKGROUND: Conventional cervical drainage tubes are placed crossing the suprasternal fossa during endoscopic thyroidectomy. In our clinical experience, some patients show shallow or absent suprasternal fossa, which affects the cosmetic outcome in the patient. Therefore, this study aimed to assess the feasibility and significance of restoring the suprasternal fossa by changing the position of neck drainage tubes. METHODS AND MATERIALS: A total of 117 female patients were enrolled and divided into 2 groups, including 59 and 58 individuals in the Conventional (conventional anterior neck region negative pressure drainage) and Improvement (improved method with a negative pressure drainage) groups. Then, restoration of the suprasternal fossa in all subjects was observed at 1 day postsurgery, the day of extubation, and 3 months postoperatively. In addition, drainage volume, the time to extubation, and abnormal neck sensations were compared between the groups. RESULTS: Compared with the Conventional group, the Improvement group showed improved restoration of the suprasternal fossa, with the patients more satisfied with the cosmetic outcome. However, operation time, postoperative drainage volume, and extubation time were not significantly different between the 2 groups. CONCLUSIONS: In endoscopic thyroidectomy via the chest and breast approach, using the new drainage technique described here could yield improved restoration of the suprasternal fossa, ameliorating the cosmetic outcome and patient satisfaction.

Utility of a novel elastic traction system in endoscopic thyroidectomy via breast approach: initial experience with 34 patients.

Objective To summarize our experiences in using an elastic traction, space-making technique for endoscopic thyroidectomy via breast approach in the treatment of early-stage differentiated papillary thyroid carcinoma. Methods A retrospective analysis was performed on patients who underwent endoscopic thyroidectomy via breast approach for thyroid carcinoma in our department. We used our self-developed "mini elastic traction space-maker" in a group of 34 patients; another 45 patients who underwent the procedure with the conventional CO2 insufflation method were enlisted as the control group. Results All patients had successful unilateral lobectomy and central lymph node dissection (CLND) surgeries. The adoption of the intraoperative elastic traction system increased the height of the subcutaneous working space (by 1 cm) and significantly decreased the times required for lobectomy and CLND compared with the controls (46.7 ± 4.7 min vs. 50.7 ± 4.9 min). However, there was no significant difference between the two groups in the set-up time to create the working space. Conclusions The elastic traction, space-making technique is a safe and feasible technique for endoscopic thyroidectomy via breast approach.

GSTP1 Ile105Val polymorphism might be associated with the risk of radiation pneumonitis among lung cancer patients in Chinese population: A prospective study.

Background: Growing data suggest that DNA damage repair and detoxification pathways play crucial roles in radiation-induced toxicities. To determine whether common functional single-nucleotide polymorphisms (SNPs) in candidate genes from these pathways can be used as predictors of radiation pneumonitis (RP), we conducted a prospective study to evaluate the associations between functional SNPs and risk of RP. Methods: We recruited a total of 149 lung cancer patients who had received intensity modulated radiation therapy (IMRT). GSTP1 and XRCC1 were genotyped using the SurPlexTM-xTAG method in all patients. RP events were prospectively scored using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Kaplan-Meier analysis was used to determine the cumulative probability of RP of grade ≥ 2. Cox proportional hazard regression was performed to identify clinical variables and SNPs associated with risk of RP grade ≥ 2, using univariate and multivariate analysis, respectively. Results: With a median follow-up of 9 months, the incidence of RP of grade ≥ 2 was 38.3%. A predicting role in RP was observed for the GSTP1 SNP (adjusted hazard ratio 3.543; 95% CI 1.770-7.092; adjusted P< 0.001 for the Ile/Val and Val/Val genotypes versus Ile/Ile genotype). Whereas, we found that patients with XRCC1 399Arg/Gln and Gln/Gln genotypes had a lower risk of RP compares with those carrying Arg/Arg genotype (adjusted HR 0.653; 95% CI 0.342-1.245), but with no statistical significance observed (adjusted P = 0.195). Conclusions: Our results suggested a novel association between GSTP1 SNP 105Ile/Val and risk of RP development, which suggests the potential use of this genetic polymorphism as a predictor of RP. In addition, genetic polymorphisms of XRCC1 399Arg/Gln may also be associated with RP.

Hydrothermal synthesis of a highly sensitive T2-weigthed MRI contrast agent: zinc-doped superparamagnetic iron oxide nanocrystals.

A highly efficient hydrothermal strategy for the synthesis of zinc-doped superparamagnetic iron oxide nanocrystals (SPION:Zn) with lower toxicity and improved sensitivity has been demonstrated. The saturation magnetizations of as-synthesized SPION:Zn were demonstrated to be Zn-dependent and could be tuned from 41.88 emu/g to 79.23 emu/g by changing the amount of Zn. As-synthesized hydrophobic SPION:Zn could be efficiently transferred into water phase through a ultrasonic process with the assistance of cetyltrimethylammonium bromide (CTAB) surfactant. As-obtained CTAB stabilized SPION:Zn was exploited as a MR enhanced contrast agent, and its T2 relaxivity coefficient (r2) was found to be as high as 342.09 mM(-1)s(-1).