Associations of maternal and personal smoking with all-cause and cause-specific mortality risk and life expectancy: a prospective cohort study.

OBJECTIVES: The aim of this study was to evaluate the individual and combined effects of maternal smoking during pregnancy (MSDP) and personal smoking on mortality and life expectancy. STUDY DESIGN: A prospective cohort study based on the UK Biobank, with a median follow-up of 12.47 years. METHODS: This study employed multivariate Cox regression to determine the relative risks of mortality from all causes and specific diseases according to maternal and/or personal smoking status and pack-years of smoking (0, 1-20, 21-30, >30). Additionally, this study estimated the additive interaction between the two exposures. Life table analyses were performed using the estimated age-specific mortality rates to forecast life expectancy. RESULTS: Results indicated that MSDP elevated the risk of all-cause mortality (HR = 1.12, 95% CI: 1.09-1.15) and mortality due to neoplasms (HR = 1.10, 95% CI: 1.06-1.12), circulatory (HR = 1.13, 95% CI: 1.06-1.19), respiratory (HR = 1.27, 95% CI: 1.16-1.40) and digestive system diseases (HR = 1.22, 95% CI: 1.08-1.38). Notably, both multiplicative and additive interactions were observed between maternal and personal smoking, with Relative Excess Risk due to Interaction (RERI) values for mortality from all causes, neoplasms, circulatory, and respiratory diseases being 0.21, 0.22, 0.16, and 0.76, respectively. This study also found a trend towards shorter gained life expectancy when maternal smoking and increasing pack-years of personal smoking were combined. CONCLUSIONS: In this cohort study of UK Biobank, MSDP was associated with an increased risk of all-cause mortality and reduced life expectancy, suggesting that quitting smoking during pregnancy might have health and longevity benefits for both generations.

KRT80 Promotes Lung Adenocarcinoma Progression and Serves as a Substrate for VCP.

Background: Keratin 80(KRT80) encodes a type II intermediate filament protein, known for maintaining cell integrity of cells and its involvement in the tumorigenesis and progression of various cancers. However, comprehensive research on its relevance to lung adenocarcinoma remains limited. Methods: In this study, we utilized multiple databases to investigate the transcriptional expression of KRT80 and its correlation with clinicopathological features. A range of assays, including the Cell Counting Kit 8 assay, colony formation assay, cell migration assay, and flow cytometry, were employed to elucidate the impact of KRT80 on the malignant behavior of lung adenocarcinoma. Immunoprecipitation and mass spectrometry were also used to identify putative genes interacting with KRT80. Results: The expression of KRT80 was elevated in lung adenocarcinoma and patients with high levels of KRT80 expression had poor clinical outcomes. Silencing KRT80 suppressed cell viability, and migration, while overexpression had the opposite effect. In addition, Immunoprecipitation and mass spectrometry revealed an interaction between KRT80 and valosin-containing protein (VCP), with VCP knockdown reducing the stability of KRT80 protein. Overexpression of KRT80 mitigated the inhibitory effect of VCP knockdown to some extent. Conclusion: Our findings collectively suggest that KRT80 is a promising diagnostic and prognostic indicator for lung adenocarcinoma. Additionally, the interaction between KRT80 and VCP plays a crucial role in the progression of lung adenocarcinoma, which implies that KRT80 is a promising therapeutic target.

Prognostic biomarker HIF1α and its correlation with immune infiltration in gliomas.

Certain glioma subtypes, such as glioblastoma multiforme or low-grade glioma, are common malignant intracranial tumors with high rates of relapse and malignant progression even after standard therapy. The overall survival (OS) is poor in patients with gliomas; hence, effective prognostic prediction is crucial. Herein, the present study aimed to explore the potential role of hypoxia-inducible factor 1 subunit alpha (HIF1α) in gliomas and investigate the association between HIF1α and infiltrating immune cells in gliomas. Data from The Cancer Genome Atlas were evaluated via RNA sequencing, clinicopathological, immunological checkpoint, immune infiltration and functional enrichment analyses. Validation of protein abundance was performed using paraffin-embedded samples from patients with glioma. A nomogram model was created to forecast the OS rates at 1, 3 and 5 years after cancer diagnosis. The association between OS and HIF1α expression was estimated using Kaplan-Meier survival analysis and the log-rank test. Finally, HIF1α expression was validated using western blotting, reverse transcription-quantitative PCR, Cell Counting Kit-8 and Transwell assays. The results demonstrated that HIF1α expression was significantly upregulated in gliomas compared with normal human brain glial cells. Immunohistochemistry staining demonstrated differential expression of the HIF1α protein. Moreover, glioma cell viability and migration were inhibited via HIF1α downregulation. HIF1α impacted DNA replication, cell cycling, DNA repair and the immune microenvironment in glioma. HIF1α expression was also positively associated with several types of immune cells and immunological checkpoints and with neutrophils, plasmacytoid dendritic cells and CD56bright cells. The Kaplan-Meier survival analyses further demonstrated a strong association between high HIF1α expression and poor prognosis in patients with glioma. Analysis of the receiver operating characteristic curves demonstrated that HIF1α expression accurately differentiated paired normal brain cells from tumor tissues. Collectively, these findings suggested the potential for HIF1α to be used as a novel prognostic indicator for patients with glioma and that OS prediction models may help in the future to develop effective follow-up and treatment strategies for these patients.

Early venous filling after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in anterior circulation.

BACKGROUND: The significance of early venous filling (EVF) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is not fully understood. In this study, we aimed to investigate the impact of EVF after MT. METHODS: From January 2019 to May 2022, AIS patients with successful recanalization (modified Thrombolysis in Cerebral Infarction score (mTICI) ≥2b) after MT were retrospectively reviewed. EVF was evaluated on final digital subtraction angiography runs after successful recanalization and was categorized into phase subgroups (arterial phase and capillary phase) and pathway subgroups (cortical veins subgroup and thalamostriate veins subgroup), respectively. The impact of EVF subgroups on functional outcomes after successful recanalization were both investigated. RESULTS: A total of 349 patients achieving successful recanalization after MT were included, including 45 patients in the EVF group and 304 patients in the non-EVF group. Multivariable logistic regression analysis showed the EVF group had a higher rate of intracranial hemorrhage (ICH; 66.7% vs 22%, adjusted odds ratio (aOR) 6.805, 95% CI 3.389 to 13.662, P<0.001), symptomatic ICH (sICH; 28.9% vs 4.9%, aOR 6.011, 95% CI 2.493 to 14.494, P<0.001) and malignant cerebral edema (MCE; 20% vs 6.9%, aOR 2.682, 95% CI 1.086 to 6.624, P=0.032) than the non-EVF group. Furthermore, the cortical veins subgroup of EVF had a higher rate of mortality than the thalamostriate veins subgroup (37.5% vs 10.3%, P=0.029). CONCLUSIONS: EVF is independently associated with ICH, sICH and MCE after successful recanalization of MT, but not with favorable outcome and mortality.

Machine learning slice-wise whole-lung CT emphysema score correlates with airway obstruction.

OBJECTIVES: Quantitative CT imaging is an important emphysema biomarker, especially in smoking cohorts, but does not always correlate to radiologists' visual CT assessments. The objectives were to develop and validate a neural network-based slice-wise whole-lung emphysema score (SWES) for chest CT, to validate SWES on unseen CT data, and to compare SWES with a conventional quantitative CT method. MATERIALS AND METHODS: Separate cohorts were used for algorithm development and validation. For validation, thin-slice CT stacks from 474 participants in the prospective cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) were included, 395 randomly selected and 79 from an emphysema cohort. Spirometry (FEV1/FVC) and radiologists' visual emphysema scores (sum-visual) obtained at inclusion in SCAPIS were used as reference tests. SWES was compared with a commercially available quantitative emphysema scoring method (LAV950) using Pearson's correlation coefficients and receiver operating characteristics (ROC) analysis. RESULTS: SWES correlated more strongly with the visual scores than LAV950 (r = 0.78 vs. r = 0.41, p < 0.001). The area under the ROC curve for the prediction of airway obstruction was larger for SWES than for LAV950 (0.76 vs. 0.61, p = 0.007). SWES correlated more strongly with FEV1/FVC than either LAV950 or sum-visual in the full cohort (r = - 0.69 vs. r = - 0.49/r = - 0.64, p < 0.001/p = 0.007), in the emphysema cohort (r = - 0.77 vs. r = - 0.69/r = - 0.65, p = 0.03/p = 0.002), and in the random sample (r = - 0.39 vs. r = - 0.26/r = - 0.25, p = 0.001/p = 0.007). CONCLUSION: The slice-wise whole-lung emphysema score (SWES) correlates better than LAV950 with radiologists' visual emphysema scores and correlates better with airway obstruction than do LAV950 and radiologists' visual scores. CLINICAL RELEVANCE STATEMENT: The slice-wise whole-lung emphysema score provides quantitative emphysema information for CT imaging that avoids the disadvantages of threshold-based scores and is correlated more strongly with reference tests than LAV950 and reader visual scores. KEY POINTS: • A slice-wise whole-lung emphysema score (SWES) was developed to quantify emphysema in chest CT images. • SWES identified visual emphysema and spirometric airflow limitation significantly better than threshold-based score (LAV950). • SWES improved emphysema quantification in CT images, which is especially useful in large-scale research.

Impact of Maternal Smoking, Offspring Smoking, and Genetic Susceptibility on Crohn's Disease and Ulcerative Colitis.

BACKGROUND AND AIMS: The long-term impact of maternal smoking during pregnancy (MSDP) on adult offspring's risk of Crohn's disease (CD) and ulcerative colitis (UC) remains uncertain. Our study aims to investigate the individual and combined effects of early life exposure (MSDP), offspring personal behavior (smoking), and genetic risk on the development of CD and UC in adult offspring. METHODS: We conducted a prospective cohort study using UK Biobank data, including 334,083 participants recruited between 2006-2010, with follow-up until December 31, 2021. Multivariable Cox regression models were used to evaluate the associations of genetic factors, maternal and personal smoking, and their combination with CD and UC. RESULTS: Participants exposed to MSDP had an 18% increased risk of CD compared to those without MSDP (hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.01-1.39). However, no significant association was found between MSDP and the UC risk (HR = 1.03, 95%CI = 0.92-1.16). Personal smoking increased the risk of CD and UC, and had a numerically amplified effect with MSDP. Participants with high genetic risk and MSDP had a 2.01-fold (95%CI = 1.53-2.65) and a 2.45-fold (95%CI = 2.00-2.99) increased risk of CD and UC, respectively, compared to participants without MSDP and with low genetic risk. CONCLUSIONS: Our prospective cohort study provides evidence that MSDP increases the risk of CD in adult offspring, whereas no evidence supports their causal association. Additionally, smoking and genetic susceptibility had a numerically amplified effect with MSDP on CD and UC, but the interaction lacked statistical significance.

Tumor regression grade in locally advanced rectal cancer after neoadjuvant chemoradiotherapy: influencing factors and prognostic significance.

OBJECTIVE: The extent of tumor regression varies widely among patients who receive neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision (TME) surgery. We evaluated the tumor regression grade (TRG) classification of patients and analyzed factors related to TRG and its value in predicting prognosis in locally advanced rectal cancer (LARC). METHODS: This study retrospectively analyzed the clinicopathologic data of 269 consecutive patients with LARC treated from February 2002 to October 2014. The grade of TRG was based on the extent of primary tumor replaced by fibrosis. Clinical characteristics and relative survival were retrospectively analyzed. RESULTS: There were 269 patients, among whom 67 patients (24.9%) achieved TRG0, whereas 46 patients (17.1%) showed TRG3. TRG1 and TRG2 were both found in 78 patients (29.0%). Clinicopathologic factors that were related to TRG included post-NACRT carcinoembryonic antigen (CEA) level (P=0.002), clinical T stage (P=0.022), pathologic T stage (P<0.001) and pathologic lymph node status (P=0.003). The 5-year overall survival (OS) was 74.6%, 55.1%, 47.4%, 28.3% for TRG0, TRG1, TRG2, TRG3, respectively (P<0.001). The 5-year disease-free survival (DFS) was 64.2%, 47.4%, 37.2%, 23.9% for TRG0, TRG1, TRG2, TRG3, respectively (P<0.001). Based on multivariate analysis, TRG was a significant predictor for both OS (P=0.039) and DFS (P=0.043). CONCLUSION: Clinicopathologic factors such as post-NACRT CEA level, clinical T stage, pathological T stage and pathological lymph node status are significantly associated with TRG. TRG is an independent predictor of survival. Therefore, it is reasonable to include the TRG for clinicopathologic assessment.

Automatic segmentation of orbital wall from CT images via a thin wall region supervision-based multi-scale feature search network.

PURPOSE: Orbital wall segmentation is critical for orbital measurement and reconstruction. However, the orbital floor and medial wall are made up of thin walls (TW) with low gradient values, making it difficult to segment the blurred areas of the CT images. Clinically, doctors have to manually repair the missing parts of TW, which is time-consuming and laborious. METHODS: To address these issues, this paper proposes an automatic orbital wall segmentation method based on TW region supervision using a multi-scale feature search network. First of all, in the encoding branch, the densely connected atrous spatial pyramid pooling based on the residual connection is adopted to achieve a multi-scale feature search. Then, for feature enhancement, multi-scale up-sampling and residual connection are applied to perform skip connection of features in multi-scale convolution. Finally, we explore a strategy for improving the loss function based on the TW region supervision, which effectively increases the TW region segmentation accuracy. RESULTS: The test results show that the proposed network performs well in terms of automatic segmentation. For the whole orbital wall region, the Dice coefficient (Dice) of segmentation accuracy reaches 96.086 ± 1.049%, the Intersection over Union (IOU) reaches 92.486 ± 1.924%, and the 95% Hausdorff distance (HD) reaches 0.509 ± 0.166 mm. For the TW region, the Dice reaches 91.470 ± 1.739%, the IOU reaches 84.327 ± 2.938%, and the 95% HD reaches 0.481 ± 0.082 mm. Compared with other segmentation networks, the proposed network improves the segmentation accuracy while filling the missing parts in the TW region. CONCLUSION: In the proposed network, the average segmentation time of each orbital wall is only 4.05 s, obviously improving the segmentation efficiency of doctors. In the future, it may have a practical significance in clinical applications such as preoperative planning for orbital reconstruction, orbital modeling, orbital implant design, and so on.

Clinicopathologic and prognostic factors for colorectal cancer in children and adolescents: a population-based study.

PURPOSE: Colorectal cancer (CRC) is rarely found in children and adolescents. The purpose of this study was to retrospectively conduct a population-based cohort of pediatric patients with CRC. METHODS: All pediatric patients with CRC diagnosed between 1975 and 2018 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. The demographics and clinical variables of the patients were summarized, and treatment outcomes and prognostic factors were examined. The study was presented in accordance with the STROBE reporting checklist. RESULTS: A total of 284 CRC patients were identified. At 3- and 5-year follow-up, the overall survival rates were 63.1% and 52.6%, respectively. Patients with local disease had a significantly improved overall survival (OS) than patients with distant disease. At 3- and 5-year follow-up, the overall survival rates of adenocarcinoma (nos) and adenocarcinoma (polyp) were similar and significantly better than those of patients with mucinous adenocarcinoma and signet ring cell carcinoma (P < 0.001). In terms of treatment, patients who underwent surgery outlived non-surgery patients (3-year OS, 70.4% versus 26.6%, P < 0.001). Multivariate analysis revealed that SEER stage and histologic type were important independent predictors of outcomes. CONCLUSIONS: Children and adolescents with CRC are likely to be in an advanced stage, have a worse histologic subtype, and have a poorly differentiated grade. Although surgical resection considerably increases survival for the majority of patients, pediatric patients with CRC have a poor prognosis. Considerable efforts are required to improve their survival outcomes.

Analysis and Validation of TMED3 correlates with poor prognosis and tumor immune infiltration of glioma.

BACKGROUND: Glioma is the most common primary intracranial tumor. It is notorious for its high degree of malignancy, strong invasion, and poor prognosis. The transmembrane emp24 trafficking protein 3 (TMED3) belongs to the TMED family, which is responsible for intracellular protein transport and innate immune signal transmission. More and more evidence shows that TMED3 plays a key role in the tumor progression of human cancer. However, the role and potential molecular mechanism of TMED3 in glioma have not been clarified. METHODS: TMED3 expression levels, clinical data, survival prognosis, prediction of upstream miRNA, and immune-related analyses were all analyzed utilizing relevant databases. Finally, a molecular cell experiment confirmed TMED3 expression in glioma. RESULTS: We discovered that TMED3 is overexpressed in most tumors, including gliomas, and is associated with tumor staging and prognosis. Subsequently, a combination of a series of bioinformatics analyses, including correlation and survival analyses, identified miR-1296-5p as the most potent upstream miRNA of TMED3 in gliomas.Additionally, we analyzed the relationship between TMED3 level and tumor immune cell infiltration and immune checkpoint expression. CONCLUSION: TMED3 is highly expressed in gliomas and is associated with tumor staging and affects the prognosis of patients. Therefore, the TMED3 gene may be a potential immunotherapy target and prognostic marker for gliomas.

Clinicopathological characteristics and prognosis of colon cancer with lung metastasis without liver metastasis: A large population-based analysis.

Distant metastasis explains the high mortality rate of colon cancer, in which lung metastasis without liver metastasis (LuM) is a rare subtype. This study is aimed to identify risk factors of LuM and LLM (lung metastasis with liver metastasis) from colon cancer, and to analyze the prognosis of patients with LuM by creating a nomogram. Patients' information were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was used to determine the risk factors for LuM and LLM. Prognostic factors for cancer-specific survival (CSS) and overall survival (OS) were identified by multivariate Cox proportional hazards regression and nomogram models were established to predict CSS and OS. Multivariate logistic regression analysis showed that blacks, splenic flexure of colon tumor, tumor size >5 cm, T4, N3, and higher lymph node positive rate were associated with the occurrence of LuM. Meanwhile, age >65 years old, female, splenic flexure of colon, higher lymph node positive rate, and brain metastasis were independent risk factors for CSS. The C-index of the prediction model for CSS was 0.719 (95% CI: 0.691-0.747). In addition, age, primary site, tumor size, differentiation grade, N stage, and bone metastasis were significantly different between LuM and LLM. The nomograms we created were effective in predicting the survival of individuals. Furthermore, patients with LuM and LLM from colon cancer might require different follow-up intervals and examinations.

Based on clinical Ki-67 expression and serum infiltrating lymphocytes related nomogram for predicting the diagnosis of glioma-grading.

Background: Compelling evidence indicates that elevated peripheral serum lymphocytes are associated with a favorable prognosis in various cancers. However, the association between serum lymphocytes and glioma is contradictory. In this study, a nomogram was established to predict the diagnosis of glioma-grading through Ki-67 expression and serum lymphocytes. Methods: We performed a retrospective analysis of 239 patients diagnosed with LGG and 178 patients with HGG. Immunohistochemistry was used to determine the Ki-67 expression. Following multivariate logistic regression analysis, a nomogram was established and used to identify the most related factors associated with HGG. The consistency index (C-index), decision curve analysis (DCA), and a calibration curve were used to validate the model. Results: The number of LGG patients with more IDH1/2 mutations and 1p19q co-deletion was greater than that of HGG patients. The multivariate logistic analysis identified Ki-67 expression, serum lymphocyte count, and serum albumin (ALU) as independent risk factors associated with HGG, and these factors were included in a nomogram in the training cohort. In the validation cohort, the nomogram demonstrated good calibration and high consistency (C-index = 0.794). The Spearman correlation analysis revealed a significant association between HGG and serum lymphocyte count (r = -0.238, P <0.001), ALU (r = -0.232, P <0.001), and Ki-67 expression (r = 0.457, P <0.001). Furthermore, the Ki-67 expression was negatively correlated with the serum lymphocyte count (r = -0.244, P <0.05). LGG patients had lower Ki-67 expression and higher serum lymphocytes compared with HGG patients, and a combination of these two variables was significantly higher in HGG patients. Conclusion: The constructed nomogram is capable of predicting the diagnosis of glioma-grade. A decrease in the level of serum lymphocyte count and increased Ki-67 expression in HGG patients indicate that their immunological function is diminished and the tumor is more aggressive.

Exploring the pathological relationships between adamantinomatous craniopharyngioma and contiguous structures with tumor origin.

PURPOSE: Identifying relationships between craniopharyngiomas (CPs) and contiguous structures, and tumor origin are crucial for treatments. This study attempted to explore the relationships and tumor origin. METHODS: CPs that underwent endoscopic surgeries were enrolled. The interfacial specimens of CPs attaching the hypothalamus, pituitary stalk (PS), pituitary grand (PG), optic chiasma (OC) and brain tissue (BT) were pathologically examined. Boundaries between CPs and these structures were observed during operations. Expression of ß-catenin and stem cell markers were analyzed to explore the tumor origin. Outcomes of patients were assessed. RESULTS: A total of 34 CPs were categorized into two groups based on the locations of finger-like protrusions (FP). Group A comprised 18 CPs with FP only present in the specimens attaching to hypothalamus. The surface of these CPs was fused with hypothalamus under endoscopic videos. However, the specimens attaching to the PS, PG, OC, and BT showed no FP. Clear boundaries was observed between these CPs and these structures. Group B comprised 16 CPs with FP only present in the specimens attaching to PS. The tumor surface was fused with PS. Specimens attaching to the hypothalamus, PG, OC and BT showed no FP. Clear boundary was observed among these CPs with these structures. These results implied CPs only invaded a certain part of hypothalamic-pituitary axis. ß-catenin and stem cells markers mainly distributed in the FP tissues of both groups. Patients in group B achieved better outcomes than group A. CONCLUSIONS: CPs only invade the hypothalamic-pituitary axis with FP and the FP would be the tumor origin.

A review on AI-based medical image computing in head and neck surgery.

Head and neck surgery is a fine surgical procedure with a complex anatomical space, difficult operation and high risk. Medical image computing (MIC) that enables accurate and reliable preoperative planning is often needed to reduce the operational difficulty of surgery and to improve patient survival. At present, artificial intelligence, especially deep learning, has become an intense focus of research in MIC. In this study, the application of deep learning-based MIC in head and neck surgery is reviewed. Relevant literature was retrieved on the Web of Science database from January 2015 to May 2022, and some papers were selected for review from mainstream journals and conferences, such as IEEE Transactions on Medical Imaging, Medical Image Analysis, Physics in Medicine and Biology, Medical Physics, MICCAI, etc. Among them, 65 references are on automatic segmentation, 15 references on automatic landmark detection, and eight references on automatic registration. In the elaboration of the review, first, an overview of deep learning in MIC is presented. Then, the application of deep learning methods is systematically summarized according to the clinical needs, and generalized into segmentation, landmark detection and registration of head and neck medical images. In segmentation, it is mainly focused on the automatic segmentation of high-risk organs, head and neck tumors, skull structure and teeth, including the analysis of their advantages, differences and shortcomings. In landmark detection, the focus is mainly on the introduction of landmark detection in cephalometric and craniomaxillofacial images, and the analysis of their advantages and disadvantages. In registration, deep learning networks for multimodal image registration of the head and neck are presented. Finally, their shortcomings and future development directions are systematically discussed. The study aims to serve as a reference and guidance for researchers, engineers or doctors engaged in medical image analysis of head and neck surgery.

Prior-aware autoencoders for lung pathology segmentation.

Segmentation of lung pathology in Computed Tomography (CT) images is of great importance for lung disease screening. However, the presence of different types of lung pathologies with a wide range of heterogeneities in size, shape, location, and texture, on one side, and their visual similarity with respect to surrounding tissues, on the other side, make it challenging to perform reliable automatic lesion segmentation. To leverage segmentation performance, we propose a deep learning framework comprising a Normal Appearance Autoencoder (NAA) model to learn the distribution of healthy lung regions and reconstruct pathology-free images from the corresponding pathological inputs by replacing the pathological regions with the characteristics of healthy tissues. Detected regions that represent prior information regarding the shape and location of pathologies are then integrated into a segmentation network to guide the attention of the model into more meaningful delineations. The proposed pipeline was tested on three types of lung pathologies, including pulmonary nodules, Non-Small Cell Lung Cancer (NSCLC), and Covid-19 lesion on five comprehensive datasets. The results show the superiority of the proposed prior model, which outperformed the baseline segmentation models in all the cases with significant margins. On average, adding the prior model improved the Dice coefficient for the segmentation of lung nodules by 0.038, NSCLCs by 0.101, and Covid-19 lesions by 0.041. We conclude that the proposed NAA model produces reliable prior knowledge regarding the lung pathologies, and integrating such knowledge into a prior segmentation network leads to more accurate delineations.

Comparison of Dural Graft Types and Graft Fixation Methods in Chiari Malformation Type I Decompression Surgery.

OBJECTIVE: Suboccipital decompression with duraplasty is being increasingly accepted for treating patients with Chiari malformation type I (CM-1). To date, the optimal duraplasty for CM-I has not been delineated. This study aims to compare the clinical and radiologic effects of duraplasty performed using 2 types of grafts and 2 graft fixation methods in 3 combinations. METHODS: In this retrospective study, 84 consecutive decompressions with duraplasty were analyzed. Two types of grafts (nonautologous [Non-Auto G], 90.5% and autologous [Auto G], 9.5%) and 2 graft fixations (suturing [S], 31.0%; and suturing plus gluing [S + G], 69.0%) were used in 3 different combinations: Non-Auto G S: 31.0%; Non-Auto G S + G: 59.5%, and Auto G S + G: 9.5%. All patients were followed up for 3 months. Clinical results were evaluated using the Gestalt scale, and syringomyelia results were evaluated using magnetic resonance imaging. RESULTS: According to the Gestalt scale, 82.1% of the patients showed improvement 3 months post operation, and the improvement was not related to the type of graft (P = 0.90), fixation (P = 0.90), or duraplasty (P = 0.81). Decreased syringomyelia was observed in 76.4% of the patients. It was not associated with the graft (P = 0.53), fixation (P = 0.72), or duraplasty (P = 0.80). Meningitis occurred in the Auto G S + G, Non-Auto G S + G and Non-Auto G S groups (25%, 48%, and 23.1%, respectively; P = 0.30), and their formations were not related to the k graft type (P = 0.57) or fixation (P = 0.19). CONCLUSIONS: Autologous and nonautologous dural grafts can be performed using either sutures or sutures plus glue, as both result in similar outcomes.

Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion.

This study was to analyze the diagnostic value of coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) based on computer-aided diagnosis (CAD) system for coronary lesions and the possible impact of calcification. 80 patients who underwent CCTA and FFR examination in hospital were selected as the subjects. The FFR value of 0.8 was used as the dividing line and divided into the ischemic group (FFR ≤ 0.8) and nonischemic group (FFR > 0.8). The basic data and imaging characteristics of patients were analyzed. The maximum diameter stenosis rate (MDS %), maximum area stenosis rate (MAS %), and napkin ring sign (NRS) in the ischemic group were significantly lower than those in the nonischemic group (P < 0.05). Remodeling index (RI) and eccentric index (EI) compared with the nonischemic group had no significant difference (P > 0.05). The total plaque volume (TPV), total plaque burden (TPB), calcified plaque volume (CPV), lipid plaque volume (LPV), and lipid plaque burden (LPB) in the ischemic group were significantly different from those in the non-ischemic group (P < 0.05). MAS % had the largest area under curve (AUC) for the diagnosis of coronary myocardial ischemia (0.74), followed by MDS % (0.69) and LPV (0.68). CT-FFR had high diagnostic sensitivity, specificity, accuracy, truncation value, and AUC area data for patients in the ischemic group and nonischemic group. The diagnostic sensitivity, specificity, accuracy, cutoff value, and AUC area data of CT-FFR were higher in the ischemic group (89.93%, 92.07%, 95.84%, 60.51%, 0.932) and nonischemic group (93.75%, 90.88%, 96.24%, 58.22%, 0.944), but there were no significant differences between the two groups (P > 0.05). In summary, CT-FFR based on CAD system has high accuracy in evaluating myocardial ischemia caused by coronary artery stenosis, and within a certain range of calcification scores, calcification does not affect the diagnostic accuracy of CT-FFR.

The eagle sign: a new preoperative MRI-based tool for predicting topographic correlation between craniopharyngioma and hypothalamus.

PURPOSE: Accurate prediction of topographical correlation between craniopharyngiomas (CPs) and hypothalamus is important for treatment. This study sought to develop a predicting tool based on preoperative-MRI through radiological-surgical-pathological-outcome analysis. MATERIALS AND METHODS: Third ventricle floor (TVF), mammillary bodies and cerebral peduncle were evaluated through preoperative-MRI. An eagle-head-like sign named "eagle sign" was observed. Normal TVF on sagittal-MRI was defined as the baseline. Variants of the sign were analyzed by comparing with the baseline and corresponding correlations of CPs with hypothalamus were verified using intraoperative records, histopathology and outcome evaluation. RESULTS: A total of 146 CPs patients, who undergone endoscopic endonasal procedure were divided into four groups based on the variants of "eagle sign". Group A: 24 patients with the upward sign; group B: 81 with the downward sign; group C: 21 with the anterior TVF upward sign and group D: 20 with the unidentifiable sign. Surgical-pathological analysis showed significant correlations between 95.8% CPs in group A and 95.2% in group C with tumor topography and tumor adherence to the hypothalamus. These CPs had their origins beneath the hypothalamus. In contrast, groups B and D, with hypothalamic origin, showed hypothalamic infiltration by tumor in 97.5% and 95% of cases in groups B and D, respectively. Outcomes of groups A and C were relatively better than groups B and D. Predictive sensitivity and specificity of "eagle sign" were more than 90%. CONCLUSION: "Eagle sign" is an accurate tool for predicting topographic correlations between CPs and hypothalamus with high sensitivity and specificity.

Case Report: Rhabdomyolysis in aneurysmal subarachnoid hemorrhage: A rare case with implications for management.

Background: In recent years, some cases of rhabdomyolysis after surgery have been reported. In this report, we present an adult patient with rhabdomyolysis after intracranial aneurysm surgery. Case Report: A 59-year-old male suffered from a coma, fever, and soy sauce urine after intracranial aneurysm clipping. A routine blood examination showed that liver and kidney function were impaired, and creatine phosphokinase(CK) and creatine phosphokinase isoenzyme(CK-MB) levels increased. Therefore, we consider patients with rhabdomyolysis after intracranial aneurysm surgery. A series of treatment schemes, such as intravenous fluid infusion, alkalized urine, and hemodialysis, were adopted immediately, and finally the patient was discharged safely. Conclusion: For some postoperative patients, once the level of CK/CK-MB increases, acute renal damage occurs, and the urine color turns soy sauce, we should be alert to postoperative rhabdomyolysis.For those patients who have been diagnosed with rhabdomyolysis, we need to take timely treatment measures to avoid an unfortunate occurrence.