The Method of Portal Making in Lumbar Unilateral Biportal Endoscopic Surgery with Different Operative Approaches According to the Constant Anatomical Landmarks of the Lumbar Spine: A Review of the Literature.

STUDY DESIGN: Review. OBJECTIVE: Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals' location varies depending on the originator's preferences or the anatomical structure's proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches' portals. METHODS: The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: "Biportal endoscopic spinal surgery", "Two portal endoscopic spinal surgery", "Percutaneous biportal endoscopic decompression", "Unilateral biportal endoscopy", "Irrigation endoscopic discectomy", "UBE" and "BESS". RESULTS: After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches' portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method. CONCLUSION: The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons' understanding and proficiency in UBE procedures.

Clinical sonochemotherapy of inoperable pancreatic cancer using diagnostic ultrasound and microbubbles: a multicentre, open-label, randomised, controlled trial.

OBJECTIVES: Sonochemotherapy, which uses microbubble (MB)-assisted ultrasound (US) to deliver chemotherapeutic agents, has the potential to enhance tumour chemotherapy. The combination of US and MB has been demonstrated to prolong the survival of patients with pancreatic cancer. This phase 2 clinical trial aimed to determine the clinical efficacy and safety of sonochemotherapy for inoperable pancreatic ductal adenocarcinoma by using US and MB. METHODS: Eighty-two patients with stage III or IV pancreatic cancer were recruited from July 2018 to March 2021 and followed up until September 2022. US treatment was performed with a modified diagnostic US scanner for 30 min after chemotherapeutic infusion. The primary endpoint was overall survival (OS), and the secondary endpoints were Eastern Cooperative Oncology Group (ECOG) status < 2, progression-free survival (PFS), disease control rate (DCR), and adverse events. RESULTS: Seventy-eight patients were randomly allocated (40 to chemotherapy and 38 to sonochemotherapy). The median OS was longer with sonochemotherapy than with chemotherapy (9.10 vs. 6.10 months; p = 0.037). The median PFS with sonochemotherapy was 5.50 months, compared with 3.50 months (p = 0.080) for chemotherapy. The time of ECOG status < 2 was longer with sonochemotherapy (7.20 months) than with chemotherapy (5.00 months; p = 0.029). The DCR was 73.68% for sonochemotherapy compared with 42.50% for the control (p = 0.005). The incidence of overall adverse events was balanced between the two groups. CONCLUSIONS: The use of sonochemotherapy can extend the survival and well-being time of stage III or IV pancreatic cancer patients without any increase in serious adverse events. TRIAL REGISTRATION: ChineseClinicalTrials.gov ChiCTR2100044721 CLINICAL RELEVANCE STATEMENT: This multicentre, randomised, controlled trial has proven that sonochemotherapy, namely, the combination of diagnostic ultrasound, microbubbles, and chemotherapy, could extend the overall survival of patients with end-stage pancreatic ductal adenocarcinoma from 6.10 to 9.10 months without increasing any serious adverse events. KEY POINTS: • This is the first multicentre, randomised, controlled trial of sonochemotherapy for clinical pancreatic cancer treatment using ultrasound and a commercial ultrasound contrast agent. • Sonochemotherapy extended the median overall survival from 6.10 (chemotherapy alone) to 9.10 months. • The disease control rate increased from 42.50% with chemotherapy to 73.68% with sonochemotherapy.

Exploring the Incentive Function of Virtual Academic Degrees in a Chinese Online Smoking Cessation Community: Qualitative Content Analysis.

BACKGROUND: Previous studies on online smoking cessation communities (OSCCs) have shown how such networks contribute to members' health outcomes from behavior influence and social support perspectives. However, these studies rarely considered the incentive function of OSCCs. One of the ways OSCCs motivate smoking cessation behaviors is through digital incentives. OBJECTIVE: This study aims to explore the incentive function of a novel digital incentive in a Chinese OSCC-the awarding of academic degrees-to promote smoking cessation. It specifically focuses on "Smoking Cessation Bar," an OSCC in the popular web-based Chinese forum Baidu Tieba. METHODS: We collected discussions about the virtual academic degrees (N= 1193) from 540 members of the "Smoking Cessation Bar." The time frame of the data set was from November 15, 2012, to November 3, 2021. Drawing upon motivational affordances theory, 2 coders qualitatively coded the data. RESULTS: We identified five key topics of discussion, including members' (1) intention to get virtual academic degrees (n=38, 2.47%), (2) action to apply for the degrees (n=312, 20.27%), (3) feedback on the accomplishment of goals (n=203, 13.19%), (4) interpersonal interaction (n=794, 51.59%), and (5) expression of personal feelings (n=192, 12.48%). Most notably, the results identified underlying social and psychological motivations behind using the forum to discuss obtaining academic degrees for smoking cessation. Specifically, members were found to engage in sharing behavior (n=423, 27.49%) over other forms of interaction such as providing recommendations or encouragement. Moreover, expressions of personal feelings about achieving degrees were generally positive. It was possible that members hid their negative feelings (such as doubt, carelessness, and dislike) in the discussion. CONCLUSIONS: The virtual academic degrees in the OSCC created opportunities for self-presentation for participants. They also improved their self-efficacy to persist in smoking cessation by providing progressive challenges. They served as social bonds connecting different community members, triggering interpersonal interactions, and inducing positive feelings. They also helped realize members' desire to influence or to be influenced by others. Similar nonfinancial rewards could be adopted in various smoking cessation projects to enhance participation and sustainability.

Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis.

BACKGROUND: To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS: PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS: The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION: Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.

Functional plasticity of neutrophils after low- or high-dose irradiation in cancer treatment - A mini review.

Over the last several decades, radiotherapy has been considered the primary treatment option for a broad range of cancer types, aimed at prolonging patients' survival and slowing down tumor regression. However, therapeutic outcomes of radiotherapy remain limited, and patients suffer from relapse shortly after radiation. Neutrophils can initiate an immune response to infection by releasing cytokines and chemokines to actively combat pathogens. In tumor immune microenvironment, tumor-derived signals reprogram neutrophils and induce their heterogeneity and functional versatility to promote or inhibit tumor growth. In this review, we present an overview of the typical phenotypes of neutrophils that emerge after exposure to low- and high-dose radiation. These phenotypes hold potential for developing synergistic therapeutic strategies to inhibit immunosuppressive activity and improve the antitumor effects of neutrophils to render radiation therapy as a more effective strategy for cancer patients, through tumor microenvironment modulation.

Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment: finite element analysis.

BACKGROUND: Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF). METHODS:  Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation. RESULTS:  BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage. CONCLUSION:  The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.

Recent progress and clinical applications of advanced biomaterials in cosmetic surgery.

Materials of different allogeneic or xenogeneic or autologous origins are widely used as soft-tissue fillers or structural scaffolds in the field of cosmetic surgery, while complications including prosthesis infection, donor site deformity and filler embolization have always been difficult problems for plastic surgeons. The application of novel biomaterials may bring in hopeful solutions for these problems. Recently, some advanced biomaterials, such as regenerative biomaterials can effectively promote the repair of defective tissues, which have been proven to have good therapeutic as well as cosmetic effects in cosmetic surgery. Therefore, biomaterials with active compounds have drawn significant attention for the tissue regeneration of reconstructive and esthetic treatment. Some of these applications have achieved better clinical outcomes than traditional biological materials. This review summarized recent progress and clinical applications of advanced biomaterials in cosmetic surgery.

Morphometric measurement of lumbar pedicle in different regions: a systematic review.

OBJECTIVE: To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. METHODS: Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. RESULTS: Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. CONCLUSIONS: People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.

In situ photo-crosslinked adhesive hydrogel loaded with mesenchymal stem cell-derived extracellular vesicles promotes diabetic wound healing.

The delayed healing of diabetic wounds is directly affected by the disturbance of wound microenvironment, resulting from persistent inflammation, insufficient angiogenesis, and impaired cell functions. Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) showed considerable therapeutic potential in diabetic wound healing. However, the low retention rate of MSC-EVs at wound sites hampers their efficacy. For skin wounds exposed to the outer environment, using a hydrogel with tissue adhesiveness under a moist wound condition is a promising strategy for wound healing. In this study, we modified methacryloyl-modified gelatin (GelMA) hydrogel with catechol motifs of dopamine to fabricate a GelMA-dopamine hydrogel. EVs isolated from MSCs were applied in the synthesized GelMA-dopamine hydrogel to prepare a GelMA-dopamine-EV hydrogel. The results demonstrated that the newly formed GelMA-dopamine hydrogel possessed improved properties of softness, adhesiveness, and absorptive capacity, as well as high biocompatibility in the working concentration (15% w/v). In addition, MSC-EVs were verified to promote cell migration and angiogenesis in vitro. In the skin wound model of diabetic rats, the GelMA-dopamine-EV hydrogel exerted prominent wound healing efficacy estimated by collagen deposition, skin appendage regeneration, and the expression of IL-6, CD31, and TGF-ß. In conclusion, this combination of MSC-EVs and the modified hydrogel not only accelerates wound closure but also promotes skin structure normalization by rescuing the homeostasis of the healing microenvironment of diabetic wounds, which provides a potential approach for the treatment of diabetic wounds.

Genome-Wide Analysis and Characterization of Eggplant F-Box Gene Superfamily: Gene Evolution and Expression Analysis under Stress.

F-box genes play an important role in plant growth and resistance to abiotic and biotic stresses. To date, systematic analysis of F-box genes and functional annotation in eggplant (Solanum melongena) is still limited. Here, we identified 389 F-box candidate genes in eggplant. The domain study of F-box candidate genes showed that the F-box domain is conserved, whereas the C-terminal domain is diverse. There are 376 SmFBX candidate genes distributed on 12 chromosomes. A collinearity analysis within the eggplant genome suggested that tandem duplication is the dominant form of F-box gene replication in eggplant. The collinearity analysis between eggplant and the three other species (Arabidopsis thaliana, rice and tomato) provides insight into the evolutionary characteristics of F-box candidate genes. In addition, we analyzed the expression of SmFBX candidate genes in different tissues under high temperature and bacterial wilt stress. The results identified several F-box candidate genes that potentially participate in eggplant heat tolerance and bacterial wilt resistance. Moreover, the yeast two-hybrid assay showed that several representative F-box candidate proteins interacted with representative Skp1 proteins. Overexpression of SmFBX131 and SmFBX230 in tobacco increased resistance to bacterial wilt. Overall, these results provide critical insights into the functional analysis of the F-box gene superfamily in eggplant and provide potentially valuable targets for heat and bacterial resistance.

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory.

BACKGROUND: To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. METHODS: CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20-30 years old group and 20 male and 20 female cases in the 30-40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. RESULTS: The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). CONCLUSIONS: According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine.

Objectives: Compared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof. Methods: Four human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement. Results: Twenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively. Conclusions: We report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.

Prognosis prediction of extremity and trunk wall soft-tissue sarcomas treated with surgical resection with radiomic analysis based on random survival forest.

Many researches have applied machine learning methods to find associations between radiomic features and clinical outcomes. Random survival forests (RSF), as an accurate classifier, sort all candidate variables as the rank of importance values. There was no study concerning on finding radiomic predictors in patients with extremity and trunk wall soft-tissue sarcomas using RSF. This study aimed to determine associations between radiomic features and overall survival (OS) by RSF analysis. To identify radiomic features with important values by RSF analysis, construct predictive models for OS incorporating clinical characteristics, and evaluate models' performance with different method. We collected clinical characteristics and radiomic features extracted from plain and contrast-enhanced computed tomography (CT) from 353 patients with extremity and trunk wall soft-tissue sarcomas treated with surgical resection. All radiomic features were analyzed by Cox proportional hazard (CPH) and followed RSF analysis. The association between radiomics-predicted risks and OS was assessed by Kaplan-Meier analysis. All clinical features were screened by CPH analysis. Prognostic clinical and radiomic parameters were fitted into RSF and CPH integrative models for OS in the training cohort, respectively. The concordance indexes (C-index) and Brier scores of both two models were evaluated in both training and testing cohorts. The model with better predictive performance was interpreted with nomogram and calibration plots. Among all 86 radiomic features, there were three variables selected with high importance values. The RSF on these three features distinguished patients with high predicted risks from patients with low predicted risks for OS in the training set (P < 0.001) using Kaplan-Meier analysis. Age, lymph node involvement and grade were incorporated into the combined models for OS (P < 0.05). The C-indexes in both two integrative models fluctuated above 0.80 whose Brier scores maintained less than 15.0 in the training and testing datasets. The RSF model performed little advantages over the CPH model that the calibration curve of the RSF model showed favorable agreement between predicted and actual survival probabilities for the 3-year and 5-year survival prediction. The multimodality RSF model including clinical and radiomic characteristics conducted high capacity in prediction of OS which might assist individualized therapeutic regimens. Level III, prognostic study.

Computed tomography-based deep-learning prediction of induction chemotherapy treatment response in locally advanced nasopharyngeal carcinoma.

BACKGROUND: Deep learning methods have great potential to predict treatment response. The objective of this study was to evaluate and validate the predictive performance of the computed tomography (CT)-based model using deep learning features for identification of responders and nonresponders to induction chemotherapy (IC) in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: All eligible patients were included retrospectively between January 2012 and December 2018, and assigned to the training (n = 208) or the testing cohort (n = 89). We extracted deep learning features of six pretrained convolutional neural networks (CNNs) via transfer learning method, and handcrafted radiomics features manually. Support vector machine (SVM) was adopted as the classifier. All predictive models were evaluated using the area under the receiver operating characteristics curve (AUC), by which an optimal model was selected. We also built clinical and clinical-radiological models for comparison. RESULTS: The model with features extracted from ResNet50 (RN-SVM) had optimal performance among all models with features extracted from pretrained CNNs with an AUC of 0.811, accuracy of 68.54%, sensitivity of 61.54%, specificity of 87.50%, positive predictive value (PPV) of 93.02%, and negative predictive value (NPV) of 45.65% in the testing cohort. The handcrafted radiomics model was slightly inferior to the RN-SVM model with an AUC of 0.663 and accuracy of 60.67% in the testing cohort. All the imaging-derived models had better predictive performance than the clinical model. CONCLUSION: The noninvasive deep learning method could provide efficient prediction of treatment response to IC in locally advanced NPC and might be a practicable approach in therapeutic strategy decision-making.

Chondrocyte-laden GelMA hydrogel combined with 3D printed PLA scaffolds for auricle regeneration.

The current gold standard for auricular reconstruction after microtia or ear trauma is the autologous cartilage graft with an autologous skin flap overlay. Harvesting autologous cartilage requires an additional surgery that may result in donor area complications. In addition, autologous cartilage is limited and the auricular reconstruction requires complex sculpting, which requires excellent clinical skill and is very time consuming. This work explores the use of 3D printing technology to fabricate bioactive artificial auricular cartilage using chondrocyte-laden gelatin methacrylate (GelMA) and polylactic acid (PLA) for auricle reconstruction. In this study, chondrocytes were loaded within GelMA hydrogel and combined with the 3D-printed PLA scaffolds to biomimetic the biological mechanical properties and personalized shape. The printing accuracy personalized scaffolds, biomechanics and chondrocyte viability and biofunction of artificial auricle have been studied. It was found that chondrocytes were fixed in the PLA auricle scaffolds via GelMA hydrogels and exhibited good proliferative properties and cellular activity. In addition, new chondrocytes and chondrogenic matrix, as well as type II collagen were observed after 8 weeks of implantation. At the same time, the transplanted auricle complex kept full and delicate auricle shape. This study demonstrates the potential of using 3D printing technology to construct in vitro living auricle tissue. It shows a great prospect in the clinical application of auricle regeneration.

Application of lanthanide-doped upconversion nanoparticles for cancer treatment: a review.

With the excellent ability to transform near-infrared light to localized visible or UV light, thereby achieving deep tissue penetration, lanthanide ion-doped upconversion nanoparticles (UCNP) have emerged as one of the most striking nanoscale materials for more effective and safer cancer treatment. Up to now, UCNPs combined with photosensitive components have been widely used in the delivery of chemotherapy drugs, photodynamic therapy and photothermal therapy. Applications in these directions are reviewed in this article. We also highlight microenvironmental tumor monitoring and precise targeted therapies. Then we briefly summarize some new trends and the existing challenges for UCNPs. We hope this review can provide new ideas for future cancer treatment based on UCNPs.

A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma.

PURPOSE: To develop and validate a clinical-radiomic nomogram for the preoperative prediction of the aldosterone-producing adenoma (APA) risk in patients with unilateral adrenal adenoma. PATIENTS AND METHODS: Ninety consecutive primary aldosteronism (PA) patients with unilateral adrenal adenoma who underwent adrenal venous sampling (AVS) were randomly separated into training (n = 62) and validation cohorts (n = 28) (7:3 ratio) by a computer algorithm. Data were collected from October 2017 to June 2020. The prediction model was developed in the training cohort. Radiomic features were extracted from unenhanced computed tomography (CT) images of unilateral adrenal adenoma. The least absolute shrinkage and selection operator (LASSO) regression model was used to reduce data dimensions, select features, and establish a radiomic signature. Multivariable logistic regression analysis was used for the predictive model development, the radiomic signature and clinical risk factors integration, and the model was displayed as a clinical-radiomic nomogram. The nomogram performance was evaluated by its calibration, discrimination, and clinical practicability. Internal validation was performed. RESULTS: Six potential predictors were selected from 358 texture features by using the LASSO regression model. These features were included in the Radscore. The predictors included in the individualized prediction nomogram were the Radscore, age, sex, serum potassium level, and aldosterone-to-renin ratio (ARR). The model showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.900 [95% confidence interval (CI), 0.807 to 0.993], and good calibration. The nomogram still showed good discrimination [AUC, 0.912 (95% CI, 0.761 to 1.000)] and good calibration in the validation cohort. Decision curve analysis presented that the nomogram was useful in clinical practice. CONCLUSIONS: A clinical-radiomic nomogram was constructed by integrating a radiomic signature and clinical factors. The nomogram facilitated accurate prediction of the probability of APA in patients with unilateral adrenal nodules and could be helpful for clinical decision making.

Application of deep learning as a noninvasive tool to differentiate muscle-invasive bladder cancer and non-muscle-invasive bladder cancer with CT.

OBJECTIVE: To construct a deep-learning convolution neural network (DL-CNN) system for the differentiation of muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC) on contrast-enhanced computed tomography (CT) images in patients with bladder cancer. MATERIALS AND METHODS: A total of 1200 cross-sectional CT images were obtained from 369 patients with bladder cancer receiving radical cystectomy from January 2015 to June 2018, including 249 non-muscle-invasive bladder cancer (NMIBC) series and 120 muscle-invasive bladder cancer (MIBC) series. All eligible images were distributed randomly into the training, validation, and testing cohorts with ratios of 70 %, 15 %, and 15 %, respectively. We developed one small DL-CNN containing four convolutional and max pooling layers and eight DL-CNNs with pretrained bases from the ImageNet dataset to differentiate NMIBC from MIBC. The intermediate activations were applied on the test dataset to visualize how successive DL-CNN layers transform their input. RESULTS: The area under the receiver operating characteristic curve (AUROC) of the validation and testing datasets for the small DL-CNN was 0.946 and 0.998, respectively. The AUROCs of eight deep learning algorithms with pretrained bases ranged from 0.762 to 0.997 in the testing dataset. The VGG16 model had the largest AUROC of 0.997 among the eight algorithms with a sensitivity and specificity of 0.889 and 0.989. The independent features encoded by the small DL-CNN filters were displayed as assemblies of individual channels. CONCLUSION: Based on contrast-enhanced CT images, our DL-CNN system could successfully classify NMIBC and MIBC with favorable AUROC in patients with bladder cancer. The application of our system in early stage might assist the pathological examination for the improvement of diagnostic accuracy.

Visualization and Analysis in the Field of Pan-Cancer Studies and Its Application in Breast Cancer Treatment.

Although all cancers are molecularly distinct, many share common driver mutations. Pan-cancer analysis, utilizes next-generation sequencing (NGS), pan-cancer model systems, and pan-cancer projects such as The Cancer Genome Atlas (TCGA), to assess frequently mutated genes and other genomic abnormalities that are common among many cancer types, regardless of the tumor origin, providing new directions for tumor biology research. However, there is currently no study that has objectively analyzed the results of pan-cancer studies on cancer biology. For this study, 999 articles on pan-cancer published from 2006 to 2020 were obtained from the Scopus database, and bibliometric methods were used to analyze citations, international cooperation, co-authorship and keyword co-occurrence clusters. Furthermore, we also focused on and summarized the application of pan-cancer in breast cancer. Our result shows that the pan-cancer studies were first published in 2006 and entered a period of rapid development after 2013. So far, 86 countries have carried out international cooperation in sharing research. Researchers form the United States and Canada have published the most articles and have made the most extensive contribution to this field, respectively. Through author keyword analysis of the 999 articles, TCGA, biomarkers, NGS, immunotherapy, DNA methylation, prognosis, and several other keywords appear frequently, and these terms are hot spots in pan-cancer studies. There are four subtypes of breast cancer (luminalA, luminalB, HER2, and basal-like) according to pan-cancer analysis of breast cancer. Meanwhile, it was found that breast cancer has genetic similarity to pan-gynecological cancers, such as ovarian cancer, which indicates related etiology and possibly similar treatments. Collectively, with the emergence of new detection methods, new cancer databases, and the involvement of more researchers, pan-cancer analyses will play a greater role in cancer biology research.

Bibliometrics Analysis of Butyrophilins as Immune Regulators [1992-2019] and Implications for Cancer Prognosis.

The butyrophilins (BTNs) represent a unique family of immunoglobulin. They were considered to be involved in milk lactation after their discovery in 1981. With the development of research, an increasing number of research revealed that BTNs play important roles in immune regulation [1992-2019]. Our research aimed to summarize the BTN research status and their relationship with lung cancers and breast cancers by bibliometrics and bioinformatics methods. Our results indicate that the researches on immune-regulatory functions of BTNs gradually developed from 1992 to 2006, whereas they increased quickly after 2007. There are international cooperations among 56 countries, of which the United States is the most active one with the highest number of studies as well as highest citations. By coauthorship and cocitation analysis, we showed that Adrian Hayday, who is active in γδ T-cell field, was an active author in BTN publications with average year of 2015 and led a subfield. By keywords co-occurrence analysis, we found that γδ T cell, which is an important cancer immune regulator, is one important hotspot. Finally, we found that several BTN members' expression levels were significantly correlated with prognosis of lung cancer and breast cancer patients. Thus, these BTNs might play immune regulatory effects and could serve as potential biomarkers for cancer.