Volumetric ADC histogram analysis for preoperative evaluation of LVSI status in stage I endometrioid adenocarcinoma.

OBJECTIVES: To investigate the value of volumetric ADC histogram metrics for evaluating lymphovascular space invasion (LVSI) status in stage I endometrioid adenocarcinoma (EAC). METHODS: Preoperative MRI of 227 patients with stage I EAC were retrospectively analyzed. ADC histogram data were derived from the whole tumor with ROIs drawn on all slices of DWI scans (b = 0, 1000 s/mm2). The Student t-test was performed to compare ADC histogram metrics (minADC, maxADC, and meanADC; 10th, 25th, 50th, 75th, and 90th percentiles of ADC; skewness; and kurtosis) between the LVSI-positive and LVSI-negative groups, as well as between stage Ia and Ib EACs. ROC curve analysis was carried out to evaluate the diagnostic performance of ADC histogram metrics in predicting LVSI status in EAC. RESULTS: The minADC and meanADC and 10th, 25th, 50th, 75th, and 90th percentiles of ADC were significantly lower in LVSI-positive EACs compared with those in the LVSI-negative groups for stage I, Ia, and Ib EACs (all p < 0.05). MeanADC ≤ 0.857 × 10-3 mm2/s, meanADC ≤ 0.854 × 10-3 mm2/s, and the 90th percentile of ADC ≤ 1.06 × 10-3 mm2/s yielded the largest AUC of 0.844, 0.844, and 0.849 for evaluating LVSI positivity in stage I, Ia, and Ib tumors, respectively, with sensitivity of 75.4%, 75.0%, and 76.2%; specificity of 80.0%, 83.1%, and 82.1%; and accuracy of 79.3%, 81.5%, and 79.6%, respectively. CONCLUSION: Volumetric ADC histogram metrics might be helpful for the preoperative evaluation of LVSI status and personalized clinical management in patients with stage I EAC. KEY POINTS: • Volumetric ADC histogram analysis helps evaluate LVSI status preoperatively. • LVSI-positive EAC is associated with a reduction in multiple volumetric ADC histogram metrics. • MeanADC and the 90th percentile of ADC were shown to be best in evaluating LVSI- positivity in stage Ia and Ib EACs, respectively.

Deep learning for the determination of myometrial invasion depth and automatic lesion identification in endometrial cancer MR imaging: a preliminary study in a single institution.

OBJECTIVE: To determine the diagnostic performance of a deep learning (DL) model in evaluating myometrial invasion (MI) depth on T2-weighted imaging (T2WI)-based endometrial cancer (EC) MR imaging (ECM). METHODS: We retrospectively enrolled 530 patients with pathologically proven EC at our institution between January 1, 2013, and December 31, 2017. All imaging data were reviewed on picture archiving and communication systems (PACS) server. Both sagittal and coronal T2WI-based MR images were used for lesion area determination. All MR images were divided into two groups: deep (more than 50%) and shallow (less than 50%) MI based on their pathological diagnosis. We trained a detection model based on YOLOv3 algorithm to locate the lesion area on ECM. Then, the detected regions were fed into a classification model based on DL network to identify MI depth automatically. RESULTS: In the testing dataset, the trained model detected lesion regions with an average precision rate of 77.14% and 86.67% in both sagittal and coronal images, respectively. The classification model yielded an accuracy of 84.78%, a sensitivity of 66.67%, a specificity of 87.50%, a positive predictive value of 44.44%, and a negative predictive value of 94.59% in determining deep MI. The radiologists and trained network model together yielded an accuracy of 86.2%, a sensitivity of 77.8%, a specificity of 87.5%, a positive predictive value of 48.3%, and a negative predictive value of 96.3%. CONCLUSION: In this study, the DL network model derived from MR imaging provided a competitive, time-efficient diagnostic performance in MI depth identification. KEY POINTS: • The models established with the deep learning method could help improve the diagnostic confidence and performance of MI identification based on endometrial cancer MR imaging. • The models enabled the classification of endometrial cancer MR images to the two categories with a sensitivity of 0.67, a specificity of 0.88, and an accuracy of 0.85. • Using the detected lesion region to evaluate myometrial invasion depth could remove redundant information in the image and provide more effective features.

Histogram Feature Analysis of Tumor Body on Diffusion-weighted MR Imaging in Differentiation between Granulosa Cell Tumors and Other Sex-cord Tumors in Ovary: Comparison with Histological Results.

OBJECTIVE: We aimed to differentiate granulosa cell tumors (GCT) from other ovarian sex-cord tumors (OSCs) based on feature analysis of the tumor body on MR imaging. METHODS: We retrospectively enrolled 27 patients with pathologically proven sex-cord tumours (14 GSTs, 8 fibromas, 4 fibrothecomas, and 1 sclerosing stromal tumour) from our institution. All MRI examinations were performed at least one month prior to surgery. MR image features were recorded by two radiologists with consensus readings. Histogram analysis was performed using FeAture Explorer software. The differences in histogram parameters between GCT (38.1 ± 14.6 years) and OSC (43.7 ± 18.0 years) groups were compared. Fourteen randomly selected cellular-type myomas who also underwent MRI in our hospital were considered as the control group. The intra-operator consistency of ADC value was evaluated across measurements twice. RESULTS: The repeatability of conventional ADC measurements on the tumor body was good. The values of ADC-mean, ADC-min, and ADC-max significantly differed across three groups (p < 0.001). The histogram variance on DWI, histogram percentage on T2WI, and ADC min showed the best discriminative performance in determining GCTs from other OSCs with an area under the receiver operator curve (AUC) of 0.997, 0.882, and 0.795, respectively. The histogram variance on DWI yielded a sensitivity of 92.3%, a specificity of 100%, and an accuracy of 96.6% in discriminating GSTs from other OSCs. CONCLUSION: In the present study, feature analysis of tumor body MR imaging has helped to differentiate GST from OSC with better performance than conventional ADC measurements.

Association of periodontitis and tooth loss with extent of coronary atherosclerosis in patients with type 2 diabetes mellitus.

Aim: The objective was to investigate the association of periodontitis and tooth loss with extent of diabetic coronary atherosclerosis. Materials and methods: 272 patients who were hospitalized at Shanghai East hospital and underwent a coronary artery calcium (CAC) CT scan were enrolled in this study. Individuals were grouped based on their CAC scores into a normal-to-mild coronary atherosclerosis (AS) group (0 ≤ score ≤ 100, n=184) and a moderate-to-severe group (score≥101, n=88). Periodontitis parameters and number of missing teeth were evaluated for every patient. The severity of periodontitis was categorized as mild, moderate, or severe. The taxonomic composition of the microbiota was determined using full-length 16S ribosomal RNA gene sequencing. Salivary inflammatory factors were tested by ELISA. Results: Clinical attachment loss (CAL) (P =0.05) and the number of teeth lost (P = 0.016) were significantly higher in the moderate-to-severe coronary AS group, with these differences being more obvious in younger patients and patients with short-duration diabetes. Multivariate logistic regression analysis revealed that CAL (OR = 1.231, 95% CI = 1.066-1.214, P = 0.047) and having 10-19 missing teeth (OR = 1.604, 95% CI = 1.393-6.555, P = 0.05) were strongly associated with the presence of moderate-to-severe coronary AS. Salivary IL-6 and TNF-α levels, as well as levels of Porphyromonas gingivalis and Neisseria mucosa, were significantly elevated in the moderate-to-severe coronary AS group. Conclusion: It was found that both tooth loss and CAL were related to the extent of diabetic coronary AS. Saliva inflammatory factors and oral bacteremia may be new biomarkers for moderate-to-severe coronary AS.

Quality by design driven development and evaluation of thermosensitive hydrogel loaded with IgY and LL37-SLNs to combat experimental periodontitis.

Egg yolk immunoglobulin (IgY) and LL37, potent antibacterial substances, can fight against periodontitis. This work aimed to develop a locally injectable hydrogel for potential co-delivery of special IgY and LL37-loaded solid lipid nanoparticles (LL37-SLNs) to synergistically inhibit the proliferation of oral pathogens, thus relieving periodontal inflammation and redness. The formulation of thermosensitive hydrogel loaded with IgY and LL37-SLNs was developed by adopting the Quality by Design approach. Then the formulations were optimized by two-factor three-level full factorial design by Design-Expert software. Finally, the optimized formulation was characterized and estimated in vitro and in vivo. In vitro release and antibacterial activity studies have revealed that the optimized formulation was homogeneous and can be released slowly, with sustainably antibacterial power. And the physical and chemical composition analysis and morphological observations further confirmed the sustained-release capability. On the other hand, in vivo studies proved that the optimized formulation significantly decreased gingival redness, bleeding, and plaque formation, avoided excessive resorption of alveolar bone, and reduced the levels of inflammatory factor in periodontitis rats. In conclusion, the optimized thermosensitive hydrogel loaded with IgY and LL37-SLNs may be a promising local sustained-release preparation for the effective treatment of periodontal diseases.

The role of volumetric ADC histogram analysis in preoperatively evaluating the tumour subtype and grade of endometrial cancer.

PURPOSE: To assess the value of volumetric ADC histogram metrics in evaluating the histological subtype and grade of endometrial cancer. METHOD: Preoperative MRI datasets of 317 patients with endometrial cancer were used to obtain volumetric ADC histogram metrics (tumour volume; minADC, maxADC and meanADC; 10th, 25th, 50th, 75th and 90th percentiles of ADC; skewness; and kurtosis). The Mann-Whitney test or Student's t-test was used to compare the difference in ADC histogram metrics between endometrioid adenocarcinomas (EACs) and serous endometrial cancers (SECs) and between different tumour grades (G1, G2, G3). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the performance of ADC histogram metrics or combined models in predicting the tumour subtype and grade. RESULTS: SECs showed a significantly larger tumour volume (P < 0.001) and lower meanADC, 50th, 75th and 90th percentiles of ADC than EACs (all P < 0.05). MinADC, maxADC, meanADC, 10th, 25th, 50th, 75th, 90th percentiles of ADC were significantly higher in G1 than in G2 and G3 EACs (all P < 0.05), while were not significantly different between G2 and G3 EACs (all P > 0.05). A tumour volume ≥ 7.752 cm3 allowed for the prediction of SECs, with an AUC of 0.765 (0.714-0.810). A meanADC ≥ 0.892 × 10-3  mm2/s enabled to discriminate G1 from G2 and G3 EACs, with an AUC of 0.818 (0.769-0.861). CONCLUSION: Volumetric ADC histogram analysis is helpful for non-invasive preoperatively predicting the subtype of endometrial cancer and differentiating G1 from G2 and G3 EACs.

Clinical effect of platelet-rich fibrin on the preservation of the alveolar ridge following tooth extraction.

The aim of the present study was to evaluate the clinical efficacy of platelet-rich fibrin (PRF) in preserving the alveolar ridge following human tooth extraction. A total of 28 patients were divided into two groups: The experimental and control groups (n=14 each). Following tooth extraction, the experimental group was implanted with PRF membrane, whereas the control group was not. The gingival healing effect was assessed at 7 days, 1 and 3 months later. Cone-beam computed tomography was performed immediately and at 3 months following tooth extraction. The changes in alveolar ridge height, width, and bone mineral density were compared between the two groups. The alveolar bone was removed using the ring drill during the implant surgery at 3 months following tooth extraction. Histomorphometric evaluation was performed to compare new bone formation between groups. The patients in the experimental group reportedly felt better compared with the patients in the control group. The healing of gingival tissue was better in the experimental group than in the control group. A significantly greater novel bone area was observed in the PRF group compared with the control group (P<0.01). However, no statistically significant differences were observed in the mean value of buccal alveolar ridge height, lingual/palatal alveolar ridge height and alveolar ridge width between the two groups. These results suggested that PRF was advantageous in human alveolar ridge preservation with ease of use and simple handling. Histological analysis of novel bone formation confirmed that PRF increased the quality of the novel bone and enhanced the rate of bone formation, despite the effect of PRF was not significant to reduce alveolar bone resorption in the extraction socket alone.

[Effect of platelet rich fibrin combining with Bio-oss to treat furcation involvement].

PURPOSE: To evaluate the effect of platelet rich fibrin (PRF) combining with Bio-oss in treating Class II furcation involvement. METHODS: Thirty patients who had Class Ⅱ furcation involvement in the mandibular first molar were included. They were all free of systemic disease. After initial periodontal therapy, they were randomly divided into 2 groups. In the experimental group, PRF combining with Bio-oss were placed in the areas with furcation defect and covered with PRF. In the control group, only flap surgery was performed. All patients were followed up for 6 months after operation. The efficacy was evaluated with clinical parameters and cone-beam computed tomography (CBCT). The data were analyzed with SPSS 2.0 software package. RESULTS: Periodontal indexes including probing depth (PD), clinical attachment loss (CAL), horizontal probing depth (HPD) significantly decreased in both groups after operation (P<0.05); alveolar bone significantly increased in the experimental group (P<0.05). CONCLUSIONS: The clinical effect of PRF combined with Bio-oss on Class II furcation involvement are remarkable.

[Effect of photodynamic therapy on IL-1beta and MMP-8 in gingival crevicular fluid of chronic periodontitis].

PURPOSE: Photodynamic therapy (PDT) is used in infectious disease for its antimicrobial effects. The aim of the study is to evaluate the effects of a diode laser-based photodynamic therapy on the treatment of chronic periodontitis. METHODS: Fifty eight patients with chronic periodontitis were divided into three groups. Group A was treated with scaling and root planing (SRP) plus photoactivated disinfection therapy for one time (Periowave(TM): a diode laser with a wavelength of 670nm and 0.01% methylene blue solution). In group B, the patients were treated with SRP followed by photoactivated disinfection, and a second photoactivated disinfection treatment 6 weeks later. Group C was treated with SRP alone. The irradiation time was 60 seconds at a power output of 140mW. Gingival crevicular fluid (GCF) samples from these three groups of patients were obtained before periodontal treatment, 6 weeks and 12 weeks after treatment. GCF was collected using a paper strip, and enzyme-linked immunoabsorbent assay (ELISA) was performed to determine the cytokine (IL-1beta and MMP-8) levels. The data were analyzed with SAS 6.12 software package. RESULTS: ELISA showed IL-1beta and MMP-8 levels of all groups were decreased significantly at 6-week after treatment compared to pretreatment levels. No significant inter-group differences were noted. At 12-week after treatment, the decreases in IL-1beta levels of group A and B and the decrease in MMP-8 level of group B were significantly higher than group C (P<0.05). CONCLUSIONS: Based on these findings, it appears that SRP and SRP with PDT are all effective for chronic periodontitis, but the effect of SRP with PDT may last longer. PDT therefore appears to be a useful adjunct to SRP for chronic periodontitis therapy. Supported by National "Tenth Five-Year" Key Science and Technology Research Project (Grant No.2004BA72026) and International Cooperation Project (Grant No.051012).

[Detection and significance of IL-1beta and MMP-8 in patients with periodontitis of whole unstimulated saliva].

PURPOSE: To detect the role of IL-1beta and MMP-8 by ELISA in whole unstimulated saliva of patients with different type of periodontitis and to determine whether they are possible specific biomarkers of periodontitis. METHODS: A total of 80 saliva samples were collected from 28 GCP patients, 28 GAgP patients and 24 healthy subjects. The levels of IL-1beta and MMP-8 were respectively measured by ELISA kits. The data were analysed statistically with one-way ANOVA. RESULTS: The mean salivary levels of IL-1beta in GCP group,GAgP group and control group were 144.40 pg/ml+/-150.70 pg/ml+/-72.56 pg/ml+/-69.36 pg/ml and 65.96 pg/ml+/-71.18 pg/ml respectively, There was no significance difference between the three groups (P>0.05); GCP and GAgP groups presented significantly elevated salivary levels of MMP-8 than that of the control group, which was (576.89+/-559.24) ng/ml, (420.93+/-533.73)ng/ml and (151.49+/-216.38) ng/ml respectively (P<0.05), while there was no significant difference between GCP and GAgP group (P>0.05). CONCLUSION: Salivary levels of MMP-8 may be a biomarker for diagnosis for periodontitis while IL-1beta needs to be further testified.