Patients with ASPSCR1-TFE3 fusion achieve better response to ICI based combination therapy among TFE3-rearranged renal cell carcinoma.

BACKGROUND: TFE3-rearranged renal cell carcinoma (TFE3-rRCC) is a rare but highly heterogeneous renal cell carcinoma (RCC) entity, of which the clinical treatment landscape is largely undefined. This study aims to evaluate and compare the efficacy of different systemic treatments and further explore the molecular correlates. METHODS: Thirty-eight patients with metastatic TFE3-rRCC were enrolled. Main outcomes included progression-free survival (PFS), overall survival, objective response rate (ORR) and disease control rate. RNA sequencing was performed on 32 tumors. RESULTS: Patients receiving first-line immune checkpoint inhibitor (ICI) based combination therapy achieved longer PFS than those treated without ICI (median PFS: 11.5 vs. 5.1 months, P = 0.098). After stratification of fusion partners, the superior efficacy of first-line ICI based combination therapy was predominantly observed in ASPSCR1-TFE3 rRCC (median PFS: not reached vs. 6.5 months, P = 0.01; ORR: 67.5% vs. 10.0%, P = 0.019), but almost not in non-ASPSCR1-TFE3 rRCC. Transcriptomic data revealed enrichment of ECM and collagen-related signaling in ASPSCR1-TFE3 rRCC, which might interfere with the potential efficacy of anti-angiogenic monotherapy. Whereas angiogenesis and immune activities were exclusively enriched in ASPSCR1-TFE3 rRCC and promised the better clinical outcomes with ICI plus tyrosine kinase inhibitor combination therapy. CONCLUSIONS: The current study represents the largest cohort comparing treatment outcomes and investigating molecular correlates of metastatic TFE3-rRCC based on fusion partner stratification. ICI based combination therapy could serve as an effective first-line treatment option for metastatic ASPSCR1-TFE3 rRCC patients. Regarding with other fusion subtypes, further investigations should be performed to explore the molecular mechanisms to propose pointed therapeutic strategy accordingly.

Hidden symmetry-induced effective moving double-zero-index metamaterials.

Materials possessing an effective zero refractive index are often associated with Dirac-like cone dispersion at the center of the Brillouin zone (BZ). It has been reported the presence of hidden symmetry-enforced triply degenerate points [nexus points (NP)] away from the Brillouin zone center with the stacked dielectric photonic crystals. The spin-1 Dirac-like dispersion in the xy plane near the nexus point suggests a method for achieving zero refractive index materials. The stacked photonic crystals at the nexus points can be deemed as an effective moving double-zero-index medium (MDZIM) traveling with a speed relative to the laboratory reference. The ability of this moving double-zero-index medium to enable perfect wave tunneling across barriers without reflection has been demonstrated, dependent on the incident waves' specific angular orientations.

Geometric Phase-Driven Scattering Evolutions.

Conventional approaches for scattering manipulations largely rely on the technique of field expansions into spherical harmonics (electromagnetic multipoles), which nevertheless is not only nongeneric (expansion coefficients depend on the origin position of the coordinate system) but also more descriptive than predictive. Here, we explore this classical topic from a different perspective of controlled excitations and interferences of quasinormal modes (QNMs) supported by the scattering system. Scattered waves are expanded into coherent additions of QNMs, among which the relative amplitudes and phases are crucial factors to architect for scattering manipulations. Relying on the electromagnetic reciprocity, we provide full geometric representations based on the Poincaré sphere for those factors, and discover the hidden geometric phase of QNMs that drives the scattering evolutions. Further synchronous exploitations of the incident polarization-dependent geometric phase and excitation amplitudes enable efficient manipulations of both scattering intensities and polarizations. Continuous geometric phase spanning 2π is directly manifest through scattering variations, even in the rather elementary configuration of an individual particle scattering waves of varying polarizations. We have essentially established a profoundly all-encompassing framework for the calculations of geometric phase in arbitrary scattering systems that are reciprocal. Our theoretical model will greatly broaden horizons of many disciplines not only in photonics but also in general wave physics where geometric phase is generic and ubiquitous.

Coupled Thermal and Power Transport of Optical Waveguide Arrays: Photonic Wiedemann-Franz Law and Rectification Effect.

In isolated nonlinear optical waveguide arrays, simultaneous conservation of longitudinal momentum flow ("internal energy") and optical power ("particle number") of the optical modes enables study of coupled thermal and particle transport in the negative temperature regime. Based on exact numerical simulation and rationale from Landauer formalism, we predict generic photonic version of the Wiedemann-Franz law in such systems, with the Lorenz number L∝|T|^{-2}. This is rooted in the spectral decoupling of thermal and particle current, and their different temperature dependence. In addition, in asymmetric junctions, relaxation of the system toward equilibrium shows apparent asymmetry for positive and negative biases, indicating rectification behavior. This Letter illustrates the possibility of simulate nonequilibrium transport processes using optical networks, in parameter regimes difficult to reach in natural condensed matter or atomic gas systems. It also provides new insights in manipulating power and momentum flow of optical waves in artificial waveguide arrays.

Development and validation of a novel nomogram to avoid unnecessary biopsy in patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml.

OBJECTIVES: To develop and validate a prediction model for identifying non-prostate cancer (non-PCa) in biopsy-naive patients with PI-RADS category ≥ 4 lesions and PSA ≤ 20 ng/ml to avoid unnecessary biopsy. PATIENTS AND METHODS: Eligible patients who underwent transperineal biopsies at West China Hospital between 2018 and 2022 were included. The patients were randomly divided into training cohort (70%) and validation cohort (30%). Logistic regression was used to screen for independent predictors of non-PCa, and a nomogram was constructed based on the regression coefficients. The discrimination and calibration were assessed by the C-index and calibration plots, respectively. Decision curve analysis (DCA) and clinical impact curves (CIC) were applied to measure the clinical net benefit. RESULTS: A total of 1580 patients were included, with 634 non-PCa. Age, prostate volume, prostate-specific antigen density (PSAD), apparent diffusion coefficient (ADC) and lesion zone were independent predictors incorporated into the optimal prediction model, and a corresponding nomogram was constructed ( https://nomogramscu.shinyapps.io/PI-RADS-4-5/ ). The model achieved a C-index of 0.931 (95% CI, 0.910-0.953) in the validation cohort. The DCA and CIC demonstrated an increased net benefit over a wide range of threshold probabilities. At biopsy-free thresholds of 60%, 70%, and 80%, the nomogram was able to avoid 74.0%, 65.8%, and 55.6% of unnecessary biopsies against 9.0%, 5.0%, and 3.6% of missed PCa (or 35.9%, 30.2% and 25.1% of foregone biopsies, respectively). CONCLUSION: The developed nomogram has favorable predictive capability and clinical utility can help identify non-PCa to support clinical decision-making and reduce unnecessary prostate biopsies.

Evolution and global charge conservation for polarization singularities emerging from non-Hermitian degeneracies.

Core concepts in singular optics, especially the polarization singularities, have rapidly penetrated the surging fields of topological and non-Hermitian photonics. For open photonic structures with non-Hermitian degeneracies in particular, polarization singularities would inevitably encounter another sweeping concept of Berry phase. Several investigations have discussed, in an inexplicit way, connections between both concepts, hinting at that nonzero topological charges for far-field polarizations on a loop are inextricably linked to its nontrivial Berry phase when degeneracies are enclosed. In this work, we reexamine the seminal photonic crystal slab that supports the fundamental two-level non-Hermitian degeneracies. Regardless of the invariance of nontrivial Berry phase (concerning near-field Bloch modes defined on the momentum torus) for different loops enclosing both degeneracies, we demonstrate that the associated far polarization fields (defined on the momentum sphere) exhibit topologically inequivalent patterns that are characterized by variant topological charges, including even the trivial scenario of zero charge. Moreover, the charge carried by the Fermi arc actually is not well defined, which could be different on opposite bands. It is further revealed that for both bands, the seemingly complex evolutions of polarizations are bounded by the global charge conservation, with extra points of circular polarizations playing indispensable roles. This indicates that although not directly associated with any local charges, the invariant Berry phase is directly linked to the globally conserved charge, physical principles underlying which have all been further clarified by a two-level Hamiltonian with an extra chirality term. Our work can potentially trigger extra explorations beyond photonics connecting Berry phase and singularities.

Multi-mode optical chirality extremizations on the incident momentum sphere.

We study the momentum-space evolutions for chiral optical responses of multi-mode resonators scattering plane waves of varying incident directions. It was revealed, in our previous study [Phys. Rev. Lett.126, 253901 (2021)10.1103/PhysRevLett.126.253901], that for single-mode resonators the scattering optical chiralities characterized by circular dichroism (CD) are solely decided by the third Stokes parameter distributions of the quasi-normal mode (QNM) radiations: CD = S3. Here we extend the investigations to multi-mode resonators, and explore numerically the dependence of optical chiralities on incident directions from the perspectives of QNM radiations and their circular polarization singularities. In contrast to the single-mode regime, for multi-mode resonators it is discovered that CDs defined in terms of extinction, scattering and absorption generally are different and cannot reach the ideal values of ±1 throughout the momentum sphere. Though the exact correspondence between CD and S3 does not hold anymore in the multi-mode regime, we demonstrate that the positions of the polarization singularities still serve as an efficient guide for identifying those incident directions where the optical chiralities can be extremized.

Avoiding Unnecessary Systematic Biopsy in Clinically Significant Prostate Cancer: Comparison Between MRI-Based Radiomics Model and PI-RADS Category.

BACKGROUND: MRI-targeted biopsy (MRTB) improves the clinically significant prostate cancer (csPCa) detection rate with fewer biopsy cores in men with suspected PCa. However, whether concurrent systematic biopsy (SB) can be avoided in patients undergoing MRTB remains unclear. PURPOSE: To evaluate the potential value of MRI-based radiomics models in avoiding unnecessary SB in biopsy-naïve patients. STUDY TYPE: Retrospective. POPULATION: A total of 226 patients (mean age 66.6 ± 9.02 years) with suspicion of PCa (PI-RADS score ≥ 3) and received combined cognitive MRTB with SB were retrospectively recruited and randomly divided into training (N = 180) and test (N = 46) cohorts at an 8:2 ratio. FIELD STRENGTH/SEQUENCE: A 3.0 T, biparametric MRI (bpMRI) including T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) map. ASSESSMENT: The whole prostate gland (PG) and the index lesion (IL) were delineated. Three radiomics models of bpMRIPG , bpMRIIL , and bpMRIPG+IL were constructed, respectively, and the performance of each radiomics model was compared with that of PI-RADS assessment. STATISTICAL TESTS: The least absolute shrinkage and selection operator (LASSO) regression method was used to select texture features. The area under the curve (AUC) and decision curve analysis were used to estimate the models. RESULTS: The bpMRIPG+IL radiomics model exhibited good discrimination, calibration, and net benefits, which would reduce the SB biopsy in 71.2% and 71.4% of men with PI-RADS ≥ 5 lesions in the training and test cohorts, respectively. DATA CONCLUSION: A bpMRIPG+IL radiomics model may outperform PI-RADS category in help reducing unnecessary SB in biopsy-naïve patients. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 6.

Quality of radiomics for predicting microvascular invasion in hepatocellular carcinoma: a systematic review.

OBJECTIVES: To comprehensively evaluate the reporting quality, risk of bias, and radiomics methodology quality of radiomics models for predicting microvascular invasion in hepatocellular carcinoma. METHODS: A systematic search of available literature was performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up to January 21, 2022. Studies that developed and/or validated machine learning models based on radiomics data to predict microvascular invasion in hepatocellular carcinoma were included. These studies were reviewed by two investigators and the consensus data were used for analyzing. The reporting quality, risk of bias, and radiomics methodological quality were evaluated by Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD), Prediction model Risk of Bias Assessment Tool, and Radiomics Quality Score (RQS), respectively. RESULTS: A total of 30 studies met eligibility criteria with 24 model developing studies and 6 model developing and external validation studies. The median overall TRIPOD adherence was 75.4% (range 56.7-94.3%). All studies were at high risk of bias with at least 2 of 20 sources of bias. Furthermore, 28 studies showed unclear risks of bias in up to 5 signaling questions because of the lack of specified reports. The median RQS score was 37.5% (range 25-61.1%). CONCLUSION: Current radiomic models for MVI-status prediction have moderate to good reporting quality, moderate radiomics methodology quality, and high risk of bias in model development and validation. KEY POINTS: • Current microvascular invasion prediction radiomics studies have moderate to good reporting quality, moderate radiomics methodology quality, and high risk of bias in model development and validation. • Data representativeness, feature robustness, events-per-variable ratio, evaluation metrics, and appropriate validation are five main aspects futures studies should focus more on to improve the quality of radiomics. • Both Radiomics Quality Score and Prediction model Risk of Bias Assessment Tool are needed to comprehensively evaluate a radiomics study.

The efficacy of hydrogen/oxygen therapy favored the recovery of omicron SARS-CoV-2 variant infection: results of a multicenter, randomized, controlled trial.

Clinical studies had found that hydrogen/oxygen mixed inhalation was beneficial to ameliorate the respiratory symptoms in the adjuvant treatment of patients with COVID-19. We aimed to explore the efficacy of hydrogen/oxygen therapy in favoring the recovery of Omicron SARS-CoV-2 variant infection. There were 64 patients who randomly assigned to receive hydrogen/oxygen inhalation (32 patients) and oxygen inhalation (32 patients). The average shedding duration of Omicron in hydrogen/oxygen group was shorter than oxygen group. The trend of cumulative negative conversion rate of Omicron increased gradually after the third day. The IL-6 levels in hydrogen/oxygen group decreased by 22.8% compared with the baseline. After hydrogen/oxygen mixed gas inhalation, the lymphocyte count increased to 61.1% of the baseline on the 3rd day in the hydrogen/oxygen group. More patients in the hydrogen/oxygen group had resolution of pulmonary lesions. Our study showed the beneficial trends of molecular hydrogen in treating patients with COVID-19, which may offer a prospective solution to adjuvant therapy for COVID-19 Patients.

Predicting Genomic Alterations of Phosphatidylinositol-3 Kinase Signaling in Hepatocellular Carcinoma: A Radiogenomics Study Based on Next-Generation Sequencing and Contrast-Enhanced CT.

BACKGROUND: Exploring the genomic landscape of hepatocellular carcinoma (HCC) provides clues for therapeutic decision-making. Phosphatidylinositol-3 kinase (PI3K) signaling is one of the key pathways regulating HCC aggressiveness, and its genomic alterations have been correlated with sorafenib response. In this study, we aimed to predict somatic mutations of the PI3K signaling pathway in HCC samples through machine-learning-based radiomic analysis. METHODS: HCC patients who underwent next-generation sequencing and preoperative contrast-enhanced CT were recruited from West China Hospital and The Cancer Genome Atlas for model training and validation, respectively. Radiomic features were extracted from volumes of interest (VOIs) covering the tumor (VOItumor) and peritumoral areas (5 mm [VOI5mm], 10 mm [VOI10mm], and 20 mm [VOI20mm] from tumor margin). Factor analysis, logistic regression analysis, least absolute shrinkage and selection operator, and random forest analysis were applied for feature selection and model construction. Model performance was characterized based on the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 132 HCC patients (mean age: 61.1 ± 14.7 years; 108 men) were enrolled. In the training set, the AUCs of radiomic signatures based on single CT phases were moderate (AUC 0.694-0.771). In the external validation set, the radiomic signature based on VOI10mm in arterial phase demonstrated the highest AUC (0.733) among all models. No improvement in model performance was achieved after adding the tumor radiomic features or manually assessed qualitative features. CONCLUSIONS: Machine-learning-based radiomic analysis had potential for characterizing alterations of PI3K signaling in HCC and could help identify potential candidates for sorafenib treatment.

Nonreciprocal light propagation induced by a subwavelength spinning cylinder.

Nonreciprocal optical devices have broad applications in light manipulations for communications and sensing. Non-magnetic mechanisms of optical nonreciprocity are highly desired for high-frequency on-chip applications. Here, we investigate the nonreciprocal properties of light propagation in a dielectric waveguide induced by a subwavelength spinning cylinder. We find that the chiral modes of the cylinder can give rise to unidirectional coupling with the waveguide via the transverse spin-orbit interaction, leading to different transmissions for guided wave propagating in opposite directions and thus optical isolation. We reveal the dependence of the nonreciprocal properties on various system parameters including mode order, spinning speed, coupling distance, and various losses. The results show that higher-order chiral modes and larger spinning speed generally give rise to stronger nonreciprocity, and there exists an optimal cylinder-waveguide coupling distance where the optical isolation reaches the maximum. The properties are sensitive to the material loss of the cylinder but show robustness against surface-roughness-induced loss in the waveguide. Our work contributes to the understanding of nonreciprocity in subwavelength moving structures and can find applications in integrated photonic circuits, topological photonics, and novel metasurfaces.

Simple yet effective analysis of waveguide mode symmetry: generalized eigenvalue approach based on Maxwell's equations.

Particular waveguide structures and refractive index distribution can lead to specified degeneracy of eigenmodes. To obtain an accurate understanding of this phenomenon, we propose a simple yet effective approach, i.e., generalized eigenvalue approach based on Maxwell's equations, for the analysis of waveguide mode symmetry. In this method, Maxwell's equations are reformulated into generalized eigenvalue problems. The waveguide eigenmodes are completely determined by the generalized eigenvalue problem given by two matrices (M, N), where M is 6 × 6 waveguide Hamiltonian and N is a constant singular matrix. Close examination shows that N usually commute with the corresponding matrix of a certain symmetry operation, thus the waveguide eigenmode symmetry is essentially determined by M, in contrast to the tedious and complex procedure given in the previous work [Opt. Express25, 29822 (2017)10.1364/OE.25.029822]. Based on this new approach, we discuss several symmetry operations and the corresponding symmetries including chiral, parity-time reversal, rotation symmetry, wherein the constraints of symmetry requirements on material parameters are derived in a much simpler way. In several waveguides with balanced gain and loss, anisotropy, and geometrical symmetry, the analysis of waveguide mode symmetry based on our simple yet effective approach is consistent with previous results, and shows perfect agreement with full-wave simulations.

Diagnostic performance of CO-RADS for COVID-19: a systematic review and meta-analysis.

OBJECTIVES: To investigate the diagnostic performance of the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) for detecting COVID-19. METHODS: We searched PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, and Scopus database until September 21, 2021. Statistical analysis included data pooling, forest plot construction, heterogeneity testing, meta-regression, and subgroup analyses. RESULTS: We included 24 studies with 8382 patients. The pooled sensitivity and specificity and the area under the curve (AUC) of CO-RADS ≥ 3 for detecting COVID-19 were 0.89 (95% confidence interval (CI) 0.85-0.93), 0.68 (95% CI 0.60-0.75), and 0.87 (95% CI 0.84-0.90), respectively. The pooled sensitivity and specificity and AUC of CO-RADS ≥ 4 were 0.83 (95% CI 0.79-0.87), 0.84 (95% CI 0.78-0.88), and 0.90 (95% CI 0.87-0.92), respectively. Cochran's Q test (p < 0.01) and Higgins I2 heterogeneity index revealed considerable heterogeneity. Studies with both symptomatic and asymptomatic patients had higher specificity than those with only symptomatic patients using CO-RADS ≥ 3 and CO-RADS ≥ 4. Using CO-RADS ≥ 4, studies with participants aged < 60 years had higher sensitivity (0.88 vs. 0.80, p = 0.02) and lower specificity (0.77 vs. 0.87, p = 0.01) than studies with participants aged > 60 years. CONCLUSIONS: CO-RADS has favorable performance in detecting COVID-19. CO-RADS ≥ 3/4 might be applied as cutoff values given their high sensitivity and specificity. However, there is a need for more well-designed studies on CO-RADS. KEY POINTS: • CO-RADS shows a favorable performance in detecting COVID-19. • CO-RADS ≥ 3 had a high sensitivity 0.89 (95% CI 0.85-0.93), and it may prove advantageous in screening the potentially infected people to prevent the spread of COVID-19. • CO-RADS ≥ 4 had high specificity 0.84 (95% CI 0.78-0.88) and may be more suitable for definite diagnosis of COVID-19.

Biparametric magnetic resonance imaging assessment for detection of muscle-invasive bladder cancer: a systematic review and meta-analysis.

OBJECTIVES: To investigate if removing DCE from the Vesical Imaging Reporting and Data System (VI-RADS) influences the diagnostic accuracy of muscle-invasive bladder cancer (MIBC). We also explored using different reference standards on the MRI diagnostic performance. METHODS: We searched the Cochrane Library, Embase, and PubMed databases to June 26, 2021. Pooled biparametric MRI (bpMRI, T2WI+DWI) and multiparametric MRI (mpMRI, T2WI+DWI+DCE) sensitivities and specificities and the diagnostic performances of these methods for MIBC were compared using different reference standards. RESULTS: Seventeen studies with 2344 patients were finally included, of which 7 studies, including 1041 patients, reported the diagnostic performance of bpMRI. VI-RADS showed sensitivities and specificities of 0.91 (95% CI 0.87-0.94) and 0.86 (95% CI 0.77-0.91) at cutoff scores of 3, and 0.85 (95% CI 0.77-0.90) and 0.93 (95% CI 0.89-0.96) at cutoff scores of 4. BpMRI showed sensitivities and specificities of 0.90 (95% CI 0.69-0.97) and 0.90 (95% CI 0.81-0.95), and 0.84 (95% CI 0.78-0.88) and 0.97 (95% CI 0.87-0.99), respectively, for cutoff scores of 3 and 4. The sensitivities of bpMRI vs mpMRI for MIBC were not significantly different, but bpMRI was more specific than mpMRI at cutoff scores of 3 (p = 0.02) and 4 (p = 0.02). The VI-RADS studies using primary transurethral resection of bladder tumors (TURBT) as the reference standard had significantly higher sensitivities (p < 0.001) than those using secondary TURBT or radical cystectomy as the reference. DATA CONCLUSION: BpMRI and conventional VI-RADS had similar diagnostic efficacies for MIBC. Since MRI overestimated MIBC diagnoses using primary TURBT as the reference standard, we recommend using secondary TURBT as the reference standard. KEY POINTS: • Biparametric MRI without DCE had similar diagnostic efficacies for MIBC compared with conventional VI-RADS. • The sensitivity of VI-RADS was overestimated when referring to the primary TURBT results. • Biparametric MRI comprised of T2WI and DWI could be used for detecting MIBC in clinical practice.

Comparison of a preoperative MR-based recurrence risk score versus the postoperative score and four clinical staging systems in hepatocellular carcinoma: a retrospective cohort study.

OBJECTIVES: To establish a risk score integrating preoperative gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) and clinical parameters to predict recurrence after hepatectomy for patients with hepatocellular carcinoma (HCC) and to compare its performance with that of a postoperative score and four clinical staging systems. METHODS: Consecutive patients with surgically confirmed HCC who underwent preoperative EOB-MRI between July 2015 and November 2020 were retrospectively included. Two recurrence risk scores, one incorporating only preoperative variables and the other incorporating all preoperative and postoperative variables, were constructed via Cox regression models. RESULTS: A total of 214 patients (derivation set, n = 150; test set, n = 64) were included. Six preoperative variables, namely tumor number, infiltrative appearance, corona enhancement, alpha-fetoprotein (AFP) level, aspartate aminotransferase (AST) level, and sex, were independently associated with recurrence. After adding postoperative features, microvascular invasion and tumor differentiation were additional significant variables in lieu of corona enhancement and AFP level. Using the above variables, the preoperative score achieved a C-index of 0.741 on the test set, which was comparable with that of the postoperative score (0.729; p = 0.235). The preoperative score yielded a larger time-dependent area under the receiver operating characteristic curve at 1 year (0.844) than three existing systems (0.734-0.742; p < 0.05 for all). Furthermore, the preoperative score stratified patients into two prognostically distinct risk strata with low and high risks of recurrence (p < 0.001). CONCLUSION: The preoperative score integrating EOB-MRI features, AFP and AST levels, and sex improves recurrence risk estimation in HCC. KEY POINTS: • The preoperative risk score incorporating three EOB-MRI findings, AFP and AST levels, and sex achieved comparable performance with that of the postoperative score for predicting recurrence after hepatectomy in patients with HCC. • Two risk strata with low and high risks of recurrence were obtained based on the preoperative score. • The preoperative score may help tailor pretreatment decision-making and facilitate candidate selection for adjuvant clinical trials.

Robust exceptional point of arbitrary order in coupled spinning cylinders.

Exceptional points (EPs), i.e., non-Hermitian degeneracies at which eigenvalues and eigenvectors coalesce, can be realized by tuning the gain/loss contrast of different modes in non-Hermitian systems or by engineering the asymmetric coupling of modes. Here we demonstrate a mechanism that can achieve EPs of arbitrary order by employing the non-reciprocal coupling of spinning cylinders sitting on a dielectric waveguide. The spinning motion breaks the time-reversal symmetry and removes the degeneracy of opposite chiral modes of the cylinders. Under the excitation of a linearly polarized plane wave, the chiral mode of one cylinder can unidirectionally couple to the same mode of the other cylinder via the spin-orbit interaction associated with the evanescent wave of the waveguide. The structure can give rise to arbitrary-order EPs that are robust against spin-flipping perturbations, in contrast to conventional systems relying on spin-selective excitations. In addition, we show that higher-order EPs in the proposed system are accompanied by enhanced optical isolation, which may find applications in designing novel optical isolators, nonreciprocal optical devices, and topological photonics.

Extremize Optical Chiralities through Polarization Singularities.

Chiral optical effects are generally quantified along some specific incident directions of exciting waves (especially for extrinsic chiralities of achiral structures) or defined as direction-independent properties by averaging the responses among all structure orientations. Though of great significance for various applications, chirality extremization (maximized or minimized) with respect to incident directions or structure orientations has not been explored, especially in a systematic manner. In this study we examine the chiral responses of open photonic structures from perspectives of quasinormal modes and polarization singularities of their far-field radiations. The nontrivial topology of the momentum sphere secures the existence of generic singularity directions along which mode radiations are either circularly or linearly polarized. When plane waves are incident along those directions, the reciprocity ensures ideal maximization and minimization of optical chiralities, for corresponding mode radiations of circular and linear polarizations, respectively. For directions of general elliptical polarizations, we have unveiled the subtle equality of a Stokes parameter and the circular dichroism, showing that an intrinsically (geometrically) chiral structure can unexpectedly exhibit no optical chirality at all or even optical chiralities of opposite handedness for different incident directions. The framework we establish can be applied to not only finite scattering bodies but also infinite structures, encompassing both intrinsic and extrinsic optical chiralities. We have effectively merged two vibrant disciplines of chiral and singular optics, which can potentially trigger more optical chirality-singularity related interdisciplinary studies.

Optically Reconfigurable Spin-Valley Hall Effect of Light in Coupled Nonlinear Ring Resonator Lattice.

Scattering immune propagation of light in topological photonic systems may revolutionize the design of integrated photonic circuits for information processing and communications. In optics, various photonic topological circuits have been developed, which were based on classical emulation of either quantum spin Hall effect or quantum valley Hall effect. On the other hand, the combination of both the valley and spin degrees of freedom can lead to a new kind of topological transport phenomenon, dubbed spin-valley Hall effect (SVHE), which can further expand the number of topologically protected edge channels and would be useful for information multiplexing. However, it is challenging to realize SVHE in most known material platforms, due to the requirement of breaking both the (pseudo)fermionic time-reversal (T) and parity symmetries (P) individually, but leaving the combined symmetry S≡TP intact. Here, we propose an experimentally feasible platform to realize SVHE for light, based on coupled ring resonators mediated by optical Kerr nonlinearity. Thanks to the inherent flexibility of cross-mode modulation, the coupling between the probe light can be engineered in a controllable way such that spin-dependent staggered sublattice potential emerges in the effective Hamiltonian. With delicate yet experimentally feasible pump conditions, we show the existence of spin-valley Hall-induced topological edge states. We further demonstrate that both degrees of freedom, i.e., spin and valley, can be manipulated simultaneously in a reconfigurable manner to realize spin-valley photonics, doubling the degrees of freedom for enhancing the information capacity in optical communication systems.

Catheters for intermittent catheterization: a systematic review and network meta-analysis.

STUDY DESIGN: Systematic review and network meta-analysis. OBJECTIVES: Intermittent catheterization (IC) is considered the standard treatment for neuro-urological patients who are unable to empty their bladders. The present study aimed to conduct a systematic evaluation and network meta-analysis of all available types of intermittent catheters, and determine which one is best suited for clinical use. METHODS: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies. Only randomized clinical trials (RCTs) were included. Five types of catheters were identified based on the included studies. A Bayesian network meta-analysis was then performed. The surface under the cumulative ranking (SUCRA) curve was used to determine the best catheter for each outcome. RESULTS: A total of 25 RCTs, involving 1233 participants, were included. The pooled odds ratios of symptomatic UTI were lower for two ready-to-use single-use catheters (gel-lubricated non-coated catheter, OR: 0.30, 95% CI 0.095-0.86; pre-activated hydrophilic-coated catheter, OR: 0.41, 95% CI 0.19-0.83) as compared to single-use non-coated catheter. In terms of patient satisfaction, the SUCRA results showed that the pre-activated hydrophilic-coated catheter may the preferred option (SUCRA = 82.8%). However, there were no significant differences in all outcome measures between traditional single-use non-coated catheters and clean non-coated catheters. CONCLUSION: Ready-to-use single-use catheters are associated with lower rates of UTI compared to traditional catheters. Patients may be most satisfied with the pre-activated one. For traditional single-use non-coated catheters and clean non-coated catheters, there is still no convincing evidence as to which is better. Thus, more well-designed trials are needed.