Deep Learning Assessment of Small Renal Masses at Contrast-enhanced Multiphase CT.

Background Accurate characterization of suspicious small renal masses is crucial for optimized management. Deep learning (DL) algorithms may assist with this effort. Purpose To develop and validate a DL algorithm for identifying benign small renal masses at contrast-enhanced multiphase CT. Materials and Methods Surgically resected renal masses measuring 3 cm or less in diameter at contrast-enhanced CT were included. The DL algorithm was developed by using retrospective data from one hospital between 2009 and 2021, with patients randomly allocated in a training and internal test set ratio of 8:2. Between 2013 and 2021, external testing was performed on data from five independent hospitals. A prospective test set was obtained between 2021 and 2022 from one hospital. Algorithm performance was evaluated by using the area under the receiver operating characteristic curve (AUC) and compared with the results of seven clinicians using the DeLong test. Results A total of 1703 patients (mean age, 56 years ± 12 [SD]; 619 female) with a single renal mass per patient were evaluated. The retrospective data set included 1063 lesions (874 in training set, 189 internal test set); the multicenter external test set included 537 lesions (12.3%, 66 benign) with 89 subcentimeter (≤1 cm) lesions (16.6%); and the prospective test set included 103 lesions (13.6%, 14 benign) with 20 (19.4%) subcentimeter lesions. The DL algorithm performance was comparable with that of urological radiologists: for the external test set, AUC was 0.80 (95% CI: 0.75, 0.85) versus 0.84 (95% CI: 0.78, 0.88) (P = .61); for the prospective test set, AUC was 0.87 (95% CI: 0.79, 0.93) versus 0.92 (95% CI: 0.86, 0.96) (P = .70). For subcentimeter lesions in the external test set, the algorithm and urological radiologists had similar AUC of 0.74 (95% CI: 0.63, 0.83) and 0.81 (95% CI: 0.68, 0.92) (P = .78), respectively. Conclusion The multiphase CT-based DL algorithm showed comparable performance with that of radiologists for identifying benign small renal masses, including lesions of 1 cm or less. Published under a CC BY 4.0 license. Supplemental material is available for this article.

In Situ Forming Gel Polymer Electrolyte for High Energy-Density Lithium Metal Batteries.

In situ forming gel polymer electrolyte (GPE) is one of the most feasible ways to improve the safety and cycle performances of lithium metal batteries with high energy density. However, most of the in situ formed GPEs are not compatible with high-voltage cathode materials. Here, this work provides a novel strategy to in situ form GPE based on the mechanism of Ritter reaction. The Ritter reaction in liquid electrolyte has the advantage of appropriate reaction temperature and no additional additives. The polymer chains are cross-linked by amide groups with the formation of GPE with superior electrochemical properties. The GPE has high ionic conductivity (1.84 mS cm-1 ), wide electrochemical stability window (>5.25 V) and high lithium ion transference number (≈0.78), compatible with high-voltage cathode materials. The Li|LiNi0.6 Co0.2 Mn0.2 O2 batteries with in situ formed GPE show excellent long-term cycle stability (93.4%, 300 cycles). The density functional theory calculation and X-ray photoelectron spectroscopy results verify that the amide and nitrile groups are beneficial for stabilizing cathode structure and promoting uniform Li deposition on Li anode. Furthermore, the in situ formed GPE exhibits excellent electrochemical performance in Graphite|LiMn2 O4 and Graphite|LiNi0.5 Co0.2 Mn0.3 O2 pouch batteries. This approach is adaptable to current battery technologies, which will be sure to promote the development of high energy-density lithium-ion batteries.

MRI for Hepatitis B-Associated Intrahepatic Cholangiocarcinoma: A Multicenter Comparative Study.

BACKGROUND: The diagnosis of intrahepatic cholangiocarcinoma (iCCA) is challenging in hepatitis B virus (HBV)-infected patients, due to the overlapping clinical manifestations and atypical imaging patterns compared to patients without HBV. PURPOSE: To investigate the preoperative imaging characteristics of iCCA in patients with HBV in comparison to those without HBV. STUDY TYPE: Retrospective. SUBJECTS: 431 patients with histopathologically confirmed iCCA (143 HBV-positive and 288 HBV-negative patients) were retrospectively enrolled from three institutes, and patients were allocated to the training (n = 302) and validation (n = 129) cohorts from different institutes or time period; 100 matching HBV-positive hepatocellular carcinoma (HCC) patients were also enrolled. FIELD STRENGTH/SEQUENCE: 1.5-T and 3-T, including T1- and T2-weighted, diffusion-weighted and dynamic gadopentetate dimeglumine-enhanced imaging. ASSESSMENT: Clinical and MRI features were analyzed and compared between HBV-positive and HBV-negative patients with iCCA, and between HBV-positive patients with iCCA and HCC. STATISTICAL TESTS: Univariate and multivariate logistic regression analyses with odds ratio (OR) to identify independent features for discriminating HBV-associated iCCA. Diagnostic model generation by incorporating independent features, and the performance for discrimination was evaluated by receiver operating characteristics with the area under the curve (AUC) and 95% confidence interval (CI). AUCs were compared by the DeLong's method. A P-value <0.05 was considered statistically significant. RESULTS: Compared to patients without HBV, washout or degressive enhancement pattern (OR = 51.837), well-defined tumor margin (OR = 8.758) and no peritumoral bile duct dilation (OR = 4.651) were independent significant features for discriminating HBV-associated iCCAs. All these features were also the predominant MRI manifestations for HBV-associated HCC. The combined index showed an AUC of 0.798 (95% CI 0.748-0.842) in the training cohort and an AUC of 0.789 (95% CI 0.708-0.856) in the validation cohort for discrimination. The sensitivity, specificity, and accuracy were all >70%, which was superior to each single feature alone in both cohorts. [Correction added after first online publication on 29 June 2023. The Field Strength/Sequence has been updated from 5-T to 1.5-T.] DATA CONCLUSION: Preoperative MRI may help to discriminate HBV-associated iCCA. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY STAGE: 2.

A multi-center diagnostic system for intrahepatic mass-forming cholangiocarcinoma based on preoperative MRI and clinical features.

OBJECTIVES: To establish a non-invasive diagnostic system for intrahepatic mass-forming cholangiocarcinoma (IMCC) via decision tree analysis. METHODS: Totally 1008 patients with 504 pathologically confirmed IMCCs and proportional hepatocellular carcinomas (HCC) and combined hepatocellular cholangiocarcinomas (cHCC-CC) from multi-centers were retrospectively included (internal cohort n = 700, external cohort n = 308). Univariate and multivariate logistic regression analyses were applied to evaluate the independent clinical and MRI predictors for IMCC, and the selected features were used to develop a decision tree-based diagnostic system. Diagnostic efficacy of the established system was calculated by the receiver operating characteristic curve analysis in the internal training-testing and external validation cohorts, and also in small lesions ≤ 3 cm. RESULTS: Multivariate analysis revealed that female, no chronic liver disease or cirrhosis, elevated carbohydrate antigen 19-9 (CA19-9) level, normal alpha-fetoprotein (AFP) level, lobulated tumor shape, progressive or persistent enhancement pattern, no enhancing tumor capsule, targetoid appearance, and liver surface retraction were independent characteristics favoring the diagnosis of IMCC over HCC or cHCC-CC (odds ratio = 3.273-25.00, p < 0.001 to p = 0.021). Among which enhancement pattern had the highest weight of 0.816. The diagnostic system incorporating significant characteristics above showed excellent performance in the internal training (area under the curve (AUC) 0.971), internal testing (AUC 0.956), and external validation (AUC 0.945) cohorts, as well as in small lesions ≤ 3 cm (AUC 0.956). CONCLUSIONS: In consideration of the great generalizability and clinical efficacy in multi-centers, the proposed diagnostic system may serve as a non-invasive, reliable, and easy-to-operate tool in IMCC diagnosis, providing an efficient approach to discriminate IMCC from other HCC-containing primary liver cancers. CLINICAL RELEVANCE STATEMENT: This study established a non-invasive, easy-to-operate, and explainable decision tree-based diagnostic system for intrahepatic mass-forming cholangiocarcinoma, which may provide essential information for clinical decision-making. KEY POINTS: • Distinguishing intrahepatic mass-forming cholangiocarcinoma (IMCC) from other primary liver cancers is important for both treatment planning and outcome prediction. • The MRI-based diagnostic system showed great performance with satisfying generalization ability in the diagnosis and discrimination of IMCC. • The diagnostic system may serve as a non-invasive, easy-to-operate, and explainable tool in the diagnosis and risk stratification for IMCC.

Efficient and Selective Electrochemical Nitrate Reduction to N2 Using a Flow-Through Zero-Gap Electrochemical Reactor with a Reconstructed Cu(OH)2 Cathode: Insights into the Importance of Inter-Electrode Distance.

Electrochemically converting nitrate, a widely distributed nitrogen contaminant, into harmless N2 is a feasible and environmentally friendly route to close the anthropogenic nitrogen-based cycle. However, it is currently hindered by sluggish kinetics and low N2 selectivity, as well as scarce attention to reactor configuration. Here, we report a flow-through zero-gap electrochemical reactor that shows a high performance of nitrate reduction with 100% conversion and 80.36% selectivity of desired N2 in the chlorine-free system at 100 mg-N·L-1 NO3- while maintaining a rapid reduction kinetics of 0.07676 min-1. More importantly, the mass transport and current utilization efficiency are significantly improved by shortening the inter-electrode distance, especially in the zero-gap electrocatalytic system where the current efficiency reached 50.15% at 5 mA·cm-2. Detailed characterizations demonstrated that during the electroreduction process, partial Cu(OH)2 on the cathode surface was reconstructed into stable Cu/Cu2O as the active phase for efficient nitrate reduction. In situ characterizations revealed that the highly selective *NO to *N conversion and the N-N coupling step played crucial roles during the selective reduction of NO3- to N2 in the zero-gap electrochemical system. In addition, theoretical calculations demonstrated that improving the key intermediate *N coverage could effectively facilitate the N-N coupling step, thereby promoting N2 selectivity. Moreover, the environmental and economic benefits and long-term stability shown by the treatment of real nitrate-containing wastewater make our proposed electrocatalytic system more attractive for practical applications.

Liver fat volume fraction measurements based on multi-material decomposition algorithm in patients with nonalcoholic fatty liver disease: the influences of blood vessel, location, and iodine contrast.

BACKGROUND: In recent years, spectral CT-derived liver fat quantification method named multi-material decomposition (MMD) is playing an increasingly important role as an imaging biomarker of hepatic steatosis. However, there are various measurement ways with various results among different researches, and the impact of measurement methods on the research results is unknown. The aim of this study is to evaluate the reproducibility of liver fat volume fraction (FVF) using MMD algorithm in nonalcoholic fatty liver disease (NAFLD) patients when taking blood vessel, location, and iodine contrast into account during measurement. METHODS: This retrospective study was approved by the institutional ethics committee, and the requirement for informed consent was waived because of the retrospective nature of the study. 101 patients with NAFLD were enrolled in this study. Participants underwent non-contrast phase (NCP) and two-phase enhanced CT scanning (late arterial phase (LAP) and portal vein phase (PVP)) with spectral mode. Regions of interest (ROIs) were placed at right posterior lobe (RPL), right anterior lobe (RAL) and left lateral lobe (LLL) to obtain FVF values on liver fat images without and with the reference of enhanced CT images. The differences of FVF values measured under different conditions (ROI locations, with/without enhancement reference, NCP and enhanced phases) were compared. Friedman test was used to compare FVF values among three phases for each lobe, while the consistency of FVF values was assessed between each two phases using Bland-Altman analysis. RESULTS: Significant difference was found between FVF values obtained without and with the reference of enhanced CT images. There was no significant difference about FVF values obtained from NCP images under the reference of enhanced CT images between any two lobes or among three lobes. The FVF value increased after the contrast injection, and there were significant differences in the FVF values among three scanning phases. Poor consistencies of FVF values between each two phases were found in each lobe by Bland-Altman analysis. CONCLUSION: MMD algorithm quantifying hepatic fat was reproducible among different lobes, while was influenced by blood vessel and iodine contrast.

Neurosurgical short-term outcomes for pediatric medulloblastoma patients and molecular correlations: a 10-year single-center observation cohort study.

This study examined the risk factors for short-term outcomes, focusing particularly on the associations among molecular subgroups. The analysis focused on the data of pediatric patients with medulloblastoma between 2013 and 2023, as well as operative complications, length of stay from surgery to adjuvant treatment, 30-day unplanned reoperation, unplanned readmission, and mortality. 148 patients were included. Patients with the SHH TP53-wildtype exhibited a lower incidence of complications (45.2% vs. 66.0%, odds ratio [OR] 0.358, 95% confidence interval [CI] 0.160 - 0.802). Female sex (0.437, 0.207 - 0.919) was identified as an independent protective factor for complications, and brainstem involvement (1.900, 1.297 - 2.784) was identified as a risk factor. Surgical time was associated with an increased risk of complications (1.004, 1.001 - 1.008), duration of hospitalization (1.006, 1.003 - 1.010), and reoperation (1.003, 1.001 - 1.006). Age was found to be a predictor of improved outcomes, as each additional year was associated with a 14.1% decrease in the likelihood of experiencing a prolonged length of stay (0.859, 0.772 - 0.956). Patients without metastasis exhibited a reduced risk of reoperation (0.322, 0.133 - 0.784) and readmission (0.208, 0.074 - 0.581). There is a significant degree of variability in the occurrence of operative complications in pediatric patients with medulloblastoma. SHH TP53-wildtype medulloblastoma is commonly correlated with a decreased incidence of complications. The short-term outcomes of patients are influenced by various unmodifiable endogenous factors. These findings could enhance the knowledge of onconeurosurgeons and alleviate the challenges associated with patient/parent education through personalized risk communication. However, the importance of a dedicated center with expertise surgical team and experienced neurosurgeon in improving neurosurgical outcomes appears self-evident.

Electrocatalytic Degradation of Phenolic Wastewater Using a Zero-Gap Flow-Through Reactor Coupled with a 3D Ti/RuO2-TiO2@Pt Electrode.

In this study, the performance of a zero-gap flow-through reactor with three-dimensional (3D) porous Ti/RuO2-TiO2@Pt anodes was systematically investigated for the electrocatalytic oxidation of phenolic wastewater, considering phenol and 4-nitrophenol (4-NP) as the target pollutants. The optimum parameters for the electrochemical oxidation of phenol and 4-NP were examined. For phenol degradation, at an initial concentration of 50 mg/L, initial pH of 7, NaCl concentration of 10.0 g/L, current density of 10 mA/cm2, and retention time of 30 min, the degradation efficiency achieved was 95.05%, with an energy consumption of 15.39 kWh/kg; meanwhile, for 4-NP, the degradation efficiency was 98.42% and energy consumption was 19.21 kWh/kg (at an initial concentration of 40 mg/L, initial pH of 3, NaCl concentration of 10.0 g/L, current density of 10 mA/cm2, and retention time of 30 min). The electrocatalytic oxidation of phenol and 4-NP conformed to the pseudo-first-order kinetics model, and the k values were 0.2562 min-1 and 0.1736 min-1, respectively, which are 1.7 and 3.6-times higher than those of a conventional electrolyzer. Liquid chromatography-mass spectrometry (LC-MS) was used to verify the intermediates formed during the degradation of phenol or 4-NP and a possible degradation pathway was provided. The extremely narrow electrode distance and the flow-through configuration of the zero-gap flow-through reactor were thought to be essential for its lower energy consumption and higher mass transfer efficiency. The zero-gap flow-through reactor with a novel 3D porous Ti/RuO2-TiO2@Pt electrode is a superior alternative for the treatment of industrial wastewater.

Cancer stem cells in TNBC.

Triple-negative breast cancer (TNBC) is a broad collection of breast cancer that tests negative for estrogen receptors (ER), progesterone receptors (PR), and excess human epidermal growth factor receptor 2 (HER2) protein. TNBC is considered to have poorer prognosis than other types of breast cancer because of a lack of effective therapeutic targets. The success of precision cancer therapies relies on the clarification of key molecular mechanisms that drive tumor growth and metastasis; however, TNBC is highly heterogeneous in terms of their cellular lineage composition and the molecular nature within each individual case. In particular, the rare and sometimes slow cycling cancer stem cells (CSCs) can provide effective means for TNBC to resist various treatments. Single cell analysis technologies, including single-cell RNA-seq (scRNA-seq) and proteomics, provide an avenue to unravel patient-level intratumoral heterogeneity by identifying CSCs populations, CSC biomarkers and the range of tumor microenvironment cellular constituents that contribute to tumor growth. This review discusses the emerging evidence for the role of CSCs in driving TNBC incidence and the therapeutic implications in manipulating molecular signaling against this rare cell population for the control of this deadly disease.

Supramolecular Framework Constructed by Dendritic Nanopolymer for Stable Flexible Perovskite Resistive Random-Access Memory.

The 3D supramolecular framework (3D-SF) is constructed in this work through the hydrogen bond assisted self-assembly of spherical dendritic nanopolymer to regulate the flexibility, stability, and resistive switching (RS) performance of perovskite resistive random-access memory (RRAM). Herein, the 3D-SF network acts as the perovskite crystallization template to regulate the perovskite crystallization process due to its coordination interaction of functional groups with the perovskite grains, presenting the uniform, pinhole-free, and compact perovskite morphology for stable flexible RRAM. The 3D-SF network in situ stays at the perovskite intergranular boundaries to crosslink the perovskite grains. The RS performance of 3D-SF-modified perovskite RRAM device is evidently improved to the ON/OFF ratio of 105 , the cycle number of 500 times, and the data retention time of 104 s. The 50-days exposure of unencapsulated RRAM device at ambient environment still makes the ON/OFF ratio to be kept at ≈104 , indicating the potential of long-term stable multilevel storage in the high-density data storage. The bending action under different radius also does not change the RS performance due to the excellent bending-resistant ability of 3D-SF-modified perovskite film. This work explores a novel polymer additive strategy to construct the 3D supramolecular framework for stable flexible perovskite optoelectronic devices.

Research progress in microalgae nutrients: emerging extraction and purification technologies, digestive behavior, and potential effects on human gut.

Microalgae contain a diverse range of high-value compounds that can be utilized directly or fractionated to obtain components with even greater value-added potential. With the use of microalgae for food and medical purposes, there is a growing interest in their digestive properties and impact on human gut health. The extraction, separation, and purification of these components are key processes in the industrial application of microalgae. Innovative technologies used to extract and purify microalgal high-added-value compounds are key for their efficient utilization and evaluation. This review's comprehensive literature review was performed to highlight the main high-added-value microalgal components. The technologies for obtaining bioactive compounds from microalgae are being developed rapidly, various innovative, efficient, green separation and purification technologies are emerging, thus helping in the scaling-up and subsequent commercialization of microalgae products. Finally, the digestive behavior of microalgae nutrients and their health effects on the human gut microbiota were discussed. Microalgal nutrients exhibit favorable digestive properties and certain components have been shown to benefit gut microbes. The reality that must be faced is that multiple processes are still required for microalgae raw materials to final usable products, involving energy, time consumption and loss of ingredients, which still face challenges.

Applications of algae to obtain healthier meat products: A critical review on nutrients, acceptability and quality.

Meat constitutes one the main protein sources worldwide. However, ethical and health concerns have limited its consumption over the last years. To overcome this negative impact, new ingredients from natural sources are being applied to meat products to obtain healthier proteinaceous meat products. Algae is a good source of unsaturated fatty acids, proteins, essential amino acids, and vitamins, which can nutritionally enrich several foods. On this basis, algae have been applied to meat products as a functional ingredient to obtain healthier meat-based products. This paper mainly reviews the bioactive compounds in algae and their application in meat products. The bioactive ingredients present in algae can give meat products functional properties such as antioxidant, neuroprotective, antigenotoxic, resulting in healthier foods. At the same time, algae addition to foods can also contribute to delay microbial spoilage extending shelf-life. Additionally, other algae-based applications such as for packaging materials for meat products are being explored. However, consumers' acceptance for new products (particularly in Western countries), namely those containing algae, not only depends on their knowledge, but also on their eating habits. Therefore, it is necessary to further explore the nutritional properties of algae-containing meat products to overcome the gap between new meat products and traditional products, so that healthier algae-containing meat can occupy a significant place in the market.

Capability of arterial spin labeling and intravoxel incoherent motion diffusion-weighted imaging to detect early kidney injury in chronic kidney disease.

OBJECTIVES: To prospectively investigate the capability of arterial spin labeling (ASL) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the identification of early kidney injury in chronic kidney disease (CKD) patients with normal estimated glomerular filtration rate (eGFR). METHODS: Fifty-four CKD patients confirmed by renal biopsy (normal eGFR group [eGFR ≥ 90 mL/min/1.73 m2]: n = 26; abnormal eGFR group [eGFR < 90 mL/min/1.73 m2]: n = 28) and 20 healthy volunteers (HV) were recruited. All subjects were examined by IVIM-DWI and ASL imaging. Renal blood flow (RBF) derived from ASL, true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) derived from IVIM-DWI were measured from the renal cortex. One-way analysis of variance was used to compare MRI parameters among the three groups. The correlation between eGFR and MRI parameters was evaluated by Spearman correlation analysis. Diagnostic performances of MRI parameters for detecting kidney injury were assessed by receiver operating characteristic (ROC) curves. RESULTS: The renal cortical D, D*, f, and RBF values showed statistically significant differences among the three groups. eGFR was positively correlated with MRI parameters (D: r = 0.299, D*: r = 0.569, f: r = 0.733, RBF: r = 0.586). The areas under the curve (AUCs) for discriminating CKD patients from HV were 0.725, 0.752, 0.947, and 0.884 by D, D*, f, and RBF, respectively. D, D*, f, RBF, and eGFR identified CKD patients with normal eGFR with AUCs of 0.735, 0.612, 0.917, 0.827, and 0.733, respectively, and AUC of f value was significantly larger than that of eGFR. CONCLUSION: IVIM-DWI and ASL were useful for detecting underlying pathologic injury in early CKD patients with normal eGFR. KEY POINTS: • The renal cortical f and RBF values in the control group were significantly higher than those in the normal eGFR group. • A negative correlation was observed between the renal cortical D, D*, f, and RBF values and SCr and 24 h-UPRO, while eGFR was significantly positively correlated with renal cortical D, D*, f, and RBF values. • The AUC of renal cortical f values was statistically larger than that of eGFR for the discrimination between the CKD with normal eGFR group and the control group.

Evaluation of interstitial fibrosis in chronic kidney disease by multiparametric functional MRI and histopathologic analysis.

OBJECTIVES: To investigate the diagnostic value of functional MRI to assess renal interstitial fibrosis in patients with chronic kidney disease (CKD). METHODS: We prospectively recruited 80 CKD patients who underwent renal biopsies and 16 healthy volunteers to undergo multiparametric functional MRI examinations. The Oxford MEST-C classification was used to score the interstitial fibrosis. The diagnostic performance of functional MRI to discriminate interstitial fibrosis was evaluated by calculating the area under the receiver operating characteristic (ROC) curves. RESULTS: IgA nephropathy (60%) accounted for the majority of pathologic type in the CKD patients. Apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) was correlated with interstitial fibrosis (rho = -0.73). Decreased renal blood flow (RBF) derived from arterial spin labeling (rho = -0.78) and decreased perfusion fraction (f) derived from DWI (rho = -0.70) were accompanied by increased interstitial fibrosis. The T1 value from T1 mapping correlated with interstitial fibrosis (rho = 0.67) (all p < 0.01). The areas under the ROC curve for the discrimination of ≤ 25% vs. > 25% and ≤ 50% vs. > 50% interstitial fibrosis were 0.87 (95% confidence interval, 0.78 to 0.94) and 0.93 (0.86 to 0.98) by ADC, 0.84 (0.74 to 0.91) and 0.94 (0.86 to 0.98) by f, 0.93 (0.85 to 0.98) and 0.90 (0.82 to 0.96) by RBF, and 0.91 (0.83 to 0.96) and 0.77 (0.66 to 0.85) by T1, respectively. CONCLUSIONS: Functional MRI parameters were strongly correlated with the interstitial fibrosis of CKD. Therefore, it might a powerful tool to assess interstitial fibrosis of CKD noninvasively. KEY POINTS: • In CKD patients, the renal cortical ADC value decreased and T1 value increased significantly compared with healthy volunteers. • Functional MRI revealed significantly decreased renal perfusion in CKD patients compared with healthy volunteers. • The renal cortical ADC, f, RBF, and T1 values were strongly correlated with the interstitial fibrosis of CKD.

Perinatal outcomes of singletons following double vitrification-warming procedures: a retrospective study using propensity score analysis.

BACKGROUND: Although repeated cryopreservation is an occasional occurrence, the effect on perinatal outcomes is unclear. Therefore, the aim of this study was to evaluate the perinatal outcomes of singletons after embryo re-cryopreservation. METHODS: In this retrospective study, a total of 647 singleton live births after blastocyst freeze-thaw embryo transfer cycles were investigated. They were divided into two groups: vitrified-warmed blastocysts (once-vitrified group) and vitrified-warmed blastocysts derived from thawed cleaved embryos (re-vitrified group). Propensity score matching (PSM) was used to control for potential confounding factors. RESULTS: A total of 592 infants were included in the once-vitrified group, and 55 infants were included in the re-vitrified group. After PSM, 108 cases were generated for comparison. The median gestational age was 38 weeks for both groups, and the birthweights were comparable (3390.6 ± 601.5 g vs. 3412.8 ± 672.6 g, P > 0.05). The incidence of preterm birth (PTB) (20.4% vs. 16.7%), low birthweight (LBW) (3.7% vs. 7.4%), macrosomia (11.1% vs. 16.7%) and large for gestational age (LGA) (29.6% vs. 22.2%) were not significantly different between the two groups. Logistic regression analysis indicated that double vitrification-warming procedures did not affect the occurrence of PTB (OR, 2.58 [95% CI, 0.77, 8.63]), LBW (OR, 0.83 [95% CI, 0.08, 8.29]), macrosomia (OR, 0.60 [95% CI, 0.13, 2.69]), or LGA (OR, 1.51 [95% CI, 0.53, 4.27]) (P > 0.05, for all). CONCLUSION: Our findings demonstrate that double vitrification-warming procedures do not increase the risk of adverse neonatal outcomes compared with those of once-vitrified embryos.

Study of T2 mapping in quantifying and discriminating uterine lesions under different magnetic field strengths: 1.5 T vs. 3.0 T.

BACKGROUND: MRI is the best imaging tool for the evaluation of uterine tumors, but conventional MRI diagnosis results rely on radiologists and contrast agents (if needed). As a new objective, reproducible and contrast-agent free quantification technique, T2 mapping has been applied to a number of diseases, but studies on the evaluation of uterine lesions and the influence of magnetic field strength are few. Therefore, the aim of this study was to systematically investigate and compare the performance of T2 mapping as a nonenhanced imaging tool in discriminating common uterine lesions between 1.5 T and 3.0 T MRI systems. METHODS: A total of 50 healthy subjects and 126 patients with suspected uterine lesions were enrolled in our study, and routine uterine MRI sequences with additional T2 mapping sequences were performed. T2 maps were calculated by monoexponential fitting using a custom code in MATLAB. T2 values of normal uterine structures in the healthy group and lesions (benign: adenomyosis, myoma, endometrial polyps; malignant: cervical cancer, endometrial carcinoma) in the patient group were collected. The differences in T2 values between 1.5 T MRI and 3.0 T MRI in any normal structure or lesion were compared. The comparison of T2 values between benign and malignant lesions was also performed under each magnetic field strength, and the diagnostic efficacies of the T2 value obtained through receiver operating characteristic (ROC) analysis were compared between 1.5 T and 3.0 T. RESULTS: The mean T2 value of any normal uterine structure or uterine lesion under 3.0 T MRI was significantly lower than that under 1.5 T MRI (p < 0.05). There were significant differences in T2 values between each lesion subgroup under both 1.5 T and 3.0 T MRI. Moreover, the T2 values of benign lesions (71.1 ± 22.0 ms at 1.5 T and 63.4 ± 19.1 ms at 3.0 T) were also significantly lower than those of malignant lesions (101.1 ± 4.5 ms at 1.5 T and 93.5 ± 5.1 ms at 3.0 T) under both field strengths. In the aspect of differentiating benign from malignant lesions, the area under the curve of the T2 value under 3.0 T (0.94) was significantly higher than that under 1.5 T MRI (0.90) (p = 0.02). CONCLUSION: T2 mapping can be a potential tool for quantifying common uterine lesions, and it has better performance in distinguishing benign from malignant lesions under 3.0 T MRI.

The insertion and management of an external ventricular drain in pediatric patients with hydrocephalus associated with medulloblastoma.

An external ventricular drain (EVD) is used to facilitate cerebrospinal fluid (CSF) removal in medulloblastoma patients suffering from hydrocephalus. It is essential to recognize that EVD management plays a crucial role in influencing the incidence of drain-related complications. However, the ideal method for EVD management remains undetermined. Our research sought to examine the safety of EVD placement and the impact of EVD on the incidences of intracranial infections, postresection hydrocephalus, and posterior fossa syndrome (PFS). We conducted a single-center observational study involving a cohort of 120 pediatric medulloblastoma patients who were treated from 2017 to 2020. The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. EVD did not influence the occurrence of intracranial infection (p = 0.466), postresection hydrocephalus (p = 0.298), or PFS (p = 0.212). A gradual EVD weaning protocol correlated with an elevated incidence of postresection hydrocephalus (p = 0.033), whereas a rapid weaning approach resulted in 4.09 ± 0.44 fewer drainage days (p < 0.001) than the gradual weaning strategy. EVD placement (p = 0.010) and intracranial infection (p = 0.002) were linked to delayed speech return, whereas a longer duration of drainage was conducive to the recovery of language function (p = 0.010). EVD insertion was not correlated with the incidence of intracranial infection, postoperative hydrocephalus, or PFS. The optimal EVD management method should encompass a rapid EVD weaning strategy, followed by prompt drain closure. We have presented additional evidence to improve the safety of EVD insertion and management in neurosurgical patients to ultimately facilitate the establishment of standardized institutional/national implementation and management protocols.

Preliminary Exploration of the Application of Vesical Imaging-Reporting and Data System (VI-RADS) in Post-treatment Patients With Bladder Cancer: A Prospective Single-Center Study.

BACKGROUND: Vesical Imaging-Reporting and Data System (VI-RADS) has been shown to be effective in diagnosing muscle invasion of bladder cancer (BC) in primary patients. PURPOSE: To evaluate the diagnostic efficacy of VI-RADS in a BC target population which included post-treatment patients, and to determine the repeatability. STUDY TYPE: Prospective. POPULATION: Seventy-three patients (42 with primary BC, 31 with post-treatment BC). FIELD STRENGTH/SEQUENCE: 3.0 T MRI with propeller fast spin-echo T2 WI, echo planer imaging diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). ASSESSMENT: VI-RADS scores were independently assessed by five radiologists with different levels of experience. The diagnostic efficiency in each group (primary and post-treatment) and of each radiologist was assessed. STATISTICAL TESTS: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and area under the curve (AUC) in receiver operating characteristic curve analysis were calculated to evaluate VI-RADS diagnostic performance. Interobserver agreement was assessed using weighted Kappa statistics. A P value <0.05 was considered statistically significant. RESULTS: At the corresponding cut-off, AUC values of three groups range from 0.936 to 0.947 and AUC values of five observers range from 0.901 to 0.963. There was no significant difference between the AUCs in the primary and post-treatment groups (P = 0.870). The cut-off of the whole group and the post-treatment group was ≥4, and the cut-off of the primary group was ≥3. The Kappa values of interobserver agreements range from 0.709 to 0.923. CONCLUSIONS: After expanding the target population to include post-treatment patients, VI-RADS still has good diagnostic efficacy and repeatability. VI-RADS could potentially be a preoperative staging tool for post-treatment patients. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.

The clinical application of single-sperm-based single-nucleotide polymorphism haplotyping for PGT of patients with genetic diseases.

RESEARCH QUESTION: Is there a simple and effective method for male patients with genetic disorders in families with no identified haplotype and with Robertsonian translocations to avoid the transfer of embryos carrying translocated chromosomes? DESIGN: Single spermatozoa were separated to identify by next-generation sequencing (NGS) those that were genetically abnormal, to establish a sperm-based single-nucleotide polymorphism (SNP) haplotype. Blastocysts that developed to day 5 or 6 were then biopsied for whole genome amplification and screening for chromosomal aneuploidy. Normal embryos were selected by comparison with a single-sperm-based SNP haplotype and were transferred. The results were verified by second trimester amniocentesis. RESULTS: Two blastocysts obtained from patients with neurofibroma type 1 (NF1) were found to be normal after NGS according to single-sperm-based SNP haplotype analysis (13 SNP sites). Three and one blastocysts, respectively, were obtained from the patients with Robertsonian translocation. Blastocysts B9 and B7 were found to be normal after NGS according to the single-sperm-based SNP haplotype analysis (12 and 13 SNP sites selected on chromosomes 14 and 22 for the first patient; 12 and 9 SNP sites selected on chromosomes 13 and 14 for the second patient). Successful pregnancies after blastocyst transfer occurred in all three patients. The identification of embryos was verified by mid-trimester amniocentesis. All three patient couples successfully delivered healthy babies. CONCLUSION: This study preliminarily summarized the process of single-sperm-based SNP haplotyping, which could be applied as preimplantation genetic testing for male patients without identified disease-causing haplotypes and with Robertsonian translocations.

Comparison of embryo implantation potential between time-lapse incubators and standard incubators: a randomized controlled study.

RESEARCH QUESTION: What are the potential clinical benefits of embryo culture and assessment in a time-lapse incubator compared with a standard incubator using static assessment? DESIGN: This large multicentre, single-blinded, randomized controlled study included 1224 participants randomly assigned (1:1) to the time-lapse or standard incubator group. In all patients one or two embryos were transferred on day 3. The primary outcome was the implantation rate in the first embryo transfer cycle. Secondary outcomes included the cumulative implantation rate, live birth rate in the first embryo transfer cycle and cumulative live birth rate. RESULTS: Among 1224 participants recruited, 1182 underwent embryo transfer. The number of successfully implanted embryos in the first transfer cycle was significantly higher in the time-lapse incubator group (time-lapse group: 52.35%, standard incubator group: 47.11%, P = 0.014). The implantation rate in the first embryo transfer cycle was still significantly higher in the time-lapse group than the standard incubator group after adjusting for age, body mass index, medical centre and embryo status (relative risk 1.11, 95% confidence interval 1.02-1.20, P = 0.020). However, the cumulative implantation rate, live birth rate in the first embryo transfer cycle and cumulative live birth rate were not statistically different between the groups. CONCLUSIONS: The implantation rate in the first embryo transfer cycle was significantly improved in the time-lapse group, but the effect of the time-lapse system on the cumulative implantation rate or cumulative live birth rate was not significant. The embryo assessment method offered by time-lapse systems rather than an undisturbed environment may play an important role in improving the implantation rate in the first embryo transfer cycle. These results are only applicable to young patients.