Placental T2WI MRI-based radiomics-clinical nomogram predicts suspicious placenta accreta spectrum in patients with placenta previa.

BACKGROUND: The incidence of placenta accreta spectrum (PAS) increases in women with placenta previa (PP). Many radiologists sometimes cannot completely and accurately diagnose PAS through the simple visual feature analysis of images, which can affect later treatment decisions. The study is to develop a T2WI MRI-based radiomics-clinical nomogram and evaluate its performance for non-invasive prediction of suspicious PAS in patients with PP. METHODS: The preoperative MR images and related clinical data of 371 patients with PP were retrospectively collected from our hospital, and the intraoperative examination results were used as the reference standard of the PAS. Radiomics features were extracted from sagittal T2WI MR images and further selected by LASSO regression analysis. The radiomics score (Radscore) was calculated with logistic regression (LR) classifier. A nomogram integrating Radscore and selected clinical factors was also developed. The model performance was assessed with respect to discrimination, calibration and clinical usefulness. RESULTS: A total of 6 radiomics features and 1 clinical factor were selected for model construction. The Radscore was significantly associated with suspicious PAS in both the training (p < 0.001) and validation (p < 0.001) datasets. The AUC of the nomogram was also higher than that of the Radscore in the training dataset (0.891 vs. 0.803, p < 0.001) and validation dataset (0.897 vs. 0.780, p < 0.001), respectively. The calibration was good, and the decision curve analysis demonstrated the nomogram had higher net benefit than the Radscore. CONCLUSIONS: The T2WI MRI-based radiomics-clinical nomogram showed favorable diagnostic performance for predicting PAS in patients with PP, which could potentially facilitate the obstetricians for making clinical decisions.

Placental T2-weighted MRI-based radiomics-clinical nomogram to predict postpartum hemorrhage of placenta previa.

BACKGROUND: Placenta previa is an obstetric complication related to severe maternal morbidity and mortality. Magnetic resonance imaging (MRI) can be used for the preoperative evaluation of postpartum hemorrhage. PURPOSE: To investigate the value of MRI-based radiomics analysis in predicting postpartum hemorrhage among pregnant women with placenta previa. MATERIAL AND METHODS: Preoperative T2-weighted MRI and related clinical data of 371 patients were retrospectively collected, and these patients were randomly allocated into two subsets: the training dataset (n = 260) and the validation dataset (n = 111). The logistic regression (LR) classifier was used for the development of the radiomics model and the calculation of the radiomics score (Radscore). RESULTS: A total of eight radiomics features and five clinical features were selected for model development. The area under the receiver operating characteristic curve (AUC) of the radiomics model in the training and validation datasets were 0.929 (95% confidence interval [CI] = 0.891-0.957) and 0.914 (95% CI = 0.846-0.959), respectively. Combined with clinical factors, nomograms demonstrated improved diagnostic efficacy, with an AUC of 0.968 (95% CI = 0.939-0.986) in the training dataset and 0.947 (95% CI = 0.888-0.981) in the validation dataset. CONCLUSION: The MRI-based model has certain value in predicting postpartum hemorrhage in pregnant women with placenta previa.

Diagnostic Accuracy and Interobserver Agreement of PI-RADS Version 2 and Version 2.1 for the Detection of Transition Zone Prostate Cancers.

BACKGROUND. PI-RADS version 2.1 (v2.1) introduced a number of key changes to the assessment of transition zone (TZ) lesions. OBJECTIVE. The purpose of this study was to evaluate interobserver agreement and diagnostic accuracy for detecting TZ prostate cancer (PCa) and clinically significant PCa (csPCa) by use of PI-RADS v2 and PI-RADS v2.1 among radiologists with different levels of experience. METHODS. This retrospective study included 355 biopsy-naïve patients who from January 2017 to March 2020 underwent prostate MRI that showed a TZ lesion and underwent subsequent biopsy. PCa was diagnosed in 93 patients (International Society of Urological Pathology [ISUP] grade group 1, n = 34; ISUP grade group ≥ 2, n = 59) and non-cancerous lesions in 262 patients. Five radiologists with varying experience in prostate MRI scored lesions using PI-RADS v2 and PI-RADS v2.1 in sessions separated by at least 4 weeks. Interobserver agreement was evaluated with kappa and Kendall W statistics. ROC curve analysis was used to evaluate performance in detection of TZ PCa and csPCa. RESULTS. Interobserver agreement among all readers was higher for PI-RADS v2.1 than for PI-RADS v2 (mean weighted κ = 0.700 vs 0.622; Kendall W = 0.805 vs 0.728; p = .03). The pooled AUC values for detecting TZ PCa and csPCa were higher among all readers using PI-RADS v2.1 (0.866 vs 0.827 for TZ PCa; 0.929 vs 0.899 for TZ csPCa; p < .001). For detecting TZ PCa, the pooled sensitivity, specificity, and accuracy were 86.9%, 79.4%, and 75.4% among all readers for PI-RADS v2.1 compared with 79.4%, 71.8%, and 73.8% for PI-RADS v2. For detecting TZ csPCa, the pooled sensitivity, specificity, and accuracy were 84.8%, 90.9%, and 89.9% among all readers for PI-RADS v2.1 compared with 81.4%, 89.9%, and 88.5% for PI-RADS v2. Reader 1, who had the least experience, had the lowest sensitivity, specificity, and accuracy (78.0%, 89.2%, and 87.3%). Reader 5, who had the most experience, had the highest sensitivity, specificity, and accuracy (88.1%, 92.9%, and 92.1%) in detecting csPCa. CONCLUSION. PI-RADS v2.1 had better interobserver agreement and diagnostic accuracy than PI-RADS v2 for evaluating TZ lesions. Reader experience continues to affect the performance of prostate MRI interpretation with PI-RADS v2.1. CLINICAL IMPACT. PI-RADS v2.1 is more accurate and reproducible than PI-RADS v2 for the diagnosis of TZ PCa.

Association Between Small Vessel Disease Markers, Medial Temporal Lobe Atrophy and Cognitive Impairment After Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVES: Two-thirds of stroke survivors suffer from cognitive impairment, and up to one-third of them progress to dementia. However, the underlying pathogenesis is complex and controversial. Recent evidence has found that cerebral small vessel disease (SVD) markers and the Alzheimer's disease (AD) neuroimaging marker medial temporal lobe atrophy (MTLA), alone or in combination, contribute to the pathogenesis of poststroke cognitive impairment (PSCI). In the present systematic review and meta-analysis, we synthesized proof for these neuroimaging risk factors among stroke patients. MATERIALS AND METHODS: PUBMED, MEDLINE, EMBASE and the Cochrane Library were searched for studies investigating imaging predictors of cognitive impairment or dementia following stroke. Meta-analysis was conducted to compute the odds ratios (ORs). RESULTS: Thirteen studies were enrolled in the present study, and only ten of them, comprising 2713 stroke patients, were eligible for inclusion in the meta-analysis. MTLA was significantly correlated with PSCI (OR = 1.97, 95% CI: 1.48-2.62, I2 = 0.0%). In addition, white matter hyperintensities (WMH), as a neuroimaging marker of SVD, were associated with PSCI (OR = 1.17, 95% CI: 1.12-1.22, I2 = 0.0%). However, the presence of lacunar infarcts and enlarged perivascular spaces (EPVS) were not associated with the risk of PSCI. CONCLUSIONS: The findings of the present study suggest that MTLA and WMH were associated with an increased risk of PSCI.

Iron deposition in Parkinson's disease by quantitative susceptibility mapping.

BACKGROUND: Patients with Parkinson's disease (PD) have elevated levels of brain iron, especially in the nigrostriatal dopaminergic system. The purpose of this study was to evaluate the iron deposition in the substantia nigra (SN) and other deep gray matter nuclei of PD patients using quantitative susceptibility mapping (QSM) and its clinical relationship, and to explore whether there is a gradient of iron deposition pattern in globus pallidus (GP)-fascicula nigrale (FN)-SN pathway. METHODS: Thirty-three PD patients and 26 age- and sex-matched healthy volunteers (HVs) were included in this study. Subjects underwent brain MRI and constructed QSM data. The differences in iron accumulation in the deep gray matter nuclei of the subjects were compared, including the PD group and the control group, the early-stage PD (EPD) group and the late-stage PD (LPD) group. The iron deposition pattern of the GP-FN-SN pathway was analyzed. RESULTS: The PD group showed increased susceptibility values in the FN, substantia nigra pars compacta (SNc), internal globus pallidus (GPi), red nucleus (RN), putamen and caudate nucleus compared with the HV group (P < 0.05). In both PD and HV group, iron deposition along the GP-FN-SN pathway did not show an increasing gradient pattern. The SNc, substantia nigra pars reticulata (SNr) and RN showed significantly increased susceptibility values in the LPD patients compared with the EPD patients. CONCLUSION: PD is closely related to iron deposition in the SNc. The condition of PD patients is related to the SNc and the SNr. There is not an increasing iron deposition gradient along the GP-FN-SN pathway. The source and mechanism of iron deposition in the SN need to be further explored, as does the relationship between the iron deposition in the RN and PD.

Neutrophils-mediated bioinspired nanoagents for noninvasive monitoring of inflammatory recruitment dynamics and navigating phototherapy in rheumatoid arthritis.

Neutrophils play a crucial role in inflammatory immune responses, but their in vivo homing to inflammatory lesions remains unclear, hampering precise treatment options. In this study, we employed a biomineralization-inspired multimodal nanoagent to label neutrophils, enabling noninvasive monitoring of the dynamic process of inflammatory recruitment and guiding photothermal therapy in rheumatoid arthritis. Our nanoagents allowed visualization of neutrophil fate through magnetic resonance imaging, photoacoustic imaging, and fluorescence imaging in the first and second near-infrared windows. Histopathology and immunofluorescence analysis revealed pronounced inflammatory cell infiltration in rheumatoid arthritis compared to the normal limb. Furthermore, the recruitment quantity of neutrophils positively correlated with the inflammatory stage. Additionally, the inherent photothermal effect of the nanoagents efficiently ablated inflammatory cells during the optimal homing time and inflammatory phase. This neutrophil imaging-guided photothermal therapy precisely targeted inflammatory nuclei in rheumatoid arthritis and downregulated pro-inflammatory cytokines in serum. These results demonstrate that in vivo tracking of inflammatory immune response cells can significantly optimize the treatment of inflammatory diseases, including rheumatoid arthritis.

Comparison between open reduction and internal fixation and minimally invasive surgery in management of Sanders type II calcaneal fracture: A randomized controlled trial protocol.

BACKGROUND: The minimally invasive surgery possesses an essential and growing function in treating the calcaneal fractures, but the related literature on this topic is limited. For our study, the main purpose was to compare the early prognosis of a group of the patients with Sanders type II fracture of calcaneus treated via minimally invasive surgery and open reduction and internal fixation (ORIF). METHODS: This is a prospective randomized controlled trial in the patients who suffer from displaced intra-articular calcaneal fractures. This current study was carried out in accordance with the guidelines of "CONSORT statement" for the randomized controlled studies. All patients were randomly assigned into 2 groups on the basis of a random number table, namely the minimally invasive treatment group and the ORIF group using conventional methods. Inclusion criteria included the followings: aged between 18 to 59 years old; closed and unilateral fracture; patients with displaced intra-articular calcaneal fracture (>2 mm) involving Sanders Type IIC and Type IIB; and patients have enough mental capacity to understand and answer questions in the evaluation scale. In the process of outpatient follow-up, the radiographs were taken at 1, 3, 6, and 12 months. The functional results involved the American Orthopaedic Foot and Ankle Score, Foot Function Index, and the pain score. CONCLUSIONS: This protocol will give us research directions in future work. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6261).

Efficacy of autologous platelet-rich plasma use for arthroscopic meniscal repair: A randomized trial protocol.

BACKGROUND: Meniscus tear is one of the most familiar orthopedic injury, and it is also the leading cause of the dysfunction of knee joint. Recent efforts to improve the success rate of the meniscus repair surgery involve the addition of platelet-rich plasma (PRP). The aim of our experiment is to assess the clinical effects of arthroscopic repair of meniscal tears without or with PRP. METHODS: This is a randomized and parallel-group superiority study. The study protocol is approved through the review committee of the corresponding institutions in PLA Army 80th Group Military Hospital. All patients will provide written informed consent to participate in the study. We implement our investigation on the basis of the ethical standards outlined in the Helsinki Declaration of 1964 and then report our outcomes according to the CONSORT statement of 2010. All the patients follow a same rehabilitation program. Patients are assessed at baseline (day before operation), 12 months and 24 months after the last time of injection; outcome assessments involve Ikeuchi score, Lysholm score, and the visual analogue scales for failure and pain rate. P value less than .05 indicates that there is statistical significance. RESULTS: We suppose that arthroscopic PRP repair of meniscus tears results in improved pain and functional results owing to the release of bioactive molecules that may affect the healing of meniscus. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6175).

Bone-Seeking Albumin-Nanomedicine for In Vivo Imaging and Therapeutic Monitoring.

Malignant osteolysis associated with irreversible primary bone tumors and bone metastases remains a clinically urgent problem. Exploiting the imaging and therapy function of flexible nanomedicine can provide an alternative for therapeutic navigation and monitoring of malignant osteolysis. Here, we report the development of albumin-based gadolinium oxide nanoparticles loaded with doxorubicin and conjugated with bone-seeking alendronate for targeted delivery and therapeutic monitoring. Compared with nontargeted nanomedicine, bone-seeking accumulation and retention can be proven by MRI in a rat model of focal malignant osteolysis. Meanwhile, we observed a whole-body distribution in the consecutive SPECT imaging after radiolabeling with 125I, SPECT imaging also indicated the enhanced bone tumor accumulation and prolonged retention. Resulting from the high drug loading and 131I labeling efficiency, the targeted nanomedicine exhibited significant chemotherapy and inter-radiotherapy capacity. Ultimately, the tumor burden of rats was obviously decreased except for the nontargeted group and the empty carrier group. In vivo CT imaging and pathological analysis revealed that the combined therapy was an efficient measure for antiosteolysis. Our findings suggest that albumin-based nanomedicine can provide a platform for bone-seeking diagnosis and therapeutic monitoring.

Synthesis of micro-mesoporous ZSM-5 zeolite with microcrystalline cellulose as co-template and catalytic cracking of polyolefin plastics.

Micro-mesoporous ZSM-5 with different Si/Al ratios (MZ-X, X = 27, 80, 150) were synthesized by adding microcrystalline cellulose (MCC) as co-template into the hydrothermal synthesis process of zeolites. The resultant ZSM-5 were used for catalytic cracking of high density polyethylene (HPDE) and polypropylene. It was found that introduction of MCC significantly enhanced the formation of mesopores and strong acid sites. MZ-27 achieved the highest oil yield: 21.5% for HPDE and 32.1% for polypropylene, and the light aromatics (BTEX) selectivity therein were 87.6% and 79.7%, respectively. HZ-150 (MCC-free ZSM-5, Si/Al = 150) achieved the highest gas yield: 85.4% for HDPE and 76.7% for polypropylene, and the light olefins (C[double bond, length as m-dash] 2-4) selectivity therein were 44% and 48.3%, respectively. The dense acidic sites and mesoporous structure of MZ-27 were responsible for its better activity for producing aromatic products. The moderate acidity and microporous structure of HZ-150 were helpful for producing light olefins from catalytic cracking of polyolefin plastics.

Biparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with "gray zone" PSA levels.

PURPOSE: To predict clinically significant prostate cancer (cs-PCa) by combining the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score based on biparametric magnetic resonance imaging (bp-MRI) and clinical indicators in men with prostate-specific antigen (PSA) levels in the gray zone of 4-10 ng/mL. METHOD: We retrospectively analyzed 364 patients with elevated PSA levels in the gray zone who had pathologically confirmed disease and had undergone MRI examinations from January 2015 to October 2019; a training group (n = 255) and validation group (n = 109) were randomly established. Multivariate logistic regression analysis of the training group was performed to identify the independent predictors for cs-PCa, thereby establishing a predictive model that was evaluated in the training and validation groups by analyzing the receiver operating characteristic (ROC) curve. RESULTS: In the training group, the PI-RADS v2 score and prostate volume (PV) were independent predictors of cs-PCa (P < 0.05). The prediction model comprising the PI-RADS v2 score and PV had a larger AUC than the other predictors alone in the training group. The diagnostic sensitivity and specificity of the prediction model were 84.1 % and 83.4 %, respectively. The prediction model was indicated to have better predictive performance in the validation group. CONCLUSIONS: The prediction model exhibits a satisfactory predictive value for cs-PCa in men with PSA levels in the gray zone. PI-RADS v2 is the strongest univariate predictor for the detection of cs-PCa in men with PSA in the gray zone, but combining this with the PV can provide superior predictive ability.

[Effectiveness of Tang's arthroscopy approach for anterior and posterior ankle impingement syndrome].

OBJECTIVE: To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. METHODS: Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang's arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups ( P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement. RESULTS: Median operation time of group A was 50.5 minutes ï¼»95%CI (49.3, 54.6)ï¼½, which was significantly shorter than that of group B ï¼»88.5 minutes, 95%CI (76.5, 92.8)ï¼½ (Z=-4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups ( t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ 2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The median subjective satisfaction score of group A was 2.0 ï¼»95%(1.4, 1.7)ï¼½, which was better than that of group B ï¼»2.0, 95%(1.6, 2.2)ï¼½ ( Z=-2.480, P=0.013). CONCLUSION: Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang's approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.

Microbial transformation of artemisinin by Aspergillus terreus.

BACKGROUND: Artemisinin (1) and its derivatives are now being widely used as antimalarial drugs, and they also exhibited good antitumor activities. So there has been much interest in the structural modification of artemisinin and its derivatives because of their effective bioactivities. The microbial transformation is a promising route to obtain artemisinin derivatives. The present study focuses on the microbial transformation of artemisinin by Aspergillus terreus. RESULTS: During 6 days at 28 °C and 180 rpm, Aspergillus terreus transformed artemisinin to two products. They were identified as 1-deoxyartemisinin (2) and 4α-hydroxy-1-deoxyartemisinin (3) on the basis of their spectroscopic data. CONCLUSIONS: The microbial transformation of artemisinin by Aspergillus terreus was investigated, and two products (1-deoxyartemisinin and 4α-hydroxy-1-deoxyartemisinin) were obtained. This study is the first to report on the microbial transformation of artemisinin by Aspergillus terreus.