Shoulder MRI-based radiomics for diagnosis and severity staging assessment of surgically treated supraspinatus tendon tears.

OBJECTIVE: To develop and validate MRI-based radiomics models capable of evaluating supraspinatus tendon tears within the shoulder joints by using arthroscopy as the reference standard. METHODS: A total of 432 patients (332 in the training set and 100 in the external validation set) with intact supraspinatus tendon (n = 202) and supraspinatus tendon tear (n = 230, 130 full-thickness tears and 100 partial-thickness tears) were enrolled. Radiomics features were extracted from fat-saturated T2-weighted coronal images. Two radiomics signature models for detecting supraspinatus tendon abnormalities (tear or not), and stage lesion severity (full- or partial-thickness tear) and radiomics scores (Rad-score), were constructed and calculated using multivariate logistic regression analysis. The diagnostic performance of the two models was validated using ROC curves on the training and validation datasets. RESULTS: For the radiomics model of no tears or tears, thirteen features from MR images were used to build the radiomics signature with an AUC value of 0.98 in the training set, 0.97 in the internal validation set, and 0.98 in the external validation set. For the radiomics model of full- or partial-thickness tears, thirteen features from MR images were used to build the radiomics signature with an AUC value of 0.79 in the training set, 0.69 in the internal validation set, and 0.77 in the external validation set. CONCLUSION: The proposed radiomics models in this study can accurately rule out supraspinatus tendon tears and are capable of assessing the severity staging of tears with moderate accuracy based on shoulder MR images. KEY POINTS: • The radiomics model of no tears or tears achieved a high overall accuracy of 93.6%, sensitivity of 91.6%, and specificity of 95.2% for supraspinatus tendon tears. • The radiomics model of full- or partial-thickness tears displayed moderate performance with an accuracy of 76.4%, a sensitivity of 79.2%, and a specificity of 74.3% for supraspinatus tendon tears severity staging.

A computed tomography-based radiomics signature for predicting expression of programmed death ligand 1 in head and neck squamous cell carcinoma.

OBJECTIVES: Accurate prediction of the expression of programmed death ligand 1 (PD-L1) in head and neck squamous cell carcinoma (HNSCC) before immunotherapy is crucial. This study was performed to construct and validate a contrast-enhanced computed tomography (CECT)-based radiomics signature to predict the expression of PD-L1 in HNSCC. METHODS: In total, 157 patients with confirmed HNSCC who underwent CECT scans and immunohistochemical examination of tumor PD-L1 expression were enrolled in this study. The patients were divided into a training set (n = 104; 62 PD-L1-positive and 42 PD-L1-negative) and an external validation set (n = 53; 34 PD-L1-positive and 19 PD-L1-negative). A radiomics signature was constructed from radiomics features extracted from the CECT images, and a radiomics score was calculated. Performance of the radiomics signature was assessed using receiver operating characteristics analysis. RESULTS: Nine features were finally selected to construct the radiomics signature. The performance of the radiomics signature to distinguish between a PD-L1-positive and PD-L1-negative status in both the training and validation sets was good, with an area under the receiver operating characteristics curve of 0.852 and 0.802 for the training and validation sets, respectively. CONCLUSIONS: A CECT-based radiomics signature was constructed to predict the expression of PD-L1 in HNSCC. This model showed favorable predictive efficacy and might be useful for identifying patients with HNSCC who can benefit from anti-PD-L1 immunotherapy. KEY POINTS: • Accurate prediction of the expression of PD-L1 in HNSCC before immunotherapy is crucial. • A CECT-based radiomics signature showed favorable predictive efficacy in estimation of the PD-L1 expression status in patients with HNSCC.

Skeletal muscle index and muscle attenuation with liver cirrhosis as survival prognosticators by sex.

BACKGROUND AND OBJECTIVES: It has been proven that skeletal muscle index (SMI) and muscle attenuation (MA) are correlated with outcomes in liver cirrhosis. However, whether there are sex differences in these factors re-mains unknown. We aimed to analyze the predictive ability of SMI and MA for the prognosis of cirrhotic patients of different sexes and promote computed tomography (CT) use in body composition assessment. METHODS AND STUDY DESIGN: CT images taken at the 3rd lumbar vertebra from 223 patients were quantified for body composi-tion. A Cox regression model was used to assess associations between mortality and body composition. Time-dependent receiver operating characteristic curves were calculated to evaluate the predictive ability of SMI and MA for the 1-, 3- and 5- year mortality of cirrhotic patients. RESULTS: The majority of patients with liver cirrhosis were male (64.6%), and there was a weak linear correlation between SMI and MA in males (r=0.33, p<0.001). In the sex stratified multivariate Cox regression analysis, SMI in males (HR=0.95; 95% CI, 0.91-0.98; p=0.002) and MA in females (HR=0.91; 95% CI, 0.87-0.96; p<0.001) were independently associated with mortality. The areas under the curve (AUCs) of SMI (AUC=0.718) and MA (AUC=0.705) were similar in the 5-year mortality predic-tion of males, while in females, MA (AUC=0.797) had a stronger predictive ability than SMI (AUC=0.541). CONCLUSIONS: SMI in males and MA in females are independent prognostic factors for liver cirrhosis. For females, MA may be a more sensitive indicator of mortality prediction than SMI, while in males, they are equivalent.

MRI-Based radiomics nomogram for differentiation of benign and malignant lesions of the parotid gland.

OBJECTIVES: Preoperative differentiation between benign parotid gland tumors (BPGT) and malignant parotid gland tumors (MPGT) is important for treatment decisions. The purpose of this study was to develop and validate an MRI-based radiomics nomogram for the preoperative differentiation of BPGT from MPGT. METHODS: A total of 115 patients (80 in training set and 35 in external validation set) with BPGT (n = 60) or MPGT (n = 55) were enrolled. Radiomics features were extracted from T1-weighted and fat-saturated T2-weighted images. A radiomics signature model and a radiomics score (Rad-score) were constructed and calculated. A clinical-factors model was built based on demographics and MRI findings. A radiomics nomogram model combining the Rad-score and independent clinical factors was constructed using multivariate logistic regression analysis. The diagnostic performance of the three models was evaluated and validated using ROC curves on the training and validation datasets. RESULTS: Seventeen features from MR images were used to build the radiomics signature. The radiomics nomogram incorporating the clinical factors and radiomics signature had an AUC value of 0.952 in the training set and 0.938 in the validation set. Decision curve analysis showed that the nomogram outperformed the clinical-factors model in terms of clinical usefulness. CONCLUSIONS: The above-described radiomics nomogram performed well for differentiating BPGT from MPGT, and may help in the clinical decision-making process. KEY POINTS: • Differential diagnosis between BPGT and MPGT is rather difficult by conventional imaging modalities. • A radiomics nomogram integrated with the radiomics signature, clinical data, and MRI features facilitates differentiation of BPGT from MPGT with improved diagnostic efficacy.

Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis.

PURPOSE: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. MATERIALS AND METHODS: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). RESULTS: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P < 0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: -0.40 to -0.21; P < 0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). CONCLUSIONS: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.

LncRNA-SNHG29 inhibits vascular smooth muscle cell calcification by downregulating miR-200b-3p to activate the α-Klotho/FGFR1/FGF23 axis.

BACKGROUND: Vascular calcification (VC) is characterized by mineral accumulation on the walls of arteries and veins, which is a pathological process commonly found in elderly individuals and patients with atherosclerosis, hypertension, and diabetes. Emerging evidence suggests that long non-coding RNAs (lncRNAs) play an important role in VC. However, the role of SNHG29 is less clear. METHODS: The expression of SNHG29, miR-200b-3p, α-Klotho, FGFR1 and FGF23 in vascular smooth muscle cells (VSMCs) was quantified by qRT-PCR and western blot assays. ß-GP was used to construct an in vitro calcification model, followed by MTT assay to detect cell viability. Calcification was determined by alizarin red S staining and quantified by calcification assay. ALP activity was investigated by ALP staining. The interactions among SNHG29, miR-200b-3p and α-Klotho were verified by luciferase assay. RESULTS: In the in vitro calcification model, SNHG29 was downregulated, while miR-200b-3p was upregulated. SNHG29 overexpression and miR-200b-3p knockdown significantly suppressed osteoblast-related factors (RUNX2 and BMP2), accompanied by activation of the α-Klotho/FGFR1/FGF23 axis, further inhibiting the formation of calcified nodules. Moreover, miR-200b-3p overexpression and α-Klotho knockdown reversed the SNHG29 overexpression-induced inhibitory effects on calcified VSMCs. CONCLUSION: Our study is the first to demonstrate that SNHG29 could inhibit VSMC calcification by downregulating miR-200b-3p to activate the α-Klotho/FGFR1/FGF23 axis, suggesting SNHG29 as a novel therapeutic target for VC-associated diseases.

Long Non-Coding RNA NEAT1 Regulates Pyroptosis in Diabetic Nephropathy via Mediating the miR-34c/NLRP3 Axis.

INTRODUCTION: Diabetic nephropathy (DN) is a serious complication of diabetes mellitus and is considered to be a sterile inflammatory disease. Increasing evidence suggest that pyroptosis and subsequent inflammatory response play a key role in the pathogenesis of DN. However, the underlying cellular and molecular mechanisms responsible for pyroptosis in DN are largely unknown. METHODS: The rat models of DN were successfully established by single 65 mg/kg streptozotocin treatment. Glomerular mesangial cells were exposed to 30 mmol/L high glucose media for 48 h to mimic the DN environment in vitro. Gene and protein expressions were determined by quantitative real-time PCR and Western blot. Cell viability and pyroptosis were measured by MTT assay and flow cytometry analysis, respectively. The relationship between lncRNA NEAT1, miR-34c, and Nod-like receptor protein-3 (NLRP3) was confirmed by luciferase reporter assay. RESULTS: We found that upregulation of NEAT1 was associated with the increase of pyroptosis in DN models. miR-34c, as a target gene of NEAT1, mediated the effect of NEAT1 on pyroptosis in DN by regulating the expression of NLRP3 as well as the expressions of caspase-1 and interleukin-1ß. Either miR-34c inhibition or NLRP3 overexpression could reverse the accentuation of pyroptosis and inflammation by sh-NEAT1 transfection in the in vitro model of DN. CONCLUSIONS: Our findings suggested NEAT1 and its target gene miR-34c regulated cell pyroptosis via mediating NLRP3 in DN, providing new insights into understanding the molecular mechanisms of pyroptosis in the pathogenesis of DN.

Development of the human fetal hippocampal formation during early second trimester.

Development of the fetal hippocampal formation has been difficult to fully describe because of rapid changes in its shape during the fetal period. The aims of this study were to: (1) segment the fetal hippocampal formation using 7.0 T MR images from 41 specimens with gestational ages ranging from 14 to 22 weeks and (2) reveal the developmental course of the fetal hippocampal formation using volume and shape analyses. Differences in hemispheric volume were observed, with the right hippocampi being larger than the left. Absolute volume changes showed a linear increase, while relative volume changes demonstrated an inverted-U shape trend during this period. Together these exhibited a variable developmental rate among different regions of the fetal brain. Different sub-regional growth of the fetal hippocampal formation was specifically observed using shape analysis. The fetal hippocampal formation possessed a prominent medial-lateral bidirectional shape growth pattern during its rotation process. Our results provide additional insight into 3D hippocampal morphology in the assessment of fetal brain development and can be used as a reference for future hippocampal studies.

Increasing breadth of the frontal lobe but decreasing height of the human brain between two Chinese samples from a Neolithic site and from living humans.

Morphological observation and measurements of endocasts have played a vital role in research on the evolution of the human brain. However, endocasts have never been used to investigate how the human brain has evolved since the Neolithic period. We investigated the evolution of the human brain during the Holocene by comparing virtual endocasts from Beiqian site (a Neolithic Chinese site) and a sample of Chinese modern-day humans. Standardized measurements and indices were taken to provide quantification of the overall endocast shape, including the length, breadth, height, frontal breadth, and the ratio of frontal breadth to breadth, as well as the cranial capacity. We found that the height of the endocasts and cranial capacity have decreased between our two samples, whereas the frontal breadth and sexual dimorphism have increased. We argue that these changes can be caused by random genetic mutation and epigenetic change in response to changes in the environment.

Ulcerative colitis and nephrotic syndrome: a two-sample Mendelian randomization study.

To investigate the potential causal relationship between ulcerative colitis and nephrotic syndrome. We obtained the whole-genome association study data of ulcerative colitis in the European population from the GWAS database. Relevant single nucleotide polymorphisms (SNPs) were selected for analysis. We employed the inverse variance-weighted meta-analysis of multiplicative random effects models to obtain SNP-specific Wald ratio estimates, which assume horizontal pleiotropy. In addition, we performed sensitivity analyses using MR-Egger, weighted median, and IVW. Our findings suggest a strong association between ulcerative colitis and nephrotic syndrome (P < 0.05). After conducting sensitivity analyses, we found no evidence of horizontal pleiotropy or heterogeneity (P > 0.05). This study provides evidence for an association between ulcerative colitis and nephrotic syndrome, which may help us better understand the conditions of ulcerative colitis and nephropathy.

Adolescent Takayasu's arteritis with hypertensive intracerebral hemorrhage: a case report and literature review.

Takayasu's arteritis is a primary systemic vasculitis that affects predominantly large vessels, affecting the aorta and its major branches. We report a case of adolescent female patient who initially experienced numbness and weakness in her limbs, subsequently developing severe hypertension. Physical examination revealed uneven blood pressure in the limbs and a murmur in the auscultation area of the abdominal aorta without decreased pulses. Auxiliary examinations revealed diffuse blood vessel stenosis, leading to the diagnosis of Takayasu's arteritis. One month later, the patient was diagnosed with multiple cerebral hemorrhages following sudden impairment of limb movement. Digital subtraction angiography did not reveal any evident vascular malformations or aneurysms. Following surgery and biologic intervention with tocilizumab, the patient's condition improved, with no new bleeding episodes and stable blood pressure control achieved. We also reviewed the literature that have been previously reported with hypertensive intracerebral hemorrhage complicated by Takayasu's arteritis. We recommend that Takayasu's arteritis be taken into account when considering the hypertension in young patients. Timely vascular imaging and standardized treatment are imperative for diagnosing and managing effectively.

Spatial-temporal atlas of human fetal brain development during the early second trimester.

During the second trimester, the human fetal brain undergoes numerous changes that lead to substantial variation in the neonatal in terms of its morphology and tissue types. As fetal MRI is more and more widely used for studying the human brain development during this period, a spatiotemporal atlas becomes necessary for characterizing the dynamic structural changes. In this study, 34 postmortem human fetal brains with gestational ages ranging from 15 to 22 weeks were scanned using 7.0 T MR. We used automated morphometrics, tensor-based morphometry and surface modeling techniques to analyze the data. Spatiotemporal atlases of each week and the overall atlas covering the whole period with high resolution and contrast were created. These atlases were used for the analysis of age-specific shape changes during this period, including development of the cerebral wall, lateral ventricles, Sylvian fissure, and growth direction based on local surface measurements. Our findings indicate that growth of the subplate zone is especially striking and is the main cause for the lamination pattern changes. Changes in the cortex around Sylvian fissure demonstrate that cortical growth may be one of the mechanisms for gyration. Surface deformation mapping, revealed by local shape analysis, indicates that there is global anterior-posterior growth pattern, with frontal and temporal lobes developing relatively quickly during this period. Our results are valuable for understanding the normal brain development trajectories and anatomical characteristics. These week-by-week fetal brain atlases can be used as reference in in vivo studies, and may facilitate the quantification of fetal brain development across space and time.

A CT-based radiomics signature for preoperative discrimination between high and low expression of programmed death ligand 1 in head and neck squamous cell carcinoma.

PURPOSE: Accurate prediction of the expression level of programmed death ligand 1 (PD-L1) in head and neck squamous cell carcinoma (HNSCC) is crucial before immunotherapy. The purpose of this study was to construct and validate a contrast-enhanced computed tomography (CECT)-based radiomics signature to discriminate between high and low expression status of PD-L1. METHODS: A total of 179 HNSCC patients who underwent immunohistochemical examination of tumor PD-L1 expression at one of two centers were enrolled in this study and divided into a training set (n = 122; 55 high PD-L1 expression and 67 low PD-L1 expression) and an external validation set (n = 57; 26 high PD-L1 expression and 31 low PD-L1 expression). The least absolute shrinkage and selection operator method was used to select the key features for a CECT-image-based radiomics signature. The performance of the radiomics signature was assessed using receiver operating characteristics analysis. RESULTS: Six features were finally selected to construct the radiomics signature. The performance of the radiomics signature in the discrimination between high and low PD-L1 expression status was good in both the training and validation sets, with areas under the receiver operating characteristics curve of 0.889 and 0.834 for the training and validation sets, respectively. CONCLUSIONS: The constructed CECT-based radiomics signature model showed favorable performance for discriminating between high and low PD-L1 expression status in HNSCC patients. It may be useful for screening out those patients with HNSCC who can best benefit from anti-PD-L1 immunotherapy.

Reference values of glomerular filtration rate for healthy adults in southern China: a cross-sectional survey.

BACKGROUND: Currently the global data on the glomerular filtration rate of healthy adults are insufficient, with relatively little data for other races and countries. Especially in China, there are no such figures. METHODS: In this cross-sectional study, we included healthy Han adults in southern China. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples collected. Serum creatinine was measured and used to estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae. The normal range of eGFR is described, and the influence of gender and age on eGFR is analyzed by the statistical method. RESULTS: We provided the largest sample size of eGFR research in China at present. The mean age of the 20,930 healthy individuals was 40.9 ± 12.3 years, 58.8% were women. The eGFRMDRD for women and men were 111.3 ± 17.4 mL/min per 1.73 m2 and 103.3 ± 15.9 mL/min per 1.73 m2, respectively. The eGFRCKD-EPI for women and men were 110.3 ± 12.1 mL/min per 1.73 m2 and 103.8 ± 13.3 mL/min per 1.73 m2, respectively. The eGFRMDRD of women and men in all age groups decreased continuously by 7.3 ml/min/1.73 m2/decade and 4.4 ml/min/1.73 m2/decade, respectively. The eGFRCKD-EPI of women and men in all age groups decreased continuously by 8.4 ml/min/1.73 m2/decade and 6.9 ml/min/1.73 m2/decade. CONCLUSIONS: The eGFR of women is higher than men and with the increasing age, the eGFR of women declines faster than men.

The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: a systematic review and meta-analysis.

PURPOSE: Several studies have shown that cystatin C levels can be used to detect decline in renal function in cancer patients receiving chemotherapy, and can serve as a supplement to creatinine level measurement for early detection of renal insufficiency. Nevertheless, use of the parameter remains controversial. This study aimed to assess the value of serum cystatin C levels in evaluation of early renal insufficiency due to chemotherapy. METHODS: Studies were retrieved from PubMed, Ovid Embase, the Web of Science, the Cochrane Library, Ovid, and the CNKI databases up to May 15, 2018. Serum levels of cystatin C before and after chemotherapy were evaluated for its ability to assess renal function. RESULTS: A total of 12 studies, including 1775 participants, met our inclusion and exclusion criteria. Pooled analysis revealed that the levels of serum cystatin C in cancer patients after chemotherapy were significantly higher than those of patients prior to treatment [standard mean difference (SMD) = 0.54, 95% CI 0.34-0.74, P = 0.0000]. Compared to creatinine, serum cystatin C increased significantly in the early phases of glomerular filtration rate (GFR) change before and after chemotherapy (GFR ≥ 90 ml/min/1.73 m2, P < 0.05 vs. P > 0.05, 5.83%; 60 < GFR < 90 ml/min/1.73 m2, P < 0.01 vs. P > 0.01, 38.83%) and increased more substantially in the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01 vs. P < 0.01, 70.87% vs. 23.09%). However, creatinine decreased even in the early phases and did not increase in an obvious manner until the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01, 23.09%). The GFR values were derived from measured methods. CONCLUSIONS: Cystatin C may be superior to creatinine for the detection of minor changes in GFR in early stages of renal insufficiency secondary to chemotherapy. More studies are needed to further verify this result.

Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis

ABSTRACT Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.

Early development of the fetal central sulcus on 7.0T magnetic resonance imaging.

In the previous studies, the criterion for deciding the occurrence time of the fetal central sulcus (CS) on magnetic resonance imaging (MRI) is based on the observation by the eyes. There have been no existing quantitative standards or numerical criteria in this field. In this study, we reconstructed the three-dimension (3D) images of the fetal brain based on the 7.0T MR images of 45 Chinese fetal specimens from the 11 to 22 weeks of gestational age (GA). Then we obtained data by measuring the maximum depth and length of the CS so as to analyze the early developmental pattern of it. These measures, especially CS depth, can be used to quantitatively determine the time of emergence of the fetal CS during the development. Statistics show that there are no gender or interhemispheric asymmetries of the CS from GA of 11 to 22 weeks.