Robotic-assisted radical resection versus open surgery for cholangiocarcinoma: a systematic review and meta-analysis.

To compare the clinical efficacy and safety of robot-assisted resection and open surgery for cholangiocarcinoma (CCA). We conducted a comprehensive search of PubMed, the Cochrane Library, and Embase databases for studies comparing treatment for CCA, covering the period from database inception to January 30, 2024. Two researchers will independently screen literature and extract data, followed by meta-analysis using Review Manager 5.3 software. A total of 5 articles with 513 patients were finally included. Among them, 231 in the robotic group, and 282 in the open group. The Meta-analysis revealed that the robotic group had a significant advantage in terms of intraoperative blood loss (MD = - 101.44, 95% CI - 135.73 to - 67.15, P < 0.05), lymph node harvest(MD = 1.03, 95% CI 0.30- 1.76, P < 0.05) and length of hospital stay(MD = - 1.92, 95% CI - 2.87 to- 0.97, P < 0.05). However, there were no statistically significant differences between the two groups in terms of transfusion rate (OR = 0.62, 95% CI 0.31-1.23, P > 0.05), R0 resection (OR = 1.49, 95% CI 0.89- 2.50, P > 0.05), 30-day mortality (OR = 1.68, 95% CI 0.43-6.65, P > 0.05) and complications (OR = 0.76, 95% CI 0.30- 1.95, P > 0.05). Robotic-assisted radical resection for CCA is feasible and safe, and its long-term efficacy and oncological outcomes need to be confirmed by further studies.

Ganoderma lucidum Polysaccharide Supplementation Significantly Activates T-Cell-Mediated Antitumor Immunity and Enhances Anti-PD-1 Immunotherapy Efficacy in Colorectal Cancer.

Ganoderma lucidum polysaccharide (GLP) is a prebiotic with immunomodulatory effects. However, the therapeutic potential of GLP in tumor immunotherapy has not been fully explored, especially in T cell-mediated antitumor immunity. In this study, we found that GLP significantly inhibited tumor growth and activated antitumor immunity in colorectal cancer (CRC). In the spleens and tumor tissues, the proportion of cytotoxic CD8+T cells and Th1 helper cells increased, while immunosuppressive Tregs decreased. Additionally, microbiota dysbiosis was alleviated by GLP, and short-chain fatty acid production was increased. Meanwhile, GLP decreased the ratio of kynurenine and tryptophan (Kyn/Trp) in the serum, which contributed to antitumor immunity of T cells. More importantly, the combination of GLP and the immune checkpoint inhibitor anti-PD-1 monoclonal antibody further enhanced the efficacy of anti-PD-1 immunotherapy. Thus, GLP as a prebiotic has the potential to be used in tumor immunotherapy.

Isolation, Bioactivity, and Molecular Docking of a Rare Gastrodin Isocitrate and Diverse Parishin Derivatives from Gastrodia elata Blume.

Gastrodia elata Blume (G. elata) is a well-known medicine food homology plant widely used in treating neurological disorders such as Alzheimer's disease (AD). Here, undiscovered gastrodin derivatives were systematically studied. Seven novel gastrodin derivatives (1-7), including a unique gastrodin isocitrate (1) and six differently substituted parishin derivatives (2-7), were isolated. Structural identification was mainly based on 1D and 2D NMR data, high-resolution ESI-MS data, and HPLC analysis. Notably, the stereochemistry of 1 was further elucidated by ECD calculations. Compounds 1 and 6 showed neuroprotective effects on the H2O2-induced PC12 cell injury model. Molecular docking analysis exhibited that 1 and 6 had good affinities with three popular AD-related targets. These findings not only enriched the chemical diversity but also revealed potential active components in G. elata.

A 58-Year-Old Woman with Acute Torsion of the Small Bowel Due to Diffuse Intestinal Lipomatosis.

BACKGROUND Diffuse intestinal lipomatosis is a rare condition that infiltrates mature fatty tissue into the intestinal submucosa and subserosa of the small or large intestine and can present with intestinal obstruction or torsion. This report is of the case of a 58-year-old woman who had acute torsion of the small bowel due to diffuse small intestinal lipomatosis. CASE REPORT A 58-year-old woman, who was otherwise in good health, arrived at our Emergency Department experiencing sudden, intense pain in the lower abdomen. She also reported abdominal swelling, feelings of nausea, vomiting, and reduced ability to defecate for at least 2 days. The next morning, contrast-enhanced abdominal computed tomography (CT) scan was performed, showing diffuse thickening of the small intestinal wall with hypodensity, fatty density, lumen narrowing, and wall thinning. The small intestine demonstrated a whirlpool-like distribution in the lower right abdomen and localized thickening of the small intestinal wall, suggesting acute intestinal torsion. An hour later, an emergency operation was performed to remove part of the small intestine. Three days later, pathological results showed a thin intestinal wall, expansion of the mucosal layer and submucosa, and hyperplasia of adipose tissue. CONCLUSIONS This report presents a rare case of torsion and small bowel obstruction caused by diffuse intestinal lipomatosis and focuses on the abdominal enhanced CT scan, which showed diffuse thickening of the small intestine, with multiple areas of fat density and torsion of the small intestine in the right lower abdomen. Histopathology is also presented, with the result showing intestinal lipomatosis.

Comparing robotic and open surgical techniques in gallbladder cancer management: a detailed systematic review and meta-analysis.

This meta-analysis aims to evaluate the safety and oncological outcomes of robotic surgery compared to open surgery in treating gallbladder cancer (GBC). In October 2023, we performed a literature search across major global databases such as PubMed, Embase, and the Cochrane Library. We employed a Review Manager for parameter comparisons. This study has been registered with PROSPERO under the identifier CRD42023476686. Our final meta-analysis incorporated 5 cohort studies, encompassing a total of 353 patients. Compared to the Open Group (OG), the Robotic Group (RG) had reduced intraoperative blood loss (WMD - 217.72 ml, 95% CI - 371.08 to - 64.35; p = 0.005), shorter hospital stay (WMD - 1.80 days, 95% CI - 2.66 to - 0.95; p < 0.0001), and fewer overall complications (OR 0.31, 95% CI 0.10-0.97; p = 0.04). However, there was no significant difference between the two groups in terms of operation duration, postoperative inpatient days, readmission rate, major complications, 1-year postoperative survival, 2-year postoperative survival, and mortality rates. In our study, we found that for patients with gallbladder cancer, robotic radical cholecystectomy offers certain potential advantages over open radical cholecystectomy. This suggests that robotic radical cholecystectomy might be the optimal choice for treating gallbladder cancer. However, further validation from high-quality randomized clinical trials is required.

The radiological characteristics, tertiary lymphoid structures, and survival status associated with EGFR mutation in patients with subsolid nodules like stage I-II LUAD.

BACKGROUND: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) recommended for the patients with subsolid nodule in early lung cancer stage is not routinely. The clinical value and impact in patients with EGFR mutation on survival outcomes is further needed to be elucidated to decide whether the application of EGFR-TKIs was appropriate in early lung adenocarcinoma (LUAD) stage appearing as subsolid nodules. MATERIALS AND METHODS: The inclusion of patients exhibiting clinical staging of IA-IIB subsolid nodules. Clinical information, computed tomography (CT) features before surgical resection and pathological characteristics including tertiary lymphoid structures of the tumors were recorded for further exploration of correlation with EGFR mutation and prognosis. RESULTS: Finally, 325 patients were enrolled into this study, with an average age of 56.8 ± 9.8 years. There are 173 patients (53.2%) harboring EGFR mutation. Logistic regression model analysis showed that female (OR = 1.944, p = 0.015), mix ground glass nodule (OR = 2.071, p = 0.003, bubble-like lucency (OR = 1.991, p = 0.003) were significant risk factors of EGFR mutations. Additionally, EGFR mutations were negatively correlated with TLS presence and density. Prognosis analysis showed that the presence of TLS was associated with better recurrence-free survival (RFS)(p = 0.03) while EGFR mutations were associated with worse RFS(p = 0.01). The RFS in patients with TLS was considerably excel those without TLS within EGFR wild type group(p = 0.018). Multivariate analyses confirmed that EGFR mutation was an independent prognostic predictor for RFS (HR = 3.205, p = 0.037). CONCLUSIONS: In early-phase LUADs, subsolid nodules with EGFR mutation had specific clinical and radiological signatures. EGFR mutation was associated with worse survival outcomes and negatively correlated with TLS, which might weaken the positive impact of TLS on prognosis. Highly attention should be paid to the use of EGFR-TKI for further treatment as agents in early LUAD patients who carrying EGFR mutation.

Structural characterization, molecular dynamic simulation, and conformational visualization of a water-soluble glucan with high molecular weight from Gastrodia elata Blume.

Polysaccharides have been widely used in the development of natural drugs and health food. However, polysaccharide characterization lags due to inherently complicated features and the limitations of existing detection approaches. We aimed to provide new insight into the fine structure and conformational visualization of polysaccharides from Gastrodia elata Blume, a medicinal and edible plant. A water-soluble polysaccharide (GEP2-6) with the high molecular weight of 2.7 × 106 Da was first obtained, and its purity reached 99.2 %. Chemical and spectroscopic analyses jointly revealed that GEP2-6 was a glucan linked by α-(1 â†’ 4) and α-(1 â†’ 6) glycosidic bonds. After enzymolysis, the local structure of GEP2-6 included α-1,4-Glcp, α-1,6-Glcp, α-1,4,6-Glcp, and α-1-Glcp at a molar ratio of 31.27∶1.32∶1.08∶0.93. The glycosidic linkage pattern of repeating units was further simulated by a glycan database and spatial examination software. The good dissolution performance was interpreted by dynamics simulation and practical molecular characteristics. Spherical flexible chains and the porous stable conformation were corroborated using atomic force microscopy. In addition, GEP2-6 could effectively scavenge DPPH and hydroxyl radicals as a promising natural antioxidant. These efforts will contribute to the expansion of clinical applications of this G. elata polysaccharide and the structural elucidation for macromolecular polysaccharides combined with traditional and modern analysis techniques.

SwinHR: Hemodynamic-powered hierarchical vision transformer for breast tumor segmentation.

Accurate and automated segmentation of breast tumors in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) plays a critical role in computer-aided diagnosis and treatment of breast cancer. However, this task is challenging, due to random variation in tumor sizes, shapes, appearances, and blurred boundaries of tumors caused by inherent heterogeneity of breast cancer. Moreover, the presence of ill-posed artifacts in DCE-MRI further complicate the process of tumor region annotation. To address the challenges above, we propose a scheme (named SwinHR) integrating prior DCE-MRI knowledge and temporal-spatial information of breast tumors. The prior DCE-MRI knowledge refers to hemodynamic information extracted from multiple DCE-MRI phases, which can provide pharmacokinetics information to describe metabolic changes of the tumor cells over the scanning time. The Swin Transformer with hierarchical re-parameterization large kernel architecture (H-RLK) can capture long-range dependencies within DCE-MRI while maintaining computational efficiency by a shifted window-based self-attention mechanism. The use of H-RLK can extract high-level features with a wider receptive field, which can make the model capture contextual information at different levels of abstraction. Extensive experiments are conducted in large-scale datasets to validate the effectiveness of our proposed SwinHR scheme, demonstrating its superiority over recent state-of-the-art segmentation methods. Also, a subgroup analysis split by MRI scanners, field strength, and tumor size is conducted to verify its generalization. The source code is released on (https://github.com/GDPHMediaLab/SwinHR).

Acetylcholine muscarinic M1 receptors in the rodent prefrontal cortex modulate cognitive abilities to establish social hierarchy.

In most social species, the attainment of social dominance is strongly affected by personality traits. Dominant individuals show better cognitive abilities, however, whether an individual's cognition can determine its social status has remained inconclusive. We found that mice show better cognitive abilities tend to possess a higher social rank after cohousing. The dynamic release of acetylcholine (ACh) in the prelimbic cortex (PL) is correlated with mouse dominance behavior. ACh enhanced the excitability of the PL neurons via acetylcholine muscarinic M1 receptors (M1). Inhibition of M1 impaired mice cognitive performance and induced losing in social competition. Mice with M1 deficiency in the PL performed worse on cognitive behavioral tests, and exhibited lower status when re-grouped with others. Elevating ACh level in the PL of subordinate mice induced winning. These results provide direct evidence for the involvement of M1 in social hierarchy and suggest that social rank can be tuned by altering cognition through cholinergic system.

Clinical efficacy of "Sancai therapy" for hyperplasia of the mammary glands: A systematic review and meta-analysis.

BACKGROUND: Hyperplasia of the mammary glands (HMG) is the most prevalent breast disease and can become malignant if left untreated. Although "Sancai therapy" has been widely used to treat HMG, its efficacy has not yet been systematically reviewed. This study aims to systematically evaluate the clinical efficacy of Sancai therapy for HMG treatment and provide a clinical basis for its future use. METHODS: PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, CBM, VIP, and Wanfang databases were reviewed for related data collection. Chinese and English databases were searched for randomized controlled trials on Sancai therapy for HMG. The retrieval date was February 27, 2023. Exclusion criteria: (1) Non-HMG patients; (2) case reports, literature reviews, animal experiments, systematic reviews; and (3) full text could not be obtained. Data obtained after literature screening were imported into the RevMan 5.4.1 software for meta-analysis, and the included literature was assessed for methodological quality using the "bias risk assessment" tool within the software. RESULTS: The meta-analysis included 11 studies. Compared to the control group, the Sancai therapy treatment group exhibited an overall increased efficacy (relative risk = 1.36, 95% confidence interval [CI] [1.18, 1.58], P < .0001), an increased cure rate (relative risk = 3.74, 95% CI [1.70, 8.25], P = .001), a significant improvement in breast pain (standard mean difference = -2.68, 95% CI [-3.41, -1.96], P < .00001), and a reduction in breast masses (standard mean difference = -2.87, 95% CI [-3.75, -1.99], P < .00001). CONCLUSION: Sancai therapy significantly improved the overall efficacy, cure rate, and breast pain and reduced breast mass compared with the control groups. However, further large-sample, high-quality, double-blind randomized controlled trials are required to increase the level of evidence. PROTOCOL REGISTRATION NUMBER: INPLASY202380124.

Bibliometric and Visualized Analysis of Global Evolution of Research in Lung Ultrasound: A Rapidly Developing Field.

BACKGROUND: Lung ultrasound (LUS) is gaining recognition as an indispensable diagnostic tool in critical care. OBJECTIVE: The study aimed to characterize the global research landscape and trend of LUS with quantification and visualization approaches. METHODS: Documents related to LUS published between 2007 and 2023 were selected from the Web of Science Core Collection and identified. Visualization and statistical analysis were conducted with the VOSviewer 1.6.18, CiteSpace 5.7.R5, and Bibliometrix 4.1.0 Package, including analysis of the trend of global publications, prominent countries, active institutions, and funding agencies, key authors and journals, co-cited references, and keywords. RESULTS: A total of 3010 publications, including 2434 articles and 576 reviews, were retrieved. The output of LUS-related research has increased steadily over the years, especially after 2018. Italy (n=756; 25.12%) has shown the highest output, being the country with the highest total citations (23423 times). The most influential author was Gargani Luna with 52 documents, who worked at the Consiglio Nazionale delle Ricerche. Chest and Intensive Care Medicine with high citations and impact factor scores were the most influential journals. Besides "lung ultrasonography", the keywords developed included "coronavirus disease 2019 (COVID-19)", "acute respiratory distress syndrome", and "acute heart failure". CONCLUSION: Research output on LUS has increased steadily, especially after 2018. Italy and the United States are staying ahead in this field. Research collaboration still needs to be strengthened. This comprehensive analysis has presented the global research landscape and trends of LUS-related research, providing valuable information for researchers to pursue further exploration.

Nonlinear relationship between dietary calcium and magnesium intake and peripheral neuropathy in the general population of the United States.

Background: Calcium and magnesium are essential minerals that have significant roles in nerve function and regulation. There may be a correlation between dietary calcium and magnesium intake and peripheral neuropathy. However, this relationship remains unclear and requires further study. Methods: Data from 7,726 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004 were analyzed in this study. The relationship between total dietary calcium and magnesium intake, as well as each quantile, and peripheral neuropathy was analyzed using a multifactor logistic regression model. To illustrate the dose-response relationship between calcium and magnesium intake and peripheral neuropathy, we utilized a restricted cubic spline (RCS) plot. Results: Our analysis found a positive correlation between dietary intake of calcium and magnesium and peripheral neuropathy (calcium: OR 1.000, 95% CI 1.000-1.000; magnesium: OR 1.001, 95% CI 1.00-1.002). Participants in the first and third quantiles of dietary calcium intake had a significantly higher incidence of peripheral neuropathy than those in the second quantile (OR 1.333, 95% CI 1.034-1.719, OR 1.497, 95% CI 1.155-1.941). Those in the first and third quantiles of dietary magnesium intake also had a significantly higher incidence of peripheral neuropathy than those in the second quantile (OR 1.275, 95% CI 1.064-1.528, OR 1.525, 95% CI 1.231-1.890). The restricted cubic spline analysis revealed a U-shaped nonlinear relationship between dietary intake of calcium and magnesium and peripheral neuropathy. Conclusion: The study found a U-shaped non-linear relationship between dietary calcium and magnesium intake levels and peripheral neuropathy, indicating that both excessive and insufficient intake of calcium and magnesium can increase the incidence of peripheral neuropathy.

Theabrownin from Dark Tea Ameliorates Insulin Resistance via Attenuating Oxidative Stress and Modulating IRS-1/PI3K/Akt Pathway in HepG2 Cells.

Dark tea has great potential in regulating glycolipid metabolism, and theabrownin (TB) is considered to be the characteristic and bioactive constituent of dark tea. This study evaluated the ability of TB1 (fermented for 7 days) and TB2 (fermented for 14 days) isolated from dark tea to reverse insulin resistance (IR) in HepG2 cells. The results indicated that TB significantly ameliorated oxidative stress by improving mitochondrial function. In addition, TB improved glycogen synthesis and glucose consumption, and inhibited gluconeogenesis and fatty acid synthesis, by regulating GSK3ß (Glycogen synthase kinase 3ß), G6Pase (Glucose-6-phosphatase), GCK (Glucokinase), PEPCK1 (Phosphoenolpyruvate carboxy kinase 1), SREBP-1C (sterol regulatory element-binding protein 1C), FASN (fatty acid synthase), and ACC (Acetyl-CoA carboxylase). Additionally, the results of Western blot and real-time PCR experiments demonstrated that TB modulated glucolipid metabolism through the IRS-1 (Insulin receptor substrate 1)/PI3K (phosphatidylinositol-3 kinase)/Akt (protein kinase B) signaling pathway. Treatment with the PI3K inhibitor demonstrated a favorable correlation between PI3K activation and TB action on glycolipid metabolism. Notably, we observed that TB2 had a greater effect on improving insulin resistance compared with TB1, which, due to its prolonged fermentation time, increased the degree of oxidative polymerization of TB.

Possible Mechanisms of Dark Tea in Cancer Prevention and Management: A Comprehensive Review.

Tea is one of the most popular drinks in the world. Dark tea is a kind of post-fermented tea with unique sensory characteristics that is produced by the special fermentation of microorganisms. It contains many bioactive substances, such as tea polyphenols, theabrownin, tea polysaccharides, etc., which have been reported to be beneficial to human health. This paper reviewed the latest research on dark tea's potential in preventing and managing cancer, and the mechanisms mainly involved anti-oxidation, anti-inflammation, inhibiting cancer cell proliferation, inducing cancer cell apoptosis, inhibiting tumor metastasis, and regulating intestinal flora. The purpose of this review is to accumulate evidence on the anti-cancer effects of dark tea, the corresponding mechanisms and limitations of dark tea for cancer prevention and management, the future prospects, and demanding questions about dark tea's possible contributions as an anti-cancer adjuvant.

Association between dietary magnesium intake and peripheral arterial disease: Results from NHANES 1999-2004.

BACKGROUND: Magnesium has been found to have a strong association with peripheral arterial disease (PAD), and dietary magnesium intake shows promise as a predictor of the condition. However, the relationship between low dietary magnesium intake and an increased risk of PAD remains uncertain, and further research is needed to clarify this relationship. METHODS: This study analyzed data from 5969 participants in the National Health and Nutrition Examination Survey (NHANES) of the United States from 1999 to 2004. Multifactorial logistic regression models were used to investigate the association between dietary magnesium intake and PAD. RESULTS: Participants with PAD had lower dietary magnesium intake compared to those without PAD. After adjusting for all covariates, dietary magnesium intake remained negatively associated with PAD (OR: 0.999, 95% CI: 0.998, 1.000). When dietary magnesium intake was divided into quartiles, compared with the fourth quantile, the first quartile is associated with a higher incidence rate of PAD (OR: 1.560, 95%CI: 1.019, 2.386). Subgroup analysis revealed that the link between dietary magnesium intake and PAD remained significant among specific subgroups, including non-white, never or former smokers, and non-hypertensive, non-diabetic individuals (P < 0.05). CONCLUSION: Our study provides evidence that dietary magnesium intake is negatively associated with the incidence of PAD. Therefore, people with inadequate dietary magnesium intake, particularly those with excessively low intake, should increase their magnesium intake to reduce the risk of PAD.

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS: Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Depicting and predicting changes of lung after lobectomy for cancer by using CT images.

Lobectomy is an effective and well-established therapy for localized lung cancer. This study aimed to assess the lung and lobe change after lobectomy and predict the postoperative lung volume. The study included 135 lung cancer patients from two hospitals who underwent lobectomy (32, right upper lobectomy (RUL); 31, right middle lobectomy (RML); 24, right lower lobectomy (RLL); 26, left upper lobectomy (LUL); 22, left lower lobectomy (LLL)). We initially employ a convolutional neural network model (nnU-Net) for automatically segmenting pulmonary lobes. Subsequently, we assess the volume, effective lung volume (ELV), and attenuation distribution for each lobe as well as the entire lung, before and after lobectomy. Ultimately, we formulate a machine learning model, incorporating linear regression (LR) and multi-layer perceptron (MLP) methods, to predict the postoperative lung volume. Due to the physiological compensation, the decreased TLV is about 10.73%, 8.12%, 13.46%, 11.47%, and 12.03% for the RUL, RML, RLL, LUL, and LLL, respectively. The attenuation distribution in each lobe changed little for all types of lobectomy. LR and MLP models achieved a mean absolute percentage error of 9.8% and 14.2%, respectively. Radiological findings and a predictive model of postoperative lung volume might help plan the lobectomy and improve the prognosis.

Identification of polyunsaturated fatty acids as potential biomarkers of osteoarthritis after sodium hyaluronate and mesenchymal stem cell treatment through metabolomics.

Introduction: Osteoarthritis (OA) is a prevalent joint disorder worldwide. Sodium hyaluronate (SH) and mesenchymal stem cells (MSCs) are promising therapeutic strategies for OA. Previous studies showed they could improve knee function and clinical symptoms of OA. However, the mechanism of the therapeutic effects on the improvement of OA has not been clearly explained. Methods: In our study, we used a technique called 5-(diisopropylamino)amylamine derivatization liquid chromatography coupled with mass spectrometry to find the metabolites in OA synovial fluid under different treatments. Results and Discussion: After looking into the metabolomics, we discovered that SH and MSC treatment led to the downregulation of ω-6 polyunsaturated fatty acids (PUFAs) and the upregulation of ω-3 PUFAs. Significantly, the contents of 5(S)-HETE, PGA2, PGB2, and PGJ2 were lower in the MSC group than in the SH group after quantification using 5-(diisopropylamino)amylamine derivatization-UHPLC-QQQ-MS. This is the first report on the relationship of 11(S)-HETE, PGA2, PGB2, PGF2ß, 11ß-PGF2α, and DK-PGE2 with OA. Moreover, the correlation analysis of metabolites and inflammation factors showed the positive association of ω-6 PUFAs with pro-inflammation cytokines, and of ω-3 PUFAs with anti-inflammation cytokines. Our results indicated the therapeutic effect of SH and MSCs in patients with OA. In addition, this reliable metabolic approach could uncover novel biomarkers to treat OA.

Computed tomography (CT) characteristics and pathologic basis of ciliated muconodular papillary tumors of the lung.

Background: Ciliated muconodular papillary tumor (CMPT) is a rare pulmonary tumor with papillary architecture. Most studies have focused on the clinicopathological features of CMPT, while computed tomography (CT) characteristics have rarely been systematically described. Methods: A cohort of 27 patients with surgically resected CMPT were identified. Clinical and demographic features were recorded. Preoperative CT images of the CMPTs and the corresponding histopathological basis were also retrospectively analyzed. Results: All of the tumors appeared as solitary nodules. Pure ground glass, part-solid nodules and solid nodules were detected in 2/27 (7.4%), 17/27 (63.0%), and 8/27 (29.6%) patients, respectively. Twenty-one tumors (77.8%) were located in the lower lobe. The average tumor size was 1.21±0.74 (range, 0.44-3.46) cm. Eighteen (66.7%) of the 27 patients had tumors with well-defined margins and lobulated contours. Fifteen patients (55.6%) had air bronchograms in the tumor, and 19 patients (70.4%) had air-containing space. There were two patients whose tumor size was enlarged and accompanied by an increase in solid components, and one patient simply had an increase in tumor size at the preoperative follow-up duration. Notably, one patient with solid tumor components was finally diagnosed with CMPT accompanied by adenocarcinoma. Conclusions: CMPTs of the lung mostly manifest as solitary, lobulated, well-defined tumors with air-containing spaces on CT and often occur in the periphery of the pulmonary lower lobe. When CT findings meet these criteria, the possibility of CMPT should be considered. Additionally, CMPT can coexist with adenocarcinoma. Further investigation will contribute significantly to the biological properties of CMPT and its relationship to the potential for malignant transformation.

An efficient memory reserving-and-fading strategy for vector quantization based 3D brain segmentation and tumor extraction using an unsupervised deep learning network.

Deep learning networks are state-of-the-art approaches for 3D brain image segmentation, and the radiological characteristics extracted from tumors are of great significance for clinical diagnosis, treatment planning, and treatment outcome evaluation. However, two problems have been the hindering factors in brain image segmentation techniques. One is that deep learning networks require large amounts of manually annotated data. Another issue is the computational efficiency of 3D deep learning networks. In this study, we propose a vector quantization (VQ)-based 3D segmentation method that employs a novel unsupervised 3D deep embedding clustering (3D-DEC) network and an efficiency memory reserving-and-fading strategy. The VQ-based 3D-DEC network is trained on volume data in an unsupervised manner to avoid manual data annotation. The memory reserving-and-fading strategy beefs up model efficiency greatly. The designed methodology makes deep learning-based model feasible for biomedical image segmentation. The experiment is divided into two parts. First, we extensively evaluate the effectiveness and robustness of the proposed model on two authoritative MRI brain tumor databases (i.e., IBSR and BrainWeb). Second, we validate the model using real 3D brain tumor data collected from our institute for clinical practice significance. Results show that our method (without data manual annotation) has superior accuracy (0.74±0.04 Tanimoto coefficient on IBSR, 97.5% TP and 97.7% TN on BrainWeb, and 91% Dice, 88% sensitivity and 87% specificity on real brain data) and remarkable efficiency (speedup ratio is 18.72 on IBSR, 31.16 on BrainWeb, 31.00 on real brain data) compared to the state-of-the-art methods. The results show that our proposed model can address the lacks of manual annotations, and greatly increase computation speedup with competitive segmentation accuracy compared to other state-of-the-art 3D CNN models. Moreover, the proposed model can be used for tumor treatment follow-ups every 6 months, providing critical details for surgical and postoperative treatment by correctly extracting numerical radiomic features of tumors.