The value of CT radiomics combined with deep transfer learning in predicting the nature of gallbladder polypoid lesions.

BACKGROUND: Computed tomography (CT) radiomics combined with deep transfer learning was used to identify cholesterol and adenomatous gallbladder polyps that have not been well evaluated before surgery. PURPOSE: To investigate the potential of various machine learning models, incorporating radiomics and deep transfer learning, in predicting the nature of cholesterol and adenomatous gallbladder polyps. MATERIAL AND METHODS: A retrospective analysis was conducted on clinical and imaging data from 100 patients with cholesterol or adenomatous polyps confirmed by surgery and pathology at our hospital between September 2015 and February 2023. Preoperative contrast-enhanced CT radiomics combined with deep learning features were utilized, and t-tests and least absolute shrinkage and selection operator (LASSO) cross-validation were employed for feature selection. Subsequently, 11 machine learning algorithms were utilized to construct prediction models, and the area under the ROC curve (AUC), accuracy, and F1 measure were used to assess model performance, which was validated in a validation group. RESULTS: The Logistic algorithm demonstrated the most effective prediction in identifying polyp properties based on 10 radiomics combined with deep learning features, achieving the highest AUC (0.85 in the validation group, 95% confidence interval = 0.68-1.0). In addition, the accuracy (0.83 in the validation group) and F1 measure (0.76 in the validation group) also indicated strong performance. CONCLUSION: The machine learning radiomics combined with deep learning model based on enhanced CT proves valuable in predicting the characteristics of cholesterol and adenomatous gallbladder polyps. This approach provides a more reliable basis for preoperative diagnosis and treatment of these conditions.

Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results.

BACKGROUND: Liver metastasis (LIM) is the most common distant site of metastasis in small intestinal stromal tumors (SISTs). The aim of this study was to determine the risk and prognostic factors associated with LIM in patients with SISTs. METHODS: Patients diagnosed with gastrointestinal stromal tumors between 2010 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression models, as well as a Cox regression model were used to explore the risk factors associated with the development and prognosis of LIM. Additionally, the overall survival (OS) of patients with LIM was analyzed using the Kaplan-Meier method. Furthermore, a predictive nomogram was constructed, and the model's performance was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: A total of 1582 eligible patients with SISTs were included, among whom 146 (9.2%) were diagnosed with LIM. Poor tumor grade, absence of surgery, later T-stage, and no chemotherapy were associated with an increased risk of developing LIM. The nomogram prediction model achieved an AUC of 0.810, 95% Confidence Interval (CI) 0.773-0.846, indicating good performance, and the calibration curve showed excellent accuracy in predicting LIM. The OS rate of patients with LIM was significantly lower than that of patients without LIM (p < 0.001). CONCLUSIONS: Patients with SISTs who are at high risk of developing LIM deserve more attention during follow-up, as LIM can significantly affect patient prognosis. The nomogram demonstrated good calibration and discrimination for predicting LIM.

Comparable prognosis of early gastric cancer between intestinal type and diffuse type in patients of age 75 and older: a SEER-based cohort study.

Background: The prognostic significance of Lauren's classification in elderly early gastric cancer (EGC) patients remains largely unknown. We aim to investigate the characteristics and clinical implications of Lauren's classification in elderly EGC patients. Methods: Patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database based on the inclusion and exclusion criteria. Univariate and multivariate Cox regression, propensity score matching, inverse-probability-weighted analysis, and propensity-score adjustment were utilized to evaluate the association between Lauren's classification and cancer-specific survival (CSS) in elderly EGC patients. Stratification and interaction analyses were used to reveal the effects of confounding factors on the association between Lauren's classification and CSS. Results: The diffuse type (median, 41.0 months) showed a similar survival (37.0 months), and was mainly distributed in female group (62.5% vs. 42.2%) with poorly differentiated or undifferentiated components (89.1% vs. 27.0%) compared with intestinal type in elderly EGC patients. Analyses of univariate and multivariate Cox regression, propensity score matching, inverse-probability-weighted analysis, and propensity-score adjustment showed that Lauren's classification was not significantly CSS in elderly EGC patients (P>0.05). Subgroup and interaction analyses confirmed the stability of the results. Conclusions: Diffuse type was mainly distributed in female patients with more poorly differentiated/undifferentiated components and similar prognosis compared with intestinal type in age 75 and older EGC patients. No significant association was observed between diffuse type and CSS of the elderly EGC patients.

Association between albumin-corrected anion gap and in-hospital mortality of intensive care patients with trauma: A retrospective study based on MIMIC-â ¢ and â £ databases.

BACKGROUND: To investigate the correlation between albumin-corrected anion gap(ACAG) within the first 24 hours of admission and in-hospital mortality in trauma patients in intensive care unit(ICU). MATERIALS AND METHODS: We utilized the MIMIC-Ⅲ and MIMIC-Ⅳ databases to examine trauma patients admitted to the ICU. The relationship between ACAG and in-hospital mortality in trauma patients was analyzed using Receiver Operating Characteristic(ROC) curve, Kaplan-Meier (K-M) survival curve, and Cox regression model. Propensity score matching (PSM) and subgroup analysis were conducted to enhance stability and reliability of the findings. Mortality at 30-day and 90-day served as secondary outcomes. RESULTS: The study enrolled a total of 1038 patients. The AUC for ACAG (0.701, 95%CI: 0.652-0.749) was notably higher than that for anion gap and albumin. The Log-rank test revealed that the optimal cut-off point of ACAG for predicting in-hospital mortality was determined to be 20.375mmol/L. The multivariate Cox regression analysis demonstrated an independent association between high ACAG level and a higher risk of in-hospital mortality (HR = 3.128, 95% CI: 1.615-6.059). After PSM analysis, a matched cohort consisting of 291 subjects was obtained. We found no signifcant interaction in most stratas. Finally, The in-hospital, 30-day, and 90-day survival rates in the high ACAG group exhibited a statistically decrease compared to those in the low ACAG group both pre- and post-matching. CONCLUSION: The elevated level of ACAG was found to be independently associated with increased in-hospital mortality among trauma patients in the ICU.

New technique for the endoscopic removal of long foreign bodies.

Removing long foreign bodies (LFBs) is a challenge due to the risk of perforation is high, especially in anatomically narrow or acute angulations areas. Here we report a new technique for removing LFBs under endoscope.

Endoscopic observation of a rare duodenal tumor.

A 30-year-old young previously healthy man presented to our hospital with middle and upper abdominal discomfort. Abdominal computerized tomography (CT) showed no significant abnormalities. White light endoscopy showed the local mucosa in the descending part of the duodenum had granuloid uplift, some of which were fused into pieces with red color, and some other areas showed fading tone. Magnifying endoscopy with indigo-carmine staining and narrow-band imaging showed a finger-like, loose villous structure with irregular microvessels on the surface. Pathological examination of biopsy specimens showed that lymphocytes were diffused and dispersed in the mucosa with relatively simple morphology, no lymphoid follicles were observed, and local compression was obvious. Immunohistochemical staining revealed a lymphoid population highly positive for CD20 and CD10. These results were consistent with duodenal-type follicular lymphoma (D-FL).

Calcifying fibrous tumor and pathological analysis.

A 55-year-old male presented to our outpatient department with complaints of upper abdominal dull pain. Gastroscopy revealed a submucosal eminence at the greater curvature of the gastric body, with smooth surface mucosa, and biopsy pathology indicated inflammation. Physical examination showed no obvious abnormalities, and laboratory results were within the normal range. Computerized tomography (CT) showed thickening of the gastric body. Endoscopic submucosal dissection (ESD) was performed,and representative photomicrographs of histologic sections were shown.

New technique for the endoscopic removal of long foreign bodies

Removing long foreign bodies (LFBs) is a challenge due to the risk of perforation is high, especially in anatomically narrow or acute angulations areas. Here we report a new technique for removing LFBs under endoscope. (AU)

Calcifying fibrous tumor and pathological analysis

A 55-year-old male presented to our outpatient department with complaints of upper abdominal dull pain. Gastroscopy revealed a submucosal eminence at the greater curvature of the gastric body, with smooth surface mucosa, and biopsy pathology indicated inflammation. Physical examination showed no obvious abnormalities, and laboratory results were within the normal range. Computerized tomography (CT) showed thickening of the gastric body. Endoscopic submucosal dissection (ESD) was performed,and representative photomicrographs of histologic sections were shown. (AU)

Endoscopic observation of a rare duodenal tumor

A 30-year-old young previously healthy man presented to our hospital with middle and upper abdominal discomfort. Abdominal computerized tomography (CT) showed no significant abnormalities. White light endoscopy showed the local mucosa in the descending part of the duodenum had granuloid uplift, some of which were fused into pieces with red color, and some other areas showed fading tone. Magnifying endoscopy with indigo-carmine staining and narrow-band imaging showed a finger-like, loose villous structure with irregular microvessels on the surface. Pathological examination of biopsy specimens showed that lymphocytes were diffused and dispersed in the mucosa with relatively simple morphology, no lymphoid follicles were observed, and local compression was obvious. Immunohistochemical staining revealed a lymphoid population highly positive for CD20 and CD10. These results were consistent with duodenal-type follicular lymphoma (D-FL). (AU)

Hemorrhagic fever with renal syndrome and reversible splenial lesion syndrome.

Hemorrhagic fever with renal syndrome (HFRS) and reversible splenial lesion syndrome are both considered uncommon conditions relatively rare. Fever, hemorrhage, and acute kidney injury are the prevailing symptoms frequently observed in cases of HFRS. We describe a case of a middle-aged man who had been hospitalized with fever and acute neurological symptoms. His main symptom was recurrent dizziness. Cranial computed tomography (CT) did not reveal any obvious lesions, such as encephalorrhagia or infarctions. The splenium of corpus callosum showed hyperintensity on brain magnetic resonance imaging (MRI), which is in line with the characteristic radiographic observations of reversible splenial lesion syndrome (RESLES). Further analyses revealed that the patient's platelet counts had decreased to 7×109/L while hemorrhagic fever antibodies were positive. Eventually, the patient was diagnosed with HFRS and exhibited clinical improvements after active treatment.

Solid food dysphagia caused by aortic arch malformation compressing esophagus.

A 66-year-old woman presented to our hospital with a long history of solid food dysphagia. Gastroscopy revealed that esophagus was distorted and slightly narrow in the middle section. High-resolution esophageal manometry testing was used to assess the esophageal motor function. We tried to insert the manometric catheter into the patient's stomach, but found that when the patient swallowed, the picture presented an up-down symmetry phenomenon, and the esophageal peristalsis lost its normal slope. Therefore, we believed that the manometer catheter folded back cephalad at her upper esophagus, demonstrating a strange appearance of a curly manometry catheter. Subsequently, a barium esophagram was performed and revealed that there was a stenosis in the middle of the esophagus, and the narrowest of which was about 2cm in diameter. We reviewed the computed tomography and found the aortic arch of the patient was compressing on her esophagus, causing local lumen stenosis.

Sustained silence of tiny signet ring cell carcinoma.

A 47-year-old man developed recurrent bloating. First gastroscopy showed there was a fading lesion about 0.5cm in size near the anterior wall of the large curve of the junction of the gastric antrum and the edge was red, and the biopsy pathology showed signet ring cell carcinoma (SRC). Subsequently, he went to other hospital for endoscopic submucosal dissection (ESD). However, postoperative pathology indicated inflammation. After 6 months, gastroscopy showed that the lesion size was similar to that of the first time, the fading was obvious, and no redness was observed. Another year later, the lesion size was not significantly changed from these before. Weak amplification of Narrow Band Imaging (NBI) showed slight dilatation of the glandular duct, mainly fading, no redness, and the biopsy was still SRC. Finally, he received a second ESD, and the postoperative pathology was consistent with that of our results.