Regulator of G protein signaling 1 is a potential target in gastric cancer and impacts tumor-associated macrophages.

Regulator of G protein signaling 1 (RGS1) is closely associated with the tumor immune microenvironment and is highly expressed in various tumors and immune cells. The specific effects of RGS1 in the dynamic progression from chronic gastritis to gastric cancer have not been reported, and the role of tumor-associated macrophages (TAMs) is also unclear. In the present study, RGS1 was identified as an upregulated gene in different pathological stages ranging from chronic gastritis to gastric cancer by using Gene Expression Omnibus (GEO) screening together with pancancer analysis of The Cancer Genome Atlas and clinical prognostic analysis. The results indicated that RGS1 is highly expressed in gastric cancer and has potential prognostic value. We confirmed through in vivo experiments that RGS1 inhibited the proliferation of gastric cancer cells and promoted apoptosis, which was further corroborated by in vitro experiments. Additionally, RGS1 influenced cell migration and invasion. In our subsequent investigation of RGS1, we discovered its role in the immune response. Through analyses of single-cell and GEO database data, we confirmed its involvement in immune cell regulation, specifically TAM activation. Subsequently, we conducted in vivo and in vitro experiments to confirm the involvement of RGS1 in polarizing M1 macrophages while indirectly regulating M2 macrophages through tumor cells. In conclusion, RGS1 could be a potential target for the transformation of chronic gastritis into gastric cancer and has a measurable impact on TAMs, which warrants further in-depth research.

The frequency of imaging markers adjusted for time since symptom onset in intracerebral hemorrhage: A novel predictor for hematoma expansion.

BACKGROUND: Hematoma expansion (HE) is common in patients with intracerebral hemorrhage (ICH) and associated with a worse outcome. Imaging makers and shorter time from symptom onset are both associated with HE, but prognostic scores based on these parameters individually have not been satisfactory. We hypothesized that a score including both imaging markers of expansion, and time of onset, would improve prediction. METHODS: Patients with supratentorial ICH within 6 h after onset were consecutively recruited from six centers between January 2018 and August 2022. Three markers were used: hypodensities, the blend sign, and the island sign. We first defined frequency of imaging markers (FIM) as the relationship between the number of imaging markers and onset-to-CT time (OCT). The time-adjusted FIM was defined as the ratio of the number of imaging markers to the onset-to-initial imaging time. Multivariate analysis was performed to determine the relationship between FIM and HE. Receiver operating curve analysis was used to identify potential threshold values of FIM that optimally predict HE. In addition, the sensitivity, specificity, positive and negative predictive values (PPVs and NPVs), and the area under the curve (AUC) of the optimal cut-off in predicting HE were calculated. RESULTS: In total, 1488 patients were eligible for inclusion, of whom 418 had incident HE. Multivariate analysis showed that age, male sex, baseline Glasgow Coma Scale score, presence of intraventricular hemorrhage, and FIM were independent predictors of HE (odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.97-0.99; OR = 1.73, 95% CI = 1.28-2.35; OR = 0.87, 95% CI = 0.83-0.92; OR = 0.42, 95% CI = 0.28-0.62; OR = 7.82, 95% CI = 5.86-10.42, respectively). The optimal cut-off point for FIM in predicting HE was 0.63, with sensitivity, specificity, PPV, NPV, and AUC values of 0.69, 0.89, 0.71, 0.88, and 0.83, respectively. CONCLUSION: The FIM adjusted for time since symptom onset is a significant predictor of HE. Its use may allow improved prediction of those patients with ICH who develop HE, and the score may be clinically applicable in the management of patients with ICH.

Computed Tomography-Based Predictive Model for the Probability of Lymph Node Metastasis in Gastric Cancer: A Meta-analysis.

OBJECTIVES: Whether or not a gastric cancer (GC) patient exhibits lymph node metastasis (LNM) is critical to accurately guiding their treatment and prognostic evaluation, necessitating the ability to reliably predict preoperative LNM status. The present meta-analysis sought to examine the diagnostic value of computed tomography (CT)-based predictive models as a tool to gauge the preoperative LNM status of patients with GC. METHODS: Relevant articles were identified in the PubMed, Web of Science, and Wanfang databases. These studies were used to conduct pooled analyses examining sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) values, and area under the curve values were computed for summary receiver operating characteristic curves. RESULTS: The final meta-analysis incorporated data from 15 studies, all of which were conducted in China, enrolling 3,817 patients with GC (LNM+: 1790; LNM-: 2027). The developed CT-based predictive model exhibited respective pooled sensitivity, specificity, PLR, and NLR values of 84% (95% confidence interval [CI], 0.79-0.87), 81% (95% CI, 0.76-0.85), 4.39 (95% CI, 3.40-5.67), and 0.20 (95% CI, 0.16-0.26). The identified results were not associated with significant potential for publication bias ( P = 0.071). Similarly, CT-based analyses of LN status exhibited respective pooled sensitivity, specificity, PLR, and NLR values of 62% (95% CI, 0.53-0.70), 77% (95% CI, 0.72-0.81), 2.71 (95% CI, 2.20-3.33), and 0.49 (95% CI, 0.40-0.61), with no significant risk of publication bias ( P = 0.984). CONCLUSIONS: Overall, the present meta-analysis revealed that a CT-based predictive model may outperform CT-based analyses alone when assessing the preoperative LNM status of patients with GC, offering superior diagnostic utility.

Computed tomography-guided biopsy for sub-centimetre pulmonary nodules: a meta-analysis.

Introduction: Pulmonary nodules (PNs) with a diameter from 5 to 10 mm exhibit malignancy rates anywhere from 47.5 to 61.5%. Despite the potential danger posed by these lesions, their small size makes the biopsy of these sub-centimetre (≤ 10 mm) PNs under computed tomography (CT) guidance very difficult. Aim: A meta-analysis was performed with the goal of evaluating the safety and diagnostic utility of CT-guided biopsy procedures for sub-centimetre PNs. Material and methods: Relevant studies published through April 2023 were identified in the PubMed, Web of Science, and Wanfang databases and used to conduct pooled analyses of selected endpoints, including technical success, diagnostic yield, diagnostic accuracy, pulmonary haemorrhage, and pneumothorax rates. Results: In total, this meta-analysis incorporated 10 studies in which 1482 patients with sub-centimetre PNs underwent CT-guided biopsy procedures. Among these patients, the respective pooled rates of technical success, diagnostic yield, diagnostic accuracy, pulmonary haemorrhage, and pneumothorax were 90%, 60%, 91%, 11%, and 24%, and significant heterogeneity was detected for all of these endpoints (I2 = 93.6%, 96%, 76.9%, 80.8%, and 93.6%). A substantial difference in diagnostic accuracy was observed when comparing biopsy procedures performed using fine- and core-needle biopsy approaches (85% vs. 95%), whereas the use of the co-axial method or the selected guidance approach (conventional vs. cone-beam CT) had no impact on diagnostic accuracy. Needle type, guidance method, and co-axial method use had no impact on the rates of pulmonary haemorrhage or pneumothorax. Conclusions: CT-guided biopsy represents a safe and effective means of accurately diagnosing sub-centimetre PNs.

Radioactive stent insertion for inoperable hilar cholangiocarcinoma: a prospective randomized controlled trial.

Introduction: Hilar cholangiocarcinoma (HC) is the leading cause of hilar biliary obstruction. Radioactive stent insertion has been utilized extensively for inoperable HC patients. Aim: To assess the relative clinical outcomes of inoperable HC patients who underwent either normal or radioactive stent insertion. Material and methods: This single-center, prospective, randomized, open-label study enrolled 90 inoperable HC patients from April 2021 to March 2022 and randomly assigned them to normal or radioactive stent groups (n = 45/group), with clinical data then being compared between these groups. Results: Technical success rates in the normal and radioactive stent insertion groups were 93.3% and 97.9%, respectively (p = 1.000), and clinical success rates were similarly consistent in both groups (95.3% vs. 97.7%, p = 0.983). Individuals in the radioactive stent group exhibited significantly longer median stent patency as compared to the normal stent group (195 days vs. 115 days, p < 0.001), and median overall survival (OS) was also significantly increased in the normal stent group (242 days vs. 125 days, p = 0.002). In the normal stent insertion group, 6 (14.3%) and 5 (11.9%) patients experienced early and late postoperative complications, respectively. Additionally, early and late postoperative complications impacted 7 (16.3%) and 8 (18.6%) patients in the radioactive stent insertion group, respectively. Complication rates were comparable in these 2 patient groups. Conclusions: Radioactive stent insertion represents a safe and effective strategy for patients with inoperable HC, potentially contributing to prolonged stent patency and OS relative to normal stent insertion.

Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.

BACKGROUND: The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases by meta-analysis. METHODS: A computer-based search of PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journal Database (VIP) was conducted from the inception of the each database to April 2023. The searched literature was then screened according to strict inclusion and exclusion criteria. The critical data were extracted and analyzed using Review Manager software5.4.1. Pooled effects were calculated on the basis of data attributes by mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI). The Newcastle-Ottawa Scale was used to assess the quality of the studies. RESULTS: A total of 13 studies and 949 patients met the inclusion criteria for this meta-analysis, 445 in the UBE-LIF group and 504 in the MIS-TLIF group. UBE-TLIF was superior to MIS-TLIF in terms of intraoperative blood flow, postoperative drainage flow, duration of hospital stay, VAS score for low back pain and ODI score, but the operative time was longer than MIS-TLIF group. There were no significant differences between the two groups in terms of total complication rate, modified Macnab grading criteria, fusion rate, VAS score of leg pain, lumbar lordosis, intervertebral disk height. CONCLUSION: Both UBE-TLIF and MIS-TLIF are effective surgical modalities for the treatment of degenerative lumbar spine diseases. They have similar treatment outcomes, but UBE-TLIF has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, and faster recovery. TRIAL REGISTRATION: This study has been registered at INPLASY.COM (No. INPLASY202320087).

Clinical and magnetic resonance imaging features predict microvascular invasion in intrahepatic cholangiocarcinoma.

Introduction: Clinical features and magnetic resonance imaging (MRI)-related data are commonly employed in clinical settings and can be used to predict the microvascular invasion (MVI) status of intrahepatic cholangiocarcinoma (ICC) patients. Aim: To generate a clinical and MRI-based model capable of predicting the MVI status of ICC patients. Material and methods: Consecutive ICC patients evaluated from June 2015 to December 2018 were retrospectively enrolled in a training group to establish a predictive clinical MRI model. Consecutive ICC patients evaluated from January 2019 to June 2019 were prospectively enrolled in a validation group to test the reliability of this model. Results: In total, 143 patients were enrolled in the training group, of whom 46 (32.2%) and 96 (67.8%) were MVI-positive and MVI-negative, respectively. Logistics analyses revealed larger tumour size (p = 0.008) and intrahepatic duct dilatation (p = 0.01) to be predictive of MVI positivity, enabling the establishment of the following predictive model: -2.468 + 0.024 × tumour size + 1.094 × intrahepatic duct dilatation. The area under the receiver operating characteristic (ROC) curve (AUC) for this model was 0.738 (p < 0.001). An optimal cut-off value of -1.0184 was selected to maximize sensitivity (71.7%) and specificity (61.9%). When the data from the validation group were incorporated into the predictive model, the AUC value was 0.716 (p = 0.009). Conclusions: Both larger tumour size and intrahepatic duct dilatation were predictive of MVI positivity in patients diagnosed with ICC, and the predictive model developed based on these variables can offer quantitative guidance for assessing the risk of MVI.

Transcriptional level of inflammation markers associates with short-term brain structural changes in first-episode schizophrenia.

BACKGROUND: Inflammation has been implicated in the pathology of schizophrenia and may cause neuronal cell death and dendrite loss. Neuroimaging studies have highlighted longitudinal brain structural changes in patients with schizophrenia, yet it is unclear whether this is related to inflammation. We aim to address this question, by relating brain structural changes with the transcriptional profile of inflammation markers in the early stage of schizophrenia. METHODS: Thirty-eight patients with first-episode schizophrenia and 51 healthy controls were included. High-resolution T1-weighted magnetic resonance imaging (MRI) and clinical assessments were performed at baseline and 2 ~ 6 months follow-up for all subjects. Changes in the brain structure were analyzed using surface-based morphological analysis and correlated with the expression of immune cells-related gene sets of interest reported by previous reviews. Transcriptional data were retrieved from the Allen Human Brain Atlas. Furthermore, we examined the brain structural changes and peripheral inflammation markers in association with behavioral symptoms and cognitive functioning in patients. RESULTS: Patients exhibited accelerated cortical thickness decrease in the left frontal cortices, less decrease or an increase in the superior parietal lobule and right lateral occipital lobe, and increased volume in the bilateral pallidum, compared with controls. Changes in cortical thickness correlated with the transcriptional level of monocyte across cortical regions in patients (r = 0.54, p < 0.01), but not in controls (r = - 0.05, p = 0.76). In addition, cortical thickness change in the left superior parietal lobule positively correlated with changes in digital span-backward test scores in patients. CONCLUSIONS: Patients with schizophrenia exhibit regional-specific cortical thickness changes in the prefrontal and parietooccipital cortices, which is related to their cognitive impairment. Inflammation may be an important factor contributing to cortical thinning in first-episode schizophrenia. Our findings suggest that the immunity-brain-behavior association may play a crucial role in the pathogenesis of schizophrenia.

Differential expression of diacylglycerol kinase ζ is involved in inferior parietal lobule-related dysfunction in schizophrenia with cognitive impairments.

BACKGROUND: Cognitive impairment is the main factor in the poor prognosis of schizophrenia, but its mechanism remains unclear. The inferior parietal lobule (IPL) is related to various clinical symptoms and cognitive impairment in schizophrenia. We aimed to explore the relationship between IPL-related functions and cognitive impairment in schizophrenia. METHODS: 136 schizophrenia patients and 146 demographically matched healthy controls were enrolled for a cross-sectional study. High-spatial-resolution structural and resting-state functional images were acquired to demonstrate the alternations of brain structure and function. At the same time, the digit span and digit symbol coding tasks of the Chinese Wechsler Adult Intelligence Test Revised (WAIS-RC) were utilized in assessing the subjects' cognitive function. Patients were divided into cognitive impairment and normal cognitive groups according to their cognitive score and then compared whether there were differences between the three groups in fractional amplitude of low-frequency fluctuation (fALFF). In addition, we did a correlation analysis between cognitive function and the fALFF for the left IPL of patients and healthy controls. Based on the Allen Human Brain Atlas, we obtained genes expressed in the left IPL, which were then intersected with the transcriptome-wide association study results and differentially expressed genes in schizophrenia. RESULTS: Grouping of patients by the backward digit span task and the digit symbol coding task showed differences in fALFF values between healthy controls and cognitive impairment patients (P < 0.05). We found a negative correlation between the backward digit span task score and fALFF of the left IPL in healthy controls (r = - 0.388, P = 0.003), which was not seen in patients (r = 0.203, P = 0.020). In addition, none of the other analyses were statistically significant (P > 0.017). In addition, we found that diacylglycerol kinase ζ (DGKζ) is differentially expressed in the left IPL and associated with schizophrenia. CONCLUSION: Our study demonstrates that the left IPL plays a vital role in cognitive impairment in schizophrenia. DGKζ may act as an essential regulator in the left IPL of schizophrenia patients with cognitive impairment.

Image-guided radiofrequency ablation for adrenal metastatic tumors: a systematic review and meta-analysis.

PURPOSE: To evaluate the safety and clinical efficacy of image-guided radiofrequency ablation (RFA) in patients exhibiting adrenal metastatic tumors (AMTs). METHODS: The PubMed, Web of Science, and Wanfang databases were searched for relevant studies published as of November 2022, and study results were pooled for subsequent analysis. The endpoints of this meta-analysis included primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year overall survival (OS) rates. RESULTS: This analysis incorporated 11 studies enrolling 351 patients that underwent RFA treatment for 373 AMTs. The pooled primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year OS rates in these patients were 84%, 91%, 4%, 6%, 7%, 19%, 82%, and 46%, respectively. The 1-year OS (I2 = 75.2%, p = 0.003) and 3-year OS (I2 = 81.4%, p = 0.001) endpoints were subject to significant heterogeneity. Subgroup analyses suggested that primary technical success rates were < 80% in patients with tumors exhibiting a mean diameter ≥ 4 cm. Guidance type and tumor size had no impact on a hypertensive crisis or local recurrence rates. CONCLUSIONS: These data indicate that image-guided RFA represents a safe and effective means of treating AMTs.

Low-dose versus standard-dose computed tomography-guided biopsy for pulmonary nodules: a randomized controlled trial.

BACKGROUND: To assess relative safety and diagnostic performance of low- and standard-dose computed tomography (CT)-guided biopsy for pulmonary nodules (PNs). MATERIALS AND METHODS: This was a single-center prospective randomized controlled trial (RCT). From June 2020 to December 2020, consecutive patients with PNs were randomly assigned into low- or standard-dose groups. The primary outcome was diagnosis accuracy. The secondary outcomes included technical success, diagnostic yield, operation time, radiation dose, and biopsy-related complications. This RCT was registered on 3 January 2020 and listed within ClinicalTrials.gov (NCT04217655). RESULTS: Two hundred patients were randomly assigned to low-dose (n = 100) and standard-dose (n = 100) groups. All patients achieved the technical success of CT-guided biopsy and definite final diagnoses. No significant difference was found in operation time (n = 0.231) between the two groups. The mean dose-length product was markedly reduced within the low-dose group compared to the standard-dose group (31.5 vs. 333.5 mGy-cm, P < 0.001). The diagnostic yield, sensitivity, specificity, and accuracy of the low-dose group were 68%, 91.5%, 100%, and 94%, respectively. The diagnostic yield, sensitivity, specificity, and accuracy were 65%, 88.6%, 100%, and 92% in the standard-dose group. There was no significant difference observed in diagnostic yield (P = 0.653), diagnostic accuracy (P = 0.579), rates of pneumothorax (P = 0.836), and lung hemorrhage (P = 0.744) between the two groups. CONCLUSIONS: Compared with standard-dose CT-guided biopsy for PNs, low-dose CT can significantly reduce the radiation dose, while yielding comparable safety and diagnostic accuracy.

Predicting Hemorrhage Progression in Deep Intracerebral Hemorrhage: A Multicenter Retrospective Cohort Study.

BACKGROUND: Hemorrhage progression in deep intracerebral hemorrhage (ICH) involves not only the growth of parenchymal hematoma but also an increase in intraventricular hemorrhage (IVH). The search for methods that predict both the increased risk of parenchymal hematoma and IVH growth is warranted. METHODS: We conducted a retrospective cohort study at multiple centers. Participants with deep ICH were enrolled from January 2018 to December 2021. Prediction models based on logistic regression analysis included clinical as well as routine radiographic and radiomics variables, separately or in combination. The performance of each model was evaluated using discrimination measures (e.g., area under the curve [AUC]). Evaluation of clinical utility was performed using decision curve analysis (DCA). RESULTS: Overall, 647 individuals across 4 stroke centers were included. A total of 429 (66%) patients from 3 centers were assigned to the primary cohort and 218 (34%) from another center were placed in the validation cohort. Multivariate analysis showed that the Glasgow Coma Scale score, baseline ICH volume, IVH, blend sign, and radiomics score were associated with hemorrhage progression in the primary cohort. The clinical-radiomics model (AUC = 0.852 and 0.835) improved the prediction performance of hemorrhage progression compared to the Noncontrast computed tomography signs model (AUC = 0.666 and 0.618) in both the primary and validation cohorts, with similar results in the decision curve analysis curves. CONCLUSIONS: The clinical-radiomics model outperformed the routine Noncontrast computed tomography signs model in predicting the progression of deep ICH. The clinical benefit of screening patients using this model may assist in risk stratification.

Comparison of the effectiveness of anchoring needles and coils in localizing multiple nodules in the lung.

BACKGROUND: Recently, a new type of pulmonary nodule positioning needle has been adopted clinically. We aimed to evaluate the efficacy and safety of a new type of localization needles compared with coils for the simultaneous localization of multiple pulmonary nodules guided by computed tomography (CT) prior to video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS: From January 2021 to March 2022, 87 pulmonary nodules from 40 patients were localized using the new localization needle. From January 2020 to December 2020, 68 pulmonary nodules in 31 patients were localized using coils. The relative outcomes were compared. RESULTS: The success rate of pulmonary nodule localization in the needle group was 97.7% while that in the coil group was 98.5%. In the needle group, the time needed to locate the first nodule was significantly shorter than in the coil group (10.9 min vs. 17.2 min, P = 0.001). Moreover, the time needed per patient was also significantly shorter for the needle group compared with the coil group (23.7 min vs. 30 min, P = 0.017). The incidence of pneumothorax in the needle group was 25.0% vs. 12.9% in the coil group (P = 0.204). The rate of pulmonary hemorrhage in the needle group was 40.0% vs. 32.3% in the coil group (P = 0.502). The success rate of VATS wedge resection was 100% in both groups. CONCLUSION: Both disposable pulmonary nodule localization needles and coils are safe and effective for CT-guided localization of multiple pulmonary nodules of the same stage prior to VATS. However, the use of needles is time-saving compared with the use of coils. The coil localization may exhibit better safety than needle localization.

Iodine-125 seeds insertion with trans-arterial chemical infusion for advanced lung cancer: a meta-analysis.

Purpose: Local treatments, including iodine-125 (125I) seeds insertion (ISI) and trans-arterial chemical infusion (TAI), were used for advanced non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) cases. The present meta-analysis investigated the clinical efficacy of combined TAI and ISI for advanced lung cancer (LC). Material and methods: This meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Relevant studies were searched in PubMed, Embase, Cochrane Library, CINK, Wanfang, and VIP (until October 2021) databases, using the following key words: (((((Iodine-125) OR (I125)) OR (125I)) OR (brachytherapy)) AND ((lung cancer) OR (NSCLC))) AND (chemotherapy). Outcomes included complete response rate (CRR), treatment success rate (TSR), disease control rate (DCR), 1-year survival rate, 2-year survival rate, overall survival (OS), and treatment-related toxicity. RevMan v. 5.3 and Stata v. 12.0 were applied for meta-analysis. Results: Eight studies were included in the evaluation. Three hundred and seventy-seven patients underwent combined TAI and ISI treatment (combined group), while 397 patients underwent TAI alone (TAI alone group). The pooled CRR (p = 0.001), TSR (p < 0.00001), DCR (p < 0.00001), 1-year survival rate (p < 0.00001), OS duration (p = 0.0002), and gastrointestinal reaction rate (p = 0.02) were superior in combined group. The pooled 2-year survival rate increased in combined cohort than in TAI alone group (p = 0.08). The pooled myelosuppression rates were comparable between the 2 groups (p = 0.29). Publication bias was not found in any of endpoints. Conclusions: ISI can enhance TAI clinical efficacy in clinical cases of advanced LC, excluding severe adverse events.

Magnetic Resonance Imaging throughout the Clinical Course of Schizophrenia: Neurobiological Underpinnings and Clinical Implications.

As a non-invasive detection method and an advanced imaging method, magnetic resonance imaging (MRI) has been widely used in the research of schizophrenia. Although a large number of neuroimaging studies have confirmed that MRI can display abnormal brain phenotypes in patients with schizophrenia, no valid uniform standard has been established for its clinical application. On the basis of previous evidence, we argue that MRI is an important tool throughout the whole clinical course of schizophrenia. The purpose of this commentary is to systematically describe the role of MRI in schizophrenia and to provide references for its clinical application.

Separate luminous structures leading positive leader steps.

The physics governing the propagation of lightning leaders and long spark leaders is still not well understood. Positive and negative leaders seem to behave differently. Negative leaders develop in a step manner, guided by the separate luminous structures termed space stems and space leaders. Positive leaders, on the other hand, are generally thought to have no separate luminous structure involved in their propagation. However, a separate luminous structure observed in a positive leader discharge had been reported in recent literature, suggesting that positive leaders may similarly do steps to negative leaders under certain conditions. Here we report the observation of the positive leader step led by a separate luminous structure at high humidity in laboratory lightning-like discharges. We also found the streamer-like common zone connecting the primary leader channel with the separate luminous structure, as well as the bi-directional development of the separate luminous structure. We hope that these findings would contribute to a better understanding of the nature underlying positive long spark leaders and lightning leaders.

Integrative analysis of key microRNA-mRNA complexes and pathways in aortic aneurysm.

Background: This study investigated the therapeutic targets of aortic aneurysm (AA) and provided insights into the pathogenesis and molecular mechanisms of AA. Methods: The messenger RNA (mRNA) datasets, GSE9106 (blood samples) and GSE7084 (tissue samples), and the microRNA (miRNA) datasets, GSE92427 (blood samples) and GSE110527 (tissue samples), were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) and differentially expressed miRNAs (DE-miRNAs) were analyzed by limma. Based on the co-DEGs and co-DE-miRNAs between the AA blood and tissue datasets, the miRNA-mRNA regulatory pairs were predicted. Functional enrichment analyses and gene set enrichment analysis (GSEA) were performed and the protein-protein interaction (PPI) network was generated to further analyze the related genes and their functions. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and tyramide signal amplification (TSA)-in situ hybridization (ISH) assays were performed to detect the expression of co-DE-miRNAs in AA clinical tissue samples and normal aorta samples. Results: There were 19 upregulated and 5 downregulated co-differential mRNAs. MiR-4306 was the upregulated co-differential miRNA, and miR-3198 was the downregulated co-differential miRNA by blood-tissue co-analysis. Based on the co-DEGs and co-DE-miRNAs, 4 miRNA-mRNA regulatory pairs were predicted. PPI networks were constructed of co-DEGs with 6 relationship pairs. RT-qPCR and TSA-ISH assays showed the upregulation of miR-4306 and the downregulation of miR-3198 in AA tissue samples. Conclusions: This study provided evidence regarding the differential regulatory miRNA-mRNA networks in AA blood and tissue samples and identified key genes and signaling pathways related to AA, which provided insights into potential targets and mechanisms of AA pathogenesis and progression.

A Nomogram Based on Molecular Biomarkers and Radiomics to Predict Lymph Node Metastasis in Breast Cancer.

Background: The aim of this study was to explore the feasibility and efficacy of a non-invasive quantitative imaging evaluation model to assess the lymphatic metastasis of breast cancer based on a radiomics signature constructed using conventional T1-weighted image (T1WI) enhanced MRI and molecular biomarkers. Methods: Patients with breast cancer diagnosed via lymph biopsies between June 2015 and June 2019 were selected for the study. All patients underwent T1WI contrast-enhancement before treatment; lymph biopsy after surgery; and simultaneous Ki-67, COX-2, PR, Her2 and proliferating cell nuclear antigen detection. All images were imported into ITK-SNAP for whole tumor delineation, and AK software was used for radiomics feature extraction. Next, the radiomics signature Rad-score was constructed after reduction of specific radiomic features. A multiple regression logistic model was built by combining the Rad-score and molecular biomarkers based on the minimum AIC. Results: In all, 100 patients were enrolled in this study, including 45 with non-lymph node (LN) metastasis and 55 with LN metastasis. A total of 1,051 texture feature parameters were extracted, and LASSO was used to reduce the dimensionality of the radiomics features. The log(λ) was set to 0.002786, and 19 parameters were retained for the construction of the radiomics tag Rad-score. ROC was used to evaluate the diagnostic efficiency of Rad-score: the area under the ROC curve (AUC) of the Rad-score for identifying non-lymphatic and lymphatic metastases was 0.891 in the training cohort and 0.744 in the validation cohort. With the incorporation of tumor molecular markers, the AUCs of the training cohort and validation cohort of the nomogram were 0.936 and 0.793, respectively, which were notably higher than the AUCs of the clinical parameters in the training and validation cohorts (0.719 and 0.588, respectively). Conclusion: The combined model constructed using the Rad-score and molecular biomarkers can be used as an effective non-invasive method to assess LN metastasis of breast cancer. Furthermore, it can be used to quantitatively evaluate the risk of breast cancer LN metastasis before surgery.

TACE with portal vein radioactive seeds for HCC with portal vein tumor thrombus: a meta-analysis.

PURPOSE: To assess the efficacy and safety of transarterial chemoembolization (TACE) and portal vein radioactive seed insertion (RSI) combination in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). MATERIAL AND METHODS: The relevant databases were searched from the earliest to January 2021. The endpoints included treatment response, treatment side effects, and overall survival (OS). RESULTS: Nine studies were included in this meta-analysis. The pooled total response (TR, p = 0.55) and disease control (DC, p = 0.13) rates for HCC were similar between the two treatment groups. The pooled TR (p = 0.0004) and DC (p < 0.0001) rates for PVTT were both significantly higher in the TACE with portal vein RSI group than in the TACE without portal vein RSI group. The pooled HR for OS was significantly better in the TACE with portal vein RSI group than in the TACE without portal vein RSI group (p < 0.00001). The pooled rates of fever (p = 0.97), vomiting (p = 0.64), and myelosuppression (p = 0.65) were similar between the two groups. CONCLUSION: Compared to traditional TACE, TACE combined with portal vein RSI can effectively prolong the patients' OS and decrease PVTT disease progression.

I-125 seeds insertion with TACE for advanced HCC: a meta-analysis of randomized controlled trials.

PURPOSE: To assess the effectiveness of I-125 seeds (IS) insertion with transcatheter arterial chemoembolization (TACE) in treating patients with advanced hepatocellular carcinoma (HCC). MATERIAL AND METHODS: An extensive search was conducted for relevant randomized controlled trials (RCTs) from the establishment date of each database to November 2020. RESULTS: A total of nine RCTs were included in this study. Our analysis showed no significant changes in the pooled Δalpha-fetoprotein values (p = .06), incident rates of myelosuppression (p = .46), vomit occurrence (p = .27), and abnormal liver function (p = .42) between the two treatment groups. However, the complete response (p < .00001), total response (p < .00001), and disease control (p < .00001) rates were significantly higher in patients who underwent TACE with IS insertion, as opposed to patients who received TACE alone. Furthermore, patients who underwent TACE with IS insertion experienced markedly longer pooled overall survival (OS) time (p < .0001), with better OS rates at the six-month (p = .0002), one-year (p < .0001), and three-year (p = .0003) follow-ups than patients who received TACE alone. CONCLUSION: TACE with IS insertion can significantly improve clinical response and prolong the survival of advanced HCC patients.