Development and validation of an ultrasound-based deep learning radiomics nomogram for predicting the malignant risk of ovarian tumours.

BACKGROUND: The timely identification and management of ovarian cancer are critical determinants of patient prognosis. In this study, we developed and validated a deep learning radiomics nomogram (DLR_Nomogram) based on ultrasound (US) imaging to accurately predict the malignant risk of ovarian tumours and compared the diagnostic performance of the DLR_Nomogram to that of the ovarian-adnexal reporting and data system (O-RADS). METHODS: This study encompasses two research tasks. Patients were randomly divided into training and testing sets in an 8:2 ratio for both tasks. In task 1, we assessed the malignancy risk of 849 patients with ovarian tumours. In task 2, we evaluated the malignancy risk of 391 patients with O-RADS 4 and O-RADS 5 ovarian neoplasms. Three models were developed and validated to predict the risk of malignancy in ovarian tumours. The predicted outcomes of the models for each sample were merged to form a new feature set that was utilised as an input for the logistic regression (LR) model for constructing a combined model, visualised as the DLR_Nomogram. Then, the diagnostic performance of these models was evaluated by the receiver operating characteristic curve (ROC). RESULTS: The DLR_Nomogram demonstrated superior predictive performance in predicting the malignant risk of ovarian tumours, as evidenced by area under the ROC curve (AUC) values of 0.985 and 0.928 for the training and testing sets of task 1, respectively. The AUC value of its testing set was lower than that of the O-RADS; however, the difference was not statistically significant. The DLR_Nomogram exhibited the highest AUC values of 0.955 and 0.869 in the training and testing sets of task 2, respectively. The DLR_Nomogram showed satisfactory fitting performance for both tasks in Hosmer-Lemeshow testing. Decision curve analysis demonstrated that the DLR_Nomogram yielded greater net clinical benefits for predicting malignant ovarian tumours within a specific range of threshold values. CONCLUSIONS: The US-based DLR_Nomogram has shown the capability to accurately predict the malignant risk of ovarian tumours, exhibiting a predictive efficacy comparable to that of O-RADS.

Ultrasound-based deep learning radiomics model for differentiating benign, borderline, and malignant ovarian tumours: a multi-class classification exploratory study.

BACKGROUND: Accurate preoperative identification of ovarian tumour subtypes is imperative for patients as it enables physicians to custom-tailor precise and individualized management strategies. So, we have developed an ultrasound (US)-based multiclass prediction algorithm for differentiating between benign, borderline, and malignant ovarian tumours. METHODS: We randomised data from 849 patients with ovarian tumours into training and testing sets in a ratio of 8:2. The regions of interest on the US images were segmented and handcrafted radiomics features were extracted and screened. We applied the one-versus-rest method in multiclass classification. We inputted the best features into machine learning (ML) models and constructed a radiomic signature (Rad_Sig). US images of the maximum trimmed ovarian tumour sections were inputted into a pre-trained convolutional neural network (CNN) model. After internal enhancement and complex algorithms, each sample's predicted probability, known as the deep transfer learning signature (DTL_Sig), was generated. Clinical baseline data were analysed. Statistically significant clinical parameters and US semantic features in the training set were used to construct clinical signatures (Clinic_Sig). The prediction results of Rad_Sig, DTL_Sig, and Clinic_Sig for each sample were fused as new feature sets, to build the combined model, namely, the deep learning radiomic signature (DLR_Sig). We used the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) to estimate the performance of the multiclass classification model. RESULTS: The training set included 440 benign, 44 borderline, and 196 malignant ovarian tumours. The testing set included 109 benign, 11 borderline, and 49 malignant ovarian tumours. DLR_Sig three-class prediction model had the best overall and class-specific classification performance, with micro- and macro-average AUC of 0.90 and 0.84, respectively, on the testing set. Categories of identification AUC were 0.84, 0.85, and 0.83 for benign, borderline, and malignant ovarian tumours, respectively. In the confusion matrix, the classifier models of Clinic_Sig and Rad_Sig could not recognise borderline ovarian tumours. However, the proportions of borderline and malignant ovarian tumours identified by DLR_Sig were the highest at 54.55% and 63.27%, respectively. CONCLUSIONS: The three-class prediction model of US-based DLR_Sig can discriminate between benign, borderline, and malignant ovarian tumours. Therefore, it may guide clinicians in determining the differential management of patients with ovarian tumours.

Insulin desensitization and cell senescence induced by heat stress in pig testicular cell model.

Thermostatic animals need to maintain a stable body temperature. A high-temperature environment can cause body temperature to exceed the range of tolerance of the organism, resulting in a heat stress response. The reproductive organs (such as the testes) are more sensitive to temperature due to their special anatomical location. However, to date, the effect of heat stress on the biological function of insulin in testicular cells has not been revealed. Therefore, the current study established a testis cell model to study the effect of heat stress on the biological activity of insulin. The results showed significant alterations in the insulin-induced intracellular signaling under heat stress conditions. Moreover, the IR-mediated intracellular signaling pathway was significantly downregulated under heat stress conditions. Further studies demonstrated that heat stress led to senescence of testicular cells by Sa-ß-gal staining. Furthermore, the expression of senescence markers (p16 and p21) was increased under heat stress. In addition, heat stress was found to cause oxidative stress in testicular cells, which may be the underlying molecular mechanism by which heat stress changes the signaling properties of insulin. Collectively, the current study showed that heat stress caused alterations in insulin-induced intracellular signaling. Heat stress also induced testicular cell senescence.

Three-dimensional Reconstruction and Comparison of Temporomandibular Joint Space Volume Before and After Orthognathic Surgery in Patients with Skeletal Class III Malocclusion With Mandibular Deviation.

OBJECTIVE: To look into the association between the degree of deviation and the changing trend in the temporomandibular joint (TMJ) space volume after orthognathic surgery in patients with skeletal Class III malocclusion. METHODS: Twenty patients having combined orthodontic-orthognathic treatment for skeletal Class III malocclusions with mandibular deviation were chosen, and craniofacial spiral CT was performed before (T0), two weeks after (T1), and six months after (T2) surgery. Using 3D volume reconstruction, further partitioning, and analysis of each domain's volume changes over time, the TMJ space volume is to be obtained. The differences in changes between groups A (mild deviation group) and B (severe deviation group) were examined to examine the impact of the degree of deviation on the TMJ space volume. RESULTS: A statistically significant difference ( P <0.05) existed between the postoperative TMJ space volume in group A and the preoperative overall, anterolateral, and anteroinferior space volume; the same difference also existed between the postoperative TMJ space volume in the NDS and the preoperative posterolateral, posteroinferior space volume. In group B, the postoperative TMJ space volume was statistically significant ( P <0.05) compared with the preoperative total and anteroinferior space volume in the DS; the difference between the total volume of the T1 stage on the NDS and the total volume of the T0 stage was statistically significant ( P <0.05). The two groups showed substantial differences in the space volume changes between the T1-T0 phase and the T2-T1 period. CONCLUSION: Patients with skeletal Class III malocclusion and mandibular deviation after orthognathic surgery see a change in the TMJ space volume. All patient types experience a largely consistent space volume change trend two weeks after surgery, and the degree of mandibular deviation is correlated with the intensity and longevity of the alteration.

LncRNA-mRNA co-expression network revealing the regulatory roles of lncRNAs in melanogenesis in vitiligo.

Vitiligo is characterized by the progressive disappearance of melanocytes, resulting in depigmentation. Long noncoding RNAs (lncRNAs) are a class of noncoding RNAs that play an essential role in the regulation of inflammation and immunity. Published reports on the expression profile of lncRNAs in vitiligo cases and the potential biological function of lncRNAs in vitiligo are lacking. We performed RNA-Seq to identify the functions of lncRNAs in vitiligo. In total, 32 upregulated lncRNAs and 78 downregulated lncRNAs were identified in skin lesions with vitiligo. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis demonstrated that mRNAs regulated by abnormally expressed lncRNAs are most relevant to melanocyte function and melanogenesis. We identified 14 aberrantly expressed lncRNAs through the co-expression pattern that regulate the melanogenesis-related genes DCT, TYR, and TYRP1. Therefore, we speculate that these hub genes may be involved in pathological mechanisms in melanocytes in vitiligo. These genes are closely related to melanogenesis in vitiligo. Abnormally expressed lncRNAs directly or indirectly act on these target genes to regulate melanogenesis. Identifying lncRNAs and clarifying the regulatory roles of the lncRNA-mRNA network may be helpful to develop novel diagnoses or treatment targets for vitiligo.

Standardized Ultrasound Diagnosis of Nuchal Cord.

OBJECTIVE: This study aims to investigate the formation factors that affect the angle of nuchal cord and explore the types of nuchal cord that exist and the process of standardized ultrasound diagnosis of nuchal cord. METHODS: Ultrasonography was performed on 707 fetuses with nuchal cord, to observe the direction of the coil, determine the type of coil, and analyze the correlation between the fetal position, placental location, and the direction of the coil with the angle of the umbilical cord. RESULTS: Among the 707 fetuses, those with 1 loop accounted for 89.67%, fetuses with 2 loops accounted for 6.08%, fetuses with 3 loops accounted for 0.28%, and fetuses with partial draping of the umbilical cord accounted for 3.96%. Nuchal cord mostly occurred in fetuses where the placenta was attached to the anterior wall of the uterus, and the α-shaped and C-shaped types were in the majority. The C-shaped type accounted for 43.14%, the α-shaped type for 40.88%, the O-shaped type for 12.02%, and the L-shaped type for 3.96%. CONCLUSION: The direction of the coil of the umbilical cord can be determined by blood flow vector observation. The fetal position, placental location, and the direction of the coil are the three factors affecting the coiling angle of the umbilical cord. Ultrasonic classification of nuchal cord can provide detailed information, which can be used by physicians when performing surgery on the fetus. The advances in the diagnosis procedure allow the diagnosis of nuchal cord to be carried out in an orderly manner, making it more accurate and standardized.

Preparation of Ca-alginate-whey protein isolate microcapsules for protection and delivery of L. bulgaricus and L. paracasei.

To promote the application of probiotics that are beneficial to hosts, calcium-alginate (Ca-Alg) coated whey protein isolate microcapsules were prepared for protection and delivery of L. bulgaricus and L. paracasei. The internal layer was formed with transglutaminase-induced gelation of whey protein isolate (WPI). Sodium alginate (SA) was applied to form outer layer with external Ca2+ gelation method. The microcapsules loaded with probiotics were characterized by scanning electron microscope (SEM), Fourier-transform infrared spectroscopy (FT-IR), and differential scanning calorimetry (DSC). The results showed that the co-encapsulation efficiency was 90.54% and 84.46% of WPI micro-beads and Ca-Alg-coated microcapsules, respectively. The trehalose was added as cryoprotectant to improve the survival rate of probiotics in freeze-dried Ca-Alg-coated microcapsules from 3% to 41.26%. Ca-Alg-coated microcapsules have regular morphology and intensified structure. The protection of Ca-Alg-coated microcapsule for probiotics was improved under simulated gastrointestinal and thermal conditions. Ca-Alg-WPI microcapsules showed a useful way for protection and delivery of L. bulgaricus and L. paracasei.

Layer (whey protein isolate) -by-layer (xanthan gum) microencapsulation enhances survivability of L. bulgaricus and L. paracasei under simulated gastrointestinal juice and thermal conditions.

In the study, Lactobacillus delbrueckii subsp. bulgaricus (L. bulgaricus) and Lactobacillus paracasei subsp. paracasei (L. paracasei) were isolated from food products and identified. The probiotics were co-encapsulated by emulsification technique with transglutaminase-induced gelation of whey protein isolate (WPI). A double layer was formed by xanthan gum (XG). The survival of both free and microencapsulated cells in each step was enumerated. The results showed that high entrapment yield (86.36 ± 1.07%) was achieved, WPI-XG provided significant protection for cells in simulated gastric juice and bile tolerance tests compared with free cells. Besides, the survivability under thermal condition also strengthened. During freeze-drying process, the survival was improved and naked cells cannot be seen on microcapsules surface when trehalose was added into WPI solution as a lyoprotectant. Additionally, the structure changes of WPI/XG in the encapsulation process were investigated by Fourier transform infrared spectrophotometer (FT-IR) and the thermal properties were studied by differential scanning calorimetry (DSC).

Modified Genioplasty Combined With Orthognathic Surgeries for the Treatment of Chin Defect Accompanying Micrognathia and Airway Stenosis.

We reported a 16-year-old patient with chin defect accompanying micrognathia and airway stenosis owing to a traffic accident. The treatment of this patient involved a modified genioplasty associated with orthognathic surgeries. Through data analysis, we found that the patient's facial morphology and airway space are greatly improved compared with preoperation: y-axis(T4-T1) = -4.5 degree; FCA (T4-T1) = -18 degree; CSAmin(T4-T1) = 227 mm. In conclusion, the modified genioplasty associated with orthognathic surgeries is an effective way to reshape the defected chin and treat micrognathia and airway stenosis in this case.

Effective degradation of the mycotoxin patulin in pear juice by porcine pancreatic lipase.

Porcine pancreatic lipase (PPL) was used to degrade the mycotoxin patulin (PAT) in pear juice. The dosage of PPL, the initial concentration of PAT, reaction temperature and time were investigated by batch experiments to study the optimal degradation condition. The concentration of PAT in pear juice was determined by high performance liquid chromatography with an ultraviolet detector (HPLC-UV). The results showed that the optimal condition was 0.02 g PPL/mL pear juice at 40 °C for 24 h. The content of organic acids, volatile flavor components, polyphenols, ascorbic acid and the degree of browning reaction in pear juice, relating to the quality of juice, changed insignificantly. Although the initial PAT concentration was very high, the degradation product was confirmed nontoxic by cytotoxicity test of Caco-2 cells. It suggested that PPL could be further considered to be applied in the degradation of PAT in pear juice.

The Precise Midline Positioning Instrument for Le Fort I Osteotomy.

To reduce the deviations in the horizontal direction of posterior maxilla during the maxilla Le Fort I osteotomy, the authors develop and validate the precise midline positioning instrument for Le Fort I osteotomy, which can guide the precise relocation of the truncated maxillary bone segment. The patent application for the precise midline positioning instrument for Le Fort I osteotomy is already submitted (patent no: 201711245533.6, China). The accuracy of Le Fort I osteotomy can be improved significantly, because of the amplification effect of this patent on the rotation/micro-movement of the posterior maxilla in all directions to achieve the precise movement and pairing of the maxillary bone segment. And this method is simple, efficient, and laborsaving.

Full inhibition of Whangkeumbae pear polyphenol oxidase enzymatic browning reaction by l-cysteine.

The enzymatic browning reaction caused by polyphenol oxidase (PPO) has a negative effect on the processing of fruits and vegetables. However, some chemical inhibitors have been used to prevent enzymatic browning reaction, although they may be toxic and potentially hazardous to use in food. In this study, PPO was isolated and purified from the Whangkeumbae pear, and four food grade inhibitors were used to prevent the enzymatic browning reaction. The results showed that the PPO activity increased by 32.93-fold; its yield was 0.2 U/100 U, and the specific activity was 519,895.73 U/mg protein. The molecular weight of the PPO was approximately 44 kDa. The most potent inhibitor was l-cysteine, which fully inhibited the PPO activity at a concentration of 0.8 mg/mL. The type of inhibition of l-cysteine was noncompetitive. It suggests that l-cysteine can be utilized to prevent enzymatic browning reaction during the processing of pear juice.

The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities.

BACKGROUND: Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. METHODS: Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go). RESULTS: All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3° ± 11.1 to 121.3° ± 2.9, and the mandibular width was improved from 117.5 mm ± 6.8 to 111.9 mm ± 4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56° ± 0.22, 0.65° ± 0.3 and 0.49 mm ± 0.43, respectively. CONCLUSIONS: The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Precise Repositioning Instrument for Genioplasty and a Three-Dimensional Printing Technique for Treatment of Complex Facial Asymmetry.

BACKGROUND: Facial asymmetry is very common in maxillofacial deformities. It is difficult to achieve accurate reconstruction. With the help of 3D printing models and surgical templates, the osteotomy line and the amount of bone grinding can be accurate. Also, by means of the precise repositioning instrument, the repositioning of genioplasty can be accurate and quick. In this study, we present a three-dimensional printing technique and the precise repositioning instrument to guide the osteotomy and repositioning, and illustrate their feasibility and validity. METHODS: Eight patients with complex facial asymmetries were studied. A precise 3D printing model was obtained. We made the preoperative design and surgical templates according to it. The surgical templates and precise repositioning instrument were used to obtain an accurate osteotomy and repositioning during the operation. Postoperative measurements were made based on computed tomographic data, including chin point deviation as well as the symmetry of the mandible evaluated by 3D curve functions. RESULTS: All patients obtained satisfactory esthetic results, and no recurrences occurred during follow-up. The results showed that we achieved clinically acceptable precision for the mandible and chin. The mean and SD of ICC between R-Post and L-Post were 0.973 ± 0.007. The mean and SD of chin point deviation 6 months after the operation were 0.63 ± 0.19 mm. CONCLUSION: The results of this study suggest that the three-dimensional printing technique and the precise repositioning instrument could aid in making better operation designs and more accurate manipulation in orthognathic surgery for complex facial asymmetry. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .