Development of a Model including MRI Features for Predicting Advanced-stage Recurrence of Hepatocellular Carcinoma after Liver Resection.

Background Identifying patients at high risk for advanced-stage hepatocellular carcinoma (HCC) recurrence after liver resection may improve patient survival. Purpose To develop a model including MRI features for predicting postoperative advanced-stage HCC recurrence. Materials and Methods This single-center, retrospective study includes consecutive adult patients who underwent preoperative contrast-enhanced MRI and curative-intent resection for early- to intermediate-stage HCC (from December 2011 to April 2021). Three radiologists evaluated 52 qualitative features on MRI scans. In the training set, Fine-Gray proportional subdistribution hazard analysis was performed to identify clinical, laboratory, imaging, pathologic, and surgical variables to include in the predictive model. In the test set, the concordance index (C-index) was computed to compare the developed model with current staging systems. The Kaplan-Meier survival curves were compared using the log-rank test. Results The study included 532 patients (median age, 54 years; IQR, 46-62 years; 465 male patients), 302 patients from the training set (median age, 54 years; IQR, 46-63 years; 265 male patients), and 128 patients from the test set (median age, 53 years; IQR, 46-63 years; 108 male patients). Advanced-stage recurrence was observed in 38 of 302 (12.6%) and 15 of 128 (11.7%) of patients from the training and test sets, respectively. Serum neutrophil count (109/L), tumor size (in centimeters), and arterial phase hyperenhancement proportion on MRI scans were associated with advanced-stage recurrence (subdistribution hazard ratio range, 1.16-3.83; 95% CI: 1.02, 7.52; P value range, <.001 to .02) and included in the predictive model. The model showed better test set prediction for advanced-stage recurrence than four staging systems (2-year C-indexes, 0.82 [95% CI: 0.74, 0.91] vs 0.63-0.68 [95% CI: 0.52, 0.82]; P value range, .001-.03). Patients at high risk for HCC recurrence (model score, ≥15 points) showed increased advanced-stage recurrence and worse all-stage recurrence-free survival (RFS), advanced-stage RFS, and overall survival than patients at low risk for HCC recurrence (P value range, <.001 to .02). Conclusion A model combining serum neutrophil count, tumor size, and arterial phase hyperenhancement proportion predicted advanced-stage HCC recurrence better than current staging systems and may identify patients at high risk. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Tsai and Mellnick in this issue.

Prognostic MRI features to predict postresection survivals for very early to intermediate stage hepatocellular carcinoma.

OBJECTIVES: Contrast-enhanced MRI can provide individualized prognostic information for hepatocellular carcinoma (HCC). We aimed to investigate the value of MRI features to predict early (≤ 2 years)/late (> 2 years) recurrence-free survival (E-RFS and L-RFS, respectively) and overall survival (OS). MATERIALS AND METHODS: Consecutive adult patients at a tertiary academic center who received curative-intent liver resection for very early to intermediate stage HCC and underwent preoperative contrast-enhanced MRI were retrospectively enrolled from March 2011 to April 2021. Three masked radiologists independently assessed 54 MRI features. Uni- and multivariable Cox regression analyses were conducted to investigate the associations of imaging features with E-RFS, L-RFS, and OS. RESULTS: This study included 600 patients (median age, 53 years; 526 men). During a median follow-up of 55.3 months, 51% of patients experienced recurrence (early recurrence: 66%; late recurrence: 34%), and 17% died. Tumor size, multiple tumors, rim arterial phase hyperenhancement, iron sparing in solid mass, tumor growth pattern, and gastroesophageal varices were associated with E-RFS and OS (largest p = .02). Nonperipheral washout (p = .006), markedly low apparent diffusion coefficient value (p = .02), intratumoral arteries (p = .01), and width of the main portal vein (p = .03) were associated with E-RFS but not with L-RFS or OS, while the VICT2 trait was specifically associated with OS (p = .02). Multiple tumors (p = .048) and radiologically-evident cirrhosis (p < .001) were the only predictors for L-RFS. CONCLUSION: Twelve visually-assessed MRI features predicted postoperative E-RFS (≤ 2 years), L-RFS (> 2 years), and OS for very early to intermediate-stage HCCs. CLINICAL RELEVANCE STATEMENT: The prognostic MRI features may help inform personalized surgical planning, neoadjuvant/adjuvant therapies, and postoperative surveillance, thus may be included in future prognostic models. KEY POINTS: • Tumor size, multiple tumors, rim arterial phase hyperenhancement, iron sparing, tumor growth pattern, and gastroesophageal varices predicted both recurrence-free survival within 2 years and overall survival. • Nonperipheral washout, markedly low apparent diffusion coefficient value, intratumoral arteries, and width of the main portal vein specifically predicted recurrence-free survival within 2 years, while the VICT2 trait specifically predicted overall survival. • Multiple tumors and radiologically-evident cirrhosis were the only predictors for recurrence-free survival beyond 2 years.

Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition).

Background: Primary liver cancer, of which around 75-85% is hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. Summary: Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China in June 2017, which were updated by the National Health Commission in December 2019, additional high-quality evidence has emerged from researchers worldwide regarding the diagnosis, staging, and treatment of liver cancer, that requires the guidelines to be updated again. The new edition (2022 Edition) was written by more than 100 experts in the field of liver cancer in China, which not only reflects the real-world situation in China but also may reshape the nationwide diagnosis and treatment of liver cancer. Key Messages: The new guideline aims to encourage the implementation of evidence-based practice and improve the national average 5-year survival rate for patients with liver cancer, as proposed in the "Health China 2030 Blueprint."

VICT2 Trait: Prognostic Alternative to Peritumoral Hepatobiliary Phase Hypointensity in HCC.

Background Peritumoral hepatobiliary phase (HBP) hypointensity is an established prognostic imaging feature in hepatocellular carcinoma (HCC), often associated with microvascular invasion (MVI). Similar prognostic features are needed for non-HBP MRI. Purpose To propose a non-hepatobiliary-specific MRI tool with similar prognostic value to peritumoral HBP hypointensity. Materials and Methods From December 2011 to November 2021, consecutive patients with HCC who underwent preoperative contrast-enhanced MRI were retrospectively enrolled and followed up until recurrence. All MRI scans were reviewed by two blinded radiologists with 7 and 10 years of experiences with liver MRI. A scoring system based on non-hepatobiliary-specific features that highly correlated with peritumoral HBP hypointensity was identified in a stratified sampling-derived training set of the gadoxetate disodium (EOB) group by means of multivariable logistic regression, and its values to predict MVI and recurrence-free survival (RFS) were assessed. Results There were 660 patients (551 men; median age, 53 years; IQR, 45-61 years) enrolled. Peritumoral portal venous phase hypoenhancement (odds ratio [OR] = 8.8), incomplete "capsule" (OR = 3.3), corona enhancement (OR, 2.6), and peritumoral mild-moderate T2 hyperintensity (OR, 2.2) (all P < .001) were associated with peritumoral HBP hypointensity and constituted the "VICT2 trait" (test set area under the receiver operating characteristic curve = 0.84; 95% CI: 0.78, 0.90). For the EOB group, both peritumoral HBP hypointensity (OR for MVI = 2.5, P = .02; hazard ratio for RFS = 2.5, P < .001) and the VICT2 trait (OR for MVI = 5.1, P < .001; hazard ratio for RFS = 2.3, P < .001) were associated with MVI and RFS, despite a higher specificity of the VICT2 trait for MVI (89% vs 80%, P = .01). These values of the VICT2 trait were confirmed in the extracellular contrast agent group (OR for MVI = 4.0; hazard ratio for RFS = 1.7; both P < .001). Conclusion Based on four non-hepatobiliary-specific MRI features, the VICT2 trait was comparable to peritumoral hepatobiliary phase hypointensity in predicting microvascular invasion and postoperative recurrence of hepatocellular carcinoma. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Harmath in this issue.

Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis.

OBJECTIVE: Transmural intestinal necrosis (TIN) is related to high mortality in patients with acute mesenteric ischemia (AMI). Radiological predictive factors of TIN in AMI remains controversial. This study aimed to identify the CT-based predictive factors of TIN in AMI. METHODS: EMBASE and PUBMED were searched for publications predicting TIN using radiological features. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of individual studies. Data were presented in terms of diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval (CI). The random-effects models were used for the meta-analysis. RESULTS: Eleven studies including 1037 cases with AMI were considered. The meta-analysis showed that bowel wall thinning (DOR = 13.10; 95% CI: 3.71, 46.25), decreased or absent bowel wall enhancement (DOR = 5.77; 95% CI: 2.95, 11.30), bowel dilation (DOR = 3.23; 95% CI: 2.03, 5.15), pneumatosis intestinalis (DOR = 5.78; 95% CI: 2.24, 14.95), porto-mesenteric venous gas (DOR = 5.36; 95% CI: 2.14, 13.40), and arterial occlusive AMI (DOR = 2.66; 95% CI: 1.53, 4.63) were risk factors for predicting TIN. Bowel wall thinning and porto-mesenteric venous gas displayed high specificity to diagnose TIN (98%, 95%, respectively). The subgroup analysis showed that decreased or absent bowel wall enhancement (DOR = 8.23; 95% CI: 4.67, 14.51) and bowel dilation (DOR = 3.14; 95% CI: 1.55, 6.39) were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI. CONCLUSIONS: For predicting TIN, there are specific radiological features. The radiological predictors of TIN may differ according to the various causes of AMI. Future primary studies should further evaluate the relationships between radiological signs and TIN based on different etiologies. KEY POINTS: • Bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilation, pneumatosis intestinalis, porto-mesenteric venous gas, and arterial occlusive AMI were risk factors for predicting TIN. • Decreased or absent bowel wall enhancement and bowel dilation were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.

Texture analysis of contrast-enhanced magnetic resonance imaging predicts microvascular invasion in hepatocellular carcinoma.

BACKGROUND: Microvascular invasion is one of the important risk factors of postoperative recurrence of hepatocellular carcinoma. Texture analysis uses mathematical methods to analyze the gray's quantitative value and distribution of images, for quantifying the heterogeneity of tissues. PURPOSE: To investigate the feasibility of predicting MVI in HCC by analyzing the texture features of hepatic MR-enhanced images. METHODS: 110 patients with HCC who underwent MR-enhanced examinations were included in this study, were divided into MVI-positive group (n = 52) and MVI-negative group (n = 58) according to postoperative pathology. Clinical, pathological data and MR imaging features were collected. 11 texture parameters were selected from the gray histogram and gray level co-occurrence matrix (GLCM). Texture parameters of MR-enhanced images were calculated for statistical analysis. RESULTS: There were statistically significant differences in tumor size, location, degree of differentiation, AFP level, signal, pseudocapsule, margin, peritumoral enhancement and intratumoral artery between MVI-positive group and MVI-negative group (P < 0.05). The AUC value of combining MR image features in prediction of MVI was 0.693(sensitivity and specificity: 53.8 %, 82.8 %, respectively). There were statistically significant differences in the texture parameters of GLCM between two groups (P < 0.05). The AUC value of combining texture parameters in prediction of MVI was 0.797 (sensitivity and specificity: 88.2 %, 62.7 %, respectively). CONCLUSION: MR image features and texture analysis have certain predictive effect on MVI, which are mutually verified and complementary. The texture parameters of GLCM could reflect tumor heterogeneity, which have great potential to help with preoperative decision. The combination of MR image features and texture analysis may improve the efficiency in prediction of MVI.

Long-range order and quantum criticality in antiferromagnetic chains with long-range staggered interactions.

We study quantum phase transitions in Heisenberg antiferromagnetic chains with a staggered power-law decaying long-range interactions. Employing the density-matrix renormalization group (DMRG) algorithm and the fidelity susceptibility as the criticality measure, we establish more accurate values of quantum critical points than the results obtained from the spin-wave approximation, quantum Monte Carlo, and DMRG in literatures. The deviation is especially evident for strong long-range interactions. We extend isotropic long-range interactions to the anisotropic cases and find that kaleidoscope of quantum phases emerge from the interplay of anisotropy of the long-range exchange interaction and symmetry breaking. We demonstrate nonfrustrating long-range interactions induce the true long-range order in Heisenberg antiferromagnetic chains with a continuous symmetry breaking, lifting the restrictions imposed by the Mermin-Wagner theorem.

Predicting microvascular invasion in hepatocellular carcinoma: A dual-institution study on gadoxetate disodium-enhanced MRI.

BACKGROUND & AIMS: Microvascular invasion (MVI) is an important risk factor in hepatocellular carcinoma (HCC), but its diagnosis mandates postoperative histopathologic analysis. We aimed to develop and externally validate a predictive scoring system for MVI. METHODS: From July 2015 to November 2020, consecutive patients underwent surgery for HCC with preoperative gadoxetate disodium (EOB)-enhanced MRI was retrospectively enrolled. All MR images were reviewed independently by two radiologists who were blinded to the outcomes. In the training centre, a radio-clinical MVI score was developed via logistic regression analysis against pathology. In the testing centre, areas under the receiver operating curve (AUCs) of the MVI score and other previous MVI schemes were compared. Overall survival (OS) and recurrence-free survival (RFS) were analysed by the Kaplan-Meier method with the log-rank test. RESULTS: A total of 417 patients were included, 195 (47%) with pathologically-confirmed MVI. The MVI score included: non-smooth tumour margin (odds ratio [OR] = 4.4), marked diffusion restriction (OR = 3.0), internal artery (OR = 3.0), hepatobiliary phase peritumoral hypointensity (OR = 2.5), tumour multifocality (OR = 1.6), and serum alpha-fetoprotein >400 ng/mL (OR = 2.5). AUCs for the MVI score were 0.879 (training) and 0.800 (testing), significantly higher than those for other MVI schemes (testing AUCs: 0.648-0.684). Patients with model-predicted MVI had significantly shorter OS (median 61.0 months vs not reached, P < .001) and RFS (median 13.0 months vs. 42.0 months, P < .001) than those without. CONCLUSIONS: A preoperative MVI score integrating five EOB-MRI features and serum alpha-fetoprotein level could accurately predict MVI and postoperative survival in HCC. Therefore, this score may aid in individualized treatment decision making.

Interference of KLF9 relieved the development of gestational diabetes mellitus by upregulating DDAH2.

Gestational diabetes mellitus (GDM) is a situation where glucose intolerance is found in pregnant women without a previous diagnosis of diabetes. The role of Kruppel-like factor 9 (KLF9) has not been investigated in GDM, which constituted the aim of our study. HTR8/SVneo cells were induced by high glucose (HG) and pregnant mice were treated with streptozocin (STZ) to establish GDM model in vitro and in vivo, respectively. The expression level of KLF9 was detected by real-time PCR, immunohistochemical staining, and Western blot. Cell viability, apoptosis, inflammation, and oxidative stress were investigated by cell counting kit-8 (CCK-8), TUNEL, enzyme-linked immunosorbent assay (ELISA) and oxidative stress detection kits, respectively. The interaction of KLF9 with dimethylarginine dimethylaminohydrolase 2 (DDAH2) was predicted by bioinformatic tools and confirmed by luciferase reporter assay and chromatin immunoprecipitation (ChIP). The expression of KLF9 was increased in the placental tissues of GDM patients and HG-induced HTR8/SVneo cells. Silencing of KLF9 increased cell viability, reduced cell apoptosis, and suppressed inflammation and oxidative stress in HG-induced HTR8/SVneo cells. KLF9 could bind to DDAH2 promoter and negatively regulate DDAH2 expression. Inhibition of DDAH2 partly weakened the effects of KLF9 silencing on cell apoptosis, inflammation, and oxidative stress. The suppressive effects of KLF9 silencing on blood glucose and insulin concentration in vivo were also abolished by DDAH2 knockdown. In conclusion, we provided evidence that interference of KLF9 could hinder the development of GDM by alleviating cell apoptosis, inflammation, and oxidative stress through upregulating DDAH2, which might instruct the targeting therapies against GDM.Abbreviations: KLF9: Kruppel-like factor 9; DDAH2: dimethylarginine dimethylaminohydrolase 2 ; GDM: gestational diabetes mellitus; ELISA: enzyme-linked immunosorbent assay; CCK-8: cell counting kit-8; ChIP: chromatin immunoprecipitation; sh: short hairpin; HG: high glucose; PBS: phosphate-buffered saline; DAPI: 4, 6-diamidino-2-phenylindole; IL-6: Interleukin-6; TNF-α: tumor necrosis factor-α; ROS: reactive oxygen species; MDA: malondialdehyde; SOD: superoxide dismutase; wt: wild-type; mut: mutant.

Aptasensor for the Detection of Ochratoxin A Using Graphene Oxide and Deoxyribonuclease I-Aided Signal Amplification.

In this investigation, a sensitive sensor for ochratoxin A detection was designed based on graphene oxide (GO) and DNase I for amplified fluorescence signal. The outcomes of this investigation indicated that this exploratory platform exhibited efficient sensitivity and good selectivity for ochratoxin A when existence of other toxins. The proposed sensor displayed a linear response over a range of 100-1000 nM (R² = 0.986) with a low detection limit of 38.2 nM (S/N = 3) and showed remarkable convenience. In addition, the constructed sensor was examined by testing real food samples spiked with different concentrations of ochratoxin A. Results demonstrated that the constructed sensor provided an effective method for ochratoxin A evaluate in complicated food sample analyses.

A radiomics nomogram for the prediction of overall survival in patients with hepatocellular carcinoma after hepatectomy.

BACKGROUND: Hepatocellular carcinoma (HCC) is associated with a dismal prognosis, and prediction of the prognosis of HCC can assist in therapeutic decision-makings. An increasing number of studies have shown that the texture parameters of images can reflect the heterogeneity of tumors, and may have the potential to predict the prognosis of patients with HCC after surgical resection. The aim of this study was to investigate the prognostic value of computed tomography (CT) texture parameters in patients with HCC after hepatectomy and to develop a radiomics nomogram by combining clinicopathological factors and the radiomics signature. METHODS: In all, 544 eligible patients were enrolled in this retrospective study and were randomly divided into the training cohort (n = 381) and the validation cohort (n = 163). The tumor regions of interest (ROIs) were delineated, and the corresponding texture parameters were extracted. The texture parameters were selected by using the least absolute shrinkage and selection operator (LASSO) Cox model in the training cohort, and a radiomics signature was established. Then, the radiomics signature was further validated as an independent risk factor for overall survival (OS). The radiomics nomogram was established based on the Cox regression model. The concordance index (C-index), calibration plot and decision curve analysis (DCA) were used to evaluate the performance of the radiomics nomogram. RESULTS: The radiomics signature was formulated based on 7 OS-related texture parameters, which were selected in the training cohort. In addition, the radiomics nomogram was developed based on the following five variables: α-fetoprotein (AFP), platelet-to-lymphocyte ratio (PLR), largest tumor size, microvascular invasion (MVI) and radiomics score (Rad-score). The nomogram displayed good accuracy in predicting OS (C-index = 0.747) in the training cohort and was confirmed in the validation cohort (C-index = 0.777). The calibration plots also showed excellent agreement between the actual and predicted survival probabilities. The DCA indicated that the radiomics nomogram showed better clinical utility than the clinicopathologic nomogram. CONCLUSION: The radiomics signature is a potential prognostic biomarker of HCC after hepatectomy. The radiomics nomogram that integrated the radiomics signature can provide a more accurate estimation of OS than the clinicopathologic nomogram for HCC patients after hepatectomy.

PTBP3 Induced Inhibition of Differentiation of Gastric Cancer Cells Through Alternative Splicing of Id1.

Overexpression of PTBP3, a factor involved in alternative splicing, may inhibit the differentiation of leukemia cells. However, its role in gastric cancer differentiation and the specific pathways involved are unclear. In this study, we found that PTBP3 was upregulated in the poorly differentiated gastric cancer tissues. Patients with high levels of PTBP3 expression had significantly shorter survival than those with low PTBP3 expression. In gastric cancer cells, the regulatory effect of PTBP3 on alternative splicing of the Id1 gene was investigated. Following sodium butyrate-induced differentiation of MKN45 cells, the expression of Id1a decreased, but the expression of Id1b increased. RNA interference and overexpression experiments showed that PTBP3 upregulated Id1a expression and downregulated Id1b expression. RNA immunoprecipitation (RIP) assays indicated PTBP3 could interact with Id1. UV cross-linking assays indicated that PTBP3 interacted with the CU rich region of the Id1 gene. Two-hybrid experiments and a gel mobility shift assays found that Id1b had a more potent affinity for Hes1 than Id1a. Chromatin immunoprecipitation (ChIP) assays verified the association of Hes1 and the promoter of PTBP3 gene. Luciferase assays revealed that Hes1 bound the N-box sequence in the PTBP3 promoter. After silencing or overexpression of Hes1, PTBP3 protein expression remained unchanged. Thus, the loss of feedback regulation among PTBP3, Id1, and Hes1 in gastric cancer cells may be one of the causes of inhibited differentiation and malignant proliferation of these cells.

La batalla contra la enfermedad del Coronavirus 2019 (COVID-19): Manejo de Emergencia y Control de Infecciones en un Departamento de Radiología.

OBJETIVO: Describir las estrategias, manejo de emergencias y los procedimientos de control de infecciones de nuestro departamento durante el brote de la enfermedad por coronavirus 2019 (COVID-19). MéTODOS: Creamos un equipo de manejo de emergencias. El equipo estableció varias medidas: Reconfiguración del flujo de trabajo en el departamento de radiología, distribución de material de protección personal y adiestramiento del personal, procedimientos para la obtención de imágenes en pacientes sospechosos o confirmados con COVID-19, así como para pacientes sin historial de exposición o síntomas. Aquellos con sospecha o confirmación de COVID-19 fueron escaneados en una unidad dedicada para ello. RESULTADOS: Del 21 de enero del 2020 hasta el 9 de marzo del 2020, 3,083 personas con sospecha o confirmación de COVID-19 recibieron CT de torax. Incluyendo los exámenes iniciales y repetidos, el número total de CT fue 3,340. Como resultado de nuestras medidas de precaución, ninguno de los miembros del personal del departamento de radiología fue infectado con COVID-19. CONCLUSIóN: Las estrategias de planificación y las protecciones adecuadas pueden ayudar a proteger a los pacientes y al personal contra una enfermedad altamente infecciosa. Y a la misma vez ayudar a mantener la capacidad de atender un volumen alto de pacientes.

The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department.

OBJECTIVE: To describe the strategy and the emergency management and infection control procedure of our radiology department during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: We set up emergency management and sensing control teams. The team formulated various measures: reconfiguration of the radiology department, personal protection and training of staff, examination procedures for patients suspected of or confirmed with COVID-19 as well as patients without an exposure history or symptoms. Those with suspected or confirmed COVID-19 infection were scanned in the designated fever-CT unit. RESULTS: From January 21, 2020, to March 9, 2020, 3,083 people suspected or confirmed to be infected with COVID-19 underwent fever-CT examinations. Including initial examinations and re-examinations, the total number of fever-CT examinations numbered 3,340. As a result of our precautions, none of the staff of the radiology department were infected with COVID-19. CONCLUSION: Strategic planning and adequate protections can help protect patients and staff against a highly infectious disease while maintaining function at a high-volume capacity.

The relationship between cognitive function and having diabetes in patients treated with hemodialysis.

PURPOSE: Patients undergoing maintenance hemodialysis (MHD) have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population, and those with cognitive impairment are at higher risk of death than those without cognitive impairment. Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant. However, these findings may not extend to the hemodialysis population. Thus, we aim to investigate the relationship between having diabetes and cognitive function in MHD patients. METHODS: This was a cross-sectional study. A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects. The Chinese version of the Montreal Cognitive Assessment (MoCA) was utilized to assess cognitive function. RESULTS: MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition, visuospatial/executive function, naming, language, abstraction and orientation tasks compared with those without diabetes. According to the multiple linear analyses, having diabetes was significantly associated with lower global cognitive function, naming, and language scores, with ß coefficients and 95% CIs of -1.30 [ -2.59, -0.01], -0.25 [-0.47, -0.02], and -0.32 [-0.58, -0.07], respectively (all P < 0.05). Having diabetes could not independently predict an increased risk of global cognitive impairment. CONCLUSIONS: In MHD patients, having diabetes is significantly associated with lower cognitive function scores. Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes, in order to achieve early diagnosis and early intervention.

Incomplete tumor capsule on preoperative imaging reveals microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis.

PURPOSE: Microvascular invasion (MVI), which is difficult to diagnose before surgery, is a major factor affecting postoperative recurrence in patients with hepatocellular carcinoma (HCC). The relationship between the radiological tumor capsule and MVI is controversial. This study aimed to evaluate the association between the tumor capsule and MVI. METHODS: We searched Medline (by PubMed) and Embase (by OvidSP). Two review authors independently screened titles and abstracts, selected studies about MVI prediction with radiologic tumor capsule and studies with enough data for extracted, assessed the methodological quality and collected data. Summary results were presented as the diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval. RESULTS: Fifteen studies with 2038 patients were included; fourteen studies, including 1331 patients, with no significant heterogeneity indicated no relationship between absent tumor capsule and MVI [DOR = 0.90 (0.64, 1.26)]. Six studies, including 541 patients, with no significant heterogeneity showed incomplete capsule could be used to predict MVI of HCC preoperatively [DOR = 1.85 (1.13, 3.04)]. The overall sensitivity and specificity estimate were 0.50 (0.37, 0.64) and 0.64 (0.53, 0.74), respectively. Eight studies, including 1349 patients, with highly significant heterogeneity revealed that complete capsule could be a protective factor for MVI [DOR = 1.97 (1.01, 3.86)]. CONCLUSIONS: For MVI of HCC, incomplete tumor capsule is a risk factor, while a complete tumor capsule might be a protective factor. However, absent capsule doesn't show significant relationship with MVI. This might be due to combination of the risk and protective effects of present capsule in MVI.

Geometrically invariant watermarking for medical images based on digital holography and three-level DWT-SVD.

Digital imaging and communications in medicine are being applied widely to improve health care for people, and their security attracted our attention when they are transmitted through the Internet. The paper proposes a digital watermarking method for medical images based on digital holography and three-level discrete wavelength transform (DWT) singular value decomposition (SVD), where a live code including privacy information is transformed into digital holography by an improved computer-generated hologram method. The holography then is embedded into the singular values of the LL3 subband wavelet of the medical image. Experimental results show that the proposed method provides sufficient security results against various attacks, especially geometrical attacks.

Signal amplification method for miR-205 assay through combining graphene oxide with duplex-specific nuclease.

Since microRNA-205 (miR-205) is a predictive biomarker for anti-radiation of nasopharyngeal carcinoma (NPC), quantitative detection of miR-205 is important for developing personalized strategies for the treatment of NPC. In this investigation, based on the graphene oxide sensor and duplex specific nuclease (DSN) for fluorescence signal amplification, a highly sensitive detection method for miR-205 was designed. A target-recycling mechanism is employed, where a single miR-205 target triggers the cleavage of many DNA signal probes. The method shows the ability to analyze miR-205 in solution, and it can detect miR-205 at concentrations as low as 132 pmol L-1 with a linear range of 5-40 nmol L-1. Furthermore, the method is specific in that it distinguishes between a target miRNA and a sequence with single base, double base and three base mismatches, as well as other miRNAs. Considering simplicity and excellent sensitivity/specificity, it is promising for applications in radioresistance studies as well as the early clinical diagnosis of NPC.