Radiomics analysis of contrast-enhanced computerized tomography for differentiation of gastric schwannomas from gastric gastrointestinal stromal tumors.

PURPOSE: To assess the performance of radiomics-based analysis of contrast-enhanced computerized tomography (CE-CT) images for distinguishing GS from gastric GIST. METHODS: Forty-nine patients with GS and two hundred fifty-three with GIST were enrolled in this retrospective study. CT features were evaluated by two associate chief radiologists. Radiomics features were extracted from portal venous phase images using Pyradiomics software. A non-radiomics dataset (combination of clinical characteristics and radiologist-determined CT features) and a radiomics dataset were used to build stepwise logistic regression and least absolute shrinkage and selection operator (LASSO) logistic regression models, respectively. Model performance was evaluated according to sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve, and Delong's test was applied to compare the area under the curve (AUC) between different models. RESULTS: A total of 1223 radiomics features were extracted from portal venous phase images. After reducing dimensions by calculating Pearson correlation coefficients (PCCs), 20 radiomics features, 20 clinical characteristics + CT features were used to build the models, respectively. The AUC values for the models using radiomics features and those using clinical features were more than 0.900 for both the training and validation groups. There were no significant differences in predictive performance between the radiomic and clinical data models according to Delong's test. CONCLUSION: A radiomics-based model applied to CE-CT images showed comparable predictive performance to senior physicians in the differentiation of GS from GIST.

Artemis as Predictive Biomarker of Responsiveness to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer.

The aim of this study was to identify Artemis as a predictive biomarker for guiding preoperative chemoradiotherapy in locally advanced rectal cancer. The resection specimens were collected from 50 patients with rectal cancer who underwent preoperative chemoradiotherapy. Artemis expression in biopsy tissues was evaluated using immunohistochemical staining according to the percentage of positively stained cells combined with staining intensity. Among the 50 patients, 36 (72%) had a weakly positive Artemis protein expression, 10 (20%) had a moderately positive expression, and 4 (8%) showed a strongly positive expression. The criteria of magnetic resonance imaging tumor regression grade (mrTRG) and pathological rectal cancer regression grade (RCRG) were used to assess the tumor response to chemoradiotherapy. Correlation analysis shows that there is a significant negative correlation between high Artemis immunoscore and treatment response (r = -0.532, p < 0.001). The results imply that high Artemis expression was associated with poor treatment response. Our study suggested a potential role of Artemis as a predictive biomarker of the tumor response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.

10 kW tandem pumping fiber amplifier with good beam quality based on tapered ytterbium-doped fiber.

In this paper, we established a high power tandem pumped fiber amplifier based on tapered ytterbium-doped fiber (TYDF). The TYDF is developed in-house with a core/inner cladding diameter of 30/250 µm at the small-core region and 48/400 µm at the large-core region. The key parameters of the amplifier in a co-pumped and counter-pumped configuration are experimentally investigated, such as slope efficiency, stimulated Raman scattering (SRS) threshold, and beam quality evolution. Up to 10.28 kW laser free of SRS or transverse mode instability is obtained from the counter-pumped amplifier, and the beam quality factor M2 is 2.29, which is significantly improved compared with the 48/400 µm uniform YDF. To the best of our knowledge, this is the highest average output power achieved so far based on the TYDF. This work could provide a solution for balancing the SRS suppression and high order modes control in high power tandem pumped YDF lasers.

Depression and anxiety in cancer patient enrolled in clinical trials with serious adverse events.

OBJECTIVE: Drug-induced side effects, particularly serious adverse events (SAEs), often affect cancer patients enrolled in clinical trials. However, little is known about anxiety and depression in cancer patients who experienced SAEs. This study evaluated the prevalence of anxiety and depression in cancer patients enrolled in clinical trials who experienced SAEs and explored the risk factors. METHODS: A multi-center, cross-sectional survey was conducted in hospitals affiliated with the University of Science and Technology of China from December 2021 to November 2022. A total of 112 cancer patients who experienced SAEs while enrolled in clinical trials, and who completed the informed consent process and study questionnaires, were included in the final analysis. RESULTS: The rate of moderate-severe depression in cancer patients was 38.4% and that of moderate-severe anxiety was 13.4%. Among the patients who had moderate-severe anxiety, 93.3% had concurrent moderate-severe depression. Lower cognitive function and lower global quality of life were risk factors for depression in cancer patients who experienced SAEs. Pain, low emotional function, low global quality of life, and a high Impact of Events Scale score were risk factors for anxiety. CONCLUSIONS: Cancer patients enrolled in a clinical trial who experienced SAEs tended to be anxious and depressed, particularly the latter. These results indicate the need to evaluate anxiety and depression, and mental health treatment among cancer patients with SAEs in clinical trials.

Low-Profile Millimeter-Wave Metasurface-Based Antenna with Enhanced Bandwidth.

A millimeter-wave broadband metasurface-based antenna with a low profile is proposed. In order to guide the mode excitation, the characteristic mode analysis (CMA) is used for the design and optimization of the proposed antenna. Four sets of coplanar patches with different dimensions on a thin printed circuit board are used to generate four adjacent broadside modes, which are directly fed by a coaxial probe. Then, to expand low-frequency bandwidth, a new resonant mode is introduced by etching slots on the parasite patch. Meanwhile, the extra mode introduced does not significantly change the radiation performance of the original modes. Moreover, dual slots are etched on the mid patch fed by the coaxial probe, which moves the orthogonal modes of the chosen modes out of the operating band to reduce cross-polarization levels. The proposed antenna realized 25.02 % (30-38.58 GHz) impedance bandwidth with dimensions of 1.423×1.423×0.029λ0 3 (λ0 is the wavelength at 34 GHz in free space), and the realized gain in the band is 8.35-11.3 dB.

Molecular Characterization of U6 Promoters from Orange-Spotted Grouper (Epinephelus coioides) and Its Application in DNA Vector-Based RNAi Technology.

The U6 promoter, a typical RNA polymerase III promoter, is widely used to transcribe small RNAs in vector-based siRNA systems. The RNAi efficiency is mainly dependent on the transcriptional activity of the U6 promoter. However, studies have found that U6 promoters isolated from some fishes do not work well in distantly related species. To isolate a U6 promoter with high transcriptional efficiency from fish, in this study, we cloned five U6 promoters in orange-spotted grouper, of which only the grouper U6-1 (GU6-1) promoter contains the OCT element in the distant region. Functional studies revealed that the GU6-1 promoter has high transcriptional ability, which could efficiently transcribe shRNA and result in target gene knockdown in vitro and in vivo. Subsequently, the deletion or mutation of the OCT motif resulted in a significant decrease in promoter transcriptional activity, demonstrating that the OCT element plays an important role in enhancing the grouper U6 promoter transcription. Moreover, the transcriptional activity of the GU6-1 promoter showed little species specificity. It not only works in the grouper but also possesses high transcriptional activity in the zebrafish. Knockdown of the mstn gene in zebrafish and grouper through shRNA driven by the GU6-1 promoter could promote fish growth, suggesting that the GU6-1 promoter can be used as a potential molecular tool in aquaculture practice.

Selection principle of seed power in high-power narrow linewidth fiber amplifier seeded by a FBGs-based fiber oscillator.

Here, we have experimentally demonstrated the selection principle of the seed power in a narrow linewidth fiber amplifier seeded by fiber oscillator based on a pair of fiber Bragg gratings. During the study on the selection of seed power, the spectral instability of the amplifier is found when a low power seed with bad temporal characteristics is amplified. This phenomenon is thoroughly analyzed from seed itself and the influence of the amplifier. Increasing the seed power or isolating the backward light of amplifier could effectively eliminate the spectral instability. Based on this point, we optimize the seed power and utilize a band pass filter circulator to isolate the backward light and filter the Raman noise. Finally, a 4.2 kW narrow linewidth output power is achieved with signal to noise ratio of 35 dB, which has exceeded the value under the highest output power reported in this type of narrow linewidth fiber amplifiers. This work provides a solution for high power and high signal to noise ratio narrow-linewidth fiber amplifiers seeded by FBGs-based fiber oscillator.

Depression and anxiety among hemophilia patients enrolled in clinical trials: a multi-center cohort study.

Hemophilia patients enrolled in clinical trials often exhibit various physical and psychological symptoms. However, little is known about anxiety and depression among them. This study assessed the effects of depression and anxiety on hemophilia patients enrolled in clinical trials and identified risk factors for these disorders. A multi-center, cohort study was conducted from January to December 2022. Sixty-nine hemophilia patients who enrolled in clinical trials participated at baseline (T1, prior to treatment initiation) and completed the informed consent. Risk factors were measured at baseline to predict depression and anxiety at 3 months (T2). Sixty-four hemophilia patients were included in the final analysis. More hemophilia patients had moderate-severe depression (28 [43.75%]) and anxiety (16 [25.00%]) at T2 than at T1 (12 [18.75]), (5 [7.81%]). Depression was aggravated in 23 (35.94%) patients and anxiety was aggravated in 12 (18.75%) patients. Frequently acquired medical information (OR 11.378, CI 1.319-98.114, P = 0.027), baseline GAD-7 (OR 1.341, CI 1.015-1.772, P = 0. 039) and PHQ-9 (OR 1.465, CI 1.039-2.065, P = 0.029) are important factors predicting depression and anxiety in hemophilia patients. Hemophilia patients enrolled in a clinical trial have significant anxiety and depression. The frequency of acquiring medical information and the baseline PHQ-9 and GAD-7 scores were risk factors for anxiety and depression. Thus, hemophilia patients should receive education regarding clinical trials and undergo evaluations of their anxiety and depression; these changes will enable prompt detection of their psychological burden and identify potential psychological intervention strategies.

Awareness of Clinical Research Coordinators Toward Ethics and Protection of Clinical Trial Patients.

PURPOSE: Clinical research coordinators (CRCs) play an important role in the protection of clinical trial participants and maintenance of ethical standards. However, limited data are available on the ethical cognition of CRCs. Understanding the knowledge, attitude, and practices (KAP) of CRCs toward ethics is essential to protect study participants and improve their compliance. METHODS: We conducted a descriptive, cross-sectional, quantitative study at 20 hospitals in Anhui province of China. A self-administered questionnaire was completed by 435 CRCs conducting clinical trials. RESULTS: The good knowledge, positive attitude, and good practice rates were 55.2%, 59.3%, and 79.5% respectively. Most CRCs (99.1%) were aware of the participants' rights. Only 127 (29.2%) and 140 (32.2%) CRCs were aware of measures to protect participants' rights and ethical guidelines regarding trials, respectively. In total, 59.6% of CRCs stated that ethical review might delay the start of a clinical trial. Marital status (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.27-0.83), CRC work experience (OR 0.11, 95% CI 0.02-0.75), and educational background (OR 0.31, 95% CI 0.13-0.76) affected the knowledge of CRCs regarding ethics. CONCLUSIONS: Some deficiencies were observed in the ethical knowledge and behavior of CRCs. Interventions to improve the ethical training of CRCs regarding study participant protection, international guidelines, and the role of ethical committees are essential when conducting clinical trials. Validated instruments should be constructed to assess the effectiveness of ethical training and measure the KAP of CRCs toward ethics.

Case report: Significant benefits of tislelizumab combined with anlotinib in first-line treatment of metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation.

Background: Renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation is a very dangerous malignant tumor and extremely rare in clinical practice. In general, these tumors with a dismal prognosis, and there is no standard treatment. Case presentation: In this case, an 81-year-old male patient was diagnosed with right renal pelvic carcinoma. After an open right radical nephroureterectomy, postoperative pathological examination showed infiltrating urothelial carcinoma with sarcomatoid differentiation. Overexpression of programmed death ligand-1 by immunohistochemistry. The carcinoma recurred 4.5 months after surgery. After informed, tislelizumab combined with anlotinib were used as first-line treatment. The patients showed a clinical partial response that lasted for 20 months. Conclusion: This case demonstrates the efficacy of tislelizumab combined with anlotinib in patients diagnosed with metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation. Moreover, to our knowledge, this is the first application of this treatment.

Whole-Process Treatment of Combined Small Cell Lung Cancer Initially Diagnosed as "Lung Squamous Cell Carcinoma": A Case Report and Review of the Literature.

The rarity and complexity of histology lead to the low diagnosis rate and high misdiagnosis rate of combined small cell lung cancer (C-SCLC). Nowadays, C-SCLC has no commonly recommended therapeutic regimen, mainly conforming to SCLC treatment. Here, we report a patient initially diagnosed as IIIA "lung squamous cell carcinoma" by a small specimen. Radical resection was achieved after neoadjuvant immunochemotherapy, and the final surgical pathology was C-SCLC containing three different histological components. Moreover, in the literature review, we explored the therapeutic effect of neoadjuvant immunotherapy in C-SCLC, expounded the therapeutic conflicts among heterogeneous components, and analyzed the pathology complexity at the tissue, cell, and molecule levels in-depth, including possible genetic characteristics, origin, and evolution by next-generation sequencing (NGS).

Epidemiology of Drug- and Herb-Induced Liver Injury Assessed for Causality Using the Updated RUCAM in Two Hospitals from China.

Drug- and herb-induced liver injury (DILI and HILI) is an increasingly common and serious condition. Here, data for DILI and HILI patients from two large tertiary hospitals were retrospectively analyzed. Patient characteristics, causes and severity of DILI and HILI, the correlation between expression of p62 and the severity of DILI and HILI, treatment of DILI and HILI, and the prognostic factors of DILI and HILI were studied. A total of 82 patients with DILI and HILI were recruited for the study. Most patients presented with hepatocellular injury, followed by cholestatic injury and mixed injury. Our results indicate that traditional Chinese medicine or herbal and dietary supplements were the prevalent causal agents of HILI, which was characterized by higher frequencies of hepatocellular injury. Expression of p62 in the liver correlated with the severity of DILI and HILI. Improvements in the results of the liver enzymatic tests correlated with alanine transaminase (ALT) levels upon the first diagnosis of DILI and HILI and with the hepatocellular type of DILI and HILI. In conclusion, we provide an epidemiological assessment of DILI and HILI based on causality using the updated RUCAM on patients from two hospitals in China. ALT levels at first diagnosis and the hepatocellular type of injury may be prognostic factors of DILI and HILI.

Computational fluid dynamics simulation of time-resolved blood flow in Budd-Chiari syndrome with inferior vena cava stenosis and its implication for postoperative efficacy assessment.

BACKGROUND: This study aimed to adopt computational fluid dynamics to simulate the blood flow dynamics in inferior vena cava stenosis based on time-dependent patient-specific models of Budd-Chiari syndrome as well as a normal model. It could offer valuable references for a retrospective insight into the underlying mechanisms of Budd-Chiari syndrome pathogenesis as well as more accurate evaluation of postoperative efficacy. METHODS: Three-dimensional inferior vena cava models of Budd-Chiari syndrome patient-specific (preoperative and postoperative) and normal morphology model were reconstructed as per magnetic resonance images using Simpleware. Moreover, computational fluid dynamics of time-resolved inferior vena cava blood flow were simulated using actual patient-specific measurements to reflect time-dependent flow rates. FINDINGS: The assessment of the preoperative model revealed the dramatic variations of hemodynamic parameters of the stenotic inferior vena cava. Moreover, the comparison of the preoperative and postoperative models with the normal model as benchmark showed that postoperative hemodynamic parameters were markedly ameliorated via stenting, with the attenuation of overall velocity and wall shear stress, and the increase of pressure. However, the comparative analysis of the patient-specific simulations revealed that some postoperative hemodynamic profiles still bore some resemblance to the preoperative ones, indicating potential risks of restenosis. INTERPRETATION: Computational fluid dynamics simulation of time-resolved blood flow could reveal the tight correlation between the hemodynamic characteristics and the pathological mechanisms of inferior vena cava stenosis. Furthermore, such time-resolved hemodynamic profiles could provide a quantitative approach to diagnosis, operative regimen and postoperative evaluation of Budd-Chiari syndrome with inferior vena cava stenosis.

Anatomic Relationship Between Right Recurrent Laryngeal Nerve and Cervical Fascia and Its Application Significance in Anterior Cervical Spine Surgical Approach.

STUDY DESIGN: An anatomic study of anterior cervical dissection of 42 embalmed cadavers. OBJECTIVE: The aim was to study the anatomic relationship between recurrent laryngeal nerve (RLN) and cervical fascia combined with the requirements in anterior cervical spine surgery (ACSS). SUMMARY OF BACKGROUND DATA: There has been no systematic research about how to avoid RLN injury in anterior cervical spine surgical approach from the aspect of the anatomic relationship between RLN and cervical fascia. METHODS: Forty-two adult cadavers were dissected to observe the relationships between RLN and different cervical fascia layers. RESULTS: RLN pierced out the alar fascia from the inner edge of the carotid sheath in all cases, and the piercing position in 22 cases (52.4%) was located at the lower segment of T1. The enter point into visceral fascia of RLN was located at C7-T1 in 25 cases (59.5%). The middle layer of deep cervical fascia exhibited the most stable anatomic relationship with RLN at the carotid sheath confluence site. Pulling visceral sheath leftwards would significantly increase the RLN tension. CONCLUSION: Using the close and stable relationship between RLN and cervical fascia could help to avoid RLN injury in anterior cervical spine surgical approach. LEVEL OF EVIDENCE: 4.

Anatomical factors/countermeasures in/against iatrogenic injury of the deep branch of radial nerve in the Thompson approach via middle and proximal segments of forearm / Factores anatómicos/contramedidas en/contra la lesión iatrogénica del ramo profundo del nervio radial en el abordaje de Thompson a través de los segmentos medio y proximal del antebrazo

This study aimed to investigate the anatomical factors affecting iatrogenic injury of the deep branch of radial nerve during the Thompson approach and to propose corresponding countermeasures. Thompson approach was used to measure the horizontal/longitudinal distance from the position where the deep branch of radial nerve leaves the supinator to the ulnar margin of extensor carpi radialis brevis/humeroradial joint line. Measurements were obtained by using 48 adult cadaver specimens, which were used in teaching. We observed the lentor situation of the extensor digitorum and extensor carpi radialis brevis in proximal forearm segments and measured the distance from the deep branch of radial nerve to the humeroradial joint line at the lateral side of the radius in the neutral position of forearm rotation. The horizontal distance from the point where the deep branch of radial nerve leaves the inferior margin of supinator to the ulnar margin of extensor carpi radialis brevis was 1.3 ± 0.3 cm. The distance to the humeroradial joint line was 61.3 ± 17.6 mm. The distance to the lentor extent of extensor digitorum and extensor carpi radialis brevis at the distal part of humeroradial joint was 7.1 ± 2.1 cm. The distance from the deep branch of radial nerve to the humeroradial joint line at the lateral side of the radius is 3.2 ± 0.6 mm. Anatomical factors are observed in iatrogenic injury of the deep branch of radial nerve during the Thompson approach. Stretching the extensor digitorum before the dissection of the supinator is hazardous.

El objetivo de este estudio fue investigar los factores anatómicos que provocan la lesión iatrogénica del ramo profundo del nervio radial durante el abordaje de Thompson y proponer las contramedidas correspondientes. El abordaje de Thompson se utilizó para medir la distancia horizontal / longitudinal desde la posición en que el ramo profundo del nervio radial sale del músculo supinador hasta el margen ulnar del músculo extensor radial corto del carpo a nivel de la línea articular humeroradial. Las mediciones se obtuvieron utilizando 48 especímenes de cadáveres adultos, que se usaron en la enseñanza. Se observó la situación de los músculos extensor de los dedos y del extensor radial corto del carpo en los segmentos proximales del antebrazo y se midió la distancia desde el ramo profundo del nervio radial hasta la línea articular humeroradial en el margen lateral del radio en posición neutra de rotación del antebrazo. La distancia horizontal desde el punto en que el ramo profundo del nervio radial sale del margen inferior del músculo supinador hasta el margen ulnar del músculo extensor radial corto del carpo fue 1,3 ± 0,3 cm. La distancia a la línea articular humeroradial fue de 61,3 ± 17,6 mm. La distancia entre el músculo extensor de los dedos y el músculo extensor radial corto del carpo en la parte distal de la articulación humeroradial fue de 7,1 ± 2,1 cm. La distancia desde el ramo profundo del nervio radial a la línea articular humeroradial en el lado lateral del radio fue de 3,2 ± 0,6 mm. Se observan factores anatómicos en la lesión iatrogénica del ramo profundo del nervio radial durante el abordaje de Thompson. El estiramiento del extensor de los dedos antes de la disección del músculo supinador es peligroso.

Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up.

OBJECTIVE: The safest and most effective conservative treatment for patients with lumbar disc herniation (LDH) has not been established. The purpose of this study was to evaluate the effect of lumbar spine stabilization exercise (LSSE) and general exercise (GE) on pain intensity and functional capacity in young male patients with LDH. METHODS: Sixty-three young male adults aged 20 to 29 years with the diagnosis of LDH were enrolled and divided into an LSSE group (n=30) and a GE group (n=33). Patients in both groups received low-power laser (LPL) therapy during the first week of the onset of LDH. Patients in the GE group underwent a GE program. Patients in the LSSE group followed an LSSE program for 3 months. All of the patients were subjected to pain intensity and functional capacity evaluations four times: at pre-and post-LPL therapy, and at 3 months and 1 year post-exercise. Pain intensity of the lower back and legs was evaluated with the visual analogue scale (VAS), and functional capacity was evaluated with the Oswestry Disability Index (ODI). RESULTS: Both groups showed a significant reduction in VAS and ODI scores at 3 and 12 months post-exercise compared with before treatment (P<0.001). The LSSE group showed a significant reduction in the average score of the VAS for low back pain (P=0.012) and the ODI (P=0.003) at 12 months post-exercise compared with the GE group. CONCLUSIONS: LSSE and GE are considered as effective interventions for young male patients with LDH. Moreover, LSSE is more effective than GE, and physical therapy, such as LPL, is required during acute LDH.