Accelerated and Guided Zn2+ Diffusion via Polarized Interface Engineering Toward High Performance Wearable Zinc-Ion Batteries.

Rechargeable aqueous Zn-ion batteries (ZIBs) are considered as a new energy storage device for wearable electronic equipment. Nowadays, dendrite growth and uneven deposition of zinc have been the principal problems to suppress the development of high-performance wearable zinc-ion batteries. Herein, a perovskite material of LaAlO3 nanoparticle has been applied for interface engineering and zinc anode protection. By adjusting transport channels and accelerating the Zn2+ diffusion, the hydrogen evolution reaction potential is improved, and electric field distribution on the Zn electrode surface is regulated to navigate the fast and uniform deposition of Zn2+. As a proof of demonstration, the assembled LAO@Zn||MnO2 batteries can display the highest capacity of up to 140 mAh g-1 without noticeable decay even after 1000 cycles. Moreover, a motor-driven fan and electronic wristwatch powered by wearable ZIBs can demonstrate the practical feasibility of LAO@Zn||MnO2 in wearable electronic equipment.

CmERF1 acts as a positive regulator of fruits and leaves growth in melon (Cucumis melo L.).

Melon (Cucumis melo L.) is an important horticultural and economic crop. ETHYLENE RESPONSE FACTOR1 (ERF1) plays an important role in regulating plant development, and the resistance to multiple biotic and abiotic stresses. In this study, developmental biology, molecular biology and biochemical assays were performed to explore the biological function of CmERF1 in melon. Abundant transcripts of CmERF1 were found in ovary at green-yellow bud (GYB) and rapid enlargement (ORE) stages. In CmERF1 promoter, the cis-regulatory elements for indoleacetic acid (IAA), methyl jasmonate (MeJA), salicylic acid (SA), abscisic acid (ABA), gibberellic acid (GA), light and low temperature responses were found. CmERF1 could be significantly induced by ethylene, IAA, MeJA, SA, ABA, and respond to continuous light and low temperature stresses in melon. Ectopic expression of CmERF1 increased the length of siliqua and carpopodium, and expanded the size of leaves in Arabidopsis. Knockdown of CmERF1 led to smaller ovary at anthesis, mature fruit and leaves in melon. In CmERF1-RNAi #2 plants, 75 genes were differently expressed compared with control, and the promoter regions of 28 differential expression genes (DEGs) contained the GCC-box (AGCCGCC) or DRE (A/GCCGAC) cis-acting elements of CmERF1. A homolog of cell division cycle protein 48 (CmCDC48) was proved to be the direct target of CmERF1 by the yeast one-hybrid assay and dual-luciferase (LUC) reporter (DLR) system. These results indicated that CmERF1 was able to promote the growth of fruits and leaves, and involved in multiple hormones and environmental signaling pathways in melon.

Mechanisms involved in the regulation of mitochondrial quality control by PGAM5 in heart failure.

Heart failure (HF) refers to a group of clinical syndromes in which various heart diseases lead to the inability of cardiac output to meet the metabolic needs of the body's tissues. Cardiac metabolism requires enormous amounts of energy; thus, impaired myocardial energy metabolism is considered a key factor in the occurrence and development of HF. Mitochondria serve as the primary energy source for cardiomyocytes, and their regular functionality underpins healthy cardiac function. The mitochondrial quality control system is a crucial mechanism for regulating the functionality of cardiomyocytes, and any abnormality in this system can potentially impact the morphology and structure of mitochondria, as well as the energy metabolism of cardiomyocytes. Phosphoglycerate mutase 5 (PGAM5), a multifunctional protein, plays a key role in the regulation of mitochondrial quality control through multiple pathways. Therefore, abnormal PGAM5 function is closely related to mitochondrial damage. This article reviews the mechanism of PGAM5's involvement in the regulation of the mitochondrial quality control system in the occurrence and development of HF, thereby providing a theoretical basis for future in-depth research.

MicroRNA Profiling Revealed the Mechanism of Enhanced Cold Resistance by Grafting in Melon (Cucumis melo L.).

Grafting is widely used to improve the resistance to abiotic stresses in cucurbit plants, but the effect and molecular mechanism of grafting on cold stress are still unknown in melon. In this study, phenotypic characteristics, physiological indexes, small-RNA sequencing and expression analyses were performed on grafted plants with pumpkin rootstock (PG) and self-grafted plants (SG) to explore the mechanism of changed cold tolerance by grafting in melon. Compared with SG plants, the cold tolerance was obviously enhanced, the malondialdehyde (MDA) content was significantly decreased and the activities of antioxidant enzymes (superoxide dismutase, SOD; catalase, CAT; peroxidase, POD) were significantly increased in PG plants. Depend on differentially expressed miRNA (DEM) identification and expression pattern analyses, cme-miR156b, cme-miR156f and chr07_30026 were thought to play a key role in enhancing low-temperature resistance resulting from grafting. Subsequently, 24, 37 and 17 target genes of cme-miR156b, cme-miR156f and chr07_30026 were respectively predicted, and 21 target genes were co-regulated by cme-miR156b and cme-miR156f. Among these 57 unique target genes, the putative promoter of 13 target genes contained the low-temperature responsive (LTR) cis-acting element. The results of qRT-PCR indicated that six target genes (MELO3C002370, MELO3C009217, MELO3C018972, MELO3C016713, MELO3C012858 and MELO3C000732) displayed the opposite expression pattern to their corresponding miRNAs. Furthermore, MELO3C002370, MELO3C016713 and MELO3C012858 were significantly downregulated in cold-resistant cultivars and upregulated in cold-sensitive varieties after cold stimulus, and they acted as the key negative regulators of low-temperature response in melon. This study revealed three key miRNAs and three putative target genes involved in the cold tolerance of melon and provided a molecular basis underlying how grafting improved the low-temperature resistance of melon plants.

A deep learning fusion network trained with clinical and high-frequency ultrasound images in the multi-classification of skin diseases in comparison with dermatologists: a prospective and multicenter study.

Background: Clinical appearance and high-frequency ultrasound (HFUS) are indispensable for diagnosing skin diseases by providing internal and external information. However, their complex combination brings challenges for primary care physicians and dermatologists. Thus, we developed a deep multimodal fusion network (DMFN) model combining analysis of clinical close-up and HFUS images for binary and multiclass classification in skin diseases. Methods: Between Jan 10, 2017, and Dec 31, 2020, the DMFN model was trained and validated using 1269 close-ups and 11,852 HFUS images from 1351 skin lesions. The monomodal convolutional neural network (CNN) model was trained and validated with the same close-up images for comparison. Subsequently, we did a prospective and multicenter study in China. Both CNN models were tested prospectively on 422 cases from 4 hospitals and compared with the results from human raters (general practitioners, general dermatologists, and dermatologists specialized in HFUS). The performance of binary classification (benign vs. malignant) and multiclass classification (the specific diagnoses of 17 types of skin diseases) measured by the area under the receiver operating characteristic curve (AUC) were evaluated. This study is registered with www.chictr.org.cn (ChiCTR2300074765). Findings: The performance of the DMFN model (AUC, 0.876) was superior to that of the monomodal CNN model (AUC, 0.697) in the binary classification (P = 0.0063), which was also better than that of the general practitioner (AUC, 0.651, P = 0.0025) and general dermatologists (AUC, 0.838; P = 0.0038). By integrating close-up and HFUS images, the DMFN model attained an almost identical performance in comparison to dermatologists (AUC, 0.876 vs. AUC, 0.891; P = 0.0080). For the multiclass classification, the DMFN model (AUC, 0.707) exhibited superior prediction performance compared with general dermatologists (AUC, 0.514; P = 0.0043) and dermatologists specialized in HFUS (AUC, 0.640; P = 0.0083), respectively. Compared to dermatologists specialized in HFUS, the DMFN model showed better or comparable performance in diagnosing 9 of the 17 skin diseases. Interpretation: The DMFN model combining analysis of clinical close-up and HFUS images exhibited satisfactory performance in the binary and multiclass classification compared with the dermatologists. It may be a valuable tool for general dermatologists and primary care providers. Funding: This work was supported in part by the National Natural Science Foundation of China and the Clinical research project of Shanghai Skin Disease Hospital.

Clinical value of grayscale ultrasound combined with real-time shear wave elastography nomogram in risk prediction of thyroid cancer.

OBJECTIVES: This study constructed a nomogram based on grayscale ultrasound features and real-time shear wave elastography (SWE) parameters to predict thyroid cancer. METHODS: Clinical data of 217 thyroid nodules of 201 patients who underwent grayscale ultrasound, real-time SWE, and thyroid function laboratory examination in Ma'anshan People's Hospital from January 2019 to December 2020 were retrospectively analyzed. The subjects were divided into a benign nodule group (106 nodules) and a malignant nodule group (111 nodules). The differences in grayscale ultrasound features, quantitative parameters of real-time SWE, and laboratory results of thyroid function between benign and malignant thyroid nodules were analyzed. We used a chi-square test for categorical variables and a t-test for continuous variables. Then, the independent risk factors for thyroid cancer were analyzed using multivariate logistic regression. Based on the independent risk factors, a nomogram for predicting thyroid cancer risk was constructed using the RMS package of the R software. RESULTS: Multivariate logistic regression showed that the grayscale ultrasound features of thyroid nodules were the shape, margin, echogenicity, and echogenic foci of the nodules,the maximum Young's modulus (SWE-max) of thyroid nodules, and the ratio of thyroid nodule and peripheral gland (SWE-ratio) measured by real-time SWE were independent risk factors for thyroid cancer (all p < 0.05), and the other variables had no statistical difference (p > 0.05). Based on the shape (OR = 5.160, 95% CI: 2.252-11.825), the margin (OR = 9.647, 95% CI: 2.048-45.443), the echogenicity (OR = 6.512, 95% CI: 1.729-24.524), the echogenic foci (OR = 2.049, 95% CI: 1.118-3.756), and the maximum Young's modulus (SWE-max) (OR = 1.296, 95% CI: 1.140-1.473), the SWE-ratio (OR = 2.001, 95% CI: 1.403-2.854) of the thyroid nodule to peripheral gland was used to establish the related nomogram prediction model. The bootstrap self-sampling method was used to verify the model. The consistency index (C-index) was 0.979, ROC curve was used to analyze the nomogram scores of all patients, and the AUC of nomogram prediction of thyroid cancer was 0.976, indicating that the nomogram model had high accuracy in the risk prediction of thyroid cancer. CONCLUSIONS: The nomogram model of grayscale ultrasound features combined with SWE parameters can accurately predict thyroid cancer.

MnO2 nanoparticles decorated with Ag/Au nanotags for label-based SERS determination of cellular glutathione.

A novel stimulus-responsive surface-enhanced Raman scattering (SERS) nanoprobe has been developed for sensitive glutathione (GSH) detection based on manganese dioxide (MnO2) core and silver/gold nanoparticles (Ag/Au NPs). The MnO2 core is not only capable to act as a scaffold to amplify the SERS signal via producing "hot spots", but also can be degraded in the presence of the target and thus greatly enhance the nanoprobe sensitivity for sensing of GSH. This approach enables a wide linear range from 1 to 100 µM with a 2.95 µM (3σ/m) detection limit. Moreover, the developed SERS nanoprobe represents great possibility in both sensitive detection of intracellular GSH and even can monitor the change of intracellular GSH level when the stimulant occurs. This sensing system not merely offers a novel strategy for sensitive sensing of GSH, but also provides a new avenue for other biomolecules detection.

PM2.5 mediates mouse testis Sertoli TM4 cell damage by reducing cellular NAD.

OBJECTIVE: This study aims to explore the mechanism of PM2.5 damage to the reproductive system of male mice. METHODS: Mouse testis Sertoli TM4 cells were divided into four groups: a control group (no additional ingredients except for medium), PM2.5 group (medium containing 100 µg/mL PM2.5), PM2.5 + NAM group (medium containing 100 µg/mL PM2.5 and 5 mM NAM), and NAM group (medium containing 5 mM nicotinamide) and cultured in vitro for 24 or 48 h. The apoptosis rate of TM4 cells was measured using flow cytometry, the intracellular levels of NAD+ and NADH were detected using an NAD+/NADH assay kit, and the protein expression levels of SIRT1 and PARP1 were determined by western blotting. RESULTS: Mouse testis Sertoli TM4 cells exposed to PM2.5 demonstrated an increase in the apoptosis rate and PARP1 protein expression, albeit a decrease in NAD+, NADH, and SIRT1 protein levels (p = 0.05). These changes were reversed in the group treated with a combination of PM2.5 and nicotinamide (p = 0.05). CONCLUSION: PM2.5 can cause Sertoli TM4 cell damage in mouse testes by decreasing intracellular NAD+ levels.

SnCo Nanoparticles Loaded in Hollow Carbon Spheres Interlinked by N-Doped Carbon Fibers for High-Performance Sodium-Ion Batteries.

The development of Sn-based materials with electrochemically inactive matrices is a novel strategy to alleviate the volume expansion and giant structure strain/stress during the sodiation/desodiation process. In this work, a freestanding membrane based on the unique bean pod-like host composed by nitrogen-doped carbon fibers and hollow carbon spheres (HCSs) encapsulated with SnCo nanoparticles is synthesized by electrospinning (B-SnCo/NCFs). In this unique bean pod-like structure, Sn acts as a host for Na+ storage, while the Co plays the important role of an electrochemically inactive matrix that can not only buffer the volume variations but also inhibit aggregation and particle growth of the Sn phase during the electrochemical Na-Sn alloying process. Meanwhile, the introduction of hollow carbon spheres can not only provide enough sufficient void space to withstand the volume expansion during the (de)sodiation processes but also improve the conductivity of the anode along the carbon fibers. Furthermore, the B-SnCo/NCF freestanding membrane can increase the contact area between the active material and the electrolyte, which can provide more active sites during the cycling process. When used as an anode material for Na-ion batteries, the freestanding B-SnCo/NCF anode exhibits an outstanding rate capacity of 243.5 mA h g-1 at 1.6 A g-1and an excellent specific capacity of 351 mA h g-1 at 0.1 A g-1 for 300 cycles.

Evaluation of the Effect of Fibroblasts on Melanoma Metastasis Using a Biomimetic Co-Culture Model.

Melanoma is a highly malignant tumor originating from melanocytes. The 5-year survival rate of primary melanoma is 98%, whereas the survival rate of metastatic melanoma is only 10%, which can be attributed to the insensitivity to existing treatments. Fibroblasts are the primary cells in the dermis that promote melanoma metastasis; however, the molecular mechanism underlying the fibroblast-melanoma interaction is yet to be completely understood. Herein, gelatin methacryloyl (GelMA) was used to construct a co-culture model for melanoma cells (A375) and fibroblasts. GelMA retains the good biological properties of collagen, which has been identified as the primary component of the melanoma tumor microenvironment. Fibroblasts were encapsulated in GelMA, whereas A375 cells were cultured on the GelMA surface, which realistically mimics the macrostructure of melanoma. A375 cells co-cultured with fibroblasts demonstrated a higher cellular proliferation rate, potentials of neoneurogenesis, overexpression of epithelial mesenchymal transition markers, and a faster migration rate compared with A375 cells cultured alone, which could be due to the cancer-associated fibroblast activation and the overexpression of transforming growth factor ß1 and fibroblast growth factor-2 by fibroblasts. Overall, this study revealed the possible mechanisms of fibroblast-melanoma interaction and suggested that this co-culture model could be potentially further developed as a platform for screening chemotherapies in the future.

Expression patterns of ABCE model genes during flower development of melon (Cucumis melo L.).

In production, most cultivars of melon are andromonoecious and characterized by carrying both male and bisexual flowers on the same plant. In this study, four A-class genes (CmAP1a, CmAP1b, CmAP2a and CmAP2b), two B-class genes (CmAP3 and CmPI), two C-class genes (CmAGa and CmAGb) and four E-class genes (CmSEP1,2,3,4) were identified in melon. However, no D-class gene of melon was identified. The conserved domains of ABCE function proteins showed relatively high similarity between Arabidopsis and melon. The expression patterns of ABCE homeotic genes in different flower buds of melon suggested that transcripts of CmAP1a, CmPI and CmSEP1 in bisexual buds were significantly lower than that in male flower buds, while the expression levels of CmAGa, CmAGb and CmSEP4 in bisexual flower buds were significantly higher than that in male flower buds. There was no significant difference in expression levels of other ABCE model genes between male buds and bisexual buds. Subsequently, qRT-PCR was performed in different floral organs of bisexual flowers in melon. For A class genes, CmAP1a and CmAP1b showed the highest accumulation in sepals than petals, stamens and pistil, while CmAP2a and CmAP2b revealed the highest expression in pistil than other three floral organs. For B class genes, CmAP3 and CmPI were highly accumulated in petals and stamens though CmAP3 also showed abundant accumulation in pistil. For C class genes, the expression levels of CmAGa and CmAGb were higher in stamens and pistil than that in sepals and petals. For E class genes, CmSEP1 showed higher expression level in sepals and petals than stamens and pistil. CmSEP2, CmSEP3 and CmSEP4 showed the highest accumulation in pistil than other floral organs. These results provided a theoretical basis for studying the function of ABCE homeotic genes in floral organs development of melon.

The Diagnostic Significance of the BI-RADS Classification Combined With Automated Breast Volume Scanner and Shear Wave Elastography for Breast Lesions.

OBJECTIVE: We herein compared the diagnostic accuracy of the BI-RADS, ABVS, SWE, and combined techniques for the classification of breast lesions. METHODS: Breast lesions were appraised using the BI-RADS classification system as well as the combinations of BI-RADS plus ABVS (BI-RADS + ABVS) and BI-RADS plus SWE (BI-RADS + SWE), and both methods (BI-RADS + ABVS + SWE) by two specialties Medical Ultrasound physician. The Fisher's exact and χ2 tests were performed to compare the degree of malignancy for the various methods with a pathology ground truth. Receiver operating characteristic curves (ROC) were generated and the corresponding area under the curve (AUC) values were determined to test the diagnostic efficacy of the various methods and identify the optimal SWE cut-off indicative of malignancy. RESULTS: The incidence of the retraction phenomenon on ABVS images of the malignant group was significantly higher (P < .001) than that of the benign group. The specificity, sensitivity, and positive and negative predictive values of the BI-RADS classification were 88.72, 79.38, 83.70, and 85.50%, respectively. BI-RADS plus SWE-Max exhibited enhanced specificity, sensitivity, and positive and negative predictive values of 88.72, 92.78, 85.70, and 94.40%, respectively. Similarly, when BI-RADS + ABVS was utilized, the sensitivity and negative predictive value increased to 95.88 and 96.40%, respectively. BI-RADS + ABVS + SWE possessed the highest overall sensitivity (96.91%), specificity (94.74%), and positive (93.10%) and negative (97.70%) predictive values from all four indices. CONCLUSION: ABVS and SWE can reduce the subjectivity of BI-RADS. As a result, BI-RADS + ABVS + SWE resulted in the best diagnostic accuracy.

Novel insight into the mechanism underlying synergistic cytotoxicity from two components in 5-Fluorouracil-phenylalanine co-crystal based on cell metabolomics.

Co-crystallization of active pharmaceutical ingredients (API) with co-formers can induce synergistic effects on cytotoxicity; however, the underlying mechanism is unclear. Here, cell metabolomics was used to gain insight into the mechanisms of synergistic effect from API and co-former in co-crystal. The 5-Fluorouracil-phenylalanine co-crystal system was selected as the model owing to the apparent difference of cytotoxicity occurring between co-crystal and physical mixture of two components (PM). The cytotoxicity of 5-FU, PM and co-crystal on B16 cells were evaluated by MTT assay. Based on the IC50 values from MTT assays, the cytotoxicity mechanism of 5-FU, PM and co-crystal was evaluated using a comprehensive non-targeted metabolomics strategy based on multivariate data analysis and statistics using UHPLC-Q-TOF-MS/MS platform with IDA data acquisition. Co-crystal showed higher cytotoxicity than PM against B16 cells. In the cell metabolomics study, a total of 12 differential metabolites were found. Pathway analysis indicated that differences in purine and glycerophospholipid metabolism occurred between PM and co-crystal. The downregulated deoxyguanosine diphosphate and adenosine diphosphate in the purine metabolism and downregulated L-glycerophosphocholine and upregulated C16-dihydroceramide in the glycerophospholipid metabolism were associated with cellular antiproliferation and apoptosis, which directly influenced the cytotoxicity. Cell metabolomics was used to investigate the cytotoxicity mechanism of the pharmaceutical co-crystal, providing an effective and innovative method for clarifying the synergistic mechanism of API and CCF in co-crystal.

Comparison of Efficacy and Psychology of Breast-Conserving Surgery and Modified Radical Mastectomy on Patients with Early Breast Cancer under Graded Nursing.

Objective: To compare the efficacy and psychology of breast-conserving surgery and modified radical mastectomy in patients with early breast cancer (BC) under graded nursing. Methods: Forty-one early breast-conserving surgery BC patients admitted to our hospital from April 2020 to March 2022 were regarded as group A, and 52 with modified radical surgery were seen as group B. The operating time, intraoperative bleeding, postoperative drainage, and hospital stay were compared, and the postoperative adverse effects were counted. In addition, patients' psychology and quality of life were assessed using the HAMD, HAMA, and QLSBC rating scales. At the time of discharge, a treatment satisfaction survey was conducted. Results: The operative time, intraoperative bleeding, postoperative drainage, and hospital stay of patients in group A were lower than those in group B (P < 0.05). After treatment, the HAMD and HAMA scores were lower in group A than in group B, while the QLSBC scores and treatment satisfaction were higher (P < 0.05). Conclusion: Breast-conserving surgery under graded nursing is less damaging to early BC patients. It can effectively shorten the postoperative recovery process and improve the psychology and quality of life, so it has higher clinical applicability.

Analysis of the Effect of Exercise Combined with Diet Intervention on Postoperative Quality of Life of Breast Cancer Patients.

To analyze the effect of exercise combined with diet intervention on postoperative quality of life of breast cancer patients, a total of 104 breast cancer patients randomly selected from October 2019 to September 2020 who received systemic adjuvant endocrine drug therapy in our hospital for the first time were divided into the observation group and control group as the research subjects. The control group was given exercise and exercise intervention on the basis of routine nursing, and the observation group was given exercise and exercise combined with diet intervention on the basis of basic nursing. Nutritional indexes, anxiety and depression, sleep quality, cancer-induced fatigue, and life quality were observed in both groups. The nutritional indicators of the observation group were slightly different from the control group after exercise and diet intervention, indicating that the observation group's data was higher than the control group (P > 0.05). The HAMA (human anti-mouse antibody) and HAMD (Hamilton depression scale) ratings of the two groups did not differ significantly (P > 0.05). Both groups' HAMA and HAMD ratings improved after intervention; although, the control group's increase was bigger than the observation group (P < 0.05). Both groups' poor sleep quality assessment (PSQI) scores improved after intervention, with the observation group's increase rate being lower than the control group (P < 0.05); the control group's sleep time fell more than the observation group (P < 0.05).

Glucocorticoids coordinate changes in gut microbiome composition in wild North American red squirrels.

The gut microbiome impacts host health and fitness, in part through the diversification of gut metabolic function and pathogen protection. Elevations in glucocorticoids (GCs) appear to reduce gut microbiome diversity in experimental studies, suggesting that a loss of microbial diversity may be a negative consequence of increased GCs. However, given that ecological factors like food availability and population density may independently influence both GCs and microbial diversity, understanding how these factors structure the GC-microbiome relationship is crucial to interpreting its significance in wild populations. Here, we used an ecological framework to investigate the relationship between GCs and gut microbiome diversity in wild North American red squirrels (Tamiasciurus hudsonicus). As expected, higher GCs predicted lower gut microbiome diversity and an increase in metabolic taxa. Surprisingly, but in line with prior empirical studies on wild animals, gastrointestinal pathogens decreased as GCs increased. Both dietary heterogeneity and an upcoming food pulse exhibited direct effects on gut microbiome diversity, whereas conspecific density and reproductive activity impacted diversity indirectly via changes in host GCs. Our results provide evidence of a gut-brain axis in wild red squirrels and highlight the importance of situating the GC-gut microbiome relationship within an ecological framework.

Decoding the molecular subtypes of breast cancer seen on multimodal ultrasound images using an assembled convolutional neural network model: A prospective and multicentre study.

BACKGROUND: Preoperative determination of breast cancer molecular subtypes facilitates individualized treatment plan-making and improves patient prognosis. We aimed to develop an assembled convolutional neural network (ACNN) model for the preoperative prediction of molecular subtypes using multimodal ultrasound (US) images. METHODS: This multicentre study prospectively evaluated a dataset of greyscale US, colour Doppler flow imaging (CDFI), and shear-wave elastography (SWE) images in 807 patients with 818 breast cancers from November 2016 to February 2021. The St. Gallen molecular subtypes of breast cancer were confirmed by postoperative immunohistochemical examination. The monomodal ACNN model based on greyscale US images, the dual-modal ACNN model based on greyscale US and CDFI images, and the multimodal ACNN model based on greyscale US and CDFI as well as SWE images were constructed in the training cohort. The performances of three ACNN models in predicting four- and five-classification molecular subtypes and identifying triple negative from non-triple negative subtypes were assessed and compared. The performance of the multimodal ACNN was also compared with preoperative core needle biopsy (CNB). FINDING: The performance of the multimodal ACNN model (macroaverage area under the curve [AUC]: 0.89-0.96) was superior to that of the dual-modal ACNN model (macroaverage AUC: 0.81-0.84) and the monomodal ACNN model (macroaverage AUC: 0.73-0.75) in predicting four-classification breast cancer molecular subtypes, which was also better than that of preoperative CNB (AUC: 0.89-0.99 vs. 0.67-0.82, p < 0.05). In addition, the multimodal ACNN model outperformed the other two ACNN models in predicting five-classification molecular subtypes (AUC: 0.87-0.94 vs. 0.78-0.81 vs. 0.71-0.78) and identifying triple negative from non-triple negative breast cancers (AUC: 0.934-0.970 vs. 0.688-0.830 vs. 0.536-0.650, p < 0.05). Moreover, the multimodal ACNN model obtained satisfactory prediction performance for both T1 and non-T1 lesions (AUC: 0.957-0.958 and 0.932-0.985). INTERPRETATION: The multimodal US-based ACNN model is a potential noninvasive decision-making method for the management of patients with breast cancer in clinical practice. FUNDING: This work was supported in part by the National Natural Science Foundation of China (Grants 81725008 and 81927801), Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), and the Science and Technology Commission of Shanghai Municipality (Grants 19441903200, 19DZ2251100, and 21Y11910800).

[Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh].

OBJECTIVE: To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. METHODS: Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade. RESULTS: The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal. CONCLUSION: Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.

A Comparative Analysis of Two Machine Learning-Based Diagnostic Patterns with Thyroid Imaging Reporting and Data System for Thyroid Nodules: Diagnostic Performance and Unnecessary Biopsy Rate.

Background: The risk stratification system of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for thyroid nodules is affected by low diagnostic specificity. Machine learning (ML) methods can optimize the diagnostic performance in medical image analysis. However, it is unknown which ML-based diagnostic pattern is more effective in improving diagnostic performance for thyroid nodules and reducing nodule biopsies. Therefore, we compared ML-assisted visual approaches and radiomics approaches with ACR TI-RADS in diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rate for thyroid nodules. Methods: This retrospective study evaluated a data set of ultrasound (US) and shear wave elastography (SWE) images in patients with biopsy-proven thyroid nodules (≥1 cm) from the Shanghai Tenth People's Hospital (743 nodules in 720 patients from September 2017 to January 2019) and an independent test data set from the Ma'anshan People's Hospital (106 nodules in 102 patients from February 2019 to April 2019). Six US features and five SWE parameters from the radiologists' interpretation were used for building the ML-assisted visual approaches. The radiomics features extracted from the US and SWE images were used with ML methods for developing the radiomics approaches. The diagnostic performance for differentiating thyroid nodules and the unnecessary FNAB rate of the ML-assisted visual approaches and the radiomics approaches were compared with ACR TI-RADS. Results: The ML-assisted US visual approach had the best diagnostic performance than the US radiomics approach and ACR TI-RADS (area under the curve [AUC]: 0.900 vs. 0.789 vs. 0.689 for the validation data set, 0.917 vs. 0.770 vs. 0.681 for the test data set). After adding SWE, the ML-assisted visual approach had a better diagnostic performance than US alone (AUC: 0.951 vs. 0.900 for the validation data set, 0.953 vs. 0.917 for the test data set). When applying the ML-assisted US+SWE visual approach, the unnecessary FNAB rate decreased from 30.0% to 4.5% in the validation data set and from 37.7% to 4.7% in the test data set in comparison to ACR TI-RADS. Conclusions: The ML-assisted dual modalities visual approach can assist radiologists to diagnose thyroid nodules more effectively and considerably reduce the unnecessary FNAB rate in the clinical management of thyroid nodules.

Ultrafine- and uniform-grained biodegradable Zn-0.5Mn alloy: Grain refinement mechanism, corrosion behavior, and biocompatibility in vivo.

An ultrafine- and uniform-grained Zn-0.5Mn alloy (D3 alloy, stands for deformation rate of 99.5%) is fabricated via multi-pass drawing. The alloy features excellent ductility and elongation properties (up to 245.0% ± 9.0% at room temperature). Zn-0.5Mn alloys are composed of two phases, namely, Zn and MnZn13. The MnZn13 phase confers multiple effects during refinement by inducing and pinning low-angle boundaries within grains. Meanwhile, the presence of these phases along grain boundaries prevents the growth of new refined grains. D3 shows uniform corrosion behaviors in c-SBF solution on account of the even distribution of the MnZn13 phase in its microstructure. Animal implantation experiments indicate that D3 has good biocompatibility; it does not cause damage to bone tissue or other organs. Taking the results together, D3 may be developed into a new type of biodegradable material with remarkable elongation and corrosion properties and satisfactory biocompatibility for medical applications.