Genome-wide identification, characterization and expression profiling of TLR family genes in Chromileptes altivelis.

Toll-like receptors (TLRs) represent a prominent category of pattern recognition receptors that have been extensively investigated for their pivotal role in combating pathogen incursions. Despite this, there has been a notable absence of comprehensive identification and exploration of the immune response associated with the TLR family genes in C. altivelis. This study successfully identified and named fourteen genes as Catlr1-1, Catlr1-2, Catlr2-1, Catlr2-2, Catlr3, Catlr5, Catlr7, Catlr8, Catlr9, Catlr13-1, Catlr13-2, Catlr18, Catlr21, and Catlr22. A series of bioinformatic analysis were performed, encompassing analysis of protein properties, examination of gene structures, evolutionary assessments, and prediction of protein tertiary structures. The expression patterns of Catlr genes were analyzed in five immune tissues: liver, spleen, kidney, gill, and intestine, in both healthy and bacterial stimulated-fish. The results showed that different tissue and different genes showed differed expression patterns after V. harveyi infection, indicating the involvement of all Catlr members in mounting immune responses following infection in various tissues. Additionally, histological evaluations of immune tissues unveiled varying levels of damage. In conclusion, this investigation into the TLR gene family offers novel information that contribute to a more profound comprehension of the immune response mechanisms in C. altivelis.

Highly-accelerated CEST MRI using frequency-offset-dependent k-space sampling and deep-learning reconstruction.

PURPOSE: To develop a highly accelerated CEST Z-spectral acquisition method using a specifically-designed k-space sampling pattern and corresponding deep-learning-based reconstruction. METHODS: For k-space down-sampling, a customized pattern was proposed for CEST, with the randomized probability following a frequency-offset-dependent (FOD) function in the direction of saturation offset. For reconstruction, the convolution network (CNN) was enhanced with a Partially Separable (PS) function to optimize the spatial domain and frequency domain separately. Retrospective experiments on a self-acquired human brain dataset (13 healthy adults and 15 brain tumor patients) were conducted using k-space resampling. The prospective performance was also assessed on six healthy subjects. RESULTS: In retrospective experiments, the combination of FOD sampling and PS network (FOD + PSN) showed the best quantitative metrics for reconstruction, outperforming three other combinations of conventional sampling with varying density and a regular CNN (nMSE and SSIM, p < 0.001 for healthy subjects). Across all acceleration factors from 4 to 14, the FOD + PSN approach consistently outperformed the comparative methods in four contrast maps including MTRasym, MTRrex, as well as the Lorentzian Difference maps of amide and nuclear Overhauser effect (NOE). In the subspace replacement experiment, the error distribution demonstrated the denoising benefits achieved in the spatial subspace. Finally, our prospective results obtained from healthy adults and brain tumor patients (14×) exhibited the initial feasibility of our method, albeit with less accurate reconstruction than retrospective ones. CONCLUSION: The combination of FOD sampling and PSN reconstruction enabled highly accelerated CEST MRI acquisition, which may facilitate CEST metabolic MRI for brain tumor patients.

Optimized early recurrence score for distal cholangiocarcinoma: A new attempt by adding imaging indicators.

PURPOSE: To improve the preoperative prediction efficacy for patients with risk for early recurrence (ER) of distal cholangiocarcinoma (DCC). METHODS: 56 patients pathologically diagnosed as DCC were included. Their clinical data and preoperative upper abdominal enhanced MSCT images were retrospectively reviewed to look for risk factors associated with ER. ER scores were calculated by Distal Cholangiocarcinoma Early Recurrence (DICER) score and optimized ER score (OERS). Chi-square test or Mann-Whitney U test was used to compare the differences between ER group and Non-ER group, DICER score and OERS, and TNM stage and OERS. Binary logistic regression analyses were performed to identify risk factors of ER. RESULTS: Of 56 DCC patients, 15 (26.8 %) experienced ER who were classified as ER group. Patients in ER group had significantly higher percentage of soft tissue around superior mesenteric artery (STASMA), positive lymph node, microvascular invasion and TNM stage III than those in Non-ER group, among which STASMA and positive lymph node were found to be independent risk factors for ER of DCC (All P values < 0.050). DICER score was optimized by adding STASMA and positive lymph node score to form OERS. OERS predicted more accurately than DICER score in low- and high-risk patients for ER of DCC (30.0 % vs. 0 %, 50.0 % vs. 75.0 %, P < 0.001). CONCLUSIONS: By adding preoperative imaging indicators, OERS could improve the predictive efficacy for ER of DCC.

Usefulness of magnetic resonance imaging characteristics in discriminating H3 K27M-mutant gliomas from wildtype gliomas in spinal cord.

AIM: The aim of this study was to determine the usefulness of magnetic resonance imaging (MRI) characteristics in discriminating H3 K27M-mutant gliomas from wildtype gliomas in the spinal cord. MATERIALS AND METHODS: Fifty-eight patients with spinal cord gliomas were enrolled in this study. The H3 K27 gene status was identified by Sanger sequencing or immunohistochemistry test of resection tumor specimens. The MR imaging characteristics were evaluated and compared between H3 K27M-mutant and wildtype gliomas using the χ2 test and the Mann-Whitney U test. RESULTS: Of 58 recruited patients, 23 (39.7%) were diagnosed with H3 K27M-mutant glioma. The H3 K27M-mutant gliomas were found to more likely occur in men compared with wildtype gliomas (87.0% vs. 42.9%, p = 0.001). On T2-weighted MR images, the signal-to-noise ratio (SNR) of H3 K27M-mutant gliomas was significantly lower than that of wildtype gliomas (103.9 ± 72.0 vs. 168.9 ± 86.8, p < 0.001). Of 35 wildtype tumors, 60% showed well-defined margin but this feature was not found in all mutant tumors (p < 0.001). The SNR of tumors on contrast-enhanced T1-weighted images of the H3 K27M-mutant gliomas was significantly lower than that of wildtype gliomas (187.7 ± 160.4 vs. 295.1 ± 207.8, p = 0.006). Receiver operating-characteristic analysis revealed that area under curve (AUC) of combination of 1/SNR on T2-weighted images, 1/SNR on contrast-enhanced T1-weighted images, ill-defined margin, and sex reached 0.937 (95% CI, 0.873-1.000) in discriminating H3 K27M-mutant gliomas. CONCLUSIONS: The MR imaging characteristics are valuable in discriminating H3 K27M-mutant from wildtype gliomas in the spinal cord and the combination of these imaging features with sex had a high strength in this discrimination.

Assessing the predictability of the H3K27M status in diffuse glioma patients using frequency importance analysis on chemical exchange saturation transfer MRI.

BACKGROUND AND OBJECTIVES: In diffuse glioma patients, Lys-27-Met mutations in histone 3 genes (H3K27M) are associated with an aggravated prognosis and further decreased overall survival. By using frequency importance analysis on chemical exchange saturation transfer (CEST) MRI, this study aimed to assess the predictability of the H3K27M status in diffuse glioma patients. METHODS: Twenty-two patients diagnosed with diffuse glioma, with a known H3K27M status, were included in the present study. All patients underwent CEST MRI scans. The previously proposed frequency importance analysis was performed to determine the relative contribution of the amide and aliphatic protons for the differentiation between normal tissues and tumors. For this comparison, the conventional MTRasym analysis of amide protons at 3.5 ppm, i.e., the amide proton transfer-weighted (APTw) signal, was employed. Statistical analysis was performed using the Mann-Whitney U test, and the receiver operating characteristic (ROC) and area under the curve (AUC) analyses. RESULTS: The mean and 90th percentile of the ΔAPTw intensities, amide and aliphatic frequency importance values revealed statistically significant differences between the wildtype and the H3K27M-altered patient groups (p < 0.05). For the prediction of the H3K27M status, amide frequency importance achieved highest AUCs of 0.97, with a specificity of 0.93. In contrast, the ΔAPTw intensities and aliphatic frequency importance showed relatively lower AUCs (<0.35) in predicting the H3K27M status. CONCLUSIONS: Amide frequency importance exhibited satisfactory performance in the prediction of the H3K27M status. As such, it may be considered as a non-invasive MRI biomarker for the diagnosis of diffuse gliomas.

Association of Sarcopenia With Mortality in Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Revascularization.

INTRODUCTION: Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease and leads high mortality. Sarcopenia, characterized by the loss of muscle mass or poor muscle quality, is associated with adverse clinical outcomes. This study aimed to investigate the association between sarcopenia and the long-term outcomes in patients with CLTI after endovascular revascularization. METHODS: We retrospectively reviewed the medical records of all patients with CLTI who underwent endovascular revascularization between January 2015, and December 2021. The skeletal muscle area was calculated at the third lumbar vertebra from computed tomography images using the manual trace method and normalized to patient height. Sarcopenia was defined as a third lumbar skeletal muscle index of <40.8 cm2/m2 in males and <34.9 cm2/m2 in females. The Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis and to evaluate the association between sarcopenia and mortality. RESULTS: A total of 137 patients (90 men; mean age 71.7 ± 9.6 y) were enrolled for the study, of whom 56 (40.8%) had sarcopenia. The 3-year overall survival rate in patients with CLTI who underwent endovascular revascularization was 71.2%. The sarcopenic group had a significantly worse 3-year overall survival rate than the nonsarcopenic group (55.3% versus 78.6%, P = 0.001). Multivariate Cox proportional hazard regression analyses revealed that sarcopenia (hazard ratio, 2.262; 95% confidence interval, 1.132-4.518; P = 0.021) and dialysis (hazard ratio, 3.021; 95% confidence interval, 1.337-6.823; P = 0.008) were independently associated with increased risk of all-cause mortality, whereas technical success had significantly opposing correlation with mortality. (hazard ratio, 0.400, 95% confidence interval, 0.194-0.826, P = 0.013). CONCLUSIONS: Sarcopenia can be highly prevalent in patients with CLTI who undergo endovascular revascularization, and is independently associated with long-term mortality. These results may help risk stratification to assist in personalized assessment and clinical decision-making.

Frequency importance analysis for chemical exchange saturation transfer magnetic resonance imaging using permuted random forest.

Chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) is a promising molecular imaging tool that allows sensitive detection of endogenous metabolic changes. However, because the CEST spectrum does not display a clear peak like MR spectroscopy, its signal interpretation is challenging, especially under 3-T field strength or with a large saturation B1 . Herein, as an alternative to conventional Z-spectral fitting approaches, a permuted random forest (PRF) method is developed to determine featured saturation frequencies for lesion identification, so-called CEST frequency importance analysis. Briefly, voxels in the CEST dataset were labeled as lesion and control according to multicontrast MR images. Then, by considering each voxel's saturation signal series as a sample, a permutation importance algorithm was employed to rank the contribution of saturation frequency offsets in the differentiation of lesion and normal tissue. Simulations demonstrated that PRF could correctly determine the frequency offsets (3.5 or -3.5 ppm) for classifying two groups of Z-spectra, under a range of B0 , B1 conditions and sample sizes. For ischemic rat brains, PRF only displayed high feature importance around amide frequency at 2 h postischemia, reflecting that the pH changes occurred at an early stage. By contrast, the data acquired at 24 h postischemia exhibited high feature importance at multiple frequencies (amide, water, and lipids), which suggested the complex tissue changes that occur during the later stages. Finally, PRF was assessed using 3-T CEST data from four brain tumor patients. By defining the tumor region on amide proton transfer-weighted images, PRF analysis identified different CEST frequency importance for two types of tumors (glioblastoma and metastatic tumor) (p < 0.05, with each image slice as a subject). In conclusion, the PRF method was able to rank and interpret the contribution of all acquired saturation offsets to lesion identification; this may facilitate CEST analysis in clinical applications, and open up new doors for comprehensive CEST analysis tools other than model-based approaches.

B0 Correction for 3T Amide Proton Transfer (APT) MRI Using a Simplified Two-Pool Lorentzian Model of Symmetric Water and Asymmetric Solutes.

Amide proton transfer (APT)-weighted MRI is a promising molecular imaging technique that has been employed in clinic for detection and grading of brain tumors. MTRasym, the quantification method of APT, is easily influenced by B0 inhomogeneity and causes artifacts. Current model-free interpolation methods have enabled moderate B0 correction for middle offsets, but have performed poorly at limbic offsets. To address this shortcoming, we proposed a practical B0 correction approach that is suitable under time-limited sparse acquisition scenarios and for B1 ≥ 1 µT under 3T. In this study, this approach employed a simplified Lorentzian model containing only two pools of symmetric water and asymmetric solutes, to describe the Z-spectral shape with wide and 'invisible' CEST peaks. The B0 correction was then performed on the basis of the fitted two-pool Lorentzian lines, instead of using conventional model-free interpolation. The approach was firstly evaluated on densely sampled Z-spectra data by using the spline interpolation of all acquired 16 offsets as the gold standard. When only six offsets were available for B0 correction, our method outperformed conventional methods. In particular, the errors at limbic offsets were significantly reduced (n = 8, p < 0.01). Secondly, our method was assessed on the six-offset APT data of nine brain tumor patients. Our MTRasym (3.5 ppm), using the two-pool model, displayed a similar contrast to the vendor-provided B0-orrected MTRasym (3.5 ppm). While the vendor failed in correcting B0 at 4.3 and 2.7 ppm for a large portion of voxels, our method enabled well differentiation of B0 artifacts from tumors. In conclusion, the proposed approach could alleviate analysis errors caused by B0 inhomogeneity, which is useful for facilitating the comprehensive metabolic analysis of brain tumors.

Magnetic resonance imaging indicators for neurological outcome after surgery in patients with intramedullary spinal ependymomas.

ABSTRACT: This is a retrospective study. The aim of this study was to determine the indicators of neurological outcome after surgery in patients with intramedullary spinal ependymomas by using magnetic resonance imaging (MRI).A total of 106 consecutive patients (mean age: 42.4 ±â€Š1.3 years; 52.8% male) diagnosed with intramedullary spinal ependymomas were retrospectively recruited. All patients underwent spine MRI and subsequent surgical resection for the spinal tumors. Data regarding clinical symptoms and pathological grades of tumors were collected from clinical records. The McCormick score was used for grading patients' neurological status before and after surgery at 12 months. Good outcome was defined as stable McCormick score (McC) score (no change of McC score between preoperation and post-operation at 12 months) or improvement in McC score (post-operative McC score at 12 months < preoperative McC score). Poor outcome was determined when there was an increase in McC score at 12 months after surgery. The MRI characteristics of spinal ependymomas between patients with good and poor neurological outcomes were compared. Logistic regression was performed to assess the association between MRI characteristics of tumors and post-operative neurological outcomes.Patients with poor neurological outcomes had larger longitudinal length (4.7 ±â€Š0.5 vs 3.3 ±â€Š0.2, P = .004) and higher enhancement signal-to-noise-ratio (SNR) (102.4 ±â€Š12.3 vs 72.8 ±â€Š4.6, P = .022) than those with good neurological outcomes. After adjusting for confounding factors, longitudinal length (OR, 0.768; 95% CI, 0.604-0.976; P = .031) and enhancement SNR (OR, 0.988; 95% CI, 0.978-0.999; P = .026) of spinal ependymomas were significantly associated with poor neurological prognosis.The longitudinal length of tumor and enhancement SNR on T1-weighted images are independently associated with neurological outcome after surgery.

AI-assisted CT imaging analysis for COVID-19 screening: Building and deploying a medical AI system.

The sudden outbreak of novel coronavirus 2019 (COVID-19) increased the diagnostic burden of radiologists. In the time of an epidemic crisis, we hope artificial intelligence (AI) to reduce physician workload in regions with the outbreak, and improve the diagnosis accuracy for physicians before they could acquire enough experience with the new disease. In this paper, we present our experience in building and deploying an AI system that automatically analyzes CT images and provides the probability of infection to rapidly detect COVID-19 pneumonia. The proposed system which consists of classification and segmentation will save about 30%-40% of the detection time for physicians and promote the performance of COVID-19 detection. Specifically, working in an interdisciplinary team of over 30 people with medical and/or AI background, geographically distributed in Beijing and Wuhan, we are able to overcome a series of challenges (e.g. data discrepancy, testing time-effectiveness of model, data security, etc.) in this particular situation and deploy the system in four weeks. In addition, since the proposed AI system provides the priority of each CT image with probability of infection, the physicians can confirm and segregate the infected patients in time. Using 1,136 training cases (723 positives for COVID-19) from five hospitals, we are able to achieve a sensitivity of 0.974 and specificity of 0.922 on the test dataset, which included a variety of pulmonary diseases.

Targeted-gene sequencing of an undifferentiated gallbladder carcinoma: a case report.

BACKGROUND: Undifferentiated carcinomas of the gallbladder are extremely rare. Most undifferentiated carcinomas are accompanied by adjacent foci of other conventional carcinomas, and a transition zone is shared between them. However, genetic alterations of undifferentiated gallbladder carcinoma and the similarities or differences between the undifferentiated carcinoma and the foci conventional carcinoma are unknown. CASE PRESENTATION: Herein, we report a case of undifferentiated gallbladder carcinoma with osteoclast-like giant cells with invasion into the liver, duodenum, and stomach in a 56-year-old man. The tumor was microscopically formed from the tubular adenocarcinoma (< 5% of the entire tumor), the undifferentiated carcinoma, and a transition zone between them. Four somatic mutations (TP53, TERT, ARID2, and CDH1), three amplifications (CCND1, FGF19, and MET), and a tumor mutation burden (TMB) of 3.45 muts/Mb were detected in the undifferentiated component using targeted gene sequencing, whereas 102 somatic mutations (including TP53, TERT, ARID2, and CDH1), one amplification (CCND1), and a higher TMB of 87.07 muts/Mb were detected in the tubular component. This patient died of tumor recurrence 2 months after the surgery. CONCLUSIONS: The undifferentiated gallbladder carcinoma had its unique molecular alterations. The similarities in the genetic alterations of the undifferentiated carcinoma and adenocarcinoma provide evidence of a common origin at the genetic level. The occurrence of an undifferentiated carcinoma may be due to heterogeneity-associated branched evolution from the tubular adenocarcinoma.

Intramedullary Spinal Cord Ganglioglioma Presenting as Hyperhidrosis: A Rare Case Report and Literature Review.

BACKGROUND: Hyperhidrosis is caused by sympathetic dysfunction of the central or peripheral nervous system. However, intramedullary spinal cord tumors presenting with hyperhidrosis as an initial symptom have been rarely reported in the literature. CASE DESCRIPTION: This case involves an 18-year-old man who presented with abnormal enhanced sweating and flushing on the bilateral side of his face and neck that had persisted for 6 years. Magnetic resonance (MR) images revealed that at the C7-T2 levels of the spinal cord, a large intramedullary tumor was involved in the cervicothoracic region. The patient underwent gross total resection of the tumor via the fluorescein-guided technique and intraoperative neurophysiologic monitoring. The histopathologic diagnosis revealed ganglioglioma. The symptoms gradually improved after surgery, and the patient presented with virtually complete remission at the end of an 18-month follow-up. CONCLUSIONS: Few cases of intramedullary spinal cord tumors presenting as hyperhidrosis in clinical manifestation have been reported in the literature. Sympathetic irritation by the tumor, particularly in the location around the gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Therefore, if a patient has autonomic dysfunction, the spine cord should be additionally examined using MR imaging.

Risk factor analysis of progressive spinal deformity after resection of intramedullary spinal cord tumors in patients who underwent laminoplasty: a report of 105 consecutive cases.

OBJECTIVELaminoplasty has been used in recent years as an alternative approach to laminectomy for preventing spinal deformity after resection of intramedullary spinal cord tumors (IMSCTs). However, controversies exist with regard to its real role in maintaining postoperative spinal alignment. The purpose of this study was to examine the incidence of progressive spinal deformity in patients who underwent laminoplasty for resection of IMSCT and identify risk factors for progressive spinal deformity.METHODSData from IMSCT patients who had undergone laminoplasty at Beijing Tsinghua Changgung Hospital between January 2014 and December 2016 were retrospectively reviewed. Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative spinal deformity and radiographic, clinical, and surgical variables.RESULTSOne hundred five patients (mean age 37.0 ± 14.5 years) met the criteria for inclusion in the study. Gross-total resection (> 95%) was obtained in 79 cases (75.2%). Twenty-seven (25.7%) of the 105 patients were found to have spinal deformity preoperatively, and 10 (9.5%) new cases of postoperative progressive deformity were detected. The mean duration of follow-up was 27.6 months (SD 14.5 months, median 26.3 months, range 6.2-40.7 months). At last follow-up, the median functional scores of the patients who did develop progressive spinal deformity were worse than those of the patients who did not (modified McCormick Scale: 3 vs 2, and p = 0.04). In the univariate analysis, age (p = 0.01), preoperative spinal deformity (p < 0.01), extent of tumor involvement (p < 0.01), extent of abnormal tumor signal (p = 0.02), and extent of laminoplasty (p < 0.01) were identified as factors associated with postoperative progressive spinal deformity. However, in subsequent multivariate logistic regression analysis, only age ≤ 25 years and preoperative spinal deformity emerged as independent risk factors (p < 0.05), increasing the odds of postoperative progressive deformity by 4.1- and 12.4-fold, respectively (p < 0.05).CONCLUSIONSProgressive spinal deformity was identified in 25.7% patients who had undergone laminoplasty for IMSCT resection and was related to decreased functional status. Younger age (≤ 25 years) and preoperative spinal deformity increased the risk of postoperative progressive spinal deformity. The risk of postoperative deformity warrants serious reconsideration of providing concurrent fusion during IMSCT resection or close follow-up after laminoplasty.

Stratification of Grade of Spinal Cord Non-Ependymal Gliomas by Magnetic Resonance Imaging.

OBJECTIVE: The purpose of this study was to demonstrate the usefulness of conventional magnetic resonance imaging (MRI) in stratification of spinal cord non-ependymal gliomas. METHODS: Forty-one patients (mean age, 29.9 ± 16.8 years; 27 men) with first-diagnosed spinal cord non-ependymal gliomas underwent conventional MRI including T1-weighted, T2-weighted (T2W) and contrast-enhanced T1-weighted imaging sequences. The tumors were removed by surgery and processed by histology 1 week after MRI. Patients were divided into low-grade and high-grade groups according to histological findings. The MRI features of gliomas including signal-to-noise-ratio (SNR), margins, heterogeneity, edema, enhancement, tumor size, longitudinal location, and presence of syrinx were measured and compared between low-grade and high-grade groups using the χ2 test and the Mann-Whitney U test. RESULTS: The SNR of low-grade gliomas on T2W images was significantly higher than that of high-grade gliomas (165.0 ± 108.7 vs. 98.6 ± 44.4; P = 0.016 by the Mann-Whitney U test). The margins of low-grade gliomas were found to be clearer compared to that of high-grade gliomas (54.5% vs. 5.3%; P = 0.001). Receiver-operating-characteristic analysis revealed that the area under the curve of 1/SNR, margin and the combination of 1/SNR and margin was 0.722 (95% confidence interval [CI], 0.564-0.880), 0.736 (95% CI, 0.578-0.894), and 0.845 (95% CI, 0.717-0.973), respectively. No significant differences were found in the heterogeneity, edema, enhancement level, enhancement SNR, size, longitudinal location, cyst, hemorrhage, and intramedullary location between low-grade and high-grade non-ependymal gliomas (all P > 0.05). CONCLUSIONS: The characteristics of signal intensity and margin on T2W imaging are valuable in stratification of spinal cord non-ependymal gliomas.