Ultrasound-based radiomics nomogram for predicting axillary lymph node metastasis in early-stage breast cancer.

PURPOSE: We aimed at assessing the predictive ability of ultrasound-based radiomics combined with clinical characteristics for axillary lymph node (ALN) status in early-stage breast cancer patients and to compare performance in different peritumoral regions. MATERIALS AND METHODS: A total of 755 patients (527 in the primary cohort and 228 in the external validation cohort) were enrolled in this study. Ultrasound images for all patients were acquired and radiomics analysis performed for intratumoral and different peritumoral regions. The MRMR and LASSO regression analyses were performed on extracted features from the primary cohort to construct a radiomics signature formula combined with clinical characteristics. Pearson's coefficient and the variance inflation factor (VIF) were performed to check the correlation and the multicollinearity among the final predictors. The best performing model was selected to develop a nomogram, which was established by performing binary logistic regression and acquiring cut-off values based on the corresponding nomogram scores of the masses. RESULTS: Among all the radiomics models, the "Mass + Margin3mm" model exhibited the best performance. The areas under the curves (AUC) of the nomogram in the primary and external validation cohorts were 0.906 (95% confidence intervals [CI] 0.882-0.930) and 0.922 (95% CI 0.894-0.960), respectively. They both showed good calibrations. The nomogram exhibited a good ability to discriminate between positive and negative lymph nodes (AUC: 0.853 (95% CI 0.816-0.889) in primary cohort, 0.870 (95% CI 0.818-0.922) in validation cohort), and between low-volume and high-volume lymph nodes (AUC: 0.832 (95% CI 0.781-0.884) in primary cohort, 0.911 (95% CI 0.858-0.964) in validation cohort). CONCLUSIONS: The established nomogram is a prospective clinical prediction tool for non-invasive assessment of ALN status. It has the ability to enhance the accuracy of early-stage breast cancer treatment.

Efficacy and effectiveness of anti-VEGF or steroids monotherapy versus combination treatment for macular edema secondary to retinal vein occlusion: a systematic review and meta-analysis.

BACKGROUND: Retinal vein occlusion (RVO) is the main cause of retinal vascular blindness. Laser photocoagulation therapy is the regarded as the standard treatment for branch retinal vein occlusion (BRVO) in the guidelines, but it is not effective for macular edema (ME) secondary to central retinal vein occlusion (CRVO). As anti-VEGF (vascular endothelial growth factor) or steroids monotherapy has been used to treat RVO, but each has its advantages and disadvantages. Our purpose was to evaluate the efficacy and safety of intraocular injection of anti-VEGF combined with steroids versus anti-VEGF or steroids monotherapy for ME secondary to RVO. METHODS: We systematically searched trials on Pubmed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for RCTs (random clinical trials) or non-RCTs, comparing anti-VEGF or steroids monotherapy to their combination. The primary outcomes were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP). The pooled data was analyzed by random effects model. FINDINGS: A total of 10 studies selected from 366 studies were included in this meta-analysis. Our results favored anti-VEGF with steroids combination therapy in comparison with anti-VEGF {pooled SMD (standardized mean difference), 95% CI, -0.16 [-0.28, -0.04], P = 0.01} or steroids (pooled SMD, 95% CI, -0.56 [-0.73, -0.40], P < 0.00001) alone on changes of BCVA. Compared with anti-VEGF monotherapy group, the combination therapy also had a better effect {pooled MD (mean difference), 95% CI, -9.62 [-17.31, -1.93], P = 0.01)} at improvements on CMT. On the changes of IOP, assessment favored that combination therapy was associated with a better relief of IOP compared to steroids monotherapy group (pooled MD, 95% CI, -5.93 [-7.87, -3.99],P < 0.00001). What's more, the incidence of ocular hypertension was lower in the combined treatment group compared with control group treated with steroids alone (Odds Ratio, 95% CI, 0.21 [0.06, 0.77], P = 0.02). Results also showed that the combination group can prolong the average time to first anti-VEGF reinjection (MD, 95% CI, 1.74 [0.57, 2.90], P = 0.003) compared to control group treated with anti-VEGF alone. CONCLUSION: Anti-VEGF with steroids combination treatment can enable a better achievement of improving BCVA, CMT, reducing the risk of increased IOP and improving patient prognosis compared to anti-VEGF or steroids therapy alone, lengthening the average time to anti-VEGF reinjection with reducing the injections during follow-up.

Quantitative analysis of eco-economic benefits of reclaimed water for controlling urban dust.

With the acceleration of urbanization and industrialization, urban air pollution, especially dust pollution, has become a global problem. The traditional method to control dust problem is to spray roads with tap water. However, this method will inevitably lead to a huge waste of water resources. Using reclaimed water instead of tap water for dust control can not only achieve the same effect of reducing dust and haze, but also save water resources. In addition, the saved tap water can be used for production and life, thereby obtaining additional benefits. In order to quantify the eco-economic benefits of sprinkling water for dust control, a quantitative method was proposed based on the emergy theory of ecological economics. It was used to calculate the cost of different water resources, the cooling and humidifying benefit, the dust control and haze reduction benefit, and the other use benefit. Taking the 2017 data of Zhengzhou as an example, the results indicated that the cost of using reclaimed water to control dust was reduced by 54%. The total benefit of using reclaimed water was about 1.30-1.80 times that of using tap water, and the net benefit was 4.65-7.17 times. Therefore, the use of reclaimed water instead of tap water for road dust control has advantages of low cost and high eco-economic benefits. The method proposed in this paper can provide quantitative basis for the popularization of using reclaimed water to dust control in cities with serious air pollution and water resource shortage.

A potential high risk for fatty liver disease was found in mice generated after assisted reproductive techniques.

Abnormal gametogenesis and embryonic development may lead to poor health status of the offspring. The operations involved in the assisted reproductive technologies (ARTs) occur during the key stage of gametogenesis and early embryonic development. To assess the potential risk of abnormal lipid metabolism in the liver of adult ARTs offspring, two ARTs mice models derived from preimplantation genetic diagnosis (PGD group) and in vitro cultured embryos without biopsy (IVEM group) were constructed. And control mice were from in vivo naturally conceived (Normal group). The results showed that ARTs offspring had increased body weight and body fat content comparing to normal group. An increasing volume and amount of lipid droplets as well as lipid droplet fusion were found in the hepatocytes of ARTs mice, and a significantly increased liver TG content was also shown in the ARTs mice, which due to the increased TG synthesis and decreased TG transport in the liver. All the results indicated that the manipulations involved in ARTs might play an important role in the lipid accumulation of adult offspring. By analyzing the DNA methylation profiles of 7.5dpc embryos, we proposed that methylation deregulation of the genes related to liver development in ARTs embryos might contribute to the abnormal phenotype in the offspring. The study demonstrated that ARTs procedures have adverse effect on liver development which resulted in abnormal lipid metabolism and induced the potential high risk of fatty liver in adulthood.

Comparison of Angio PLanewave UltraSensitive and Power Doppler Ultrasound in Detecting Synovial Blood Flow in Wrist and Finger Joints of Rheumatoid Arthritis Patients.

RATIONALE AND OBJECTIVES: The purpose of this study is to conduct a comparison between the newly introduced Angio PLanewave UltraSensitive (AngioPLUS) method and the power Doppler ultrasound (PDUS) technique, evaluating the efficacy of these two methods in detecting synovial blood flow in wrist and finger joints of rheumatoid arthritis (RA) patients. Furthermore, the study aimed to investigate the potential associations between the observed blood flow patterns and various symptoms and indicators associated with RA. MATERIALS AND METHODS: A cohort of 101 patients diagnosed with RA was included and subsequently categorized into two groups: 20 male participants (19.80%) and 81 female participants (80.20%). Their grayscale ultrasound, PDUS, and AngioPLUS were utilized to acquire data, and subsequent scoring was conducted. Serological tests of the patients were also performed, and DAS28 scores were calculated. The McNemar and Wilcoxon tests were used to compare the blood flow display rate and grading of PDUS as well as AngioPLUS, respectively. RESULTS: AngioPLUS blood was significantly improved compared to PDUS. In all joints, the proportion of slight and significant improvement in wrist joints was the highest (14.11% and 1.98%, respectively). AngioPLUS was moderately correlated with C-reactive Protein (CRP), Disease Activity Score that includes 28-joint counts, and swollen joint counts and weakly correlated with platelet, hemoglobin, tender joint counts, and CRP before and after treatment. CONCLUSION: Compared to PDUS, AngioPLUS has a better auxiliary diagnostic role in evaluating disease activity and can provide a reference to improve the management of RA further.

Associated factors leading to misdiagnosis of a combined diagnostic model of different types of strain imaging and conventional ultrasound in evaluation of breast lesions: Selection strategy for using different types of strain imaging in evaluation of breast lesions.

OBJECTIVE: To evaluate the effectiveness of a decision tree that integrates conventional ultrasound (CUS) with two different strain imaging (SI) techniques for diagnosing breast lesions, and to analyze the factors contributing to false negative (FN) and false positive (FP) in the decision tree's outcomes. MATERIALS AND METHODS: Imaging and clinical data of 796 cases in the training set and 351 cases in the validation set were prospectively collected. A decision tree model that combines two types of SI and CUS was constructed, and its diagnostic performance was analyzed. Univariate analysis and multivariate analysis were applied to identify independent risk factors associated with FP and FN results of the decision tree model. RESULTS: Size, shape, margin, vascularity, the types of internal calcifications, EI score and VTI pattern were found to be significantly independently associated with the diagnosis of benign and malignant breast lesions. Therefore, size, shape, margin, vascularity, EI score and VTI pattern were used to construct decision tree models. The Tree (EI+VTI) model had the highest AUC. Both in the training and validation groups, the AUC of Tree (EI+VTI) was significantly higher compared with that of EI, VTI, and BI-RADS (all, P < 0.05). Orientation, posterior acoustic features and the types of internal calcifications were significantly positively associated with misdiagnosis results of Tree (EI+VTI) in evaluation of breast lesions (all P < 0.05). CONCLUSION: The diagnostic model based on a decision tree that integrates two distinct types of SI with CUS enhances the diagnostic accuracy of each method when used individually. This integration lowers the misdiagnosis rate, potentially assisting radiologists in more effective lesion assessments. When applying the decision tree model, attention should be paid to the orientation, posterior acoustic features, and the types of internal calcifications of the lesions.

Effectiveness of Panretinal Photocoagulation Plus Intravitreal Anti-VEGF Treatment Against PRP Alone for Diabetic Retinopathy: A Systematic Review With Meta-Analysis.

Objective: To compare the efficacy and safety of panretinal photocoagulation (PRP) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) against PRP monotherapy for diabetic retinopathy (DR). Methods: We searched Pubmed, Cochrane Library, Web of Science, Embase, and Science Direct Register of Controlled Trials from April 2011 to January 2021 to identify the randomized trials that compared the efficacy and safety between PRP combined with intravitreal anti-VEGF and PRP monotherapy for DR. We searched in the following databases between April 2011 and January 2021: Pubmed, Cochrane Library, Web of Science, Embase, and Science Direct without any restriction of countries or article type. The outcome measures were the best-corrected visual acuity (BCVA), neovascularization on the disc (NVD), neovascularization elsewhere (NVE), central macula thickness (CMT), and total retinal volume over time (FAS), and we also observed the adverse events (AEs) between the two groups. Results: A total of 351 studies were identified, of which 11 studies were included in this meta-analysis (N = 1,182 eyes). Compared with PRP monotherapy, PRP plus anti-VEGF combination treatment produced a mean reduction in BCVA in units of logMAR of -0.23 [95% CI -0.32, -0.15] or a mean improvement in BCVA in units of letters of 4.99 [95% CI 3.79, 6.19], and also yielded a mean reduction in NVD of -28.41 [95% CI -30.30, -26.52], in NVE of -1.33 [95% CI -1.52, -1.14], in CMT of -1.33 [95% CI -1.52, -1.14], or in total FAS. No significant difference was observed on the risk of AEs as vitreous hemorrhage, elevation in intraocular pressure, and cataract between the two different treatments. Conclusion: PRP with anti-VEGF combination treatment can achieve the ideal efficacy on DR by improving BCVA and NV regression, with no potential increased incidence of AEs, which proves that the combination therapy is an efficient therapeutic strategy that could improve the management of patients with DR.

Ultrasound and elastography role in pre- and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome.

Introduction: Carpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery. Methods: First, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery. Results: The cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls (p < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS (p < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity. Conclusions and discussion: Conventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.

Root and root canal variations of the human maxillary and mandibular third molars in a Chinese population: A micro-computed tomographic study.

OBJECTIVES: To investigate the anatomical variations of the root and root canal configuration of the human third molars. DESIGNS: A total of 130 maxillary and 130 mandibular third molars were collected from a native Chinese population. All teeth were scanned by micro-computed tomography. After 3D reconstruction, the root and canal morphology of each tooth was examined both qualitatively and quantitatively. RESULTS: For maxillary molars, a single fused root (67 cases, 51.5%) and a single root canal system (64 cases, 49.2%) was most common root/canal form; the typical three-rooted molars were detected only in 33 cases (25.4%), and the secondary MB canals were detected only in 9 molars (6.9%). For mandibular molars, 62 teeth were single-rooted (47.7%) and 42 had a single root canal system (32.3%); 20 singled-rooted and 60 double-rooted molars exhibited independent mesial and distal root canal systems (61.5%), and the type 1-1 canal was the most common configuration for mesial (57 cases) and distal (81 cases) root canal systems. C-shaped canals were detected in 11 maxillary and 36 mandibular single-rooted molars. The mean root surface area, root and crown volume of mandibular third molars were significantly higher than the maxillary third molars (P < 0.01). CONCLUSION: The root canal system of the third molars may exhibit several anatomic variations. Whereas in most of cases, the degree of the canal differentiation was at a low level, and the canal form was not complicate.