Pathological Type Research Articles

Outcome and risk factors of ulcer healing after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

BACKGROUND Endoscopic submucosal dissection (ESD) is widely utilized for the treatment of large adenomas, submucosal lesions, and early gastric cancer. A significant artificial ulcer typically forms after ESD. Delayed or incomplete healing of these ulcers can result in complications such as delayed bleeding and perforation. However, a comprehensive review of the outcomes and risk factors related to ulcer healing following ESD is currently lacking. AIM To assess ulcer healing outcomes and identify risk factors associated with delayed ulcer healing. METHODS Databases retrieved by computer include PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, and VIP. The study collects reports on ESD post-surgical ulcer healing outcomes and risk factors, using Stata 16.0 and RevMan 5.0 software for meta-analysis. RESULTS Our analysis included 12 studies, involving a total of 3430 patients. The meta-analysis revealed an overall healing rate of 65.55% for ulcers following ESD [odds ratio (OR) = 2.71; 95% confidence interval (CI): 2.45-3.00]. The healing rate within eight weeks was 48.32% (OR = 0.76; 95%CI: 0.35-1.66), while the rate beyond eight weeks was 88.32% (OR = 6.73; 95%CI: 3.82-11.87). Risk factors included Helicobacter pylori (H. pylori ) infection (OR: = 5.32; 95%CI: 1.90-14.87; P = 0.001), ulcer size (OR = 2.08; 95%CI: 1.19-3.61; P = 0.01), lesion site (OR = 2.08; 95%CI: 1.19-3.11), and pathological type (OR = 1.64; 95%CI: 1.06-2.52). Diabetes (OR = 0.56; 95%CI: 0.05-5.80; P = 0.63) and duration of operation (OR = 1.00; 95%CI: 0.99-1.01; P = 0.96) were not significant factors. CONCLUSION The healing rate of ulcers following ESD is high after eight weeks. Risk factors affecting the healing process include H. pylori infection, ulcer size, lesion site, and pathological type.

Does the type of aortic pathology affect periprocedural outcomes in patients undergoing thoracic endovascular aortic repair?

Aim: To examine whether the type of aortic pathology affects periprocedural outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Material and Methods: This retrospective observational cohort study included 47 TEVAR patients in total. Based on the kind of aortic pathology, the patients were categorized into three groups: Group 1 (n=23) included patients with type B aortic dissection (TBAD), Group 2 (n=14) included patients with descending thoracic aortic aneurysm (DTAA), and Group 3 (n=10) included patients with thoracic aortic mural thrombus (TAMT). Preprocedural basic clinical features, procedural data, and postprocedural outcomes and complications were compared between the groups. Results: The study population consisted of 36 males and 11 females, with a mean age of 62.48±14.2 years. Most of the patients in Groups 1 and 2 were male (82.6% and 92.8%), while 40% of the patients in Group 3 were male, and this difference was statistically significant. Compared to patients in other groups, individuals in Group 2 were significantly older and exhibited a higher incidence of chronic obstructive pulmonary disease and coronary artery disease. Group 3 required thromboembolectomy more frequently during the postprocedural period. In terms of other postprocedural outcomes, complications and mortality, there were no significant differences between the groups. Conclusion: Our study demonstrated that the type of aortic pathology did not significantly influence periprocedural outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). The TEVAR procedure can be effectively performed in suitable patients with various pathologies of the descending thoracic aorta.

Development and validation of a risk prediction model for cognitive impairment in breast cancer patients.

Breast cancer patients often experience cognitive impairment as a complication during treatment, which seriously affects their quality of life. This study aimed to assess the risk factors associated with cognitive impairment in breast cancer patients and to construct and validate a nomogram model to predict cognitive impairment in this population. In this study, we used a convenience sampling method to select 423 breast cancer patients who attended the Department of Breast Surgery at the First Hospital of Jinzhou Medical University from September 2023 to March 2024. We analyzed these patients' cognitive impairment risk factors through LASSO regression and logistic regression analysis to develop a predictive model. The model was evaluated using the area under the curve (AUC) from the receiver operating characteristic (ROC) curve and the calibration curve and decision curve analysis. This study found a prevalence of cognitive impairment of 19.62% among breast cancer patients. A nomogram model was developed based on six influencing factors: age, educational level, pathological type, treatment program, emotional state, and fatigue. The area under the curve (AUC) for the model's training and validation groups was 0.944 and 0.931, respectively. The model calibration curves showed a high degree of consistency, and the decision curve analysis (DCA) indicated good clinical applicability of the model. This nomogram demonstrates good discrimination, calibration, and clinical applicability, making it a more intuitive predictor of the risk of cognitive impairment in breast cancer patients.

T1 mapping-based radiomics in the identification of histological types of lung cancer: a reproducibility and feasibility study.

T1 mapping can quantify the longitudinal relaxation time of tissues. This study aimed to investigate the repeatability and reproducibility of T1 mapping radiomics features of lung cancer and the feasibility of T1 mapping-based radiomics model to predict its pathological types. The chest T1 mapping images and clinical characteristics of 112 lung cancer patients (54 with adenocarcinoma and 58 with other types of lung cancer) were collected retrospectively. 54 patients underwent twice short-term T1 mapping scans. Regions of interest were manually delineated on T1 mapping pseudo-color images to measure the mean native T1 values of lung cancer, and radiomics features were extracted using the semi-automatic segmentation method by two independent observers. The patients were randomly divided into training group (77 cases) and validation group (35 cases) with the ratio of 7:3. Interclass correlation coefficients (ICCs), Student's t-test or Mann-Whitney U tests and least absolute shrinkage and selection operator (LASSO) were used for feature selection. The optimum features were selected to establish a logistic regression (LR) radiomics model. Independent sample t-test, Mann Whitney U-test or chi square test were used to compare the differences of clinical characteristics and T1 values. Performance was compared by the area under the receiver operating characteristic (ROC) curve (AUC). In the training group, smoking history, lesion type and native T1 values were different between adenocarcinoma and non-adenocarcinoma patients (P = 0.004-0.038). There were 1035 (54.30%) radiomics features meet the intra-and inter-observer, and test-retest reproducibility with ICC > 0.80. After feature dimensionality reduction and model construction, the AUC of T1 mapping-based radiomics model for predicting the pathological types of lung cancer was 0.833 and 0.843, respectively, in the training and validation cohorts. The AUCs of T1 value and clinical model (including smoking history and lesion type) were 0.657 and 0.692 in the training group, and 0.722 and 0.686 in the validation group. Combined with T1 mapping radiomics, clinical model and T1 value to establish a combined model, the prediction efficiency was further improved to 0.895 and 0.915 in the training and validation groups. About 50% of the T1 mapping-based radiomics features displayed relatively poor repeatability and reproducibility. While T1 mapping-based radiomics model is valuable in identification of histological types of lung cancer despite the measurement variability. Combination of T1 mapping radiomics model, clinical characteristics and native T1 value can improve the predictive value of pathological types of lung cancer.

Laparoscopic access is the modern standard for extended liver resection

Objective. To evaluate the safety and early results of laparoscopic extended liver resection in case of focal liver pathology by retrospective comparison with the relevant parameters of a similar open intervention. Materials and methods. The study involved 162 patients who were divided into two groups: Group 1 – 50 patients who underwent laparoscopic extended liver resection, and Group 2 – 112 patients who underwent open extended liver resection. The groups were compared by age structure, sex, body mass index, type of pathology (benign/malignant), as well as by characteristics of surgical intervention and postoperative period. Statistical analysis included a t–test for independent samples, Pearson's chi–square test, and other appropriate methods with the calculation of the confidence level p (parametric criterion). The difference in indicators was considered statistically significant at p < 0.05. Results. Laparoscopic osshire for liver resection was longer (p = 0.0012), but was associated with a lower level of pain according to the visual analog scale (p = 0.02) and fewer bed days to discharge (p = 0.0007) than a similar open intervention. There was no statistically significant difference between the groups in terms of age structure, body mass index, number of liver tumors, blood loss, complication rate, and degree of ischemic liver damage. Conclusions. Laparoscopic extended liver resection is a less invasive method than open liver resection, and patients recover faster after it, although its duration is longer. At the same time, laparoscopic and open intervention had a similar incidence of complications, which indicates acceptable safety and high clinical efficacy of the laparoscopic approach in the treatment of patients with liver disease.

Prognostic Factors of Long-Term Survival and Conditional Survival Analysis in MPM Patients Treated with CRS+HIPEC: A Retrospective Study of Two Centers.

This study was designed to explore the survival benefit factors of malignant peritoneal mesothelioma (MPM) patients after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and to make dynamic survival prediction by conditional survival (CS). Data of 212 patients with MPM who underwent CRS+HIPEC were retrospectively analyzed. Patients were divided into long-term survival (LTS) group (≥48.0 months) and short-term survival (STS) group (≤16.0 months) according to OS. Conditional survival is the probability of surviving y years after already survived for x years. Univariate and multivariate analyses were performed to explore the favorable factors of LTS. Conditional survival and Kaplan-Meier were applied to assess the postoperative survival probability. Ninety patients were enrolled: 53 (58.9%) were LTS, and 37 (41.1%) were STS. Univariate analysis revealed 14 meaningful factors (P < 0.05): age, surgery history, Karnofsky performance status, pathological types, tumor vascular emboli, lymphatic metastasis, Ki-67 index, preoperative CA125 level, peritoneal cancer index (PCI), completeness of cytoreduction, bleeding, red blood cell (RBC) transfusion, ascites, and severe adverse events (SAEs). Multivariate analysis identified that PCI ≤ 20, less RBC transfusion and no SAEs were independent prognostic factors for LTS. Five-year CS increased from 27% at 0 years to 84% at 4 years with the increasing number of survival years. The survival curve flattens at postoperative 5 years. The key factors in CRS+HIPEC for MPM patients to achieve LTS are lower tumor burden, less intraoperative RBC transfusion, and prevention of SAEs. Malignant peritoneal mesothelioma patients demonstrated a substantial increase in CS over time. Some patients may achieve clinical cure 5 years after surgery.

The effect of thyroid cancer on the survival of patients with digestive system tumors using SEER database.

The number of cancer survivors worldwide is increasing every year, making secondary primary cancers (SPC) is a growing health threat. Studies have been conducted to investigate the risk of occurrence between digestive system tumors (DST) and thyroid cancer (TC). However, existing studies have tended to focus more on the risk of developing SPC and less on the impact of SPC on the survival of cancer survivors. In this study, using the Surveillance, Epidemiology, and End Results database, we aimed to explore the impact of TC on the survival of patients with DST by data between 2000 and 2018. The study employed the standardized incidence ratio to assess the relative risk of SPC, propensity score matching was conducted to mitigate confounding effects, Kaplan-Meier, Cox proportional risk model and competitive risk model were used to analyze the factors affecting the overall survival and cancer-specific survival. We furthermore explored the influence of pathological types and radiotherapy of TC on the survival of DST patients. 518,901 patients with DST only, 801 patients with TC occurring earlier than DST (TC-1st), and 744 patients with DST occurring earlier than TC (DST-1st) were included. The total incidence rate of small intestine cancer after TC was higher than that of the general population, and the incidence of TC after DST was higher than in the general population. DST patients with a history of TC had better overall survival and lower cancer-specific mortality and this difference was particularly significant in patients with DST-1st. In addition, radiotherapy for TC had no effect on cancer-specific mortality in patients with DST.

Impulse oscillometry system and pulmonary function test assessment of the impact of tumor location, staging, and pathological type on lung function in primary lung cancer.

To study the effects of tumor site, stage, pathologic type and imaging findings on lung function in primary lung cancer, as well as the correlation between impulse oscillometry system (IOS) and pulmonary function test (PFT) parameters. The impact of tumor location, staging, and pathological type on lung function were evaluated in 219 patients with primary lung cancer through IOS and PFT. Spearman correlation coefficient was used to analyze the relationship between IOS parameters and PFT parameters. The PFT parameters in adenocarcinoma were significantly higher than those in SCLC, while the other parameters in IOS were obviously lower than those in SCLC except X5Hz (P < 0.05). The PFT parameters of FVC%, FEV1% and MVV% in SCC were evidently higher than those in SCLC, while the parameters of IOS were significantly lower than those in SCLC (P < 0.05). The PFT parameters of adenocarcinoma were higher than those of SCC (P < 0.05). In the PFT parameters of stage I patients, FEV1/FVC%, MEF50%, MMEF75/25%, and DLCO% were markedly higher than those of stage II patients, and FVC%, FEV1%, FEV1/FVC%, MEF50%, MEF25%, PEF%, MMEF75/25%, TLC%, and DLCO% were obviously higher than those of stage III and IV patients; and the MVV%, Z5Hz%, R5Hz% in IOS parameters were obviously lower than those in stage III, while Fres (1/s) and X5Hz were significantly lower than those in stage IV (P < 0.05). Compared with Phase IV, the X5Hz of stage II patients was clearly higher (P = 0.023). Besides, PFT parameters of peripheral lung cancer were obviously higher than those of central lung cancer (P < 0.05), while Z5Hz%, Fres (1/s) and R5Hz% of IOS parameters were clearly lower than those of central lung cancer (P < 0.05). Moreover, for patients without and with other pulmonary imaging manifestations, the PFT parameters of the former were significantly higher than those of the latter (P < 0.05), while only Fres (1/s) of IOS parameters was significantly lower than the latter (P < 0.05). Furthermore, there is a low to moderate correlation between IOS parameters and PFT parameters. Patients with central SCLC and SCC and advanced lung cancer had the worst lung function. The IOS parameters show a good correlation with the traditional PFT parameters, and IOS can be used as an alternative measurement method for PFT when necessary.

Is intercalary frozen autograft augmented with intramedullary cement and bridging plates fixation a durable reconstruction?

AimsWe analysed the survival, complications, and function of frozen autograft augmented with intramedullary cement and bridging plates fixation for intercalary bone defect reconstruction in primary bone sarcomas.Patients and MethodsA retrospective cohort study was conducted on 72 patients with primary bone sarcomas (34 males, 38 females) between January 2016 and June 2023. The average age was 22.0 ± 13.6 years (6 to 61 years) and the pathological type included osteosarcoma (55), followed by adamantinoma (5), Ewing’s sarcoma (4), undifferentiated pleomorphic sarcoma (4), chondrosarcoma (3), and malignant tenosynovial giant cell tumor (1). The oncological outcomes included local control, metastasis, progression-free survival and overall survival. The functional outcomes were evaluated by the Musculoskeletal Tumor Society Score (MSTS-93), the Toronto Extremity Salvage Score (TESS), and the motion of the joint.ResultsThe mean follow-up time was 50.0 ± 27.4 months (12 to 99 months). 10 patients died of the disease, 9 patients were alive with disease and 53 patients were alive with no evidence of disease. The average 5-year overall survival of autograft was 85.8% (95% CI, 72.1-93.1%). The average MSTS-93 score was 96% ( 67–100%) and the average TESS score was 98% (74–100%). Twenty-four patients (33.3%) had at least one complication in the follow-up period. The most common complications were nonunion (9.7%, 7/72) and local recurrence (9.7%, 7/72), followed by leg length discrepancy (6.9%, 5/72), infection (5.6%, 4/72), implant failure (4.2%, 3/72), delayed union (2.8%, 2/72), and graft fractures (1.4%, 1/72). Tumor site was an independent risk factor for bone nonunion (OR, 22.23; p = 0.006).ConclusionsWe presented a large technique series for preventing autograft-related complications (especially for autograft fractures) of intercalary frozen autograft reconstruction. This method showed promising functional outcomes and provided durable reconstruction.Level of evidencelevel IV therapeutic study.

Arthroscopic Management of an Extremely Rare Wrist Fracture-Dislocation Pattern

Abstract Background Axial dislocation involves the displacement of carpal bones along the longitudinal axis of the wrist joint. There are three major groups: (1) axial ulnar, (2) axial radial, and (3) combined. On the other hand, radiocarpal dislocation entails disruption of the articulation between the radius and carpal bones. There are two groups: (group 1) it is either a pure radiocarpal dislocation or a minor avulsion of the radial styloid and (group 2) a fracture-dislocations characterized by a significant radial styloid fragment. Case Description The patient, a 66-year-old female involved in a car accident, underwent imaging studies and arthroscopic exploration, revealing a transcapitate perihamate translunate fracture-dislocation, associated with a radiocarpal dislocation type 1. Arthroscopic treatment was performed through common dorsal radiocarpal and midcarpal portals, along with the volar radial portal. Anatomical reduction of the joints and fractures was achieved under arthroscopic control, along with suturing of the volar radiocarpal ligaments. Literature Review The simultaneous occurrence of axial dislocation and radiocarpal dislocation, as observed in our case, is exceedingly rare and lacks comprehensive documentation in the existing literature. Furthermore, the specific type of axial dislocation (transcapitate perihamate translunate) has not been previously reported.Various treatment approaches, including closed reduction, open reduction, and external fixation, have been described for these types of complex pathologies, but few reports describe their arthroscopy management. Clinical Relevance This case report describes a rare occurrence of axial ulnar dislocation associated with radiocarpal dislocation of the wrist, which is exceptionally uncommon and not reported previously in the literature. This arthroscopic approach yielded excellent results, avoiding the need for multiple open approaches to address several fractures and ligament injuries.

Pain syndrome, “dropped head” and myasthenia gravis: a case report and literature review

The objective of the study is to present a description of the first domestic clinical observation of the painful dropped head syndrome in a patient with myasthenia gravis (MG).Materials and Methods. Clinical, laboratory and instrumental data were analyzed over the course of MG symptoms with late onset in combination with thymoma, manifesting with pain and weakness in the neck extensors.Results. The characteristic and unique features of diagnostics and treatment of MG developed in a 59-year-old patient associated with antecollis and significant pain syndrome, initially considered as manifestations of osteochondrosis, are observed in comparison with the literature data. The information on the occurrence, demographic origin, association with the type of receptor targets, thymus pathology and reversibility of these disorders in MG is systematized, and the importance of addressing the concepts of pain in MG is emphasized. The positive effect of ipidacrine in the symptomatic treatment of MG in a patient with marked cholinergic manifestations induced by conventional anticholinergic agents (AA) therapy is confirmed.Conclusions. MG can cause axial muscle impairment leading to the phenomenon of “dropped head” and the development of pain syndrome atypical for the classical course of the disease. Pathogenetic treatment of seropositive MG in most cases leads to the elimination of its clinical manifestations, including pain. In some cases, the use of the reversible AA ipidacrine is an additional advantage in the therapy of such conditions, taking into account its concomitant proven efficacy as an adjuvant analgesic.

Mesenchymal stromal cells and platelet-riach fibrin membrane for the treatment of osteochondral defect in the rabbit

Cartilage has limited self-repair ability due to its complex structure and chondrocytes' relatively low metabolic activities. Functional repair of articular cartilage defects is a significant challenge for cartilage tissue engineering. Mesenchymal stromal cells (MSC) and platelet-rich fibrin membrane (PRFM) in repairing damaged articular cartilage in rabbit. They were subjected to osteochondral lesion and randomly into five groups: Group A, evaluated immediately after injury; Group B, natural evolution the injury; Group C, MSC; Group D, PRFM and Group E, MSC+ PRFM. Animals in Group A were euthanized after removing the cartilaginous flap, while animals in Groups B, C, D, and E were euthanized 60 days. The regeneration of the lesion was evaluated by analyzing its residual extension, as well as the density of chondrocytes and chondroblasts in the regenerated tissue adjacent to the lesion. Results, the Group E (MSC + PRFM) showed a greater reduction in the lesion size and a greater density of chondrocytes and chondroblasts in the regenerated and adjacent tissue compared to the other groups. Our results indicate that the combination of MSC and PRFM can successfully resurface the defect with cartilage and restore the subchondral bone in the specie studied, being effective in reducing hyaline cartilage defects; however, the combination of MSC and PRFM products might be more or less appropriate for treating different types of tissues and pathologies. The clinical efficacy of PRP remains under debate. Therefore, further research is needed at both the basic science and clinical levels.

Nucleolar casein kinase 2 alpha as a prognostic factor in patients with surgically resected early‑stage lung adenocarcinoma.

Lung cancer remains a leading cause of global cancer‑related deaths, therefore the identification of prognostic factors for lung cancer is critical. Casein kinase 2 alpha (CK2α) is one of the driver kinases in various cancers, and it was previously demonstrated that CK2α localization was associated with a poor prognosis in invasive breast cancer. In the present study, the importance of CK2α in the nucleolus was explored as a potential prognostic marker for surgically resected early‑stage lung adenocarcinoma. The present study included 118 patients who underwent pulmonary lobectomy between 2014 and 2018 in Fukushima Medical University Hospital (Fukushima, Japan), and in whom CK2α localization in tumor samples was assessed by immunohistochemistry. Patient and tumor characteristics, including pathological stage, histological type and histological grade, were analyzed. Recurrence‑free survival (RFS) and overall survival were evaluated in relation to nucleolar CK2α staining. CK2α staining in the nucleoli was observed in 50.8% of lung adenocarcinoma tumors. Positive nucleolar CK2α staining was independent of pathological stage, histological type and histological grade. Patients with positive nucleolar CK2α staining exhibited significantly worse RFS compared with patients with negative staining. Multivariate analysis identified nucleolar CK2α staining and lymph node metastasis as independent poor prognostic factors. The results of the present study suggested that nucleolar CK2α staining is a novel and independent prognostic factor in surgically resected early‑stage lung adenocarcinoma. These findings indicated the potential of nucleolar CK2α as a predictive biomarker for future recurrence, and a guide to treatment decisions. Further research is required, particularly in understanding the molecular mechanisms linking nucleolar CK2α to recurrence.

The clinical pathway in China county for lung cancer diagnosis and treatment (2024 edition)

Standardizing the diagnosis and treatment of lung cancer is a key measure to improve the survival rate of lung cancer patients and reduce the mortality rate. However, county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies. Therefore, when developing quality control standards and clinical diagnosis and treatment specifications, it is necessary to combine the actual situation of county hospitals and formulate specific recommendations. The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List (NRDL), to ensure the access to medicines. To address the above issues, based on the existing guidelines at home and abroad and the clinical work characteristics of county hospitals, the " the clinical pathway in China county for lung cancer diagnosis and treatment (2024 edition)" has been updated on the basis of the first edition. This pathway elaborated on the imaging diagnosis, pathological diagnosis, molecular testing, precision medicine, and developed different diagnosis and treatment processes for different types of lung cancer patients. Consistent with the first pathway, this update still divides the recommendations for diagnosis and treatment of clinical scenarios into basic strategies and optional strategies for elaboration. The basic strategies are the standards that county hospitals must meet, while the optional strategies provide more choices for hospitals, which are convenient for county doctors to put into clinical practice. All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus. Compared to the first edition, based on the latest high-level evidence-based medicine and the approval status of indications, the pathway has updated the diagnosis and treatment recommendations for lung cancer under different pathological types, TNM classification, and molecular classification in basic and optional strategies.

A nomogram to predict the risk of relapse in patients with minimal change disease: a retrospective cohort study

Background Minimal change disease (MCD) is a common pathological type of nephrotic syndrome. Relapses of MCD present a significant challenge for patients. This study aims to develop a predictive model for evaluating the probability of relapse in patients with MCD. Methods This study enrolled 152 patients with biopsy-confirmed MCD, all of whom received exclusive glucocorticoid treatment at the First Affiliated Hospital of Zhejiang University in Hangzhou, China, between October 2012 and April 2021. The Cox regression analysis was utilized to identify the risk factors associated with the relapse in MCD, and a nomogram was constructed to predict the probability of relapse. Results The results demonstrated that serum immunoglobulin E (IgE) levels > 936 IU/mL, age ≤ 30 years old, estimated glomerular filtration rate (eGFR) < 90 mL/(min × 1.73 m2), serum total cholesterol (TCh) levels > 12.3 mmol/L, and time to remission were independent risk factors associated with relapses in patients with MCD. A nomogram was established and achieved a concordance index of 0.726 (95% CI = 0.659–0.793). The receiver operating characteristic curves demonstrated areas under the curve of 0.771, 0.853, and 0.811 for the prediction of relapse at 1-, 2-, and 3-year intervals after achieving remission in MCD patients respectively. These findings along with the calibration curves indicated the good discrimination and calibration performance of the nomogram in this cohort. Conclusion: The established nomogram provides a valuable tool for the identification of patients with MCD who are at risk of relapse, which may facilitate prompt treatment for these patients.

Scalable deep learning artificial intelligence histopathology slide analysis and validation.

Deep learning involves an artificial intelligence (AI) approach and has been shown to provide superior performance for automating image recognition tasks, as well as exceeding human capabilities in both time and accuracy. Histopathology diagnostics is one of the more popular challenges at the intersection of artificial intelligence, computer vision, and medicine. Developing methods to automatically detect and identify pathologies in digitized histology slides imposes unique challenges due to the large size of these images and the complexity of the features present in biological tissue. Most methods that are capable of human-level recognition in histopathology are tuned to a specific problem since the computational complexity exceeds that of traditional image classification problems. In the current study, a deep learning approach is developed and presented that can be trained to locate and accurately classify different types of pathologies in gigapixel digitized histology slides along with completing the binary disease classification for the entire image. The approach uses a novel pyramid tiling approach to take advantage of spatial awareness around the area to be classified, while maintaining efficiency and scalability for gigapixel images. The approach is trained and validated on a wide variety of tissue types (i.e., testis, ovary, prostate, kidney) and pathologies taken from an epigenetically altered histology study at Washington State University. The newly developed procedure was optimized and validated along with comparison and validation on public histology datasets. The current developed procedure was found to be optimal and more reproducible when compared to manual procedures, and optimal to previous protocols that used fragmented tissue or slide analysis. Observations demonstrate that the deep learning histopathology analysis is significantly more efficient and accurate than standard manual histopathology analysis.

Spatiotemporal Ultrastructural, Histological, and Morphometric Changes in the Buccal Cavity of Grass Carp (Ctenopharyngodon idella) During Fingerling, Yearling, and Adult Stages.

Grass carp (Ctenopharyngodon idella) is a Cyprinid fish of aquacultural and research importance. The buccal cavity represents the gateway of the digestive tract. The present study investigated the adaptational changes involving various components of the buccal cavity of fingerling (three months posthatching, mph), yearling (12 mph), and adult (48 mph) C. idella using scanning electron microscopy, histology, and morphometry. The upper and lower lips appeared uninterrupted at the three studied stages and were limited caudally by the upper and lower jaws. The jaw epithelium was the thickest part of the buccal epithelium; ultrastructurally, it appeared smooth with ridge-like borders in fingerlings that transformed into microgrooves in yearlings. In adult C. idella, the jaw mucosa was organized into dome-shaped masses separated from each other by tight furrows. Each mass was formed from several keratinocytes with corrugated surfaces that featured numerous microdepressions. Except for the jaws, taste buds, mainly of type I, and acidic and neutral goblet cells were observed throughout the mucosa of the buccal cavity, and their densities were highest along the mucosal folds of the palate and oral floor, suggesting a principal role for these parts in both gustation and food lubrication. This study is the first to report age-associated spatiotemporal changes in the buccal cavity of grass carp and will serve as a fundamental reference during the interpretation of various types of oral pathologies in teleost.

Five-gene prognostic model based on autophagy-dependent cell death for predicting prognosis in lung adenocarcinoma

Non-small cell lung adenocarcinoma (LUAD) is the predominant form of lung cancer originating from lung epithelial cells, making it the most prevalent pathological type. Currently, reliable indicators for predicting treatment efficacy and disease prognosis are lacking. Despite extensive validation of autophagy-dependent cell death (ADCD) in solid tumor studies and its correlation with immunotherapy effectiveness and cancer prognosis, systematic research on ADCD-related genes in LUAD is limited. We utilized AddModuleScore, ssGSEA, and WGCNA to identify genes associated with ADCD across single-cell and bulk transcriptome datasets. The TCGA dataset, comprising 598 cases, was randomly divided into training and validation sets to develop an ADCD-related LUAD prediction model. Internal validation was performed using the TCGA validation set. For external validation, datasets GSE13213 (119 LUAD samples), GSE26939 (115 LUAD samples), GSE29016 (39 LUAD samples), and GSE30219 (86 LUAD samples) were employed. We evaluated the model’s accuracy and effectiveness in predicting prognostic risk. Additionally, CIBERSORT, ESTIMATE, and ssGSEA techniques were used to explore immunological characteristics, drug response, and gene expression in LUAD. Real-time RT-PCR was conducted to assess variations in mRNA expression levels of the gene XCR1 between cancerous and normal tissues in 10 lung cancer patients. We identified 249 genes associated with autophagy-dependent cell death (ADCD) at both single-cell and bulk transcriptome levels. Univariate COX regression analysis revealed that 18 genes were significantly associated with overall survival (OS). Using LASSO-Cox analysis, we developed an ADCD signature based on five genes (BIRC3, TAP1, SLAMF1, XCR1, and HLA-DMB) and created the ADCD-related risk scoring system (ADCDRS). Validation of this model demonstrated its ability to predict disease prognosis and its correlation with clinical characteristics, immune cell infiltration, and the tumor microenvironment. To enhance clinical applicability, we integrated an ADCDRS nomogram. Furthermore, we identified potential drugs targeting specific risk subgroups. We successfully identified a model based on five ADCD genes to predict disease prognosis and treatment efficacy in LUAD, as well as to assess the tumor immune microenvironment. An efficient and practical ADCDRS nomogram was designed.

The Correlation Between the Natural Course, Pathologic Properties With Ki-67 Expression in Lung Adenocarcinoma Presenting as Ground-Glass Nodules.

With the increasing use of lung cancer screening, the detection of ground glass nodules (GGNs) has risen. However, the natural course of GGNs and their relationship to pathologic features remains unclear. Differentiating between invasive and pre-invasive lesions based on GGN growth may improve clinical intervention timing. Ki-67, a proliferation marker, holds value in assessing tumor malignancy. This study analyzes the association between GGN growth, pathology, and Ki-67 expression to provide new insights into early-stage lung cancer management. We retrospectively evaluated 183 GGNs with at least two preoperative CT scans. Nodule location, type, natural course, and volume doubling time (VDT) were compared between invasive adenocarcinoma (IAC) and pre-IAC groups. We also assessed differences in Ki-67 expression and correlated VDT with Ki-67 levels. A total of 183 nodules were finally included; gender, nodule location, smoking history, and duration of follow-up did not differ between the IAC group and the pre-IAC group, whereas age was statistically different between the two groups. Of the 183 nodules, 52 showed growth and the predominant pathologic type was IAC, these IACs showed more PSN in nodule type, while the IAC group showed more significant differences in nodule type, nodules growth, and VDT than the pre-IAC group. There were also differences in pathologic type and VDT between different Ki-67 expression groups, and Ki-67 expression gradually increased as VDT decreased. Lung adenocarcinoma (LUAD) presenting as GGNs exhibit distinct natural courses among pathologic subtypes. VDT effectively distinguishes these growth characteristics, with IACs showing shorter VDT. The significant correlation between VDT and Ki-67 expression suggests that combining these parameters may provide valuable insights into the biological behavior and invasiveness of LUAD.

Diagnostic Accuracy of B-scan Ultrasonography in Detecting Vitreoretinal Pathology after Open-Globe Injury

To assess the diagnostic accuracy of B-scan ultrasonography (echography) after open-globe injury (OGI) repair in detecting vitreoretinal pathology, as confirmed by intraoperative inspection during subsequent pars plana vitrectomy (PPV). Retrospective, single-center, consecutive case series. Patients with OGI treated at the University of Iowa Hospitals and Clinics (UIHC) from February 2018 through December 2023 who underwent OGI repair and had at least one B-scan performed post-repair but prior to subsequent PPV. B-scans were performed by an experienced echographer and reviewed by the managing vitreoretinal surgeon for the presence of vitreous hemorrhage (VH), retinal tear (RT), retinal detachment (RD), choroidal detachment, and vitreoretinal incarceration. B-scan findings were compared to findings on direct inspection during PPV, which served as the gold standard. Sensitivity, specificity, and positive/negative predictive value of B-scan findings. The study included 62 eyes of 61 patients, predominantly with severe OGIs (mean presenting logMAR VA of 2.52 ± 0.41; 75% with Ocular Trauma Score of 1 or 2). B-scan had excellent diagnostic accuracy for VH, but for every other type of vitreoretinal pathology there were significant false positives, false negatives, or both. B-scan sensitivity was particularly low for vitreoretinal incarceration (11%), RT (32%), and RD (78%). This study identified much lower diagnostic accuracy of B-scan ultrasonography after OGI for all vitreoretinal pathologies except VH compared to previous, smaller studies that reported perfect accuracy (100% sensitivity and specificity). Ultrasonography provides useful clinical information but should not be solely relied upon to diagnose or rule out severe vitreoretinal pathology that may prompt vitreoretinal referral and/or PPV after OGI.