Short Diameter Research Articles

High pulse energy, narrow-linewidth all-fiber 1064 nm picosecond master oscillator power amplifier system

We demonstrated the generation of narrow spectral bandwidth, high energy picosecond pulses from a low repetition rate SESAM mode-locked laser seeded Yb-doped fiber MOPA system. A short large mode field diameter gain fiber (DCF-30/250) was adopted to efficiently reduce the influence of nonlinear effects. The maximum pulse energy of 12.36 μJ, ∼60 ps pulses with a narrow bandwidth was obtained at a repetition rate of 5 MHz, corresponding to the peak power of 0.2 MW and average output power of 64 W. The optical-to-optical conversion efficiency was ∼64% in such a low repetition rate all-fiber laser design. The output pulse spectra and temporal trace of the MOPA system for different output powers was investigated by simulation. The simulation results were in agreement with experiment but further showed that the spectral splitting would occur as output power increased.

Challenges in Appropriate Sizing of Thoracic Endografts for Thoracic Aortic Transection

<h3>Introduction and Objective</h3> Blunt aortic injury (BAI) is the second leading cause of death from motor vehicle collisions. Implementation of Thoracic Endovascular Aortic Repair (TEVAR) for aortic transection has resulted in decreased morbidity and mortality. Accurate sizing of the graft depends on appropriate measurement of the Aortic Lumen Diameter (ALD). The aorta of the trauma patient is often healthier and smaller, and oversizing should be conservative. While trauma patients with high impact injury might be under resuscitated on presentation and with possible hemodynamic abnormalities, the data on the effect of those findings on ALD measurements is limited. We aim to assess the effect of hemodynamic instability on the reliability of admission CT scan measurements for accurate graft sizing in patients with BAI. <h3>Method</h3> This is a retrospective review of 10 consecutive patients presenting with BAI and undergoing TEVAR. Demographic data and repeat imaging studies as well as intraoperative findings were reviewed. All measurements were performed in an axial plane with the shortest diameter at the origin of the left subclavian artery as well at 10 and 20 cm distal to left subclavian origin. <h3>Results</h3> Average age of presentation was 33.2 years (16-63). 80% were males. Mechanism of injury was motor vehicle collision in 90% of the patients. 50% had a systolic blood pressure (SBP) under 90 or a shock index (SI) above 1 in the trauma bay and required blood products. Average time from presentation to CT was 60 minutes (13-123). One patient had persistently elevated SI in the CT scanner. Aortic injury was distal to the left subclavian artery in all patients. Injury grade was grade two (n=2) or grade three (n=8). 90% of patients had associated thoracic injury (Hemothorax n=7, mediastinal hematoma n=5, rib fractures n=4). All patients had associated extra thoracic injuries (long bone fracture n=2, solid organ injury n=2, combined n=6). None had intracranial hemorrhage. Average diameter of the thoracic aorta at the left subclavian artery ostium was 22.4mm (19.0-31.1). 70% of patients had either a repeat CT of the chest (n=4) or intraoperative intravascular ultrasound (n=3) before deployment of the graft. Average ALD difference was 1.2mm (0.0-4.2). The only patient with ALD difference significant enough to affect graft size choice was the patient with persistently elevated SI. Mean operative time was 79 minutes (42-138). Conformable GORE® TAG® was used in 8 patients while Medtronic Valiant™ was used in two patients. All patients had follow up CT imaging. One patient had an endoleak that resolved overtime. Average follow up was 1 year (14-958 days). <h3>Conclusion</h3> Patients with BAI tend to present with long bone fracture and solid organ injury which can result in blood loss and hemodynamic instability. Size discrepancy between admission CT scan and repeat imaging significant enough to affect graft choice was only seen in one out of seven patients. This patient also happened to have persistently elevated SI. We recommend incorporating information of the patient's hemodynamic status during imaging studies, utilized for graft sizing, when repeat imaging is not feasible.

Feasibility of Predicting Pelvic Lymph Node Metastasis Based on IVIM-DWI and Texture Parameters of the Primary Lesion and Lymph Nodes in Patients with Cervical Cancer

To investigate the feasibility and value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and texture parameters of primary lesions and lymph nodes for predicting pelvic lymph node metastasis in patients with cervical cancer. A total of 143 patients with cervical cancer confirmed by surgical pathology were analyzed retrospectively and 125 patients were enrolled in primary lesions study, 83 patients and 134 lymph nodes were enrolled in lymph nodes study. Patients and lymph nodes were randomly divided into training group and test group at a ratio of 2: 1. The IVIM-DWI parameters and 3D texture features of primary lesions and lymph nodes of all patients were measured. The least absolute shrinkage and selection operator algorithm, spearman's correlation analysis, independent two-sample t-test and Mann-Whitney U-test were used to select texture parameters. Multivariate Logistic regression analysis and receiver operating characteristic curves were used to model and evaluate diagnostic performances. In primary lesions study, model 1 was constructed by combining f value, original_shape_Sphericity and original_firstorder_Mean of primary lesions. In lymph nodes study, model 2 was constructed by combining short diameter, circular enhancement and rough margin of lymph nodes. Model 3 was constructed by combining ADC, f value and original_glszm_Small Area Emphasis of lymph nodes. The areas under curve of model 1, 2 and 3 in training group and test group were 0.882, 0.798, 0.907 and 0.862, 0.771, 0.937 respectively. Models based on IVIM-DWI and texture parameters of primary lesions and lymph nodes both performed well in diagnosing pelvic lymph node metastasis of cervical cancer and were superior to morphological features of lymph nodes. Especially, parameters of lymph nodes showed higher diagnostic efficiency and clinical significance.

Differentiation between small (< 4.5 cm) true subepithelial tumors and ectopic pancreas in the small bowel on computed tomography enterography.

To identify imaging features that can differentiate ectopic pancreas from true subepithelial tumors (SETs) in the small bowel using CT enterography and to assess whether radiologists' performance for the differentiation can be improved with the knowledge of significant CT findings. CT images of ectopic pancreas (n = 29) and pathologically proven SETs (n = 61) were retrospectively reviewed by two radiologists in consensus. CT items analyzed included lesion location, contour (round, ovoid, flat/conformed), growth pattern, margin, homogeneity, necrosis, feeding vessel, surface ulceration, and enhancement pattern. For quantitative analysis, Hounsfield unit, longer diameter (LD), and shorter diameter (SD) of the lesion were measured. Univariate and multivariate analyses were performed. Diagnostic performance for differentiating ectopic pancreas from SETs was independently evaluated by two other radiologists using a receiver operating characteristic analysis. Age < 63 years, female sex, flat/conformed appearance, homogeneous enhancement, the absence of feeding vessels and necrosis, and an LD/SD ratio > 1.5 were significant variables for differentiating ectopic pancreas from small bowel SETs (p < 0.05). In the multivariate analysis, flat/conformed appearance, the absence of feeding vessels, and female sex remained suggestive features for ectopic pancreas. Area under the curve values for differentiating between two disease entities increased by both independent reviewers with knowledge of these significant CT features. Ectopic pancreas in the small bowel can be effectively differentiated from small (< 4.5 cm) true SETs by a flat/conformed appearance and the absence of feeding vessels on CT enterography. In addition, radiologists' performance for differentiating ectopic pancreas from small bowel SETs was improved with the knowledge of these significant CT findings. • Ectopic pancreas in the small bowel can be differentiated from small (< 4.5 cm) subepithelial tumors on CT. • Differential CT findings of the ectopic pancreas are a flat or conformed appearance and the absence of a feeding vessel. • Radiologists' performance for differentiating ectopic pancreas from small bowel SETs can be improved with the knowledge of differential CT findings.

Radiological criteria for selecting candidates for neoadjuvant chemotherapy for gastric cancer: an exploratory analysis from the PRODIGY study.

In this exploratory analysis from the PRODIGY study, we aimed to define the radiological criteria to identify patients with gastric cancer who may derive maximal clinical benefit from neoadjuvant chemotherapy. There were 246 patients allocated to receive surgery followed by adjuvant S-1 (SC group) and 238 allocated to receive neoadjuvant chemotherapy (CSC group). As the PRODIGY's radiological method of lymph node (LN) evaluation considers short diameter and morphology (the size and morphology method), a method considering only short diameter was also employed. In the SC group, the correlation between radiologic and pathologic findings was analyzed. The hazard ratio (HR) for the progression-free survival (PFS) of the CSC group was analyzed in subgroups with different cT/N stages. cT4 disease showed a sensitivity of 85.6% for detecting pT4 and had a low proportion of pathologic stage (pStage) I disease (4.5%). Among the criteria determined by different cT/N stages by each method of LN positivity, those involving cT4Nany or cT4N + by both methods had a minimal proportion of pStage I disease (≤ 5%), while cT4Nany by both methods and cT4N + by the size and morphology method exhibited ≥ 75.9% sensitivity for detecting pStage III disease. The relative risk reduction in PFS of the CSC group was greatest in patients meeting the cT4Nany criterion defined by both methods (HR 0.67, 95% confidence interval 0.48-0.93). The cT4Nany criterion, regardless of the radiological method used for LN evaluation, may help select patients with resectable gastric cancer for neoadjuvant chemotherapy.

Comparitive Study of Human Lymph Nodes

All the lymph nodes observed were typically bean shaped irrespective of their age or sex. The cervical lymph nodes were the largest of all the four groups in size. The mean maximum short axis axial diameter was 7.19mm (Range 5.67mm - 8.12mm). The mesentericl lymph nodes were the smallest of all the four groups in size. The mean maximum short axis axial diameter was 3.89mm (Range 2.7mm -6.lmm). The lymph nodes showed well defined deep cortical regions often containing large lymphoblasts and prominent endothelial cells in small blood vessels. The thickness of the deep cortex was however reduced when compared to its foetal counterpart. The mean thickness of the deep cortical region was 423 microns. To reconfirm the age related involution of the paracortical region, the mesenteric lymph nodes were observed. In sharp· distinction, axillary lymph nodes showed fewer germinal centres which were relatively smaller in size.Mean actual diameter of the germinal centre was77 microns also had had fewer and smaller germinal centres. Mean actual diameter of the germinal centre was 68 microns.

Application of Ultrasound Virtual Reality in the Diagnosis and Treatment of Cardiovascular Diseases.

Cardiovascular disease is a common chronic disease in the medical field, which has a great impact on the health of Chinese residents (especially the elderly). At present, the effectiveness of the prevention and treatment of cardiovascular diseases in my country is not optimistic. Overall, the prevalence and mortality of CVD are still on the rise. The timely and effective detection and treatment of cardiovascular and cerebrovascular diseases are of great practical significance to improve the health of residents and to carry out prevention and treatment. This article aims to study the application of ultrasound-based virtual reality technology in the diagnosis and treatment of cardiovascular diseases to improve the efficiency and accuracy of the diagnosis of cardiovascular and cerebrovascular diseases by medical staff. The focus is on the application of feature attribute selection related algorithms and classification related algorithms in medical and health diagnosis systems, and a cardiovascular and cerebrovascular disease diagnosis system based on naive Bayes algorithm and improved genetic algorithm is designed and developed. The system builds a diagnostic model for cardiovascular and cerebrovascular diseases and diagnoses and displays the corresponding results based on the patient's examination data. This paper first puts forward the theoretical concepts of ultrasonic virtual reality technology, scientific computing visualization, genetic algorithm, naive Bayes algorithm, and surgery simulation system and describes them in detail. Then, we construct a three-dimensional ultrasonic virtual measurement system, from the collection and reconstruction of image data to the filtering and segmentation of image data, plus the application of three-dimensional visualization and virtual reality technology to construct a three-dimensional measurement system. The experimental results in this paper show that 10 isolated congenital heart disease models with atrial septal defect (ASD) established through the use of three-dimensional visualization and virtual reality technology measured the short diameter, long diameter, and area of the atrial septal defect in the left and right atria. Finally, a value of L less than 0.05 indicates that the statistics are meaningful, and a value of r generally greater than 0.9 indicates that the virtual measurement result is highly correlated with the real measurement result.

Pollution-driven morphological plasticity in a running water ecosystem.

Various types of pollutants derived from rapid industrialization and urbanization have largely threaten biodiversity and functioning of freshwater ecosystems globally. Morphological plasticity, especially body size-associated traits, is considered a functional response to water pollution in species, as such changes are often directly related to functioning of freshwater ecosystems through dynamics of food webs. However, detailed dynamics of pollution impacts on morphological plasticity remain largely unknown, particularly in the wild. Here, we used the model planktonic rotifer Brachionus calyciflorus to assess morphological response to chemical pollution in a river reach disturbed by sewage discharges. Multiple analyses showed dynamic morphological response to water pollution in wild B. calyciflorus populations. The distance between anterior lateral spines, lorica length, and egg short diameter were the most sensitive morphological indicators to water pollution, while spine length was stable in varied pollution conditions. Interestingly, body size and egg size were increased with accentuated water pollution, suggesting that wild populations maintain fitness by increasing feeding efficiency and reducing vulnerability to predation and ensure survival by producing large newborns in polluted environments. Total ammonia nitrogen was the leading nitrogen pollutant affecting body size, while total phosphorus and elements of Mn and As were the key factors relating to egg size. The results obtained here provide new sights into biological consequences of environmental pollution in the wild, thus advancing our understanding of pollution impacts on structure and functioning of freshwater ecosystems.

Comparison on efficacy between fascia-oriented versus vascular-oriented lateral lymph node dissection in patients with rectal cancer

Objective: To compare the postoperative function, the short-term and long-term outcomes between fascia-oriented and vascular-oriented lateral lymph node dissection (LLND) in patients with rectal cancer. Methods: A retrospective cohort study was performed. Clinical data of patients who received total mesorectal excision (TME) with LLND at National Cancer Center, Cancer Hospital of Chinese Academy of Medical Science from January 2014 to December 2019 were retrospectively collected. Inclusion criteria were as follows: (1) rectal cancer was pathologically diagnosed, and the lower margin was below the peritoneal reflection. (2) resectable advanced rectal cancer with suspected lateral lymph node metastasis was evaluated based on rectal MRI assessment. (3) preoperative MRI showed lateral lymph node short diameter ≥5 mm and/or lymph node morphology (spike, blur, irregular) as well as heterogenous signal intensity. Lymph node shrinkage was less than 60% after receiving neoadjuvant therapy based on the reassessment of rectal MRI. (4) TME+LLND surgery was performed synchronously. Exclusion criteria were as follows: (1) previous history of pelvic surgery; (2) preoperative cystitis, urethritis, moderate and severe prostatic hyperplasia and other diseases resulting in abnormal urination function; (3) preoperative sexual dysfunction or loss of function; (4) patients receiving LLND due to lateral recurrence after TME; (5) distant metastasis of the tumor at initial diagnosis; (6) Incomplete collection of clinical data. A total of 73 consecutive patients were enrolled in this study. Based on the surgical approaches in performing LLND, patients were divided into fascia-oriented group (n=30) and vascular-oriented group (n=43). There were no significant differences in baseline data between the two groups (all P>0.05). The main outcome indicators of this study were the incidence of postoperative urinary and male sexual dysfunction, the efficacy, the number of lateral lymph nodes harvested and the detection rate of positive lymph nodes. Overall survival (OS) rates and progression free survival (PFS) rates were calculated by the Kaplan-Meier method and compared by log-rank test. Results: All patients in both groups completed surgery successfully. There were no significant differences in operation time, intraoperative blood loss, postoperative complications, and the length of hospital stay between the two groups (all P>0.05). In the whole group, the incidence of postoperative urinary dysfunction and male sexual dysfunction was 43.8% (32/73) and 62.5% (25/40), respectively. The median number of lateral lymph nodes harvested was 8.0(4.0,11.0) with a positive rate of 20.5%(15/73). Compared to the vascular-oriented group, the fascia-oriented group demonstrated a decreased rate of urinary dysfunction [26.7% (8/30) vs. 55.8% (24/43), χ(2)=6.098, P=0.014], lower rate of sexual dysfunction in males [6/15 vs. 76% (19/25), χ(2)=5.184, P=0.023], more harvested lateral lymph nodes [M (P25, P75): 9.5 (6.8, 15.3) vs. 6.0 (3.0, 9.0), Z=-2.849, P=0.004]. There was no significant difference in the positvie rate of lateral lymph nodes between the two groups [20% (6/30) versus 20.9% (9/43), χ(2)=0.009, P=0.923]. Three(4.1%) patients were lost during a median follow-up of 34 (1-66) months. The 3-year PFS and OS of the whole cohort were 69.5% and 88.3%, respectively. No significant difference in 3-year PFS rates (79.6% vs. 62.0%, P=0.172) and 3-year OS rates (91.2% vs. 85.9%, P=0.333) were observed between the fascia-oriented group and the vascular-oriented group (both P>0.05). Conclusion: Fascia-oriented LLND is associated with lower risk of postoperative urinary and male sexual dysfunction in patients with rectal carcinoma, and harvest of more lymph nodes, but no significant advantage in long-term survival.

Risk factors of perivalvular leakage after transcatheter aortic valve replacement with Venus-A valve

Objective: To investigate the risk factors of moderate or severe perivalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) with Veneus-A valve. Methods: This study was a single-center case-control study. The clinical data of patients with severe aortic stenosis, who underwent TAVR in the Department of Cardiology of Second Affiliated Hospital of Army Medical University from October 2017 to January 2021, were analyzed. According to the circumferential extent of prosthetic valve paravalvular regurgitation measured by transthoracic echocardiography before discharge (patients who died in hospital were referred to transesophageal echocardiography results after valve implanted), the patients were divided into moderate or severe PVL group and mild or non-PVL group. The clinical features, CT scan and analysis results of aortic root were compared between the two groups. Multivariate logistic regression analysis was used to identify the independent risk factors of postoperative moderate or severe PVL, and receiver operating characteristic (ROC) curve was used to explore the predictive value of related factors. Results: Eighty-two patients (mean age: (70.9±6.5) years, 46 males) were included in the analysis, there were 16 patients in the moderate or severe PVL group and 66 patients in the mild or non-PVL group. The proportion of male gender, depth of valve implantation, size of valve annulus and left ventricular outflow tract (LVOT), and coverage index of LVOT were significantly higher in moderate or severe PVL group than those in mild or non-PVL group (Pall<0.05). As there was a strong collinearity among the valve annular short diameter, LVOT short diameter and LVOT coverage index (partial correlation coefficient R 0.251-0.779, P<0.05), these parameters were not entered in regression model. Multivariate logistic regression analysis showed that valve implantation depth(OR=1.239,95%CI 1.036-1.442,P=0.023), aortic angulation(OR=1.128, 95%CI 1.044-1.312,P=0.038)and LVOT tract coverage index (OR=1.123, 95%CI1.003-1.315, P=0.032) were independent risk factors for moderate or severe PVL after TAVR. The ROC curve showed that the valve implantation depth could predict the occurrence of moderate or severe PVL after TAVR (area under ROC curve (AUC)=0.697, 95%CI 0.554-0.851, P=0.039). Conclusion: Among patients with severe aortic stenosis who undergo TAVR with Venus-A valve, the implantation depth, aortic angulation and LVOT coverage index are independent risk factors of moderate/severe PVL after TAVR, among which valve implantation depth could be used to predict the occurrence of moderate/severe PVL after TAVR.

Mg(H2O)2[TeO2(OH)4]: a polytypic structure with a two-mode disordered stacking arrangement

Crystals of the hydrous magnesium orthotellurate(VI) Mg(H2O)2[TeO2(OH)4] were grown by slow diffusion of an aqueous MgCl2 solution into a KOH/Te(OH)6 solution immobilized in gelatin. The crystal structure is built of sheets of nearly regular corner-sharing [MgO6] and [TeO6] octahedra. Half of the bridging O atoms are connected to disordered H atoms, which are located in rhomboidal voids (long and short diameters of ∼5.0 and ∼2.5 Å, respectively) of these layers. Moreover, the TeVI atom connects to two OH− ions and the MgII atom to two H2O molecules. The OH− ions and H2O molecules connect adjacent layers forming a disordered hydrogen-bonding network. In a given layer, an adjacent layer may be positioned in four ways, which can be characterized by one of two origin shifts and one of two orientations with respect to [100]. The crystals feature a disordered stacking arrangement, leading to rods of diffuse scattering in the diffraction pattern. The polytypism is explained by application of the order–disorder (OD) theory. Different refinement models are compared and the diffuse scattering is evaluated with structure factor calculations. The correlation coefficient of subsequent origin shifts is ∼ −0.33, whereas the orientation of the layers is essentially random. Determining the latter is particularly difficult owing to a small contribution to the diffraction pattern and virtually indistinguishable diffraction patterns for pairs of correlations with the same absolute value. On longer standing in a glass vial, an ordered polytype forms.

The diagnostic value of metabolic, morphological and heterogeneous parameters of 18F-FDG PET/CT in mediastinal lymph node metastasis of non-small cell lung cancer.

To investigate the value of PET/CT metabolic, morphological and heterogeneous parameters in the diagnosis of 18F-FDG positive mediastinal lymph node metastasis in non-small cell lung cancer (NSCLC). A total of 156 patients with pathologically diagnosed NSCLC and underwent 18F-FDG PET/CT scans were enrolled in this study. Mediastinal lymph nodes with 18F-FDG uptake greater than the mediastinum were analyzed. The metabolic parameters of maximum and mean standardized uptake value (SUVmax, SUVmean), SUVratio (node SUVmax/mediastinum SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), morphological parameters of maximum short diameter (Dmin), CT values and metabolic heterogeneity parameter of coefficient of variation (COV) were measured. The performance of each parameter and their combinations for diagnosis of lymph node metastasis was evaluated through receiver operating characteristic (ROC) curves and binary logistic regression analysis. There were 206 lymph nodes with pathological evidence included in the study, including 103 metastatic and 103 nonmetastatic nodes. The SUVmax, SUVmean, SUVratio, TLG, COV and Dmin of metastatic lymph nodes were significantly higher/greater than those in nonmetastatic ones (P < 0.05). ROC curve analysis revealed that the combination of SUVratio, Dmin and COV showed the highest diagnostic efficacy among all single and combined parameters, the area under the curve (AUC) was 0.907 (P = 0.000), these three parameters all increased the risk of lymph node metastasis, with odds ratios of 1.848, 1.293 and 1.258, respectively (all P < 0.05). Heterogeneity parameter was helpful for the accurate distinction of mediastinal lymph node metastasis in NSCLC. The combination of the SUVratio, Dmin and COV could improve the diagnostic accuracy. Multiple-parameters analysis plays an important complementary role in the diagnosis of lymph node metastasis.

Broadband acoustic metamaterial for the design of an asymmetric focusing lens with single-mode output

Acoustic asymmetric focusing (AAF) can increase the intensity of acoustic energy in a region with one direction, which may greatly benefit medical ultrasound imaging. However, its shortcoming is the narrow bandwidth of the frequency, which severely constrains the application of the AAF lens. In this paper, we propose a broad bandwidth AAF lens based on an asymmetric transmission metamaterial supercell with single-mode output composed of three types of phased unit cells and a wave-guide material. The supercell can realize the asymmetric transmission and the conversion of even-mode to odd-mode simultaneously, due to the phase modulation offered by the phased unit cell and the even-mode band gap of the wave-guide. We design the AAF lens with high performance based on 14 supercells, which demonstrate a long diameter focusing region of 1.56 and short diameter of 0.27 and the broad bandwidth focusing from 3.1 kHz to 4.73 kHz. The proposed AAF lens based on the metamaterial supercells with single-mode output has broad application prospects in the design of asymmetric sound focusing devices with multi-functional capability.

Comparison of 18F FDG PET / CT, MRI (DWI DCE) and MRI 18F FDG PET/CT in the detection of axillary metastatic lymph nodes in patients with newly diagnosed breast cancer

Aim: We visually and quantitatively investigated the success of using 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) and magnetic resonance imaging (MRI) [Dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI)] separately and together in detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer. Methods: One hundred and thirteen patients who underwent 18F FDG PET/CT were evaluated, 102 patients of these patients had also MRI (DEC + DWI). Primary tumour size (Tsize), SUVmax of primary tumour (SUVmaxT), short diameter of largest axillary lymph node on PET/CT (LnDPET/CT), SUVmax of axillary lymph node (SUVmaxLn), metabolic tumour volume of the primary tumour (MTV), short diameter of largest axillary lymph node on MRI (LnDMRI), the presence of fatty hilum absence and apparent diffusion coefficient (ADC) were evaluated. Results: In visual analysis, sensitivity and specificity values of 18F FDG PET/CT, MRI and MRI+18F FDG PET/CT were 78.85, 94% – 72.27%, 96.15 – 83.87%, 98.04%, respectively. In the quantitative evaluation, ADC≤1.2 x 10-3 mm2/sec (OR = 6.665, p = 0.001, 95CI%: 2.181–20.370) and LnSUVmax> 2 (OR = 15.2, p<0.001, 95CI%: 4.587–50.376) were independent predictors in detecting axillary lymph node metastasis. Conclusion: LnSUVmax >2 and ADC ≤ 1.2 x 10-3 mm2/sec can be used as independent predictors of detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer. t predictors in detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer.

In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves\u2019 orbitopathy

BackgroundTo evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves’ orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings.MethodsForty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. A researcher recorded the clinical activity score (CAS) for each patient. A complete ophthalmic examination was then performed, including external eye, ocular surface and MGs. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF).ResultsAll confocal microscopy assessments of MGs significantly differed among groups (all P = 0.000). Compared to controls, GO groups showed lower MOA (1985.82 ± 1325.30 μm2 in active GO and 2021.59 ± 1367.45 μm2 in inactive GO vs. 3896.63 ± 891.90 μm2 in controls, all P = 0.000) and MAD (87.21 ± 32.69 /mm2 in active GO and 80.72 ± 35.54 /mm2 in inactive GO vs. 114.69 ± 34.90 /mm2 in controls, P = 0.001 and 0.000, respectively); greater MALD (118.11 ± 30.23 μm in active GO and 120.58 ± 27.64 μm in inactive GO vs. 58.68 ± 20.28 μm in controls, all P = 0.000) and MASD (44.77 ± 19.16 μm in active GO and 46.02 ± 20.70 μm in inactive GO vs. 27.80 ± 9.90 μm in controls, all P = 0.000); and higher degrees of MAI, MSR, and MF (all P<0.05). Eyes with active GO had higher degrees of MAI (P = 0.015), AWI (P = 0.000), and API (P = 0.000), while eyes with inactive GO had higher degrees of MSR (P = 0.000) and MF (P = 0.017). In GO groups, AWI and API were positively correlated with CAS (r = 0.640, P = 0.000; r = 0.683, P = 0.000, respectively), and MF was negatively correlated with CAS (r = − 0.228, P = 0.042).ConclusionsIVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.

Constructing dual-CISTs with short diameters using a generic adjustment scheme on bicubes

Recently, an innovative hypercube-variant network called bicube, denoted as BQn, has been proposed to possess both short diameter and symmetry advantages. Unlike other existing hypercube-variant networks, they lose their symmetry in pursuit of short diameters. For solving the problems of fault-tolerant transmission and secure message distribution in a reliable network, one solution suggested a dual-CIST (two completely independent spanning trees) to design a multi-path routing (e.g., a recently proposed secure-protection routing). We can make the construction using the standard arrangement guideline (SAG) like the hypercubes to obtain a dual-CIST with a diameter of 2n−1 on BQn. This paper proposes a newly generic adjustment scheme (GAS) for reducing the diameter of the dual-CIST under this construction. As a result, the diameter of Ti for i=1,2 we constructed for BQn are as follows:diam(Ti)={7if n=4;2n−2if n⩾5 and nis odd;2n−3if n⩾6 and nis even.

Establishment of a nomogram prediction model for long diameter 10–15 mm gallbladder polyps with malignant tendency

BackgroundSurgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. MethodsClinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. ResultsExcluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). ConclusionIndications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.

A Specific Assessment of the Normal Anatomy of the Aortic Root in Relation to Age and Gender.

BackgroundA limitation associated with coronary computed tomography angiography (CCTA) is the lack of a normal reference value for aortic root dimensions and the uncertainty of the influence of age and gender on these dimensions. The purpose of the present study was to identify the normal values and variations of aortic root dimensions in healthy individuals and investigate how gender and age affect aortic root size.MethodsA total of 1286 healthy yellow population (52.7 ± 11.0 years, 634 male) who underwent CCTA were retrospectively included in the present study. Male and female patients were divided into seven groups according to age (< 30 years old, 30–39, 40–49, 50–59, 60–69, 70–79, ≥ 80 years old). In these age groups, we measured and compared the parameters of the aortic root.ResultsAfter body surface area (BSA) correction, the aortic root parameters of females were found to be greater than those of males in the 40–49 age group (P<0.05). There were no significant differences in aortic root parameters between genders in other age groups, except for the diameter of the ascending aorta, which was greater in females (P<0.05). In males, age was positively correlated with aortic root parameters (P<0.05), except for the annulus short diameter and LVOT short diameter. In females, age was positively correlated with aortic root parameters (P<0.05), except for the left coronary ostia height and the LVOT short diameter.ConclusionAortic root dimensions are affected by age and gender. After BSA correction, females show larger aortic root dimensions than males, and aortic root diameters increase with age.

Machine Learning for the Prediction of Lymph Nodes Micrometastasis in Patients with Non-Small Cell Lung Cancer: A Comparative Analysis of Two Practical Prediction Models for Gross Target Volume Delineation.

PurposeThe lymph node gross target volume (GTV) delineation in patients with non-small cell lung cancer (NSCLC) is crucial for prognosis. This study aimed to develop a predictive model that can be used to differentiate between lymph nodes micrometastasis (LNM) and non-lymph nodes micrometastasis (non-LNM).Patients and MethodsA retrospective study involving 1524 patients diagnosed with NSCLC was collected in the First Hospital of Wuhan between January 1, 2017, and April 1, 2020. Duplicated and useless variables were excluded, and 16 candidate variables were selected for further analysis. The random forest (RF) algorithm and generalized linear (GL) algorithm were used to screen out the variables that greatly affected the LNM prediction, respectively. The area under the curve (AUC) was compared between the RF model and GL model.ResultsThe RF model revealed that the variables, including pathology, degree of differentiation, maximum short diameter of lymph node, tumor diameter, pulmonary membrane invasion, clustered lymph nodes, and T stage, were more significant for LNM prediction. Multifactorial logistic regression analysis for the GL model indicated that vascular invasion, tumor diameter, degree of differentiation, pulmonary membrane invasion, and maximum standard uptake value (SUVmax) were positively associated with LNM. The AUC for the RF model and GL model was 0.83 (95% CI: 0.75 to 0.90) and 0.64 (95% CI: 0.60 to 0.70), respectively.ConclusionWe successfully established an accurate and optimized RF model that could be used to predict LNM in patients with NSCLC. This model can be used to evaluate the risk of an individual patient experiencing LNM and therefore facilitate the choice of treatment.

Combined dynamic contrast enhanced MRI parameter with clinical factors predict the survival of concurrent chemo-radiotherapy in patients with 2018 FIGO IIICr stage cervical cancer

PurposeCombined clinical prognostic factors and magnetic resonance imaging (MRI) parameters on predicting the prognosis after concurrent chemo-radiotherapy (CCRT)in patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) IIICr stage patients. MethodsA total of 117 patients with cervical cancer (2018 FIGO stage IIICr) who underwent CCRT were enrolled from Dec.2014 to Jul.2017. 47 patients developed outcome events, including 32 recurrences and 15 deaths. Clinical and MR parameters of primary tumors were analyzed, including apparent diffusion coefficient (ADC) values (ADCmean, ADCmin, and ADCmax) and dynamic contrast-enhanced MRI (DCE-MRI) parameters (Ktrans, Kep, Ve) were recorded. The short diameters of visible lymph nodes in the MRI and enhanced computed tomography (CT) images were measured. Progression-free survival (PFS) was compared by Kaplan-Meier analysis and independent predictors were identified using cox regression analysis. ResultsThe median PFS was 35 months (6–68 month). The 1-year and 3-year PFS rates were was 90.4 %, 74.4 %, respectively. Multivariate analysis showed that 2018 FIGOIIIC2r stage (HR 2.701,95 %CI1.259to. 5.797; p = 0.011), Ktrans(HR 0.353;95 %CI 0.189 to 0.659; p = 0.001) and ADCmin (HR0.423,95 %CI0.229to0.783; p = 0.006) were highly correlated with poor PFS. ConclusionIn conclusion, we have identified IIIC2r stage, Ktrans value and ADCmin value as the most important factors in evaluating the survival rate and prognosis of patients with stage IIICr cervical cancer. For stage IIIC1r subgroup, Ktrans, ADCmin value and site of positive lymph node >2 were independent prognostic factors.