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Cancers Apr 2024The accurate discrimination of uterine leiomyosarcomas and leiomyomas in a pre-operative setting remains a current challenge. To date, the diagnosis is made by a...
BACKGROUND
The accurate discrimination of uterine leiomyosarcomas and leiomyomas in a pre-operative setting remains a current challenge. To date, the diagnosis is made by a pathologist on the excised tumor. The aim of this study was to develop a machine learning algorithm using radiomic data extracted from contrast-enhanced computed tomography (CECT) images that could accurately distinguish leiomyosarcomas from leiomyomas.
METHODS
Pre-operative CECT images from patients submitted to surgery with a histological diagnosis of leiomyoma or leiomyosarcoma were used for the region of interest identification and radiomic feature extraction. Feature extraction was conducted using the PyRadiomics library, and three feature selection methods combined with the general linear model (GLM), random forest (RF), and support vector machine (SVM) classifiers were built, trained, and tested for the binary classification task (malignant vs. benign). In parallel, radiologists assessed the diagnosis with or without clinical data.
RESULTS
A total of 30 patients with leiomyosarcoma (mean age 59 years) and 35 patients with leiomyoma (mean age 48 years) were included in the study, comprising 30 and 51 lesions, respectively. Out of nine machine learning models, the three feature selection methods combined with the GLM and RF classifiers showed good performances, with predicted area under the curve (AUC), sensitivity, and specificity ranging from 0.78 to 0.97, from 0.78 to 1.00, and from 0.67 to 0.93, respectively, when compared to the results obtained from experienced radiologists when blinded to the clinical profile (AUC = 0.73 95%CI = 0.62-0.84), as well as when the clinical data were consulted (AUC = 0.75 95%CI = 0.65-0.85).
CONCLUSIONS
CECT images integrated with radiomics have great potential in differentiating uterine leiomyomas from leiomyosarcomas. Such a tool can be used to mitigate the risks of eventual surgical spread in the case of leiomyosarcoma and allow for safer fertility-sparing treatment in patients with benign uterine lesions.
PubMed: 38672651
DOI: 10.3390/cancers16081570 -
European Journal of Radiology Open Jun 2024The Response Evaluation Criteria in Solid Tumors (RECIST) aims to provide a standardized approach to assess treatment response in solid tumors. However, discrepancies in...
BACKGROUND
The Response Evaluation Criteria in Solid Tumors (RECIST) aims to provide a standardized approach to assess treatment response in solid tumors. However, discrepancies in the selection of measurable and target lesions among radiologists using these criteria pose a significant limitation to their reproducibility and accuracy. This study aimed to understand the factors contributing to this variability.
METHODS
Machine learning models were used to replicate, in parallel, the selection process of measurable and target lesions by two radiologists in a cohort of 40 patients from an internal pan-cancer dataset. The models were trained on lesion characteristics such as size, shape, texture, rank, and proximity to other lesions. Ablation experiments were conducted to evaluate the impact of lesion diameter, volume, and rank on the selection process.
RESULTS
The models successfully reproduced the selection of measurable lesions, relying primarily on size-related features. Similarly, the models reproduced target lesion selection, relying mostly on lesion rank. Beyond these features, the importance placed by different radiologists on different visual characteristics can vary, specifically when choosing target lesions. Worth noting that substantial variability was still observed between radiologists in both measurable and target lesion selection.
CONCLUSIONS
Despite the successful replication of lesion selection, our results still revealed significant inter-radiologist disagreement. This underscores the necessity for more precise guidelines to standardize lesion selection processes and minimize reliance on individual interpretation and experience as a means to bridge existing ambiguities.
PubMed: 38660370
DOI: 10.1016/j.ejro.2024.100562 -
PeerJ. Computer Science 2024Melanoma is a malignant skin tumor that threatens human life and health. Early detection is essential for effective treatment. However, the low contrast between melanoma...
Melanoma is a malignant skin tumor that threatens human life and health. Early detection is essential for effective treatment. However, the low contrast between melanoma lesions and normal skin and the irregularity in size and shape make skin lesions difficult to detect with the naked eye in the early stages, making the task of skin lesion segmentation challenging. Traditional encoder-decoder built with U-shaped networks using convolutional neural network (CNN) networks have limitations in establishing long-term dependencies and global contextual connections, while the Transformer architecture is limited in its application to small medical datasets. To address these issues, we propose a new skin lesion segmentation network, SUTrans-NET, which combines CNN and Transformer in a parallel fashion to form a dual encoder, where both CNN and Transformer branches perform dynamic interactive fusion of image information in each layer. At the same time, we introduce our designed multi-grouping module SpatialGroupAttention (SGA) to complement the spatial and texture information of the Transformer branch, and utilize the Focus idea of YOLOV5 to construct the Patch Embedding module in the Transformer to prevent the loss of pixel accuracy. In addition, we design a decoder with full-scale information fusion capability to fully fuse shallow and deep features at different stages of the encoder. The effectiveness of our method is demonstrated on the ISIC 2016, ISIC 2017, ISIC 2018 and PH2 datasets and its advantages over existing methods are verified.
PubMed: 38660200
DOI: 10.7717/peerj-cs.1935 -
Virus Research Jul 2024The aim of this study was to investigate the in vitro and in vivo antiviral effects of CLEVir-X, against porcine reproductive and respiratory syndrome virus (PRRSV)....
The aim of this study was to investigate the in vitro and in vivo antiviral effects of CLEVir-X, against porcine reproductive and respiratory syndrome virus (PRRSV). CLEVir-X is a nucleoside analogue and a dialdehyde form of xanthosine. CLEVir-X demonstrated antiviral action during the in vitro portion of this experiment with its inosine monophosphate dehydrogenase (IMPDH) inhibition against PRRSV. The anti-PRRSV effect of CLEVir-X was recovered through supplementation with guanosine. This suggests that PRRSV replication may be regulated through IMPDH and its guanosine biosynthetic pathway. CLEVir-X treatment in cultures resulted in mutation frequency increase of up to 7.8-fold within the viral genomes (e.g. ORF6) compared to their parallel, untreated cultures. The incorporation of CLEVir-X into the viral genome causes lethal mutagenesis and subsequent decrease in specific infectivity. During the in vivo antiviral experiment, 21-day-old pigs began oral administration of 5 mL of phosphate buffered saline containing CLEVir-X (with purity of 68 % and dosage of 40 mg/kg body weight). This treatment was provided twice daily at 9:00AM and 5:00PM for 14 days. Pigs were simultaneously intranasally inoculated with PRRSV at the beginning of CLEVir-X treatment (21 days of age). Several beneficial effects from the oral administration of CLEVir-X were observed including reduction of body temperature, alleviation of respiratory clinical signs, decreased PRRSV load in both blood and lung tissues, and mitigation of lung interstitial pneumonia lesions. The results of the present study demonstrated that CLEVir-X has mutagenic and nonmutagenic modes of antiviral action against PRRSV based on both in vitro and in vivo antiviral experiments.
Topics: Animals; Porcine respiratory and reproductive syndrome virus; Swine; Antiviral Agents; Porcine Reproductive and Respiratory Syndrome; Virus Replication; Lung; Viral Load; Administration, Oral
PubMed: 38657837
DOI: 10.1016/j.virusres.2024.199380 -
EBioMedicine May 2024The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for many diseases including perianal fistulizing Crohn's disease...
BACKGROUND
The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for many diseases including perianal fistulizing Crohn's disease (CD). Whether hUC-MSCs can promote the healing of luminal ulcer in CD has not been studied so far.
METHODS
The model of TNBS-induced colitis in rats was used to confirm the efficacy of hUC-MSCs in the treatment of CD. Then, seventeen CD patients refractory to or unsuitable for currently available therapies were enrolled and received once submucosal local injection through colonoscopy combined with once intravenous drip on the next day. All patients received a 24-week follow-up. Clinical and laboratory assessments were monitored at baseline, week 4, 8, 12, and 24. Endoscopic evaluations were conducted at baseline and week 12. Mucosal specimens were obtained at the margin of lesions by endoscopy biopsies and used for RNA sequencing. Two hUC-MSCs co-culture systems were established in vitro, one with the mucosa specimens and the other with M1 macrophages induced from THP1. The expressions of genes representing inflammation (TNFα, IL-6, and IL-1β) and intestinal barrier function (ZO1, CLAUDIN1, and CDH1) were tested by RT-PCR.
FINDINGS
hUC-MSCs treatment increased body weight and decreased disease activity index (DAI), colon macroscopic damage index (CMDI), and histopathological score (HPS) of rats with TNBS-induced colitis. The results of the clinical study also showed that this mode of hUC-MSCs application was associated with regression of intestinal ulceration. Eight patients (47%) got endoscopic responses (SES-CD improvement of ≥50% from baseline) and three patients (17.65%) got mucosal healing (SES-CD is zero), with a parallel improvement of clinical and laboratory parameters without serious adverse events. RNA sequencing showed hUC-MSCs therapy was associated with an upregulation of transcripts linked to intestinal epithelial barrier integrity and a downregulation of inflammatory signaling pathways in the intestinal mucosa, especially the TNF signaling pathway, IL-17 signaling pathway, and TLR signaling pathway. RNA expression of intestinal epithelial tight junction protein (ZO1, CLAUDIN1, and CDH1), and the RNA expression of major intestinal inflammatory factors in CD (IL-1β, IL-6, and TNFα, p < 0.001 for all) were improved significantly. Moreover, hUC-MSCs could attenuate the polarization of M1 macrophage induced from THP1, thereby decreasing the mRNA expression of IL-1β, IL-6, and TNFα significantly (p < 0.05 for all). TSG-6 expression was evaluated in hUC-MSCs culture supernatant after treatment with TNFα, IFNγ, and LPS for 48 h. And hUC-MSCs could inhibit the phosphorylation of JAK/STAT1 in the intestinal mucosa of CD patients.
INTERPRETATION
hUC-MSCs transplantation alleviated TNBS-induced colitis in rats. In this pilot clinical study, preliminary data suggested that this approach to administering hUC-MSCs might have potential for clinical efficacy and manageable safety in treating refractory CD, potentially providing hope for better outcomes. No serious adverse events were observed.
FUNDING
This work was funded by General Program of National Natural Science Foundation of China (Grant No. 82270639), the Scientific research project of Shanghai Municipal Health Committee (Grant No. 202240001), Specialty Feature Construction Project of Shanghai Pudong New Area Health Commission (Grant No. PWZzb2022-05), Shanghai East Hospital Youth Research and Cultivation Foundation program (Grant No. DFPY2022015), Peak Disciplines (Type IV) of Institutions of Higher Learning in Shanghai, Technology Development Project of Pudong Science, Technology and Economic Commission of Shanghai (Grant No. PKJ2021-Y08), Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission (Grant No. PWZxq2022-06), Medical discipline Construction Project of Pudong Health Committee of Shanghai (Grant No. PWYgf2021-02) and National Natural Science Foundation of China (Grant No. 82300604).
Topics: Animals; Crohn Disease; Mesenchymal Stem Cell Transplantation; Rats; Humans; Male; Female; Disease Models, Animal; Adult; Mesenchymal Stem Cells; Trinitrobenzenesulfonic Acid; Pilot Projects; Colitis; Middle Aged; Intestinal Mucosa; Treatment Outcome; Cytokines
PubMed: 38653187
DOI: 10.1016/j.ebiom.2024.105128 -
Europace : European Pacing,... May 2024Using thermal-based energy sources [radiofrequency (RF) energy/cryo energy] for catheter ablation is considered effective and safe when performing pulmonary vein... (Comparative Study)
Comparative Study
Comparing pulsed field electroporation and radiofrequency ablation for the treatment of paroxysmal atrial fibrillation: design and rationale of the BEAT PAROX-AF randomized clinical trial.
AIMS
Using thermal-based energy sources [radiofrequency (RF) energy/cryo energy] for catheter ablation is considered effective and safe when performing pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). However, treatment success remains limited and complications can occur due to the propagation of thermal energy into non-target tissues. We aim to compare pulsed field ablation (PFA) with RF ablation in terms of efficacy and safety for patients with drug-resistant paroxysmal AF.
METHODS AND RESULTS
The BEAT PAROX-AF trial is a European multicentre, superiority, open-label randomized clinical trial in two parallel groups. A total of 292 participants were recruited in 9 high-volume European clinical centres in 5 countries. Patients with paroxysmal AF were randomized to PFA (FARAPULSE Endocardial Ablation System©, Boston Scientific) or RF using the CLOSE protocol with contact force sensing catheter (SmartTouch© catheter and CARTO© Biosense Webster). The primary endpoint will be the 1-year recurrence of atrial arrhythmia, and the major secondary safety endpoint will be the occurrence of acute (<7 days) procedure-related serious adverse events, or pulmonary vein stenosis, or atrio-oesophageal fistula up to 12 months. Additionally, five sub-studies investigate the effect of PFA on oesophageal safety, cerebral lesions, cardiac autonomic nervous system, durability of PVI as assessed during redo ablation procedures, and atrial and ventricular function. The study began on 27 December 2021 and concluded recruitment on 17 January 2024. Results will be available in mid-2025.
CONCLUSION
The BEAT PAROX-AF trial aims to provide critical insights into the optimal treatment approach for patients with paroxysmal AF.
Topics: Humans; Atrial Fibrillation; Catheter Ablation; Treatment Outcome; Pulmonary Veins; Female; Male; Recurrence; Europe; Middle Aged
PubMed: 38646926
DOI: 10.1093/europace/euae103 -
Journal of the Korean Society of... Mar 2024MRI plays an important role in abdominal imaging because of its ability to detect and characterize focal lesions. However, MRI examinations have several challenges, such... (Review)
Review
MRI plays an important role in abdominal imaging because of its ability to detect and characterize focal lesions. However, MRI examinations have several challenges, such as comparatively long scan times and motion management through breath-holding maneuvers. Techniques for reducing scan time with acceptable image quality, such as parallel imaging, compressed sensing, and cutting-edge deep learning techniques, have been developed to enable problem-solving strategies. Additionally, free-breathing techniques for dynamic contrast-enhanced imaging, such as extra-dimensional-volumetric interpolated breath-hold examination, golden-angle radial sparse parallel, and liver acceleration volume acquisition Star, can help patients with severe dyspnea or those under sedation to undergo abdominal MRI. We aimed to present various advanced abdominal MRI techniques for reducing the scan time while maintaining image quality and free-breathing techniques for dynamic imaging and illustrate cases using the techniques mentioned above. A review of these advanced techniques can assist in the appropriate interpretation of sequences.
PubMed: 38617869
DOI: 10.3348/jksr.2023.0067 -
BioRxiv : the Preprint Server For... Apr 2024Prior lesion, noninvasive-imaging, and intracranial-electroencephalography (iEEG) studies have documented hierarchical, parallel, and distributed characteristics of...
Prior lesion, noninvasive-imaging, and intracranial-electroencephalography (iEEG) studies have documented hierarchical, parallel, and distributed characteristics of human speech processing. Yet, there have not been direct, intracranial observations of the latency with which regions respond to speech, or how these responses are impacted by task demands. We leveraged human intracranial recordings via stereo-EEG to measure responses from diverse forebrain sites during (i) passive listening to /bi/ and /pi/ syllables, and (ii) active listening requiring /bi/-versus-/pi/ categorization. We find that neural response latency increases from a few tens of ms in Heschl's gyrus (HG) to several tens of ms in superior temporal gyrus (STG), superior temporal sulcus (STS), and early parietal areas, and hundreds of ms in later parietal areas, insula, frontal cortex, hippocampus, and amygdala. These data also suggest parallel flow of speech information dorsally and ventrally, from HG to parietal areas and from HG to STG and STS, respectively. Latency data also reveal areas in parietal cortex, frontal cortex, hippocampus, and amygdala that are not responsive to the stimuli during passive listening but are responsive during categorization. Furthermore, multiple regions-spanning auditory, parietal, frontal, and insular cortices, and hippocampus and amygdala-show greater neural response amplitudes during active versus passive listening (a task-related effect). Overall, these results are consistent with hierarchical processing of speech at a macro level and parallel streams of information flow in temporal and parietal regions. These data also reveal regions where the speech code is stimulus-faithful and those that encode task-relevant representations.
PubMed: 38617227
DOI: 10.1101/2024.04.05.588349 -
International Journal of Molecular... Mar 2024Colorectal cancer (CRC) screening relies primarily on stool analysis to identify occult blood. However, its sensitivity for detecting precancerous lesions is limited,...
Colorectal cancer (CRC) screening relies primarily on stool analysis to identify occult blood. However, its sensitivity for detecting precancerous lesions is limited, requiring the development of new tools to improve CRC screening. Carcinogenesis involves significant alterations in mucosal epithelium glycocalyx that decisively contribute to disease progression. Building on this knowledge, we examined patient series comprehending premalignant lesions, colorectal tumors, and healthy controls for the T-antigen-a short-chain -glycosylation of proteins considered a surrogate marker of malignancy in multiple solid cancers. We found the T-antigen in the secretions of dysplastic lesions as well as in cancer. In CRC, T-antigen expression was associated with the presence of distant metastases. In parallel, we analyzed a broad number of stools from individuals who underwent colonoscopy, which showed high T expressions in high-grade dysplasia and carcinomas. Employing mass spectrometry-based lectin-affinity enrichment, we identified a total of 262 proteins, 67% of which potentially exhibited altered glycosylation patterns associated with cancer and advanced pre-cancerous lesions. Also, we found that the stool (glyco)proteome of pre-cancerous lesions is enriched for protein species involved in key biological processes linked to humoral and innate immune responses. This study offers a thorough analysis of the stool glycoproteome, laying the groundwork for harnessing glycosylation alterations to improve non-invasive cancer detection.
Topics: Humans; Colorectal Neoplasms; Hyperplasia; Precancerous Conditions; Carcinogenesis; Antigens, Viral, Tumor
PubMed: 38612533
DOI: 10.3390/ijms25073722 -
NeuroImage. Clinical 2024Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome.... (Randomized Controlled Trial)
Randomized Controlled Trial
Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome. Attentional deficits are associated with poor functional outcome and are challenging to treat, with non-lateralised deficits often persisting into the chronic stage and representing a common complaint among patients and families. In this study, we investigated the effects of non-invasive brain stimulation on non-lateralised attentional deficits in right-hemispheric stroke. In a randomised double-blind sham-controlled crossover study, twenty-two patients received real and sham transcranial Direct Current Stimulation (tDCS) whilst performing a non-lateralised attentional task. A high definition tDCS montage guided by stimulation modelling was employed to maximise current delivery over the right dorsolateral prefrontal cortex, a key node in the vigilance network. In a parallel study, we examined brain network response to this tDCS montage by carrying out concurrent fMRI during stimulation in healthy participants and patients. At the group level, stimulation improved target detection in patients, reducing overall error rate when compared with sham stimulation. TDCS boosted performance throughout the duration of the task, with its effects briefly outlasting stimulation cessation. Exploratory lesion analysis indicated that response to stimulation was related to lesion location rather than volume. In particular, reduced stimulation response was associated with damage to the thalamus and postcentral gyrus. Concurrent stimulation-fMRI revealed that tDCS did not affect local connectivity but influenced functional connectivity within large-scale networks in the contralesional hemisphere. This combined behavioural and functional imaging approach shows that brain stimulation targeted to surviving tissue in the ipsilesional hemisphere improves non-lateralised attentional deficits following stroke. This effect may be exerted via contralesional network effects.
Topics: Humans; Male; Female; Transcranial Direct Current Stimulation; Middle Aged; Stroke; Aged; Attention; Double-Blind Method; Magnetic Resonance Imaging; Cross-Over Studies; Adult; Functional Laterality; Nerve Net; Brain
PubMed: 38608376
DOI: 10.1016/j.nicl.2024.103599