Extracorporeal membrane oxygenation (ECMO) is primarily used in clinical practice to provide continuous extracorporeal respiratory and circulatory support for patients with severe heart and lung failure, thereby sustaining life. It is a key technology for managing severe heart failure and respiratory failure that are difficult to control. With the accumulation of clinical experience in ECMO for circulatory and/or respiratory support, as well as advancements in biomedical engineering technology, more portable and stable ECMO devices have been introduced into clinical use, benefiting an increasing number of critically ill patients. Although ECMO technology has become relatively mature, the timing of ECMO initiation, management of sudden complications, and monitoring and early warning of physiological indicators are critical factors that greatly affect the therapeutic outcomes of ECMO. This article reviews traditional methods and artificial intelligence techniques used in risk assessment related to ECMO, including the latest achievements and research hotspots. Additionally, it discusses future trends in ECMO risk management, focusing on six key areas: multi-center and prospective studies, external validation and standardization of model performance, long-term prognosis considerations, integration of innovative technologies, enhancing model interpretability, and economic cost-effectiveness analysis. This provides a reference for future researchers to build models and explore new research directions.
Extracorporeal Membrane Oxygenation ; Humans ; Artificial Intelligence ; Risk Assessment ; Respiratory Insufficiency/therapy* ; Heart Failure/therapy*

Objective:To analyze the hepatobiliary phase (HBP) image manifestation classification and pathological features of nodules in nodules accompanied by hepatocellular carcinoma (NIN-HCC).Methods:Twenty-five cases cases (27 lesions) with cirrhosis who were confirmed as NIN-HCC by surgical pathology and underwent gadoxetate disodium-enhanced MRI examination before surgery at Nantong Third Hospital affiliated with Nantong University from July 2015 to November 2022 were retrospectively enrolled. The size, signal intensity, enhancement pattern, and pathological features of internal and external nodules were analyzed in NIN-HCC. The lesions score were recorded according to the 2018 version of the Liver Imaging Reporting and Data Systems (LI-RADS) classification criteria. NIN-HCCs were grouped and typed according to the different HBP signal intensities of the inner and outer nodules. The independent-samples t-test, Mann-Whitney U test or Fisher's exact probability method were used to compare the differences in imaging features and LI-RADS scores between the groups. The Spearman correlation coefficient was used to evaluate the correlation between the pathological differentiation degree of internal and external nodules and the HBP signal intensity. The Kaplan-Meier curve was used to analyze recurrence-free survival (RFS) following NIN-HCC surgery. Results:The internal nodules of the 27 NIN-HCCs showed altered hypervascularity with a maximum diameter of (13.2±5.5) mm during the arterial phase. 51.9% (14/27) and 48.1% (13/27) showed "fast in and fast out" and fast in and slow out"enhancement patterns. The external nodules showed altered hypovascularity with a maximum diameter of (25.7±7.3) mm, and 13 (48.1%) of them were accompanied to manifest during the arterial phase. NIN-HCC was divided into two groups according to the signal intensity of HBP of the outer nodules with the background liver parenchyma signal intensity as a reference: the hyposignal group ( n=17, 63.0%) and the isosignal group ( n=10, 37.0%). The hyposignal group and the isosignal group were divided into A~C type and D~F type, a total of six types, according to the hypo, iso, and hyper signals of the inner nodules and the signal intensity of the outer nodules as a reference. Within the hyposignal group, 7.4% (2/27) of the inner nodules showed hyposignal (type A), 37.0% (10/27) showed isosignal (type B), and 18.5% (5/27) showed hypersignal (type C). Within the isosignal group, 29.6% (8/27) of the inner nodules showed hyposignal (type D), 7.4% (2/27) showed isosignal (type E), and there was no hypersignal (type F). 40.7% (11/27) of the lesions were LR-4 in LI-RADS score, and 59.3% (16/27) were LR-5. There was no statistically significant difference ( P>0.05) in the maximum diameter, enhancement pattern, and LI-RADS score of internal and external nodules between the hypo and iso signal group. Histologically, NIN-HCC showed fine trabecular/pseudoglandular duct type without microvascular invasion, among which the inner nodules were mainly moderately differentiated HCC, and the outer nodules were mainly well-differentiated HCC. The degree of differentiation between the inner and outer nodules and the HBP signal intensity had no statistically significant difference ( r=0.290, P=0.143; r=0.079, P=0.697). The median RFS follow-up time after NIN-HCC radical resection was 31.7 months, and the cumulative RFS rates at 1, 3, and 5 years were 96.0%, 76.0%, and 64.0%, respectively. Conclusions:NIN-HCC can serve as a morphological marker for early-stage diagnosis of multi-step cancer evolution in HCC, with certain imaging and pathological features. HBP imaging classification is helpful to enhance the diagnostic recognition of this disease.

Objective To evaluate the category modifications and prognosis of cirrhotic nodules depending on MRI imaging report and data system of LR-2,LR-3 and LR-4.Methods Clinical data of 109 patients(151 lesions)with cirrhosis who underwent two or more MRI examinations in the Third People's Hospital of Nantong City from September 2012 to February 2017 were retrospectively collected. All the patients were diagnosed as LR-2, LR-3 and LR-4 lesions for the first time without biopsy or operation. Among all the lesions, 40 were LR-2,71 were LR-3 and 32 were LR-4.Routine liver MRI scanning,DWI and multiphase dynamic contrast-enhanced MRI were performed on all patients. The follow-up time and category modifications were recorded for each lesion. The single-factor analysis was used to analyze the follow-up time of LR-2, LR-3 and LR-4 lesions. The incidence of up-regulation of LR-2, LR-3 and LR-4 nodules were analyzed by Kaplan-Meier curve. Log-Rank test was used to compare the results. Results The mean follow-up time of LR-2, LR-3 and LR-4 was (17.4 ± 9.2), (16.3 ± 8.5) and (12.4 ± 9.3) months respectively,the difference were statistically significant(F=3.30,P=0.041).Among 48 index LR-2 lesions, 1 upgraded to LR-5 after 52.3 months of follow-up, 4 upgraded to LR-3, 29 remained stable, and 14 decreased to LR-1. Among 71 index LR-3 lesions, 13 upgraded to LR-5, among which 12 demonstrated threshold growth, 9 developed newly enriched pleural signs, 7 showed capsules and 3 demonstrated hypervascular transformation;6 upgraded to LR-4,34 remained stable and 18 decreased to LR-1.Among 32 index LR-4 lesions, 14 upgraded to LR-5, among which 11 demonstrated threshold growth, 1 developed newly enriched pleural signs,6 showed capsules and 1 demonstrated hypervascular transformation;1 leision developed to LR-5V with portal vein thrombosis, 15 remained stable and 2 decreased to LR-1. The cumulative incidence of LR-4 nodules up-regulated to LR-5 was higher than that of LR-2 and LR-3 nodules (all P<0.01). The cumulative incidence of LR-4 nodules at 3, 6, 12 months to LR-5 were 6.3%, 18.8%, 34.4%, and LR-3 nodules were 0, 4.2%, 5.6%. LR-2 nodules are 0. The cumulative incidence of LR-3 nodules classified as LR≥4 was higher than that of LR-2 nodules(P<0.01).Conclusion LR-2,LR-3,and LR-4 nodules have different prognostic outcomes based on the LI-RADS classification criteria for MRI,and the cumulative incidence of LR-4 progression to LR-5 was higher.