Purpose: This study aimed to evaluate changes in optical quality after pterygium excision. Methods: We retrospectively reviewed the medical records of 14 patients (14 eyes) who had undergone pterygium excision using a limbal conjunctival autograft. All participants underwent the best-corrected visual acuity (BCVA) test, corneal topography, and Optical Quality Analysis System (OQAS) test preoperatively and 1 month postoperatively. The changes in these parameters associated with surgery were analyzed. Results: The participants were 10 men (10 eyes) and four women (four eyes), with a mean age of 61.6 years. There was no significant difference in the BCVA preoperatively and 1 month postoperatively. Corneal topography revealed significantly reduced astigmatism and OQAS showed that the modulation transfer function (MTF) cutoff value and Strehl ratio significantly improved postoperatively. Pterygium-induced astigmatism was significantly associated with the objective scatter index, MTF cutoff value, and Strehl ratio. Conclusions Pterygium excision may result in improved optical quality, suggesting that pterygia can decrease optical quality. A greater degree of pterygium-induced astigmatism may be associated with a more severe impairment of optical quality.

Humans and animals have a fundamental ability to use experiences and environmental information to organize behavior. It often happens that humans and animals make decisions and prepare actions under uncertain situations. Uncertainty would significantly affect the state of animals' minds, but may not be reflected in behavior. How to "read animals' mind state" under different situations is a challenge. Here, we report that neuronal activity in the medial prefrontal cortex (mPFC) of rats can reflect the environmental uncertainty when the task situation changes from certain to uncertain. Rats were trained to perform behavioral tasks under certain and uncertain situations. Under certain situations, rats were required to simply repeat two nose-poking actions that each triggered short auditory tone feedback (single-task situation). Whereas under the uncertain situation, the feedback could randomly be either the previous tone or a short musical rhythm. No additional action was required upon the music feedback, and the same secondary nose-poking action was required upon the tone feedback (dual-task situation); therefore, the coming task was uncertain before action initiation. We recorded single-unit activity from the mPFC when the rats were performing the tasks. We found that in the dual task, when uncertainty was introduced, many mPFC neurons were actively engaged in dealing with the uncertainty before the task initiation, suggesting that the rats could be aware of the task situation change and encode the information in the mPFC before the action of task initiation.
Animals ; Prefrontal Cortex/cytology* ; Uncertainty ; Neurons/physiology* ; Male ; Rats ; Rats, Long-Evans ; Action Potentials/physiology* ; Acoustic Stimulation

Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.

Objective:To explore the value of the deep learning model based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in preoperatively predicting vessels completely encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC).Methods:This study adopted a case-control design to retrospectively analyze 420 patients with HCC confirmed by postoperative pathology who underwent Gd-EOB-DTPA enhanced MRI between June 2016 and March 2023. A total of 420 patients were divided into a training set ( n=305) from the First Affiliated Hospital of Soochow University and an external validation set ( n=115) from Affiliated Nantong Hospital 3 of Nantong University. Based on postoperative pathological findings, patients were stratified into VETC-positive and VETC-negative groups. The training set comprised 161 VETC-positive cases and 144 VETC-negative cases, while the external validation set included 55 VETC-positive cases and 60 VETC-negative cases. Tumor regions of interest in arterial, portal venous, and hepatobiliary phases were manually delineated using ITK-SNAP software. Pre-trained Vgg19, Densenet121, and Vision Transformer (ViT) models were employed for transfer learning, extracting deep learning features from each image. Feature data were processed using FAE software, and 12 logistic regression models (arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase models) were constructed to select the optimal deep learning model. Independent predictors in clinical characteristics were identified through univariate and multivariate logistic analyses to establish a clinical model for predicting VETC pattern. Subsequently, a clinical-deep learning fusion model was developed by integrating these clinical predictors with the optimal deep learning features. Model performance in predicting VETC-positive HCC was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Results:In the external validation set, the area under the curve (AUC) of the Vgg19 model in the arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase, respectively were 0.799,0.756,0.789,0.821, which were higher than those of Densenet121 (AUC: 0.544,0.581,0.544,0.583) and ViT (AUC: 0.740,0.752,0.785,0.767) model. The three-phase combined Vgg19 model achieved the highest AUC of 0.821 (95% CI 0.746-0.897). Multivariate logistic regression identified alpha-fetoprotein level ( OR=1.826,95% CI 1.069-3.120, P=0.028) and tumor diameter ( OR=1.329,95% CI 1.206-1.466, P<0.001) as independent predictors of VETC-positive HCC, forming the clinical model with an AUC of 0.789 (95% CI 0.703-0.859). The clinical-deep learning fusion model further achieved the AUC of 0.825 (95% CI 0.749-0.900). Calibration curves confirmed high concordance between predicted and actual probabilities for the three-phase Vgg19 model, while DCA revealed greater net clinical benefit for the combined Vgg19 and fusion models compared with the clinical model alone. Conclusions:The deep learning model based on Gd-EOB-DTPA enhanced MRI can be used to predict VETC of HCC preoperatively, among which the three-phase combined Vgg19 model and the clinical-deep learning model provide high predictive value.

Objective:A nomogram model for predicting double positivity of microvascular invasion (MVI) and vascular endothelial-to-mesenchymal transition (VETC) in patients with hepatocellular carcinoma (HCC) was constructed and its predictive performance was evaluated.Methods:A retrospective analysis was conducted on 326 HCC patients who were treated at the Third People's Hospital of Nantong and the First Affiliated Hospital of Soochow University from January 2013 to June 2023, including 240 males and 86 females, with an average age of (58.7±9.0) years. The 326 patients were randomly divided into a training set ( n=228) and a test set ( n=98) at a ratio of 7: 3 using the random number table method. The training set was divided into a double-positive group ( n=54) and a control group ( n=174) based on whether the HCC patients were double positive for MVI and VETC. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors of double positivity of microvascular invasion in HCC patients, and a nomogram for predicting double positivity of microvascular invasion patterns was constructed based on the multivariate. The predictive performance and clinical net benefit of the nomogram were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Results:There were statistically significant differences in alpha-fetoprotein, gamma-glutamyl transferase, and phosphatidylinositol proteoglycan between the two groups (all P<0.05). Multivariate logistic regression analysis showed that LI-RADS category ( OR=8.58, 95% CI: 1.87-39.38), intratumoral hemorrhage ( OR=2.16, 95% CI: 1.14-4.07), and intratumoral arteries ( OR=2.59, 95% CI: 1.19-5.64) were all influencing factors of double positivity of microvascular invasion patterns in HCC patients (all P<0.05). Based on the multivariate results, a nomogram was constructed. In the training set, the area under the ROC curve for predicting double positivity of microvascular invasion patterns in HCC patients was 0.769 (95% CI: 0.720-0.814). In the test set, the area under the ROC curve for predicting double positivity of microvascular invasion patterns in HCC patients was 0.756 (95% CI: 0.622-0.850). The calibration curve showed a good fit between the predicted model and the ideal curve. Decision curve analysis showed that the clinical applicability was good when the threshold was 0.01-0.80 in the training set and 0.01-0.65 in the test set. Conclusion:The nomogram model based on LI-RADS category, intratumoral hemorrhage, and intratumoral arteries can effectively predict double positivity of microvascular invasion patterns in HCC patients and has good clinical applicability.

OBJECTIVE To analyze the relationship between interleukin-35(IL-35)and serine/arginine-rich splicing factor 6(SRSF6)levels and pleural thickness in patients with tuberculous pleurisy,as well as their values of joint assessment for the risk of pleural tuberculoma.METHODS A total of 100 patients with tuberculous pleurisy admit-ted to the Second Affiliated Hospital of Zhejiang University School of Medicine,Linping Campus,from Jan.2022 to Jul.2024 were selected.The IL-35 and SRSF6 levels in pleural effusion and pleural thickness were measured.The relationship between IL-35,SRSF6 levels and pleural thickness were analyzed.After a one-year follow-up,patients with tuberculosis were divided into the occurrence group and non-occurrence group according to whether pleurotuberculoma developed.The risk factors for developing pleurotuberculoma and the value of IL-35 and SRSF6 in accessing the risk of developing pleurotuberculoma were analyzed.RESULTS In patients with tuberculous pleuri-sy,IL-35 and SRSF6 in pleural effusion was(529.78±146.85)ng/L and(1.44±0.43)ng/ml,respectively,and the pleural thickness was(4.07±0.53)mm.IL-35 and SRSF6 levels in pleural effusion were positively correlated with pleural thickness(P<0.05).Logistic analysis showed that the risk of pleural tuberculoma significantly in-creased in patients with tuberculous pleurisy when there was pleural fluid separation,abnormal pleural thickness and elevated levels of IL-35 and SRSF6 in pleural effusion(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),specificity and sensitivity of combined IL-35 and SRSF6 in predicting the occurrence of pleural tuberculoma in patients with tuberculous pleurisy were significantly higher than those of either marker alone(P<0.05).CONCLUSION IL-35 and SRSF6 levels are positively correla-ted with the pleural thickness of tuberculous pleurisy,and the combined detection of IL-35 and SRSF6 can effec-tively assess the risk of pleural tuberculoma in tuberculous pleurisy patients.

Objective:To conduct performance tests on medical ultrasound probes repaired by the third party,and explore whether the key parameters of the probes of third-party repair can meet the requirements of clinical use for quality.Methods:A total of 79 ultrasound probes that had been repaired by the third party were selected from different medical institutions.The performance tests were conducted on multiple parameters of ultrasound probes of different models and brands in accordance with national technical standards and relevant industry norms.Then,the test results were analyzed,studied and evaluated.Results:The tested results of the temperature rise and the leakage current of the ultrasound probes,which were repaired by the third party,met the national standards.However,in the test for sound power,26.58%of the probes failed to meet the national standards,which outputted sound intensity that was calculated was higher than the specified value.Conclusion:The general performance of the probes that have been repaired by the third party is well,but the quality of the repair is uneven levels,and some indicators do not meet national standards or industry norms,which might lead to occur risks in ultrasound diagnosis of medical institutions.It is recommended to implement regular test for quality and performance of medical ultrasound equipment,and establish a method and system for quality monitoring and re-evaluation after sale of repair for medical ultrasound,so as to ensure the use and safety of the equipment.

Objective:To investigate the predictive value of perirenal fat thickness(PrFT)of the assessment of computed tomography(CT)for vascular access-related events of elderly patients who received maintenance hemodialysis(MHD).Methods:A total of 160 MHD patients admitted to The 904th Hospital of People's Liberation Army Joint Service Support Force(Wuxi Taihu Hospital)from January 2021 to December 2023 were retrospectively selected.They were divided into event group(53 cases)and non-event group(107 cases)according to whether occurred vascular access-related events.Univariate and binary Logistics regression were used to analyze the influencing factors for vascular access-related events in MHD patients.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PrFT for vascular access-related events of elderly MHD patients,and Pearson correlation was used to analyze the correlation among platelet(PLT)count,mean platelet volume(MPV)and PrFT.Results:There were statistically significant differences in PLT count,MPV and PrFT between the event group and non-event group(t=7.068,4.843,10.572,P<0.05),and the Binary Logistics regression analysis showed that PLT,MPV and PrFT were the influential factors for vascular access-related events of MHD patients(OR=0.963,2.483,1.284,P<0.05).ROC curve analysis showed that the area under curve(AUC)of ROC curve of PrFT was 0.880 in prediction,and the sensitivity and specificity of that were respectively 95.00%and 58.88%.According to Pearson's linear correlation analysis,PrFT was negatively correlated with PLT(r=-0.341,P<0.001),which was positively correlated with MPV(r=0.245,P<0.05).Conclusion:The PrFT of CT assessment has better predictive value in vascular access-related events of elderly MHD patients.

Objective:To compare 99Tc m-hydrazinonicotinamide-(polyethylene glycol) 4-E((polyethylene glycol) 4-c((Arg-Gly-Asp)fK)) 2(3PRGD 2) SPECT/CT with 18F-FDG PET/CT in the evaluation of patients with oral malignancy and cervical lymph node metastases. Methods:From January 2019 to October 2019, 22 patients (16 males, 6 females; age (56.9±9.8) years) with oral malignancy who underwent both 99Tc m-3PRGD 2 SPECT/CT and 18F-FDG PET/CT at the First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. The pathology was used as the gold standard, and McNemar test was used to compare the diagnostic efficacy of the two imaging methods for cervical lymph node metastases. ROC curve analysis was performed to determine the diagnostic performance for lymph node metastases. The correlation between 99Tc m-3PRGD 2 uptake and integrin α vβ 3 expression was analyzed by Spearman rank correlation analysis. Results:Both imaging modalities identified all primary tumors. Diagnostic efficiency analyses based on patient, neck side, nodal region and lymph node all showed that there were no significant differences in the sensitivity, specificity and accuracy between the two imaging modalities in diagnosing cervical metastatic lymph nodes ( χ2 values: 0-3.36, all P>0.05). The AUC of SUV max in metastatic lymph nodes detected by 99Tc m-3PRGD 2 and 18F-FDG imaging were 0.825 and 0.855, with the sensitivity, specificity and accuracy of 71.9%(23/32), 93.9%(92/98), 88.5%(115/130) and 78.1%(25/32), 93.9%(92/98), 90.0%(117/130), respectively ( χ2 values: 0.05-0.10, all P>0.05). SUV max of 99Tc m-3PRGD 2 in primary tumors and cervical metastatic lymph nodes were positively correlated with the expression of integrin α vβ 3 ( rs values: 0.58, 0.51, P values: 0.019, 0.013). Conclusion:99Tc m-3PRGD 2 SPECT/CT is a valuable diagnostic tool for oral malignancy and cervical lymph node metastases, which is comparable to 18F-FDG PET/CT.

Objective:To explore the safety and efficacy of laparoscopic-assisted radical surgery in the treatment of metachronous multiple primary colorectal cancer (MCC).Methods:A retrospective analysis was conducted on 27 MCC patients undergoing laparoscopic-assisted radical surgery (laparoscopic group) and 36 MCC patients undergoing open radical surgery (open group) from Jan 2012 to Jan 2022 at the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences.Results:The laparoscopic group was superior to the open group in terms of intraoperative blood loss [(53.7±111.5) ml vs. (132.5±154.9) ml, t=-2.241, P=0.029], time to first postoperative flatus [(2.2±0.7) days vs. (3.5±0.6) days, t=-7.752, P<0.001], time to first postoperative defecation [(2.9±0.6) days vs. (4.3±0.6) days, t=-8.841, P<0.001], and postoperative hospital stay [(7.2±2.4) days vs. (10.6±3.5) days, t=-4.518, P<0.001]. There were no significant differences between the two groups in terms of operation time, number of lymph nodes dissected, positive rate of specimen margin, resection rate of previous colorectal cancer anastomotic stoma, and incidence of postoperative complications (all P>0.05). Conclusion:Laparoscopic surgery is a safe and minimally invasive alternative to open surgery for MCC patients.