Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

Spontaneous rupture of the ovarian artery is very rare and can cause retroperitoneal hemorrhage, which is seriously life-threatening. Herein, we reported a case of massive retroperitoneal hematoma caused by spontaneous rupture of the right ovarian artery during pregnancy and intrauterine fetal death. A 32-year-old woman, gravida 6 para 5, had non-specific right lower abdomen and low back pain in the third trimester. Emergency cesarean section was performed due to the increased pain and decreased fetal heart rate. A huge retroperitoneal hematoma and intrauterine fetal death were found. Then, the abdomen was closed due to unknown source of bleeding and unstable vital signs. Computed tomography scan was conducted to clarify the extent of the retroperitoneal hematoma. Digital subtraction angiography confirmed the rupture of the right ovarian artery. A transcatheter artery embolization was successfully performed to control the bleeding. The patient ultimately recovered well after surgery.
Pregnancy ; Humans ; Female ; Adult ; Rupture, Spontaneous ; Cesarean Section ; Fetal Death ; Arteries

Objective:To explore the value and significance of sensorimotor cortex (SMC) in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods:A total of 17 patients with primary onset of striatal intracapsular infarction (SCI) with unilateral severe upper limb paralysis, who were strictly screened from the Department of Neurology, Affiliated Hospital of Yangzhou University from June 2015 to December 2017, were selected as research subjects, and 15 healthy volunteers were selected as controls. BOLD-fMRI under the passive finger extension (FE) task on the hemiplegic side was performed within one week, one month and three months after the onset of the disease. The activation of SMC was observed by SPM8 software. The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically. The upper limb section of the Fugl-Meyer Scale (FM-UL) was used to track the motor function of the upper limb. The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging (fMRI) scanning, at one month and three months after onset of the disease.Results:In the controls, fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area. According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area, the study patients were divided into three groups: group 1 (six patients), in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset; group 2 (five patients), in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset; group 3 (six patients), in which the activation intensity of SMC in the affected side increased gradually in three months, but still did not exceed the standard brain activation area. The activated voxel values of the affected side SMC in group 1 patients at the first time, one month and three months were 3 570.2±1 125.9, 1 205.8±328.2 and 1 121.5±407.5, respectively, the difference within the group being statistically significant ( F=12.8, P=0.001); the activated voxel values of the affected SMC in group 2 patients were 556.2±171.7, 648.6±177.3 and 993.2±182.9, respectively, and the differences within the group were statistically significant ( F=6.5, P=0.018); the activated SMC values of the affected SMC in group 3 patients were 520.0±375.9, 573.5±375.0 and 680.9±359.8, respectively, and there was no statistically significant difference within the group ( P>0.05). The three times FM-UL scores corresponding to group 1 patients were (10.0±3.3) points, (52.3±4.6) points and (63.7±2.9) points; the three times FM-UL scores corresponding to group 2 patients were (10.6±5.7) points, (36.6±2.4) points and (59.2±3.1) points; and the three times FM-UL scores corresponding to group 3 patients were (9.2±4.0) points, (12.5±3.0) points and (13.3±5.0) points; FM-UL scores in group 1 and group 2 patients showed statistically significant differences within the groups ( F=348.4, 183.6; P<0.001), whereas that in group 3 patients showed no statistically significant difference within the group ( P>0.05). There was no statistically significant difference in the initial FM-UL score among the groups ( P>0.05), while the differences among the groups at one month and three months were statistically significant ( F=191.7,304.5; P<0.001). Conclusions:The survival of SMC on the affected side after cerebral infarction is a prerequisite for the rehabilitation of limb motor function. Its early activation cannot predict the clinical prognosis, but the dynamic enhancement of SMC activation on the affected side is related to the rehabilitation speed of the affected limb.

Objective:To study the dynamic changes of cortical functional reorganization in striatocapsular infarction (SCI) by blood oxygenation level dependent-functional MR imaging (BOLD-fMRI) and its relation with recovery of motor function in the upper extremity of the hemiplegia.Methods:A total of 17 patients with SCI at first onset and combined with upper extremity of the hemiplegia, admitted to our hospital from June 2015 to December 2017, were included; 15 healthy volunteers recruited at the same time were selected as control group. Within 1 week of onset, and 1 and 3 months after onset, BOLD-fMRI was performed under passive finger flexion and extension task on hemiplegia side, and the activation of brain functional areas at different stages was observed by SPM8 software. The Xjview software was used to observe the activation of the corresponding brain activation areas in BOLD-fMRI and make dynamic comparison with the standard brain activation areas. The upper limb part of Fugl-Meyer (FM-UL) scale was used to track the motor function of the upper limb.Results:The activation in the control group was mainly located in the contralateral sensorimotor cortex (SMC) and bilateral supplementary motor area (SMA). The regions of interest in early BOLD-fMRI for stroke patients at early stage can be divided into 3 types. The activation in patients with type I was mainly at the affected side, enjoying bilateral SMC and SMA activation; 1 and 3 months after onset, activation at the contralateral SMC decreased gradually, and activation at the ipsilateral SMC region gradually increased. The activation in patients with type Ⅱ was merely at the ipsilateral SMC and SMA regions; 1 month after onset, bilateral SMC area and SMA area were significantly activated, mainly at the contralateral side; 3 months after onset, the SMC area was further activated at the ipsilateral side and weakened at the ipsilateral side. The activation in patients with type Ⅲ was only at SMC or M1 at the ipsilateral side; 1 month after onset, activation at the ipsilateral SMC area increased slightly; 3 months after onset, activation at the ipsilateral SMC area further enhanced, and SMA area was without activation performance. The FM-UL scores of the affected limbs of patients with type I, type II and type III at the early onst were 10.0±3.3, 10.6±5.7 and 9.2±4.0, respectively, without statistical differences ( P>0.05); 1 month after onset, the FM-UL scores of patients with type I, type II and type III were 52.3±4.6, 36.6±2.4 and 12.5±3.0, respectively, with significant differences ( P<0.05); 3 months after onset, FM-UL scores of patients with type I, type II and type III were 63.7±2.9, 59.2±3.1 and 13.3±5.0, respectively, with statistical differences ( P<0.05). Conclusions:Intracranial functional reorganization is a dynamic process. The early and dynamic activation of the affected SMC region and the early activation of the contralateral SMC region and bilateral SMA regions are of great significance in the process of stroke rehabilitation.

The human brain deteriorates as we age, and the rate and the trajectories of these changes significantly vary among brain regions and among individuals. Because neuroimaging data are potentially important indicators of individual's brain health, they are commonly used in brain age prediction. In this review, we summarize brain age prediction model from neuroimaging-based studies in the last ten years. The studies are categorized based on their image modalities and feature types. The results indicate that the prediction frameworks based on neuroimaging holds promise toward individualized brain age prediction. Finally, we addressed the challenges in brain age prediction and suggested some future research directions.
Aging ; Brain ; diagnostic imaging ; physiology ; Humans ; Neuroimaging

OBJECTIVE: To prepare Wheat germ agglutinin (WGA) modified vinorelbine (VRB) cationic liposomes (WGA-VRB cationic liposomes), and to optimize the formulation and conduct cytotoxicity test.METHODS: Thin-film diffusion and ammonium sulfate gradient method were used to prepare WGA-VRB cationic liposomes using phospholipid and cholesterol as excipient, 3β-[N-(N' -N' -dimethyl aminoethane) -carbamoyl] cholesterol hydrochloride (DC-Chol) as cationic material, distearoyl phosphatidylethanolamine-polyethylene glycol 2000 (DSPE-PEG2000) as long cycle chain. Using encapsulation rate as index, central composite design-response surface methodology was used to optimize the amount of DC-Chol, cholesterol and VRB. The contents of VRB in VRB liposomes and WGA-VRB cationic liposomes were determined. The effects of them and blank cationic liposomes on survival rates of human breast cancer cell MCF-7 and human non-small cell lung cancer cells A549 were compared. RESULTS: The optimal formulation of 5 mL WGA-VRB cationic liposomes was as follows as phospholipid 22 mg, cholesterol 12 mg, DC-Chol 8 mg, VRB 0. 5 mg. Encapsulation rate of the liposomes was (92. 24 ± 1. 21)％ (n=3), relative error of which to predicted value was 5. 3％. The contents of VRB in VRB liposomes and WGA-VRB cationic liposomes were (96. 01 ± 3. 26), (93. 39 ± 1. 59) μg/mL(n=3). Compared with blank cationic liposomes and VRB liposomes, WGA-VRB cationic liposomes could significantly reduce survival rate of MCF-7 and A549. CONCLUSIONS: WGA-VRB cationic liposomes are prepared successfully. Inhibitory effect of WGA-VRB cationic liposomes on MCF-7 and A549 cell survival is stronger than that of VRB liposomes.

OBJECTIVETo investigate the clinical effect of lateral superior genicular composite tissue flap for tissue defect.

METHODSThe axis line of flap is the lateral thigh vertical midline. The cutaneous branch is inserted 4 cm near the femoral lateral epicondylus. The anterior border is the elongation line along patellar lateral border. The posterior margin is the hinder margin of femoral biceps. The lower border is the horizontal line along the upper line of patella. The composite flaps were used in 18 cases with soft tissue defects in extremities, 11 cases with clacaneus tenden defects and 16 cases with bony nonunion. Results From Mar. 2002 to Sept. 2013, 45 cases were treated with the composite tissue flaps. The flaps size ranged from 6 cm x 3 cm to 17cm x 9 cm. All the flaps survived completely. Blood supply crisis happened in 2 cases, which was released by reanastomosis. The patients were followed up for 1 - 2. 5 years with satisfactory aesthetic and functional results. All the bone defect and nonunion were healed. Good healing was also achieved in donor sites. 8 months after operation, knee joint function is evaluated as good by hospital special surgery knee score (HSS).

CONCLUSIONLateral superior genicular compostie tissue flap can be used to reconstruct soft tissue defect, bone defect and tenden calcaneus defect in one stage.

Anatomic Landmarks ; anatomy & histology ; Follow-Up Studies ; Graft Survival ; Humans ; Knee ; anatomy & histology ; Muscle, Skeletal ; anatomy & histology ; Soft Tissue Injuries ; pathology ; surgery ; Surgical Flaps ; transplantation ; Thigh ; Time Factors ; Wound Healing

OBJECTIVETo investigate the therapeutic effect of primary reconstruction of skin avulsion injury with bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

METHODSFrom June 2005 to Aug. 2011, 4 cases with skin avulsion injury on both feet were treated. The bilateral anterolateral thigh flaps, including with anterolateral thigh cutaneous nerves, were transferred to cover the feet plantar. The thorax umbilicus flap or latissimus dorsi flap were used to cover the feet dorsum.

RESULTSAll the skin avulsion injury were reconstructed primarily. All the flaps survived completely with good cosmetic and functional results. The patients were followed up for 6 months to 2 years with good sensory recovery (two point discrimination: 14-18 mm).

CONCLUSIONThe skin avulsion injury on both feet can be primarily reconstructed by bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

Adolescent ; Follow-Up Studies ; Foot Injuries ; surgery ; Humans ; Lacerations ; surgery ; Myocutaneous Flap ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; innervation ; Surgical Flaps ; innervation ; transplantation ; Thigh ; innervation

Objectives To approach the method and clinical effect on tendo calcaneus and complex tissue defect with microsurgery repair.Methods Retrospective summary the methods of 356 cases with tendo calcaneus and complex tissueserious defect,which repaired by different microsurgery from June 1994 to March 201 1.Two type were divided on account of different degree of serious tendo calcaneus and complex tissue defect.Type A:the length of tendo calcaneus defect was less than 3 cm,and cutaneous deficiency is less than 3 cm × 20 cm.Direct suture (166 cases) or Abraham retrograde V-Y method (72 cases)was used to repair endo calcaneus defec,anfregional flap metastasis was used to repair cutaneous deficiency.Two hundred and thirtyeight cases were used by those methods,including of lateral heel flap repair(23 cases),medial plantar island flap(58 cases),instep island flap(40 cases),above medial malleolus flap(48 cases),above ateral malleolus flap (24 cases),sural nerve nutrient vessel flap (29 cases) gastrocnemius muscle flap (16 cases).Type B:the length of tendo calcaneus defect was more than 3 cm,and cutaneous deficiency was more than 3 cm × 20 cm.Direct suture could not repair tendo calcaneus,the complex tissue flap free grafting was used to primary repair tendo calcaneus and complex tissue defect.One hundred and erghteen cases were used by those methods,including of tensor fasciae latae flap free grafting (52 cases),lateral above knee complex tissue flap free grafting (26 cases),latissimus dorsi muscle fascia flap free grafting (24 cases),rectus abdominis muscle front sheath flap free grafting (16 cases).Three hundred and fifty-six cases were repaired by these methods,including 238 cases of regional flap transfer 118 cases of tissue flap free grafting.Results In 238 cases of regional flap transfer,two hundred and twenty-six cases were successful,and 12 cases were partly success,which were wound healing by change dressings.In 118 cases of tissue flap free grafting,one hundred and nine cases were successful,and blood vesse articulo were happened to 8 casess,which were success by operations research,and 1 case was failure which had to use another tissue flap.Follow-up visit was dane from 1.0 year to 4.5 years after operation (average 3.2 years).Functional assessment according to the Thermann ralted the results as excellent in 240 csaes,good in 86 cases,common in 22 cases and worse in 8 cases.The fineness rate was 91.6％.Conclusion Microsurgical repair is a good method to tendo calcaneus and complex tissue defect,different method and strategy selected actively by tissue defect degree of tendo calcaneus and complex tissue can achieve satisfactory functional rehabilitation purpose.