OBJECTIVE: To propose a new protocol for personalized mandibular reconstruction assisted by three-dimensional (3D) retrieval model based on fully connected neural network (FCNN) and a database of mandibles, and to verify clinical feasibility of the protocol. METHODS: A database of mandibles of 300 normal northern Chinese Han people was established. On the basis of cephalometry, the mandible landmarks with good stability were further screened. Mandibular landmarks were selected and geometric features of the mandible were extracted. A 3D retrieval algorithm was developed, which could retrieve the mandible most similar to a given mandible from the database. A FCNN was built to train the algorithm to improve accuracy of the 3D retrieval model. Using Geomagic Control 2014 software, matching accuracy of the 3D retrieval model was based on aforementioned mandible database and algorithm. From December 2019 to March 2021, a total of 5 patients underwent personalized mandibular reconstruction assisted by a 3D retrieval model based on mandible database and FCNN in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. The most similar mandible was retrieved from mandible database through 3D retrieval algorithm. It was used to restore the premorbid morphology of defect area and guide mandibular reconstruction. For the 5 patients, mandible was reconstructed with iliac flap. Virtual surgical plan was transformed using individual surgical guides. RESULTS: Through screening, mandibular landmarks with high reproducibility and stability were identified and composed of mandibular landmarker protocols. After training, the average deviation between most similar mandible retrieved from the 300-case mandible database through 3D retrieval model based on FCNN and given mandible was (1.77±0.44) mm. And the root-mean-square deviation between the most similar mandible retrieved from the database and given mandible was (2.58±0.86) mm. The mandibular reconstruction surgery was successful in all the 5 patients. Their facial symmetry and occlusion were restored. All the patients were satisfied with postoperative appearance. The mean deviation between postoperative mandible and preoperative design was (0.98±0.17) mm. The area with a deviation ≤1 mm accounted for 61.34%±14. 13%, ≤2 mm accounted for 83.82%±7.35%, and ≤3 mm accounted for 93.94%± 2.87%. CONCLUSION The personalized mandibular reconstruction assisted by 3D retrieval model based on the 300-case mandible database and FCNN is feasible clinically.
Humans ; Neural Networks, Computer ; Mandibular Reconstruction/methods* ; Mandible/diagnostic imaging* ; Imaging, Three-Dimensional/methods* ; Adult ; Databases, Factual ; Female ; Male ; Algorithms ; Middle Aged ; Cephalometry

Objective:To investigate the current status of clinical practice of optical surface guided radiation therapy (SGRT) technology in China.Methods:A survey questionnaire was designed based on a similar investigation conducted by the European Society for Radiotherapy and Oncology in collaboration with the American Association of Physicists in Medicine on SGRT. The questionnaire covered aspects such as the installation, implementation, commissioning, quality assurance, clinical application, challenges, and cost considerations of SGRT systems. An online questionnaire was distributed to 49 institutions in China that have installed or are in the process of installing SGRT systems. Data were summarized and analyzed using Excel and SPSS 29 software.Results:Among the 49 institutions, 96% had at least one SGRT system. In terms of commissioning, quality assurance and implementation, it was mainly operated by physicists (94%) and technicians (82%), the cycle of test items for quality assurance was only achieved by the highest percentage of units with end-to-end test items for the annual inspection (50%). Eighty-six percent of the institutions used phantoms provided by suppliers, and 53% followed supplier recommendations or guidelines. For the installation of the first SGRT system, 37% of the institutions reported that initial staff training required more than 48 hours, while 73% found the training content easy to understand. Regarding the clinical application of SGRT technology, the majority of the institutions (53%) had used it for 1-3 years, with breast radiotherapy being the most commonly used treatment site. The primary scenario of SGRT application was intra-fraction motion monitoring / patient monitoring (69%). Furthermore, 47% of the institutions combined SGRT with open-face masks, and 71% used visual feedback devices for breath-hold or free-breathing gating. In terms of treatment thresholds, the median thresholds for monitoring and positioning were the same for breast, abdominopelvic (non- stereotactic body radiation therapy), and head-and-neck (non-brain stereotactic radiosurgery) treatments but varied for other sites.Conclusions:Although SGRT technology requires a relatively long initial training period, it is generally well accepted in terms of training and operation. Clinically, SGRT has been widely applied in breast radiotherapy, playing a crucial role in patient monitoring and intra-fraction motion management. However, most institutions have had limited clinical experience with the technology, highlighting the need for continuous technical supervision and improvement. The establishment of standardized protocols is necessary to ensure broader clinical adoption and long-term effectiveness.

The specific mechanisms of interferon regulatory factor 8(IRF8)in porcine intestinal in-nate immunity and resistance to enteric virus infection remain to be elucidated.To investigate the immunoregulatory role of IRF8,establishing an IRF8 gene knockout porcine intestinal epithelial cell(IPEC-J2)monoclonal cell line is of significant importance.This study initially aimed to obtain recombinant adeno-associated virus rAAV-sgIRF8-eGFP capable of knocking out the IRF8 gene through co-transfection of HEK-293T cells with three plasmids.Subsequently,IPEC-J2 cells were infected with the virus,and those expressing eGFP were selected by flow cytometry and cultured to form monoclonal cell lines.These cell lines were then identified by Sanger sequencing and West-ern blot techniques.Lastly,qPCR analysis was used to measure the expression levels of interferon factors IFN-α,IFN-β,IFN-γ and IFN-λ,providing preliminary insights into the impact of IRF8 gene knockout on IPEC-J2 cell immunity.The results demonstrated successful generation of rAAV-sgIRF8-eGFP,which successfully infected IPEC-J2 cells leading to eGFP fluorescence.Flow cytometry followed by cell culture led to the establishment of two monoclonal cell lines,IRF8-KO1 and IRF8-KO3.Sanger sequencing revealed a five-base deletion in IRF8-KO1 and a seven-base dele-tion in IRF8-KO3.Western blot confirmed the absence of IRF8 protein expression in IRF8-KO1,making it an ideal candidate monoclonal cell line.qPCR analysis of interferon factors indicated sig-nificant decrease in IFN-γ(P＜0.05)and IFN-λ(P＜0.01)transcription level in IRF8-knockout cells,while the transcription levels of IFN-α and IFN-β remained relatively unchanged.This study successfully established an IRF8 gene knockout IPEC-J2 monoclonal cell line,providing a founda-tion for further research on IRF8-related porcine intestinal immune regulation and mechanisms of intestinal virus infection.

Objective:To evaluate preoperative high-resolution thin-layer cervical enhanced CT used to predict the venous route of the submental flap reflux vein and its relationship with adjacent structures in order to guide the anatomical understanding and protection of submental flap in pharyngeal cancer surgery.Methods:Sixty consecutive patients with pharyngeal cancer who underwent submental flap repair surgery in our department from March 2022 to December 2024, as well as 60 patients who were accepted neck dissection suffering other cancers, were selected. Before surgery, high-resolution cervical enhanced CT scans were performed, and the position of the transverse section of the facial vein in the venous phase horizontal image gradually variation tendency was focused layer by layer. The direction and adjacent relationship of the submental flap reflux veins were determined and recorded. Combined with 60 patients with other head and neck tumors who underwent neck dissection in our department during the same period (a total of 120 cases, 240 sides), the classification and management of the draining veins of Fang′s mental flap were conducted. Type Ⅰ mainly drains into the internal jugular vein; Type Ⅱ mainly drains into the external jugular vein and Type Ⅲ mainly drains into the anterior jugular vein (often accompanied by an external jugular draining branch). The status and proportion of venous drainage were analyzed.Results:Vascular predictive coincidence rate was 98.3% (59/60) among the 60 patients with pharyngeal cancer. Only one patient was predicted to have a simple return to the external jugular vein. However, during the operation, in addition to the main return to the external jugular vein, a small portion also returned to the internal jugular vein. Submental flap reflux vessels were classified into three types based on intraoperative submental flap venous return in 60 cases of laryngopharyngeal cancer, in conjunction with the analysis of venous return patterns from 240 cervical CT scans. Type Ⅰ mainly refluxed to the internal jugular vein, accounting for 42.1%. Type Ⅱ mainly refluxed to the external jugular vein (47.9%). Type Ⅲ mainly refluxed to the anterior jugular vein (10.0%). The total detection rate of CT reading of 240 venous reflux was 98.7% (237/240). Vascular predictive coincidence rate was 97.9%(235/240).Conclusion:The detailed analysis of submental venous return vessels can accurately predict the direction of reflux veins and its surrounding areas by preoperative high-resolution enhanced CT scan. This provides reliable guidance for the anatomy and protection of the submental flap reflux veins during surgery.

As a non-invasive imaging modality,cardiac magnetic resonance(CMR)enables a"one-stop"in vivo assessment of cardiac morphology,structure,functional status and histological features,plays an irreplaceable role in the diagnosis,prognosis and risk stratification of cardiovascular diseases.In 2024,CMR has made continuous progress towards precision medicine.Upgraded technologies such as tissue characterization imaging and myocardial strain analysis,are gradually transformed into standard clinical practice.Artificial intelligence and other new algorithms have improved the quality and efficiency of CMR.The application of CMR in non-ischemic heart disease,ischemic heart disease and other areas is highly valued in the new version of various guidelines,highlighting the importance of CMR in the clinical management of cardiovascular diseases.This article aims to systematically review representative achievements of CMR in 2024 from the perspectives of both technological innovation and clinical translation,providing the latest update in this field.

The specific mechanisms of interferon regulatory factor 8(IRF8)in porcine intestinal in-nate immunity and resistance to enteric virus infection remain to be elucidated.To investigate the immunoregulatory role of IRF8,establishing an IRF8 gene knockout porcine intestinal epithelial cell(IPEC-J2)monoclonal cell line is of significant importance.This study initially aimed to obtain recombinant adeno-associated virus rAAV-sgIRF8-eGFP capable of knocking out the IRF8 gene through co-transfection of HEK-293T cells with three plasmids.Subsequently,IPEC-J2 cells were infected with the virus,and those expressing eGFP were selected by flow cytometry and cultured to form monoclonal cell lines.These cell lines were then identified by Sanger sequencing and West-ern blot techniques.Lastly,qPCR analysis was used to measure the expression levels of interferon factors IFN-α,IFN-β,IFN-γ and IFN-λ,providing preliminary insights into the impact of IRF8 gene knockout on IPEC-J2 cell immunity.The results demonstrated successful generation of rAAV-sgIRF8-eGFP,which successfully infected IPEC-J2 cells leading to eGFP fluorescence.Flow cytometry followed by cell culture led to the establishment of two monoclonal cell lines,IRF8-KO1 and IRF8-KO3.Sanger sequencing revealed a five-base deletion in IRF8-KO1 and a seven-base dele-tion in IRF8-KO3.Western blot confirmed the absence of IRF8 protein expression in IRF8-KO1,making it an ideal candidate monoclonal cell line.qPCR analysis of interferon factors indicated sig-nificant decrease in IFN-γ(P＜0.05)and IFN-λ(P＜0.01)transcription level in IRF8-knockout cells,while the transcription levels of IFN-α and IFN-β remained relatively unchanged.This study successfully established an IRF8 gene knockout IPEC-J2 monoclonal cell line,providing a founda-tion for further research on IRF8-related porcine intestinal immune regulation and mechanisms of intestinal virus infection.

As a non-invasive imaging modality,cardiac magnetic resonance(CMR)enables a"one-stop"in vivo assessment of cardiac morphology,structure,functional status and histological features,plays an irreplaceable role in the diagnosis,prognosis and risk stratification of cardiovascular diseases.In 2024,CMR has made continuous progress towards precision medicine.Upgraded technologies such as tissue characterization imaging and myocardial strain analysis,are gradually transformed into standard clinical practice.Artificial intelligence and other new algorithms have improved the quality and efficiency of CMR.The application of CMR in non-ischemic heart disease,ischemic heart disease and other areas is highly valued in the new version of various guidelines,highlighting the importance of CMR in the clinical management of cardiovascular diseases.This article aims to systematically review representative achievements of CMR in 2024 from the perspectives of both technological innovation and clinical translation,providing the latest update in this field.

Objective:To evaluate preoperative high-resolution thin-layer cervical enhanced CT used to predict the venous route of the submental flap reflux vein and its relationship with adjacent structures in order to guide the anatomical understanding and protection of submental flap in pharyngeal cancer surgery.Methods:Sixty consecutive patients with pharyngeal cancer who underwent submental flap repair surgery in our department from March 2022 to December 2024, as well as 60 patients who were accepted neck dissection suffering other cancers, were selected. Before surgery, high-resolution cervical enhanced CT scans were performed, and the position of the transverse section of the facial vein in the venous phase horizontal image gradually variation tendency was focused layer by layer. The direction and adjacent relationship of the submental flap reflux veins were determined and recorded. Combined with 60 patients with other head and neck tumors who underwent neck dissection in our department during the same period (a total of 120 cases, 240 sides), the classification and management of the draining veins of Fang′s mental flap were conducted. Type Ⅰ mainly drains into the internal jugular vein; Type Ⅱ mainly drains into the external jugular vein and Type Ⅲ mainly drains into the anterior jugular vein (often accompanied by an external jugular draining branch). The status and proportion of venous drainage were analyzed.Results:Vascular predictive coincidence rate was 98.3% (59/60) among the 60 patients with pharyngeal cancer. Only one patient was predicted to have a simple return to the external jugular vein. However, during the operation, in addition to the main return to the external jugular vein, a small portion also returned to the internal jugular vein. Submental flap reflux vessels were classified into three types based on intraoperative submental flap venous return in 60 cases of laryngopharyngeal cancer, in conjunction with the analysis of venous return patterns from 240 cervical CT scans. Type Ⅰ mainly refluxed to the internal jugular vein, accounting for 42.1%. Type Ⅱ mainly refluxed to the external jugular vein (47.9%). Type Ⅲ mainly refluxed to the anterior jugular vein (10.0%). The total detection rate of CT reading of 240 venous reflux was 98.7% (237/240). Vascular predictive coincidence rate was 97.9%(235/240).Conclusion:The detailed analysis of submental venous return vessels can accurately predict the direction of reflux veins and its surrounding areas by preoperative high-resolution enhanced CT scan. This provides reliable guidance for the anatomy and protection of the submental flap reflux veins during surgery.

Objective:To investigate the current status of clinical practice of optical surface guided radiation therapy (SGRT) technology in China.Methods:A survey questionnaire was designed based on a similar investigation conducted by the European Society for Radiotherapy and Oncology in collaboration with the American Association of Physicists in Medicine on SGRT. The questionnaire covered aspects such as the installation, implementation, commissioning, quality assurance, clinical application, challenges, and cost considerations of SGRT systems. An online questionnaire was distributed to 49 institutions in China that have installed or are in the process of installing SGRT systems. Data were summarized and analyzed using Excel and SPSS 29 software.Results:Among the 49 institutions, 96% had at least one SGRT system. In terms of commissioning, quality assurance and implementation, it was mainly operated by physicists (94%) and technicians (82%), the cycle of test items for quality assurance was only achieved by the highest percentage of units with end-to-end test items for the annual inspection (50%). Eighty-six percent of the institutions used phantoms provided by suppliers, and 53% followed supplier recommendations or guidelines. For the installation of the first SGRT system, 37% of the institutions reported that initial staff training required more than 48 hours, while 73% found the training content easy to understand. Regarding the clinical application of SGRT technology, the majority of the institutions (53%) had used it for 1-3 years, with breast radiotherapy being the most commonly used treatment site. The primary scenario of SGRT application was intra-fraction motion monitoring / patient monitoring (69%). Furthermore, 47% of the institutions combined SGRT with open-face masks, and 71% used visual feedback devices for breath-hold or free-breathing gating. In terms of treatment thresholds, the median thresholds for monitoring and positioning were the same for breast, abdominopelvic (non- stereotactic body radiation therapy), and head-and-neck (non-brain stereotactic radiosurgery) treatments but varied for other sites.Conclusions:Although SGRT technology requires a relatively long initial training period, it is generally well accepted in terms of training and operation. Clinically, SGRT has been widely applied in breast radiotherapy, playing a crucial role in patient monitoring and intra-fraction motion management. However, most institutions have had limited clinical experience with the technology, highlighting the need for continuous technical supervision and improvement. The establishment of standardized protocols is necessary to ensure broader clinical adoption and long-term effectiveness.

Background and aims:Hepatocellular carcinoma(HCC),which is prevalent worldwide and has a high mortality rate,needs to be effectively diagnosed.We aimed to evaluate the significance of plasma microRNA-15a/16-1(miR-15a/16)as a biomarker of hepatitis B virus-related HCC(HBV-HCC)using the machine learning model.This study was the first large-scale investigation of these two miRNAs in HCC plasma samples. Methods:Using quantitative polymerase chain reaction,we measured the plasma miR-15a/16 levels in a total of 766 participants,including 74 healthy controls,335 with chronic hepatitis B(CHB),47 with compensated liver cirrhosis,and 310 with HBV-HCC.The diagnostic performance of miR-15a/16 was examined using a machine learning model and compared with that of alpha-fetoprotein(AFP).Lastly,to validate the diagnostic efficiency of miR-15a/16,we performed pseudotemporal sorting of the samples to simulate progression from CHB to HCC. Results:Plasma miR-15a/16 was significantly decreased in HCC than in all control groups(P＜0.05 for all).In the training cohort,the area under the receiver operating characteristic curve(AUC),sensitivity,and average precision(AP)for the detection of HCC were higher for miR-15a(AUC=0.80,67.3％,AP=0.80)and miR-16(AUC=0.83,79.0％,AP=0.83)than for AFP(AUC=0.74,61.7％,AP=0.72).Combining miR-15a/16 with AFP increased the AUC to 0.86(sensitivity 85.9％)and the AP to 0.85 and was significantly superior to the other markers in this study(P＜0.05 for all),as further demonstrated by the detection error tradeoff curves.Moreover,miR-15a/16 impressively showed potent diagnostic power in early-stage,small-tumor,and AFP-negative HCC.A validation cohort confirmed these results.Lastly,the simulated follow-up of patients further validated the diagnostic efficiency of miR-15a/16. Conclusions:We developed and validated a plasma miR-15a/16-based machine learning model,which exhibited better diagnostic performance for the early diagnosis of HCC compared to that of AFP.