1.Hydrogels:role and problems in the repair of oral and maxillofacial defects
Zhixin WU ; Wenwen JIANG ; Jianhui ZHAN ; Yangshurun LI ; Wenyan REN ; Yiyu WANG
Chinese Journal of Tissue Engineering Research 2025;29(10):2178-2188
		                        		
		                        			
		                        			BACKGROUND:Hydrogels have become a research hotspot due to their unique advantages in the biomedical field due to their superior mechanical and biological properties.At present,related research involves tissue engineering,wound dressing and so on. OBJECTIVE:To review the advantages and properties of hydrogels and the research progress of their application in the repair of oral and maxillofacial defects,discuss the current limitations and challenges of hydrogels in application and promotion,and provide new ideas for future research directions. METHODS:Relevant literature was searched in PubMed,CNKI,and WanFang database by computer.The search terms were"hydrogel,oral and maxillofacial defects,mechanical properties,tissue engineering,wound dressing"in Chinese and"hydrogel,oral and maxillofacial defects,mechanical properties,guided tissue regeneration,wound dressing"in English.Preliminary screening was carried out by reading titles and abstracts,and articles not related to the topic of the article were excluded.According to the inclusion and exclusion criteria,108 articles were finally included for the result analysis. RESULTS AND CONCLUSION:(1)The hydrogel has good biological activity,mechanical controllability,and stimulation response.(2)Polymer,metal,and ceramic hydrogel composites have appropriate mechanical properties,biodegradability,and controlled release rate,which are suitable for maxillofacial bone tissue engineering.(3)Fibrin-based hydrogel could fill the hollow nerve conduit through the nerve defect area and promote the regeneration and growth of axons to restore the function of maxillofacial nerve.(4)Controlling the interaction between nanomaterials and hydrogels can improve the formation of muscle fiber oriented structure to promote maxillofacial muscle tissue regeneration.(5)Polysaccharide hydrogel has gradually become the first choice for repairing irregular periodontal defects due to its ability to control drug delivery,carry bioactive molecules,and combine with other materials to produce the best scaffold matching the extracellular matrix.(6)Calcium phosphate or calcium carbonate-based hydrogels can be used to fill irregular or fine tissue defects and remineralize hard tissues.The self-assembled hydrogels are simple to prepare and have good biological activity.(7)Salivary gland-derived extracellular matrix-like gel is expected to participate in the treatment of many salivary gland diseases.(8)Hydrogels can be used as wound dressings in combination with biological adhesives,acellular biomaterials,antimicrobials,antioxidants,or stem cells to treat various wounds.(9)Fibrin-based hydrogel has the most potential in the repair of oral and maxillofacial defects.It has excellent biocompatibility,flexibility,and plasticity.It can combine with cells,extracellular matrix proteins,and various growth factors,and promote the osteogenic differentiation of mesenchymal stem cells,axon regeneration and growth,angiogenesis,myotube differentiation,salivary gland tissue regeneration,and periodontal tissue regeneration.It has a broad prospect in the repair of oral and maxillofacial defects.However,its therapeutic effect depends on the function of the substance carried.The complex preparation process,its safety and long-term efficacy,and the special anatomical oral and maxillofacial structure is the problem that hinders its promotion,which also provides directions for future research.
		                        		
		                        		
		                        		
		                        	
2.The Adoption of Non-invasive Photobiomodulation in The Treatment of Epilepsy
Ao-Yun LI ; Zhan-Chuang LU ; Li CAO ; Si CHEN ; Hui JIANG ; Chang-Chun CHEN ; Lei CHEN
Progress in Biochemistry and Biophysics 2025;52(4):882-898
		                        		
		                        			
		                        			Epilepsy is a chronic neurological disease caused by abnormal synchronous discharge of the brain, which is characterized by recurrent and transient neurological abnormalities, mainly manifested as loss of consciousness and limb convulsions, and can occur in people of all ages. At present, anti-epileptic drugs (AEDs) are still the main means of treatment, but their efficacy is limited by the problem of drug resistance, and long-term use can cause serious side effects, such as cognitive dysfunction and vital organ damage. Although surgical resection of epileptic lesions has achieved certain results in some patients, the high cost and potential risk of neurological damage limit its scope of application. Therefore, the development of safe, accurate and personalized non-invasive treatment strategies has become one of the key directions of epilepsy research. In recent years, photobiomodulation (PBM) has gained significant attention as a promising non-invasive therapeutic approach. PBM uses light of specific wavelengths to penetrate tissues and interact with photosensitive molecules within cells, thereby modulating cellular metabolic processes. Research has shown that PBM can enhance mitochondrial function, promote ATP production, improve meningeal lymphatic drainage, reduce neuroinflammation, and stimulate the growth of neurons and synapses. These biological effects suggest that PBM not only holds the potential to reduce the frequency of seizures but also to improve the metabolic state and network function of neurons, providing a novel therapeutic avenue for epilepsy treatment. Compared to traditional treatment methods, PBM is non-invasive and avoids the risks associated with surgical interventions. Its low risk of significant side effects makes it particularly suitable for patients with drug-resistant epilepsy, offering new therapeutic options for those who have not responded to conventional treatments. Furthermore, PBM’s multi-target mechanism enables it to address a variety of complex etiologies of epilepsy, demonstrating its potential in precision medicine. In contrast to therapies targeting a single pathological mechanism, PBM’s multifaceted approach makes it highly adaptable to different types of epilepsy, positioning it as a promising supplementary or alternative treatment. Although animal studies and preliminary clinical trials have shown positive outcomes with PBM, its clinical application remains in the exploratory phase. Future research should aim to elucidate the precise mechanisms of PBM, optimize light parameters, such as wavelength, dose, and frequency, and investigate potential synergistic effects with other therapeutic modalities. These efforts will be crucial for enhancing the therapeutic efficacy of PBM and ensuring its safety and consistency in clinical settings. This review summarizes the types of epilepsy, diagnostic biomarkers, the advantages of PBM, and its mechanisms and potential applications in epilepsy treatment. The unique value of PBM lies not only in its multi-target therapeutic effects but also in its adaptability to the diverse etiologies of epilepsy. The combination of PBM with traditional treatments, such as pharmacotherapy and neuroregulatory techniques, holds promise for developing a more comprehensive and multidimensional treatment strategy, ultimately alleviating the treatment burden on patients. PBM has also shown beneficial effects on neural network plasticity in various neurodegenerative diseases. The dynamic remodeling of neural networks plays a critical role in the pathogenesis and treatment of epilepsy, and PBM’s multi-target mechanism may promote brain function recovery by facilitating neural network remodeling. In this context, optimizing optical parameters remains a key area of research. By adjusting parameters such as wavelength, dose, and frequency, researchers aim to further enhance the therapeutic effects of PBM while maintaining its safety and stability. Looking forward, interdisciplinary collaboration, particularly in the fields of neuroscience, optical engineering, and clinical medicine, will drive the development of PBM technology and facilitate its transition from laboratory research to clinical application. With the advancement of portable devices, PBM is expected to provide safer and more effective treatments for epilepsy patients and make a significant contribution to personalized medicine, positioning it as a critical component of precision therapeutic strategies. 
		                        		
		                        		
		                        		
		                        	
3.Effects of Different Microbial Fertilizers on Physiology and Rhizosphere Soil Environment of Codonopsis pilosula
Xia JIANG ; Junxi ZHAO ; Panpan SHI ; Xiaoxuan WANG ; Chenhui DU ; Shuosheng ZHANG ; Haixian ZHAN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):241-251
		                        		
		                        			
		                        			ObjectiveTo study the effects of applying different microbial fertilizers on the growth and rhizosphere soil environment of Codonopsis pilosula and provide a theoretical basis for ecological cultivation of this medicinal plant. MethodsSeven groups were designed, including CK (no application of microbial fertilizer), T1 (Trichoderma longibrachiatum fertilizer), T2 (Bacillus subtilis fertilizer), T3 (Trichoderma viride fertilizer), T4 (compound microbial fertilizer), T5 (C. pilosula stems and leaves fermented with compound microbial fertilizer), and T6 (Scutellaria baicalensis stems and leaves fermented with T. viride fertilizer). The physiological indicators, yield, and quality of C. pilosula and the physicochemical properties, enzyme activities, and microbial diversity in the rhizosphere soil of different fertilizer treatments were measured. ResultsGroup T1 showed slight decreases in soluble protein content (SPC) and superoxide dismutase (SOD). Groups T2-T6 showed increases in physiological indicators such as proline (Pro), soluble solids content (SSC), SPC, catalase (CAT), and peroxidase (POD) and a decrease in malondialdehyde (MDA) in C. pilosula leaves. All the fertilizer treatments increased the yield of C. pilosula and the total polysaccharide content in the roots. T1, T2, T3, T4, and T5 increased the total flavonoid content in the roots. Meanwhile, T4 increased the total saponin content in the roots. All the fertilizer treatments reduced the pH and increased the electric conductivity (EC), soil organic matter (SOM), and alkaline nitrogen (AN) in the soil. T2 and T5 increased the available phosphorus (AP), and T3, T4, T5, and T6 increased the available potassium (AK) in the soil. All the fertilizer treatments increased the activities of urease, sucrase, and CAT in the soil. Except that T1 decreased the bacterial diversity in the soil, other fertilizer treatments significantly increased bacterial and fungal diversity in the soil. Different fertilizer treatments significantly affected the composition of bacterial and fungal communities in the soil. At the phylum level, the dominant bacterial phyla included Proteobacteria, Acidobacteriota, and Bacteroideta, and the dominant fungal phyla were Ascomycota, Mortierellomycota, and unclassified_fungi in the rhizosphere soil of C. pilosula after bacterial fertilizer treatment. At the genus level, unclassified Gemmatimonadaceae, Sphingomonas, and unclassified Vicinamibacteraceae were the dominant bacterial genera, while unidentified, unclassified Fungi, and unclassified Sordariomycetes were the dominant fungal genera in the rhizosphere soil. The results of redundancy analysis indicated that the main physicochemical factors affecting changes of microbial communities in the rhizosphere soil of C. pilosula were pH, EC, AK, AN, AP, and soil organic matter (SOM) in the soil. The correlation heatmap showed that Bryobacter had significantly positive correlations with EC, AK, and AN. There was a significantly negative correlation between Fusarium and SOM. In summary, applying an appropriate amount of microbial fertilizer can promote the growth and improve the rhizosphere soil environment of C. pilosula. ConclusionThe compound microbial fertilizer and the C. pilosula stems and leaves fermented with compound microbial fertilizer can improve the soil nutrients, growth, development, yield, and quality of C. pilosula, and thus they can be applied to the artificial cultivation of C. pilosula. 
		                        		
		                        		
		                        		
		                        	
4.Effects of Different Microbial Fertilizers on Physiology and Rhizosphere Soil Environment of Codonopsis pilosula
Xia JIANG ; Junxi ZHAO ; Panpan SHI ; Xiaoxuan WANG ; Chenhui DU ; Shuosheng ZHANG ; Haixian ZHAN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):241-251
		                        		
		                        			
		                        			ObjectiveTo study the effects of applying different microbial fertilizers on the growth and rhizosphere soil environment of Codonopsis pilosula and provide a theoretical basis for ecological cultivation of this medicinal plant. MethodsSeven groups were designed, including CK (no application of microbial fertilizer), T1 (Trichoderma longibrachiatum fertilizer), T2 (Bacillus subtilis fertilizer), T3 (Trichoderma viride fertilizer), T4 (compound microbial fertilizer), T5 (C. pilosula stems and leaves fermented with compound microbial fertilizer), and T6 (Scutellaria baicalensis stems and leaves fermented with T. viride fertilizer). The physiological indicators, yield, and quality of C. pilosula and the physicochemical properties, enzyme activities, and microbial diversity in the rhizosphere soil of different fertilizer treatments were measured. ResultsGroup T1 showed slight decreases in soluble protein content (SPC) and superoxide dismutase (SOD). Groups T2-T6 showed increases in physiological indicators such as proline (Pro), soluble solids content (SSC), SPC, catalase (CAT), and peroxidase (POD) and a decrease in malondialdehyde (MDA) in C. pilosula leaves. All the fertilizer treatments increased the yield of C. pilosula and the total polysaccharide content in the roots. T1, T2, T3, T4, and T5 increased the total flavonoid content in the roots. Meanwhile, T4 increased the total saponin content in the roots. All the fertilizer treatments reduced the pH and increased the electric conductivity (EC), soil organic matter (SOM), and alkaline nitrogen (AN) in the soil. T2 and T5 increased the available phosphorus (AP), and T3, T4, T5, and T6 increased the available potassium (AK) in the soil. All the fertilizer treatments increased the activities of urease, sucrase, and CAT in the soil. Except that T1 decreased the bacterial diversity in the soil, other fertilizer treatments significantly increased bacterial and fungal diversity in the soil. Different fertilizer treatments significantly affected the composition of bacterial and fungal communities in the soil. At the phylum level, the dominant bacterial phyla included Proteobacteria, Acidobacteriota, and Bacteroideta, and the dominant fungal phyla were Ascomycota, Mortierellomycota, and unclassified_fungi in the rhizosphere soil of C. pilosula after bacterial fertilizer treatment. At the genus level, unclassified Gemmatimonadaceae, Sphingomonas, and unclassified Vicinamibacteraceae were the dominant bacterial genera, while unidentified, unclassified Fungi, and unclassified Sordariomycetes were the dominant fungal genera in the rhizosphere soil. The results of redundancy analysis indicated that the main physicochemical factors affecting changes of microbial communities in the rhizosphere soil of C. pilosula were pH, EC, AK, AN, AP, and soil organic matter (SOM) in the soil. The correlation heatmap showed that Bryobacter had significantly positive correlations with EC, AK, and AN. There was a significantly negative correlation between Fusarium and SOM. In summary, applying an appropriate amount of microbial fertilizer can promote the growth and improve the rhizosphere soil environment of C. pilosula. ConclusionThe compound microbial fertilizer and the C. pilosula stems and leaves fermented with compound microbial fertilizer can improve the soil nutrients, growth, development, yield, and quality of C. pilosula, and thus they can be applied to the artificial cultivation of C. pilosula. 
		                        		
		                        		
		                        		
		                        	
5.The Influence of Social Context on Perceptual Decision Making and Its Computational Neural Mechanisms
Yu-Pei LIU ; Yu-Shu WANG ; Bin ZHAN ; Rui WANG ; Yi JIANG
Progress in Biochemistry and Biophysics 2025;52(10):2568-2584
		                        		
		                        			
		                        			Perceptual decision making refers to the process by which individuals make choices and judgments based on sensory information, serving as a fundamental ability for human adaptation to complex environments. While traditional research has focused on perceptual decision making in isolated contexts, growing evidence highlights the profound influence of social contexts prevalent in real-world scenarios. As a crucial factor supporting individual survival and development, social context not only provides rich information sources but also shapes perceptual decision making through top-down processing mechanisms, prompting researchers to recognize the inherently social nature of human decisions. Empirical studies have demonstrated that social information, such as others’ choices or group norms, can systematically bias individuals’ perceptual decisions, often manifesting as conformity behaviors. Social influence can also facilitate performance under certain conditions, particularly when individuals can accurately identify and adopt high-quality social information. The impact of social context on perceptual decisions is modulated by a variety of external and internal factors, including group characteristics(e.g., group size, response consistency), attributes of peers (e.g., familiarity, social status, distinctions between human and artificial agents), as well as individual differences such as confidence, personality traits, and developmental stage. The motivations driving social influence encompass three primary mechanisms: improving decision accuracy through informational influence, gaining social acceptance through normative influence, and maintaining positive self-concept. Recent computational approaches have employed diverse theoretical frameworks to provide valuable insights into the cognitive mechanisms underlying social influence in perceptual decision making. Reinforcement learning models demonstrate how social feedback shapes future choices through reward-based updating. Bayesian inference frameworks describe how individuals integrate personal beliefs with social information based on their respective reliabilities, dynamically updating beliefs to optimize decisions under uncertainty. Drift diffusion models offer powerful tools to decompose social influence into distinct cognitive components, allowing researchers to differentiate between changes in perceptual processing and shifts in decision criteria. Collectively, these models establish a comprehensive methodological foundation for disentangling the multiple pathways by which social context shapes perceptual decisions. Neuroimaging and electrophysiological studies provide converging evidence that social context influences perceptual decision making through multi-level neural mechanisms. At early perceptual processing stages, social influence modulates sensory evidence accumulation in parietal cortex and directly alters primary visual cortex activity, while guiding selective attention to stimulus features consistent with social norms through attentional alignment mechanisms. At higher cognitive levels, the reward system (ventral striatum, ventromedial prefrontal cortex) is activated during group-consistent decisions; emotion-processing networks (anterior cingulate cortex, insula, amygdala) regulate experiences of social acceptance and rejection; and mentalizing-related brain regions (dorsomedial prefrontal cortex, temporoparietal junction) support inference of others’ mental states and social information integration. These neural circuits work synergistically to achieve top-down multi-level modulation of perceptual decision making. Understanding the mechanisms by which social context shapes perceptual decision making has broad theoretical and practical implications. These insights inform the optimization of collective decision-making, the design of socially adaptive human-computer interaction systems, and interventions for cognitive disorders such as autism spectrum disorder and anorexia nervosa. Future studies should combine computational modeling and neuroimaging approaches to systematically investigate the multi-level and dynamic nature of social influences on perceptual decision making. 
		                        		
		                        		
		                        		
		                        	
6.mIgM-mediated splenic marginal zone B cells targeting of folic acid for immunological evasion.
Huan WANG ; Zhuxuan JIANG ; Zhiwei GUO ; Gan LUO ; Tianhao DING ; Changyou ZHAN
Acta Pharmaceutica Sinica B 2024;14(2):808-820
		                        		
		                        			
		                        			Folic acid is a fully oxidized synthetic folate with high bioavailability and stability which has been extensively prescribed to prevent congenital disabilities. Here we revealed the immunosuppressive effect of folic acid by targeting splenic marginal zone B (MZB) cells. Folic acid demonstrates avid binding with the Fc domain of immunoglobulin M (IgM), targeting IgM positive MZB cells in vivo to destabilize IgM-B cell receptor (BCR) complex and block immune responses. The induced anergy of MZB cells by folic acid provides an immunological escaping window for antigens. Covalent conjugation of folic acid with therapeutic proteins and antibodies induces immunological evasion to mitigate the production of anti-drug antibodies, which is a major obstacle to the long-term treatment of biologics by reducing curative effects and/or causing adverse reactions. Folic acid acts as a safe and effective immunosuppressant via IgM-mediated MZB cells targeting to boost the clinical outcomes of biologics by inhibiting the production of anti-drug antibodies, and also holds the potential to treat other indications that adverse immune responses need to be transiently shut off.
		                        		
		                        		
		                        		
		                        	
7.Recent advances in small-molecule inhibitors targeting influenza virus RNA-dependent RNA polymerase
Hui-nan JIA ; Rui-fang JIA ; Ji-wei ZHANG ; Yuan-min JIANG ; Chuan-feng LIU ; Ying ZHANG ; Xin-yong LIU ; Peng ZHAN
Acta Pharmaceutica Sinica 2024;59(1):43-60
		                        		
		                        			
		                        			 Influenza virus causes serious threat to human life and health. Due to the inherent high variability of influenza virus, clinically resistant mutant strains of currently approved anti-influenza virus drugs have emerged. Therefore, it is urgent to develop antiviral drugs with new targets or mechanisms of action. RNA-dependent RNA polymerase is directly responsible for viral RNA transcription and replication, and plays key roles in the viral life cycle, which is considered an important target of anti-influenza drug design. From the point of view of medicinal chemistry, this review summarizes current advances in diverse small-molecule inhibitors targeting influenza virus RNA-dependent RNA polymerase, hoping to provide valuable reference for development of novel antiviral drugs. 
		                        		
		                        		
		                        		
		                        	
8.Clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis
Yu GUAN ; Lei YANG ; Shi-Ru JIANG ; Wei-Dong DOU ; Jin-Gui WANG ; Shan-Wen CHEN ; Zhan-Bing LIU ; Ying-Chao WU
Medical Journal of Chinese People's Liberation Army 2024;49(1):23-30
		                        		
		                        			
		                        			Objective To identify the clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis(RCLM).Methods The clinical data of young RCLM patients at 45 years or under(n=40,as younger patient group)in Peking University First Hospital from January 2016 to January 2021 were reviewed,meanwhile,elder RCLM patient group were comprised of 82 patients older than 45-year-old in a 1:2 ratio.Proportions of categorical variables were compared between young patients and old patients.The clinicopathologic parameters were analyzed with univariate and multivariate Cox regression models and Kaplan-Meier method for demonstrating survival differences between the maximum diameter of liver metastasis and local therapy.Results One hundred and twenty-two RCLM patients were identified,the 1-,3-and 5-year survival rates of young patient group were 97.5%,47.5%,15.0%,those of elder patient group were 84.1%,26.8%,9.8%,respectively.The differences in BMI(P=0.008),primary tumor with obstruction and bleeding(P=0.006),synchronous rectal cancer liver metastases(P=0.005),the maximum diameter of liver metastasis>3 cm(P=0.019)were statistically significant between the two groups.And univariate and multivariate analyses showed that age(P=0.003),N stage(P=0.007),local therapy for liver metastases(P=0.047)and the maximum diameter of liver metastasis(P=0.030)were independent risk factors for influencing the prognosis of RCLM patients;curative resection or not of primary tumor(P=0.035)and the maximum diameter of liver metastasis(P=0.041)were independent risk factors for influencing the prognosis of young RCLM patients.Kaplan-Maier curve demonstrated survival differences between the maximum diameter of liver metastasis and local therapy for liver metastasis in RCLM patients(log-rank P=0.000).Conclusions Although with later staging of initial tumor station,young RCLM patients may obtain better survival benefit compared with old patients.Higher degree of lymph node metastasis,local therapy for liver metastases and the maximum diameter of liver metastasis>3 cm indicates poor prognosis in RCLM patients,and without curative resection of primary tumor and maximum diameter of liver metastasis are also considered as the independent poor prognostic factors of young RCLM patients.Local therapy for liver metastases appears to play an important role in the treatment strategy of RCLM patients.
		                        		
		                        		
		                        		
		                        	
9.Association Between V1 Lead r'Wave Amplitude and Impedance Changes With Left Bundle Branch Pacing Electrode Implantation Depth
Qianghui HUANG ; Yueping JIANG ; Biming ZHAN ; Qianwei HUANG ; Jinzhu HU
Chinese Circulation Journal 2024;39(3):273-278
		                        		
		                        			
		                        			Objectives:To explore the association between the r'wave amplitude in lead V1 and impedance changes with left bundle branch pacing electrode implantation depth. Methods:A total of 78 patients with normal heart structure and underwent left bundle branch area pacing(LBBAP)in the Second Affiliated Hospital of Nanchang University from January 1,2019 to December 31,2021 were included in this retrospective analysis.Baseline data,intraoperative and imaging data,and 3,6,9 and 12 months of follow-up results were collected.Correlation and regression analysis were performed to define the feasibility using the r'wave in lead V1 during pacing and impedance changes to estimate the electrode depth. Results:r'waves at the end of the QRS complex in lead V1 during pacing were found in 70 cases(89.7%),and 8 cases(10.3%)showed rS,RS type QRS waves,or no r'wave at the end.Correlation analysis showed that r'wave amplitude was positively correlated with electrode depth(r=0.424,P<0.01),negatively correlated with impedance(r=-0.256,P=0.03).There was no significant statistical correlation between electrode implantation depth and impedance(r=-0.132,P=0.27).Regression analysis found that electrode depth was an important factor affecting r'wave amplitude(regression coefficient=0.056,P=0.000).Combined with the established regression model and impedance,it was found that the amplitude of the r'wave in lead V1 is at the range of 0.24-0.69 mV,and the impedance ranges from 648.30 to 828.90 Ω,and the electrode implantation depth is 6-11 mm,which is most suitable.The risk of perforation is low,and the left bundle branch can be successfully captured with a high probability.The pacing parameters are satisfactory,and the pacing QRS wave duration is narrow.During the intraoperative,postoperative 48 hours,and 12-month follow-up period,the patient did not experience complications such as electrode perforation,thromboembolism,cardiac tamponade,infection,or wire dislocation. Conclusions:Left bundle branch region pacing is a safe and feasible pacing method.During LBBAP,the amplitude of the r'wave in lead V1 at the range of 0.24-0.69 mV,and the impedance ranges from 648.30 to 828.90 Ω can be used to guide the pacing in the left bundle branch region and reduce the risk of electrode perforation.
		                        		
		                        		
		                        		
		                        	
10.Establishment and validation of a risk prediction model combined CT-radiomics and clinical features for lymph node metastasis in hilar cholangiocarcinoma
Pengchao ZHAN ; Keyan LIU ; Xing LIU ; Hanyu JIANG ; Peijie LYU ; Jianbo GAO
Chinese Journal of Radiology 2024;58(4):409-415
		                        		
		                        			
		                        			Objective:To establish and validate a clinical and CT radiomics combined model for predicting lymph node metastasis (LNM) risk in patients with hilar cholangiocarcinoma (HCCA).Methods:This was a case-control study. Data from 158 pathologically confirmed HCCA patients between January 2016 and January 2022 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Using stratified random sampling, the patients were randomly divided into a training set ( n=95) and an internal validation set ( n=63) at a 6∶4 ratio. According to postoperative pathology, 31 LNM-positive cases and 64 LNM-negative cases were in the training set, and 22 LNM-positive cases and 41 LNM-negative cases were in the internal validation set. A cohort of 50 HCCA patients was retrospectively collected from West China Hospital of Sichuan University between October 2018 and June 2021 as an external validation set, including 21 LNM-positive and 29 LNM-negative cases. Clinical features were selected by multivariate logistic regression analysis to establish a clinical model. Radiomics features were extracted from portal venous phase CT images using 3D Slicer software. A radiomics model was developed using the least absolute shrinkage and selection operator regression algorithm. A clinical-radiomics model was constructed by integrating clinical features and Radscore, and a nomogram was developed. The prediction performance of models was evaluated by the area under the receiver operating characteristic curve (AUC). The AUC values were compared using the DeLong test. Calibration curves and decision curves were plotted to assess calibration and clinical net benefit. Results:Clinical N (cN) staging was an independent risk factor for LNM ( OR=6.86, 95% CI 2.70-18.49, P<0.001). Totally 12 optimal features were selected to construct the radiomics model, and the clinical-radiomics nomogram model was constructed by combining cN staging and Radscore. In the external validation set, the AUC (95% CI) of the clinical model, radiomics model, and clinical-radiomics nomogram were 0.706 (0.576-0.836), 0.768 (0.637-0.899), and 0.803 (0.680-0.926), respectively. The nomogram achieved higher AUC than clinical and radiomics models with statistical significance ( Z=2.01, 2.21; P=0.044, 0.027). The calibration and decision curves demonstrated good model fit, providing clinical net benefits for patients. Conclusion:The clinical-radiomics nomogram model combining cN staging and CT radiomics features can effectively predict LNM risk in HCCA patients.
		                        		
		                        		
		                        		
		                        	
            
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