bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance to Cholesterol Gallstone Disease: Hepatic Cholesterol Metabolism
Authors: Zhang Chenghao , Dai Wanlin , Yang Shaojie , Wu Shuodong , Kong Jing
Published: September 2023

Cholesterol gallstone disease (CGD) is one of the most common digestive diseases, and it is closely associated with hepatic cholesterol metabolism. Cholesterol gallstones may be caused by abnormal hepatic cholesterol metabolism, such as excessive cholesterol biosynthesis within the liver, interfering with the uptake or export of cholesterol in the liver, and abnormal hepatic cholesterol esterification. In this review, we begin with a brief overview of the clinical diagnosis and treatment of gallstone disease (GSD). Then, we briefly describe the major processes of hepatic cholesterol metabolism and summarize the key molecular expression changes of hepatic cholesterol metabolism in patients with gallstones. We review and analyze the recent advances in elucidating the relationships between these key molecules and CGD, and some targets significantly impacting on CGD via hepatic cholesterol metabolism are also listed. We also provide a significant discussion on the relationship between CGD and nonalcoholic fatty liver disease (NAFLD). Finally, the new discoveries of some therapeutic strategies associated with hepatic cholesterol metabolism to prevent and treat CGD are summarized.
Performance of a Nonlinear Magnetic Handheld Probe for Intraoperative Sentinel Lymph Node Detection: A Phantom Study
Authors: Nieuwenhuis Eliane R. , Mir Nida , Horstman-van de Loosdrecht Melissa M. , Meeuwis Antoi P. W. , de Bakker Maarten G. J. , Scheenen Tom W. J. , Alic Lejla
Published: September 2023

Objective

This study investigates the performance of the DiffMag handheld probe (nonlinear magnetometry), to be used for sentinel lymph node detection. Furthermore, the performance of DiffMag is compared with a gamma probe and a first-order magnetometer (Sentimag®, linear magnetometry).

Methods

The performance of all three probes was evaluated based on longitudinal distance, transverse distance, and resolving power for two tracer volumes. A phantom was developed to investigate the performance of the probes for a clinically relevant situation in the floor of the mouth (FOM).

Results

Considering the longitudinal distance, both DiffMag handheld and Sentimag® probe had comparable performance, while the gamma probe was able to detect at least a factor of 10 deeper. Transverse distances of 13, 11, and 51 mm were measured for the small tracer volume by the DiffMag handheld, Sentimag®, and the gamma probe, respectively. For the large tracer volume this was 21, 18, and 55 mm, respectively. The full width at half maximum, at 7 mm probe height from the phantom surface, was 14, 12, and 18 mm for the small tracer volume and 15, 18, and 25 mm for the large tracer volume with the DiffMag handheld, Sentimag®, and gamma probe, respectively.

Conclusions

With a high resolving power but limited longitudinal distance, the DiffMag handheld probe seems suitable for detecting SLNs which are in close proximity to the primary tumor. In this study, comparable results were shown using linear magnetometry. The gamma probe reached 10 times deeper, but has a lower resolving power compared with the DiffMag handheld probe.
Perfusion MRI in the evaluation of brain metastases: current practice review and rationale for study of baseline MR perfusion imaging prior to stereotactic radiosurgery (STARBEAM-X)
Authors: Dobeson Caroline Beverley , Birkbeck Matthew , Bhatnagar Priya , Hall Julie , Pearson Rachel , West Serena , English Philip , Butteriss David , Perthen Joanna , Lewis Joanne
Published: September 2023

Stereotactic radiosurgery is an established focal treatment for brain metastases with high local control rates. An important side-effect of stereotactic radiosurgery is the development of radionecrosis. On conventional MR imaging, radionecrosis and tumour progression often have similar appearances, but have contrasting management approaches. Perfusion MR imaging is often used in the post-treatment setting in order to help distinguish between the two, but image interpretation can be fraught with challenges.

Perfusion MR plays an established role in the baseline and post-treatment evaluation of primary brain tumours and a number of studies have concentrated on the value of perfusion imaging in brain metastases. Of the parameters generated, relative cerebral blood volume is the most widely used variable in terms of its clinical value in differentiating between radionecrosis and tumour progression. Although it has been suggested that the relative cerebral blood volume tends to be elevated in active metastatic disease following treatment with radiosurgery, but not with treatment-related changes, the literature available on interpretation of the ratios provided in the context of defining tumour progression is not consistent.

This article aims to provide an overview of the role perfusion MRI plays in the assessment of brain metastases and introduces the rationale for the STARBEAM-X study (Study of assessment of radionecrosis in brain metastases using MR perfusion extra imaging), which will prospectively evaluate baseline perfusion imaging in brain metastases. We hope this will allow insight into the vascular appearance of metastases from different primary sites, and aid in the interpretation of post-treatment perfusion imaging.
Air embolism after CT-guided localization of pulmonary ground-glass nodules
Authors: Sun Shi-long , Yang Zeng-jian , Sun Hong-liang , Huang Zhen-guo , Xu Yan-yan , Wang Yu-li , Gao Bao-xiang , Li Chuan-dong
Published: September 2023

Objective:

To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS).

Methods:

The data of all patients who received CT-guided localization of GGNs before VATS from May 2020 to October 2021 were retrospectively analyzed.

Results:

A total of 1395 consecutive patients with 1553 GGNs were enrolled. AEs occurred in seven patients (0.5%). In four of the seven patients with AE, the embolism was detected before the patients left the CT table and emergency treatments were carried out. Among them, one patient had chest tightness and unilateral limb dyskinesia, one patient had convulsions and transient loss of consciousness, and two patients had no definite clinical symptoms. After a short-term high-flow oxygen inhalation, the clinical symptoms of two patients with symptomatic AE disappeared and two patients with asymptomatic AE did not show any symptoms. In the remaining three patients with AE, the embolism were detected retrospectively when evaluating the images in the PACS for this study. Fortunately, these three patients never developed clinical symptoms related to AE. All seven patients with AE underwent VATS on the day of localization and all GGNs were successfully removed under the guidance of markers.

Conclusion:

The incidence of AE related to CT-guided localization of GGNs was 0.5%, which was significantly higher than expected. Post-localization whole thoracic CT should be performed and observed carefully so as to avoid missed AE and delayed treatment.

Advances in knowledge:

The incidence of AE related to CT-guided localization of GGNs was 0.5%. In order to timely detect AE, whole thoracic CT scan rather than local CT in the lesion area should be performed after localization. A small amount of AE may be missed if the post- localization CT images are not carefully observed.
Imaging findings of intraventricular pilocytic astrocytoma
Authors: Korkmazer Bora , Arslan Serdar , Onal Emine Meltem , Ozogul Murat , Urganci Nil , Isler Cihan , Comunoglu Nil , Kizilkilic Osman , Kocer Naci , Islak Civan
Published: September 2023

Objective

The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas (PAs).

Methods

16 patients with histopathological diagnosis of intraventricular PA between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as apparent diffusion coefficient (ADC) measurements were analyzed.

Results

Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20.8 years (2–44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15–92 mm). 9 out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T1W and hyperintense in T2W images. The mean ADC value of PAs was 1.57 × 10−3 ± 0.2 mm2/s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10-3 ± 0.04 and 0.76 × 10-3 ± 0.06 mm2/s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter (p < 0.001).

Conclusion

PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular PAs are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely.

Advances in knowledge

PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.
Differences between left adrenal vein sampling sites revealed with segmental sampling in primary aldosteronism
Authors: Tannai Hiromitsu , Makita Kohzoh , Nakai Kazuki , Sato Yuko , Tsurutani Yuya , Saito Jun , Matsui Seishi , Nishikawa Tetsuo
Published: September 2023

Objectives:

To clarify the differences between two left sampling sites (left adrenal central vein [LCV] and common trunk [CMT], conjunction with LCV and inferior phrenic vein) and their impact on adrenal venous sampling (AVS) in primary aldosteronism by analyzing the results of segmental AVS (sAVS).

Methods:

We retrospectively analyzed a final cohort of 432 patients who underwent cosyntropin-stimulated sAVS from 2017 to 2020. Hormone levels in the LCV and the CMT were compared. Subtype diagnosis was based on the lateralization index with LCV and CMT sampling (a cutoff value of 4) and sAVS after excluding patients with a selectivity index (SI) <3.

Results:

Compared with the LCV, CMT sampling showed significantly lower aldosterone and cortisol levels and a higher proportion of cases with an SI of <3 (2.8% vs 0.5%, p = 0.025) and <5 (6.9% vs 0.5%, p < 0.001), while the aldosterone-to-cortisol ratio and the lateralization index were not significantly different. Subtyping of both sites was concordant in 94.7% (393/415) and discordant in the remainder, which included left and right aldosterone-producing adenoma and idiopathic hyperaldosteronism cases referring to the sAVS. There was no significant difference between the concordance rate of the two sampling sites based on the sAVS diagnosis.

Conclusions:

LCV sampling meets the SI criteria for successful AVS more frequently compared with CMT sampling, but neither was better than the other in terms of diagnosis under conditions of meeting the criteria.

Advances in knowledge:

LCV sampling would decrease the number of cases judged as AVS failure.
Fat quantification of the rotator cuff muscles using CT histogram analysis in comparison with Dixon MRI sequence
Authors: Oh Jiseon , Yoo Hye Jin , Chae Hee Dong , Choi Ja-Young , Hong Sung Hwan
Published: September 2023

Objectives:

To quantify the proportion of fat within the rotator cuff muscles using CT histogram analysis (HA) and to compare fat fraction (FF) values obtained from CT and T2*-corrected 6-echo three-dimensional gradient-echo Dixon sequences.

Methods:

Twenty-six patients who underwent both shoulder CT and MRI were enrolled. The FF of rotator cuff muscles was measured on FF maps of the Dixon technique. Using CT, the FF values were obtained in two ways: 1) CT mean Hounsfield Unit (HU) measurement-based fat quantification using subcutaneous fat and the teres major muscle as internal standards; and 2) CT HA-based fat quantification in which pixels from −190 to −30 HU were arbitrarily classified as fat, and those from −30 to 150 HU as muscle. Afterward, the relationship between FF values from MRI (FF-MR), CT mean HU-based analysis (FF-HU), and CT HA (FF-HA) was assessed.

Results:

There were strong positive correlations (p < 0.001) between FF-MR and FF-HA, which were higher when compared with FF-HU (r = 0.90 vs. 0.77 for total). For a total of 104 rotator cuff muscles, the intraclass correlation between FF-MR and FF-HA was excellent (ICC, 0.90), which was higher than that between FF-MR and FF-HU (ICC, 0.76). The ICCs showed excellent interobserver agreement between FF-MR, FF-HU, and FF-HA (ICCs, 0.93–0.96).

Conclusions:

Fat quantification within the rotator cuff muscles using CT HA is both feasible and reliable.

Advances in knowledge:

CT HA provides reliable quantification of intramuscular fat and has strengths regarding its retrospective applicability to conventional CT studies without additional radiation dose to subjecting patients.
Multimodal imaging-based material mass density estimation for proton therapy using supervised deep learning
Authors: Chang Chih-Wei , Marants Raanan , Gao Yuan , Goette Matthew , Scholey Jessica E , Bradley Jeffrey D , Liu Tian , Zhou Jun , Sudhyadhom Atchar , Yang Xiaofeng
Published: September 2023

Objective

Mapping CT number to material property dominates the proton range uncertainty. This work aims to develop a physics-constrained deep learning-based multimodal imaging (PDMI) framework to integrate physics, deep learning, MRI, and advanced dual-energy CT (DECT) to derive accurate patient mass density maps.

Methods:

Seven tissue substitute MRI phantoms were used for validation including adipose, brain, muscle, liver, skin, spongiosa, 45% hydroxyapatite (HA) bone. MRI images were acquired using T1 weighted Dixon and T2 weighted short tau inversion recovery sequences. Training inputs are from MRI and twin-beam dual-energy images acquired at 120 kVp with gold/tin filters. The feasibility investigation included an empirical model and four residual networks (ResNet) derived from different training inputs and strategies by PDMI framework. PRN-MR-DE and RN-MR-DE denote ResNet (RN) trained with and without a physics constraint (P) using MRI (MR) and DECT (DE) images. PRN-DE stands for RN trained with a physics constraint using only DE images. A retrospective study using institutional patient data was also conducted to investigate the feasibility of the proposed framework.

Results:

For the tissue surrogate study, PRN-MR-DE, PRN-DE, and RN-MR-DE result in mean mass density errors: −0.72%/2.62%/−3.58% for adipose; −0.03%/−0.61%/−0.18% for muscle; −0.58%/−1.36%/−4.86% for 45% HA bone. The retrospective patient study indicated that PRN-MR-DE predicted the densities of soft tissue and bone within expected intervals based on the literature survey, while PRN-DE generated large density deviations.

Conclusion

The proposed PDMI framework can generate accurate mass density maps using MRI and DECT images. The supervised learning can further enhance model efficacy, making PRN-MR-DE outperform RN-MR-DE. The patient investigation also shows that the framework can potentially improve proton range uncertainty with accurate patient mass density maps.

Advances in knowledge:

PDMI framework is proposed for the first time to inform deep learning models by physics insights and leverage the information from MRI to derive accurate mass density maps.
SpaceOAR hydrogel distribution and early complications in patients undergoing radiation therapy for prostate cancer
Authors: Yates Andrew H , Power Jack W , Dempsey Philip J , Agnew Adam , Murphy Brian D , Moore Richard , El Bassiouni Mazen , McNicholas Michelle M J
Published: September 2023

Objectives:

Hydrogel spacers aim to separate the rectum from the prostate during radiation therapy for patients with prostate cancer to decrease the radiation dose and thus toxicity to the rectum. The aim of this study was to evaluate the distribution of the hydrogel spacer between the rectum and the prostate, to assess for hydrogel rectal wall infiltration and to assess for immediate complications

Methods:

Retrospective study of 160 patients who had undergone hydrogel spacer placement. Distribution of the hydrogel was assessed on MRI. MRI images were reviewed for rectal wall injection or other malplacement of gel. Early post-procedure complications were recorded.

Results:

117 (73.1%) patients had a symmetrical distribution of the hydrogel spacer. The mean anteroposterior rectoprostatic separation was 10.2 ± 3.7 mm (range 0–27 mm). Seven (4.3%) patient had minimal rectal wall infiltration and one (0.6%) patient had moderate infiltration. One (0.6%) patient had an intraprostatic injection of hydrogel. Two (1.3%) patients required treatment in the emergency department: one for urinary retention and one for pain.

Conclusions:

Transperineal hydrogel placement separates the prostate from the rectum with a symmetrical distribution in the majority of cases prior to radiation therapy with a low rate of rectal wall injection and immediate complications.

Advances in knowledge:

SpaceOAR hydrogel can be safely injected into radiation naive patients with low- or intermediate-risk organ-confined prostate cancer. The spacer separates the prostate from the rectum with a symmetrical distribution in the majority of cases prior to radiation therapy.
The kinetic quantitative characteristics of non-mass breast lesions with contrast-enhanced ultrasound: a prospective study
Authors: Cai Ying-Yu , Du Yi-Chao , Zhao Lei , Hu Wen-Jie , Bai Yun , Chen An , Du Lian-Fang , Li Fan
Published: September 2023

Objective

To characterize non-mass breast lesions (NML) quantitatively by contrast-enhanced ultrasound (CEUS) and to evaluate its additional diagnostic value based on the Breast Imaging Reporting and Data System (BI-RADS) categories.

Methods

A prospective study was performed among consecutive patients with NMLs. All lesions were examined by grayscale ultrasound and CEUS and diagnosed on pathology. Standard mammograms were obtained in the patients over 30 years old. Three independent radiologists assessed the features on grayscale ultrasound and mammograms and classified NMLs according to BI-RADS categories. Combined with the quantitative analysis in CEUS, the BI-RADS categories were reassessed, and the sensitivity, specificity, positive-predictive value, negative-predictive value and area under the receiver operating characteristic curve (AUC) were calculated for the evaluation of the diagnostic performance.

Results:

30 benign and 24 malignant NMLs were finally enrolled in this study, with ductal carcinoma in situ being the majority of malignant (15/24). Average contrast signal intensity (AI), wash-in rate (WiR) and enhancement intensity at 40 s (I40) were found to be the most efficient kinetic parameters to diagnose malignant NMLs. Combined with the cut-off values of 205.2 for AI, 127.8 for WiR and 136.4 for I40, the diagnostic accuracy was improved (AUC = 0.904), with the sensitivity of 95.8% and the specificity of 70.0%.

Conclusion

The results suggested that hyperenhancement and rapid wash-in and wash-out are the characteristics of malignant NMLs. The kinetic analysis using CEUS can reflect hypervascular nature of malignant NMLs, thus improving the diagnostic performance combined with grayscale ultrasound.

Advances in knowledge:

In this study, we quantified the enhancement characteristics of non-mass breast lesions with CEUS. We revealed that the combination of CEUS and conventional ultrasound provided higher sensitivity for diagnosing malignant NMLs.
Multisequence MRI-based radiomics model for predicting POLE mutation status in patients with endometrial cancer
Authors: Lin Zijing , Gu Weiyong , Guo Qinhao , Xiao Meiling , Li Rong , Deng Lin , Li Ying , Cui Yanfen , Li Haiming , Qiang Jinwei
Published: September 2023

Objectives:

Preoperative identification of POLE mutation status would help tailor the surgical procedure and adjuvant treatment strategy. This study aimed to explore the feasibility of developing a radiomics model to pre-operatively predict the pathogenic POLE mutation status in patients with EC.

Methods:

The retrospective study involved 138 patients with histopathologically confirmed EC (35 POLE-mutant vs 103 non-POLE-mutant). After selecting relevant features with a series of steps, three radiomics signatures were built based on axial fat-saturation T2WI, DWI, and CE-T1WI images, respectively. Then, two radiomics models which integrated features from T2WI + DWI and T2WI + DWI+CE-T1WI were further developed using multivariate logistic regression. The performance of the radiomics model was evaluated from discrimination, calibration, and clinical utility aspects.

Results:

Among all the models, radiomics model2 (RM2), which integrated features from all three sequences, showed the best performance, with AUCs of 0.885 (95%CI: 0.828–0.942) and 0.810 (95%CI: 0.653–0.967) in the training and validation cohorts, respectively. The net reclassification index (NRI) and integrated discrimination improvement (IDI) analyses indicated that RM2 had improvement in predicting POLE mutation status when compared with the single-sequence-based signatures and the radiomics model1 (RM1). The calibration curve, decision curve analysis, and clinical impact curve suggested favourable calibration and clinical utility of RM2.

Conclusions:

The RM2, fusing features from three sequences, could be a potential tool for the non-invasive preoperative identification of patients with POLE-mutant EC, which is helpful for developing individualized therapeutic strategies.

Advances in knowledge:

This study developed a potential surrogate of POLE sequencing, which is cost-efficient and non-invasive.
Histogram-based analysis in progressive pulmonary fibrosis: relationships between pulmonary functional tests and HRCT indexes
Authors: Palmucci Stefano , Tiralongo Francesco , Galioto Federica , Toscano Stefano , Reali Linda , Scavone Carlotta , Fazio Giulia , Ferlito Agata , Sambataro Gianluca , Vancheri Ada , Sciacca Enrico , Vignigni Giovanna , Spadaro Carla , Mauro Letizia Antonella , Foti Pietro Valerio , Vancheri Carlo , Basile Antonio
Published: September 2023

Objectives:

To investigate relationships between histogram-based high-resolution CT (HRCT) indexes and pulmonary function tests (PFTs) in interstitial lung diseases.

Methods:

Forty-nine patients having baseline and 1-year HRCT examinations and PFTs were investigated. Histogram-based HRCT indexes were calculated; strength of associations with PFTs was investigated using Pearson correlation. Patients were divided into progressive and non-progressive groups. HRCT indexes were compared between the two groups using the U-test; within each group, baseline and follow-up Wilcoxon analysis was performed. Receiver operating characteristic analysis was used for predicting disease progression.

Results:

At baseline, moderate correlations were observed considering kurtosis and diffusion capacity of the lungs for carbon monoxide (DLCO) (r = 0.54) and skewness and DLCO (r = 0.559), whereas weak but significant correlations were observed between forced vital capacity and kurtosis (r = 0.368, p = 0.009) and forced vital capacity and skewness (r = 0.391, p = 0.005). Negative correlations were reported between HAA% and PFTs (from r = −0.418 up to r = −0.507). At follow-up correlations between quantitative indexes and PFTs were also moderate, except for high attenuation area (HAA)% −700 and DLCO (r = −0.397). In progressive subgroup, moderate and strong correlations were found between DLCO and HRCT indexes (r = 0.595 kurtosis, r = 0.672 skewness, r=-0. 598 HAA% −600 and r = −0.626 HAA% −700). At follow-up, we observed significant differences between the two groups for kurtosis (p = 0.029), HAA% −600 (p = 0.04) and HAA% −700 (p = 0.02). To predict progression, ROC analysis reported sensitivity of 90.9% and specificity of 51.9% using a threshold value of δ kurtosis <0.03.

Conclusion:

At one year, moderate correlations suggest that progression could be assessed through HRCT quantification.

Advances in knowledge:

This study promotes histogram-based HRCT indexes in the assessment of progressive pulmonary fibrosis.
MRI features to aid the identification of lateral temporal bone cephaloceles
Authors: Srinivasan Rohit , Obholzer Rupert J , Connor Steve EJ
Published: September 2023

Objectives:

To evaluate ancillary MRI features which may aid the identification of lateral temporal bone cephaloceles (LTBCs).

Methods:

A retrospective cohort study analysed patients with MRI evidence of surgically confirmed spontaneous LTBCs as defined by intracranial contents traversing the tegmen tympani or mastoideum. Cases were identified from radiology and surgical databases. Two observers analysed three-dimensional T  2W temporal bone and whole brain imaging according to a priori criteria by consensus, with emphasis on the relationship of any adjacent cerebrospinal fluid (CSF) cleft to the defect. The contents, location, and clinical features of the LTBCs were recorded.

Results:

Eighteen patients (11 female, 7 male; mean age 59.3 years, age range 42–86 years) with 20 surgically confirmed spontaneous LTBCs (2 bilateral;16 unilateral) were evaluated. A temporal lobe sulcus or other CSF cleft extending to or traversing the defect was identified in 19/20 (95%) cases. Isointense CSF tympanomastoid signal was present in 41.2% cases, whilst superior semi-circular canal dehiscence was found in 40% of cephaloceles. At least two MRI features of idiopathic intracranial hypertension were seen in 38.9% patients. Cephaloceles were most commonly centred on the tegmen tympani (55%). Meningoencephaloceles were present in 95% cases.

Conclusion:

A temporal lobe sulcus or CSF cleft extending to or traversing the defect may aid the identification of LTBCs. Isointense CSF tympanomastoid signal, superior semi-circular canal dehiscence and MRI features of idiopathic intracranial hypertension are only present in under half of LTBCs.

Advances in knowledge:

The study details novel ancillary MRI features of LTBCs which may aid their identification.
Transarterial chemoembolization plus lenvatinib with or without a PD-1 inhibitor for advanced and metastatic intrahepatic cholangiocarcinoma: a retrospective real-world study
Authors: Ning Zhouyu , Xie Lin , Yan Xia , Hua Yongqiang , Shi Weidong , Lin Junhua , Xu Litao , Meng Zhiqiang
Published: September 2023

Objectives:

Most patients with intrahepatic cholangiocarcinoma (ICC) present with locally advanced or metastatic disease. We report the combined potency of transarterial chemoembolization (TACE), lenvatinib and programmed cell death-1 (PD-1) inhibitors in patients with advanced and metastatic ICC.

Methods:

This retrospective study enrolled 32 patients with advanced or metastatic ICC between January 2017 and August 2021. Eligible patients had received gemcitabine-based TACE combined with lenvatinib with or without PD-1 inhibitor in any line of treatment. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Risk factors associated with OS were assessed using univariate and multivariate Cox regression analyses.

Results:

Eighteen patients received a combination of TACE and lenvatinib (TL group) and 14 patients received TACE and lenvatinib plus aPD-1 inhibitor (TLP group). The median follow-up time was 19.8 months (range 1.8–37.8). The median OS was 25.3 months (95% CI 18.5–32.1) and the median PFS was 7.3 months (95% CI 4.9–9.7). Partial response was achieved in 10 patients (31.3%), and stable disease in 13 (40.6 %) with disease control rate of 71.9%. The median OS was comparable in the TL and TLP groups (22.4 vs 27.3 months, respectively; hazard ratio: 1.245, 95% CI 0.4245–3.653; p = 0.687). The regression analysis revealed that, regardless of treatment group, a favorable independent prognostic factor for OS was HBV/HCV infection (HR: 0.063, 95% CI 0.009–0.463; p = 0.007). There were no treatment-related deaths and 81.3% of study participants experienced adverse events (AEs), the majority of which were of moderate severity (71.8% Grade 1–2).

Conclusions:

Gemcitabine-based TACE plus lenvatinib with or without aPD-1 inhibitor was well tolerated and provided promising therapeutic outcomes for patients with advanced and metastatic ICC.

Advances in knowledge:

Monotherapy with TACE, or Lenvatinib, or PD-1 inhibitors has shown limited efficacy over standard first-line chemotherapy in advanced and metastatic ICC. This work suggested the combined potency of these treatments and well-tolerance.
Pearls and pitfalls of structured staging and reporting of rectal cancer on MRI: an international multireader study
Authors: el Khababi Najim , Beets-Tan Regina GH , Curvo-Semedo Luís , Tissier Renaud , Nederend Joost , Lahaye Max J , Maas Monique , Beets Geerard L , Lambregts Doenja MJ
Published: September 2023

Objectives:

To investigate uniformity and pitfalls in structured radiological staging of rectal cancer.

Methods:

Twenty-one radiologists (12 countries) staged 75 rectal cancers on MRI using a structured reporting template. Interobserver agreement (IOA) was calculated as the percentage agreement between readers (categorical variables) and Krippendorff’s α (continuous variables). Agreement with an expert consensus served as a surrogate standard of reference to estimate diagnostic accuracy. Polychoric correlation coefficients were used to assess correlations between diagnostic confidence and accuracy (=agreement with expert consensus).

Results:

Uniformity to diagnose high-risk (≥cT3 ab) versus low-risk (≤cT3 cd) cT-stage, cN0 versus cN+, lateral nodes and tumour deposits, MRF and sphincter involvement, and solid versus mucinous tumours was high with IOA > 80% in the majority of cases (and >80% agreement with expert consensus). Results for assessing extramural vascular invasion, cT-stage (cT1-2/cT3/cT4a/cT4b), cN-stage (cN0/N1/N2), relation to the peritoneal reflection, extent of sphincter involvement (internal/intersphincteric/external) and morphology (solid/annular/semi-annular) were considerably poorer. IOA was high (α = 0.72–0.84) for tumour height/length and extramural invasion depth, but low for tumour-MRF distance and number of (suspicious) nodes (α = 0.05–0.55). There was a significant positive correlation between diagnostic confidence and accuracy (=agreement with expert consensus) (p < 0.001-p = 0.003).

Conclusions:

- Several staging items lacked sufficient reproducibility.

- Results for cT- and N-staging g improved when using a dichotomized stratification.

- Considering the significant correlation between diagnostic confidence and accuracy, a confidence level may be incorporated into structured reporting for specific items with low reproducibility.

Advances in knowledge:

Although structured reporting aims to achieve uniformity in reporting, several items lack sufficient reproducibility and might benefit from dichotomized assessment and incorporating confidence levels.
Modelling the influence of radiosensitivity on development of second primary cancer in out-of-field organs following proton therapy for paediatric cranial cancer
Authors: Dell'Oro Mikaela , Wilson Puthenparampil , Short Michala , Peukert Dylan , Bezak Eva
Published: September 2023

Objective:

Radiobiological modelling the risks of second primary cancer (SPC) after proton therapy (PT) for childhood cranial cancer remains largely unknown. Organ-specific dose-response risk factors such as radiosensitivity require exploration. This study compared the influence of radiosensitivity data (slope of βEAR) on children’s lifetime attributable risks (LAR) of SPC development in out-of-field organs following cranial scattering and scanning PT.

Methods:

Out-of-field radiosensitivity parameter estimates for organs (α/β and βEAR) were sourced from literature. Physical distances for 13 out-of-field organs were measured and input into Schneider’s SPC model. Sensitivity analyses were performed as a function of radiosensitivity (α/β of 1–10 Gy) and initial slope (βEAR) from Japanese/UK data to estimate the influence on the risk of radiation-induced SPC following scattering and scanning PT.

Results:

Models showed similar LAR of SPC estimates for age and sex-matched paediatric phantoms, however, for breast there was a significant increase using Japanese βEAR data. For most organs, scattering PT demonstrated a larger risk of LAR for SPC which increased with α/β.

Conclusion:

Breast tissue exhibited the highest susceptibility in calculated LAR risk, demonstrating the importance for accurate data input when estimating LAR of SPC.

Advances in knowledge:

The findings of this study demonstrated younger female patients undergoing cranial proton therapy have a higher risk of developing second primary cancer of the breast tissue. Long-term multicenter registries are important to improve predictive radiobiological modelling studies of side effects.
Differences and similarities in false interpretations by AI CAD and radiologists in screening mammography
Authors: Salim Mattie , Dembrower Karin , Eklund Martin , Smith Kevin , Strand Fredrik
Published: September 2023

Objective:

We aimed to evaluate the false interpretations between artificial intelligence (AI) and radiologists in screening mammography to get a better understanding of how the distribution of diagnostic mistakes might change when moving from entirely radiologist-driven to AI-integrated breast cancer screening.

Methods and materials:

This retrospective case–control study was based on a mammography screening cohort from 2008 to 2015. The final study population included screening examinations for 714 women diagnosed with breast cancer and 8029 randomly selected healthy controls. Oversampling of controls was applied to attain a similar cancer proportion as in the source screening cohort. We examined how false-positive (FP) and false-negative (FN) assessments by AI, the first reader (RAD 1) and the second reader (RAD 2), were associated with age, density, tumor histology and cancer invasiveness in a single- and double-reader setting.

Results:

For each reader, the FN assessments were distributed between low- and high-density females with 53 (42%) and 72 (58%) for AI; 59 (36%) and 104 (64%) for RAD 1 and 47 (36%) and 84 (64%) for RAD 2. The corresponding numbers for FP assessments were 1820 (47%) and 2016 (53%) for AI; 1568 (46%) and 1834 (54%) for RAD 1 and 1190 (43%) and 1610 (58%) for RAD 2. For ductal cancer, the FN assessments were 79 (77%) for AI CAD; with 120 (83%) for RAD 1 and with 96 (16%) for RAD 2. For the double-reading simulation, the FP assessments were distributed between younger and older females with 2828 (2.5%) and 1554 (1.4%) for RAD 1 + RAD 2; 3850 (3.4%) and 2940 (2.6%) for AI+RAD 1 and 3430 (3%) and 2772 (2.5%) for AI+RAD 2.

Conclusion:

The most pronounced decrease in FN assessments was noted for females over the age of 55 and for high density-women. In conclusion, AI could have an important complementary role when combined with radiologists to increase sensitivity for high-density and older females.

Advances in knowledge:

Our results highlight the potential impact of integrating AI in breast cancer screening, particularly to improve interpretation accuracy. The use of AI could enhance screening outcomes for high-density and older females.
Artificial intelligence (AI) and machine learning (ML) in precision oncology: a review on enhancing discoverability through multiomics integration
Authors: Wei Lise , Niraula Dipesh , Gates Evan D H , Fu Jie , Luo Yi , Nyflot Matthew J , Bowen Stephen R , El Naqa Issam M , Cui Sunan
Published: September 2023

Multiomics data including imaging radiomics and various types of molecular biomarkers have been increasingly investigated for better diagnosis and therapy in the era of precision oncology. Artificial intelligence (AI) including machine learning (ML) and deep learning (DL) techniques combined with the exponential growth of multiomics data may have great potential to revolutionize cancer subtyping, risk stratification, prognostication, prediction and clinical decision-making.

In this article, we first present different categories of multiomics data and their roles in diagnosis and therapy. Second, AI-based data fusion methods and modeling methods as well as different validation schemes are illustrated. Third, the applications and examples of multiomics research in oncology are demonstrated. Finally, the challenges regarding the heterogeneity data set, availability of omics data, and validation of the research are discussed. The transition of multiomics research to real clinics still requires consistent efforts in standardizing omics data collection and analysis, building computational infrastructure for data sharing and storing, developing advanced methods to improve data fusion and interpretability, and ultimately, conducting large-scale prospective clinical trials to fill the gap between study findings and clinical benefits.
The assessment of pathological response to neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with DCE-MRI and DWI: a systematic review and meta-analysis
Authors: Zong Ruilong , Ma Xijuan , Shi Yibing , Geng Li
Published: September 2023

Objective:

The purpose of this meta-analysis was to determine the value of dynamic contrast-enhanced-MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in evaluating the pathological response of muscle invasive bladder cancer (MIBC) to neoadjuvant chemotherapy (NAC), and further indirectly compare the diagnostic performance of DCE-MRI and DWI.

Methods:

Literatures associated to DCE-MRI and DWI in the evaluation of pathological response of MIBC to NAC were searched from PubMed, Cochrane Library, web of science, and EMBASE databases. The quality assessment of diagnostic accuracy studies 2 tool was used to assess the quality of studies. Pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curves (AUC) with their 95% confidence intervals (CIs) were calculated to evaluate the diagnostic performance of DCE-MRI and DWI in predicting the pathological response to NAC in patients with MIBC.

Results:

There were 11 studies involved, 6 of which only underwent DCE- MRI examination, 4 of which only underwent DWI examination, and 1 of which underwent both DCE- MRI and DWI examination. The pooled SE, SP, PLR, NLR, DOR of DCE-MRI were 0.88 (95% CI: 0.78–0.93), 0.88 (95% CI: 0.67–0.96), 7.4 (95% CI: 2.3–24.2), 0.14 (95% CI: 0.07–0.27), and 53 (95% CI: 10–288), respectively. The pooled SE, SP, PLR, NLR, DOR of DWI were 0.83 (95% CI: 0.75–0.88), 0.88 (95% CI: 0.81–0.93), 7.1 (95% CI: 4.3–11.7), 0.20 (95% CI: 0.14–0.28), and 36 (95% CI:18–73), respectively. The AUCs of SROC curve for DCE-MRI and DWI were 0.93 (95% CI: 0.91–0.95) and 0.92 (95% CI: 0.89–0.94), respectively. There were no significant differences between DWI and DCE-MRI for SE, SP, and AUC.

Conclusion:

This meta-analysis demonstrated high diagnostic performance of both DCE-MRI and DWI in predicting the pathological response to NAC in MIBC. DWI might be a potential substitute for DCE-MRI, with no significant difference in diagnostic performance between the two. However, caution should be taken when applying our results, as our results were based on indirect comparison.

Advances in knowledge:

No previous studies have comprehensively analysed the value of DCE-MRI and DWI in evaluating the pathological response to NAC in MIBC. According to the current study, both DCE-MRI and DWI yielded high diagnostic performance, with the AUCs of 0.93 and 0.92, respectively. Indirect comparison no significant difference in the diagnostic performanceof DCE-MRI and DWI.
Repeatability of quantitative individual lesion and total disease multiparametric whole-body MRI measurements in prostate cancer bone metastases
Authors: Donners Ricardo , Candito Antonio , Blackledge Matthew , Rata Mihaela , Messiou Christina , Koh Dow-Mu , Tunariu Nina
Published: September 2023

Objectives:

To assess the repeatability of quantitative multiparametric whole-body MRI (mpWB-MRI) parameters in advanced prostate cancer (APC) bone metastases.

Methods:

1.5T MRI was performed twice on the same day in 10 APC patients. MpWB-MRI-included diffusion weighted imaging (DWI) and T1-weighted gradient-echo 2-point Dixon sequences. ADC and relative fat-fraction percentage (rFF%) maps were calculated, respectively. A radiologist delineated up to 10 target bone metastases per study. Means of ADC, b900 signal intensity(SI), normalised b900 SI, rFF% and maximum diameter (MD) for each target lesion and overall parameter averages across all targets per patient were recorded. The total disease volume (tDV in ml) was manually delineated on b900 images and mean global (g)ADC was derived. Bland-Altman analyses were performed with calculation of 95% repeatability coefficients (RC).

Results:

Seventy-three individual targets (median MD 26 mm) were included. Lesion mean ADC RC was 12.5%, mean b900 SI RC 137%, normalised mean b900 SI RC 110%, rFF% RC 3.2 and target MD RC 5.5 mm (16.3%). Patient target lesion average mean ADC RC was 6.4%, b900 SI RC 104% and normalised mean b900 SI RC 39.6%. Target average rFF% RC was 1.8, average MD RC 1.3 mm (4.8%). tDV segmentation RC was 6.4% and mean gADC RC 5.3%.

Conclusions:

APC bone metastases’ ADC, rFF% and maximum diameter, tDV and gADC show good repeatability.

Advances in knowledge:

APC bone metastases’ mean ADC and rFF% measurements of single lesions and global disease volumes are repeatable, supporting their potential role as quantitative biomarkers in metastatic bone disease.
Ultrasound-guided interventions in primary carpal tunnel syndrome: perineural injection to thread carpal tunnel release
Authors: Kumar Nishith , Chandan Shishir Kumar , Jalan Divesh , Sinha Skand , Jaiswal Binita , Singh Dharmendra Kumar
Published: September 2023

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and electrophysiological study are complementary in the diagnosis and grading of CTS in appropriate clinical settings. The initial management of patients with CTS is conservative with medical therapy and splinting. However, surgical interventions are indicated in patients in whom medical management has failed. With evolution of the concept of safe zone on ultrasonography and identification of the sonoanatomical landmarks of carpal tunnel in greater detail, Ultrasonography-guided interventions are safer and preferred over surgical management in CTS. The primary ultrasonography-guided interventions include perineural injection, perineural hydrodissection and ultrasonography-guided release of transverse carpal ligament. This review article presents the principles of ultrasonography-guided perineural injection, perineural hydrodissection in CTS, the merits and demerits of injectant used in perineural injection/ hydrodissection, and percutaneous ultrasonography-guided thread release of transverse carpal ligament utilizing the concept of safe zone of the ultrasonography-guided interventions for CTS.
Relação líder-membro na identidade organizacional dos docentes
Authors: Lizote Suzete Antonieta , Batista Marcos Aurélio
Published: September 2023

Este estudo objetivou mensurar a relação entre a troca líder-membro e a identidade organizacional na percepção dos docentes de uma universidade comunitária. A pesquisa de natureza descritiva, teve abordagem quantitativa, sendo aplicado um questionário de autopreenchimento com base no modelo de Liden e Maslyn (1998) para a Teoria da Troca Líder-membro e a escala de Mael e Ashforth (1992) para a Identidade Organizacional. Os respondentes foram 252 docentes de uma universidade comunitária do sul do Brasil. Os resultados mostraram que a existe relação entre liderança de troca e identidade organizacional, evidenciando o papel do líder na construção da identidade organizacional.
Relações entre marca eleitoral e decisão do voto
Authors: Costa Gonzaga Silva Waléria Taise , Franco D'anjour Miler , Campelo Medeiros Bruno
Published: September 2023

A pesquisa analisou as relações entre a marca eleitoral e a decisão de voto de estudantes em uma instituição federal de ensino. Desta forma foi realizada uma survey aplicada com 126 estudantes eleitores. Como resultados, foi possível identificar a existência de um fator para a influência da marca e três fatores para decisão de voto. A análise através da função canônica possibilitou identificar estatisticamente a influência que a marca exerce sobre a decisão do voto, sendo esta relação estatisticamente significante a 1%, a qual exerceu um impacto positivo sobre a decisão do voto.
Ontologia e epistemologia para estudos de estratégia baseados em prática
Authors: Fedato Geovana
Published: September 2023

Este ensaio teórico tem o objetivo de analisar os pressupostos ontológicos e epistemológicos da abordagem filosófica da prática de Theodore Schatzki e as implicações para estudar o acontecimento da estratégia na organização. A utilização da abordagem filosófica de Schatzki, para os estudos em estratégia baseados em prática, apresenta avanços em dois aspectos principais: i) reconhecimento das práticas constituídas formalmente na organização e as emergentes, que podem moldar os resultados estratégicos, e a rede de práticas que compõe este evento e ii) análise do estrategista como um corpo/mente que “carrega” e “realiza” práticas sociais e usa seu know-how e conhecimento de acordo com a prática que participa.
Efetividade dos eventos de inovação e empreendedorismo
Authors: Katiuça Patel Kelly , Zanella Cleunice , Dalmutt Kruger Silvana
Published: September 2023

O estudo tem por objetivo analisar a efetividade dos eventos de inovação promovidos na região Oeste de Santa Catarina. A coleta de dados deu-se a partir de entrevistas semiestruturadas e questionários, com uma amostra de 140 respondentes. Os resultados sinalizam a falta de engajamento entre os atores do ecossistema de inovação observado, muitas startups idealizadas não conseguem ser viabilizadas por falta de estrutura, investimentos e até engajamento dos sócios. De forma geral, os eventos promovem a mobilização para a cultura empreendedora local, no entanto falta maturidade para o ecossistema aumentar a efetividade das startups idealizadas nos eventos de inovação.
Governança corporativa
Authors: Ribeiro Henrique César Melo
Published: September 2023

O objetivo desta pesquisa foi investigar o comportamento e a tendência da formação das redes sociais e da produção científica do tema Governança Corporativa divulgada nos periódicos científicos indexados na biblioteca eletrônica SPELL, desde o escândalo da Enron em 2001. Utilizou-se as técnicas bibliométricas e sociometricas em 1.121 artigos. Constatou-se: as redes das palavras-chave evidenciam os temas: auditoria, bibliometria, BM&Fbovespa, Brasil, conselho de administração, desempenho, disclosure, divulgação, empresas brasileiras, empresas familiares, estratégia, estrutura de propriedade, evidenciação, gerenciamento de resultados, governança, mercado de capitais, responsabilidade social corporativa, risco, sustentabilidade, teoria da agência, transparência e valor de mercado.
Predisposição de empresas inovadoras à inovação frugal
Authors: Hermann Nodari Cristine , Specht Ismael , Bondan Juliana , Da Silva Fabio
Published: September 2023

A inovação frugal tem ganhado espaço no círculo acadêmico e empresarial nos últimos anos. Nesse contexto, o objetivo do estudo é analisar a predisposição das empresas vencedoras do Prêmio Nacional de Inovação (PNI) para inovação frugal. Para tanto, utilizou-se de dados secundários dos relatórios das três últimas edições do PNI e da análise qualitativa destes dados. Ao total foram analisadas 52 empresas. Os resultados mostram que 39 empresas apresentaram pelo menos uma característica da inovação frugal e que a “redução de custos” e a “sustentabilidade” são as categorias predominantes que indicam que as empresas estão predispostas à inovação frugal.