Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer

BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.

Posthepatectomy jaundice induced by paroxysmal nocturnal hemoglobinuria: A case report

BACKGROUND Jaundice is a major manifestation of posthepatectomy liver failure,a feared complication after hepatic resection.Herein,we report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria(PNH)-induced hemolysis.CASE SUMMARY A 56-year-old woman underwent right hepatectomy and biliary tract exploration surgery due to hepatic duct stones.Prior to surgery,the patient was mildly anemic.The direct antiglobulin test was negative.A bone marrow biopsy showed mild histiocyte hyperplasia.After surgery,the patient suffered a progressive increase in serum bilirubin.Meanwhile,the patient developed hemolytic symptoms after blood transfusion.She was ultimately diagnosed with PNH.PNH is a rare bone marrow failure disorder that manifests as complement-dependent intravascular hemolysis with varying severity.After steroid treatment,the patient’s jaundice gradually decreased,and the patient was discharged on the 35th postoperative day.CONCLUSION PNH-induced hemolysis is a rare cause of posthepatectomy jaundice.It should be suspected in patients having posthepatectomy hyperbilirubinemia without other signs of liver failure.Steroid therapy can be considered for the treatment of PNH in such cases.

Tetrahydrobiopterin Protects against Radiation-induced Growth Inhibition in H9c2 Cardiomyocytes

Background：Tetrahydrobiopterin （BH4） is an essential cofactor of nitric oxide synthases （NOSs） for the synthesis of nitric oxide （NO）.BH4 therapy can reverse the disease-related redox disequilibrium observed with BH4 deficiency.However,whether BH4 exerts a protective effect against radiation-induced damage to cardiomyocytes remains unknown.Methods：Clonogenic assays were performed to determine the effects of X-ray on H9c2 cells with or without BH4 treatment.The contents of lactate dehydrogenase （LDH）,superoxide dismutase （SOD）,and malondialdehyde （MDA） in H9c2 cells were measured to investigate oxidative stress levels.The cell cycle undergoing radiation with or without BH4 treatment was detected using flow cytometry.The expression levels of proteins in the phosphatidylinositol 3 kinase （PI3K）/protein kinase B （AKT）/P53 signaling pathway,inducible NOS （iNOS）,and endothelial NOS （eNOS） were examined using Western blotting.Results：X-ray radiation significantly inhibited the growth of H9c2 cells in a dose-dependent manner,whereas BH4 treatment significantly reduced the X-ray radiation-induced growth inhibition （control group vs.X-ray groups,respectively,P 〈 0.0 l）.X-ray radiation induced LDH release,apoptosis,and G0/G 1 peak accumulation,significantly increasing the level of MDA and the production of NO,and decreased the level of SOD （control group vs.X-ray groups,respectively,P 〈 0.05 or P 〈 0.01）.By contrast,BH4 treatment can significantly reverse these processes （BH4 treatment groups vs.X-ray groups,P 〈 0.05 or P 〈 0.01）.BH4 reversed the X-ray radiation-induced expression alterations ofapoptosis-related molecules,including B-cell lymphoma-2 （Bcl-2）,Bcl-2 associated X protein,and caspase-3,and molecules of the PI3K/Akt/P53 signaling pathway.BH4 enhanced the production of NO in 2 Gy and 4 Gy radiated groups by upregulating eNOS protein expression and downregulating iNOS protein expression.Conclusions：BH4 treatment can protect against X-ray-induced cardiomyocyte injury,possibly by recoupling eNOS rather than iNOS.BH4 treatment also decreased oxidative stress in radiated H9c2 cells.