Blood-brain barrier pathology in cerebral small vessel disease

Cerebral small vessel disease is a neurological disease that affects the brain microvasculature and which is commonly observed among the elderly.Although at first it was considered innocuous,small vessel disease is nowadays regarded as one of the major vascular causes of dementia.Radiological signs of small vessel disease include small subcortical infarcts,white matter magnetic resonance imaging hyperintensities,lacunes,enlarged perivascular spaces,cerebral microbleeds,and brain atrophy;however,great heterogeneity in clinical symptoms is observed in small vessel disease patients.The pathophysiology of these lesions has been linked to multiple processes,such as hypoperfusion,defective cerebrovascular reactivity,and blood-brain barrier dysfunction.Notably,studies on small vessel disease suggest that blood-brain barrier dysfunction is among the earliest mechanisms in small vessel disease and might contribute to the development of the hallmarks of small vessel disease.Therefore,the purpose of this review is to provide a new foundation in the study of small vessel disease pathology.First,we discuss the main structural domains and functions of the blood-brain barrier.Secondly,we review the most recent evidence on blood-brain barrier dysfunction linked to small vessel disease.Finally,we conclude with a discussion on future perspectives and propose potential treatment targets and interventions.

Cognitive impairment in cerebral small vessel disease induced by hypertension

Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.

Experimental investigation of the inhibition of deep-sea mining sediment plumes by polyaluminum chloride

Deep-sea sediment disturbance may occur when collecting polymetallic nodules,resulting in the creation of plumes that could have a negative impact on the ecological environment.This study aims to investigate the potential solution of using polyaluminum chloride(PAC)in the water jet.The effects of PAC are examined through a self-designed simulation system for deep-sea polymetallic nodule collection and sediment samples from a potential deep-sea mining area.The experimental results showed that the optimal PAC dose was found to be 0.75 g/L.Compared with the test conditions without the addition of PAC,the presence of PAC leads to a reduction in volume,lower characteristic turbidity,smaller diffusion velocity,and shorter settling time of the plume.This indicates that PAC inhibits the entire development process of the plume.The addition of PAC leads to the flocculation of mm-sized particles,resulting in the formation of cm-sized flocs.The flocculation of particles decreases the rate of erosion on the seabed by around 30%.This reduction in erosion helps to decrease the formation of plumes.Additionally,when the size of suspended particles increases,it reduces the scale at which they diffuse.Furthermore,the settling velocity of flocs(around 10^(-2) m/s)is much higher that of compared to sediment particles(around 10^(-5) m/s),which effectively reduces the amount of time the plume remains in suspension.

Integrated biomarker response to assess toxic impacts of iron and manganese on deep-sea mussel Gigantidas platifrons under a deep-sea mining activity scenario

Deep-sea mining activities can potentially release metals,which pose a toxicological threat to deep-sea ecosystems.Nevertheless,due to the remoteness and inaccessibility of the deep-sea biosphere,there is insufficient knowledge about the impact of metal exposure on its inhabitants.In this study,deep-sea mussel Gigantidas platifrons,a commonly used deep-sea toxicology model organism,was exposed to manganese(100,1000μg/L)or iron(500,5000μg/L)for 7 d,respectively.Manganese and iron were chosen for their high levels of occurrence within deep-sea deposits.Metal accumulation and a battery of biochemical biomarkers related to antioxidative stress in superoxide dismutase(SOD),catalase(CAT),malondialdehyde(MDA);immune function in alkaline phosphatase(AKP),acid phosphatase(ACP);and energy metabolism in pyruvate kinase(PK)and hexokinase(HK)were assessed in mussel gills.Results showed that deep-sea mussel G.platifrons exhibited a high capacity to accumulate Mn/Fe.In addition,most tested biochemical parameters were altered by metal exposure,demonstrating that metals could induce oxidative stress,suppress the immune system,and affect energy metabolism of deep-sea mussels.The integrated biomarker response(IBR)approach indicated that the exposure to Mn/Fe had a negative impact on deep-sea mussels,and Mn demonstrated a more harmful impact on deep-sea mussels than Fe.Additionally,SOD and CAT biomarkers had the greatest impact on IBR values in Mn treatments,while ACP and HK were most influential for the low-and high-dose Fe groups,respectively.This study represents the first application of the IBR approach to evaluate the toxicity of metals on deep-sea fauna and serves as a crucial framework for risk assessment of deep-sea mining-associated metal exposure.

Bio-Inspired Screwed Conduits from the Microfluidic Rope-Coiling Effect for Microvessels and Bronchioles

Tubular microfibers have recently attracted extensive interest for applications in tissue engineering.However,the fabrication of tubular fibers with intricate hierarchical structures remains a major challenge.Here,we present a novel one-step microfluidic spinning method to generate bio-inspired screwed conduits(BSCs).Based on the microfluidic rope-coiling effect,a viscous hydrogel precursor is first curved into a helix stream in the channel,and then consecutively packed as a hollow structured stream and gelated into a screwed conduit(SC)via ionic and covalent crosslinking.By taking advantage of the excellent fluid-controlling ability of microfluidics,various tubes with diverse structures are fabricated via simple control over fluid velocities and multiple microfluidic device designs.The perfusability and permeability results,as well as the encapsulation and culture of human umbilical vein endothelial cells(HUVECs),human pulmonary alveolar epithelial cells(HPAs),and myogenic cells(C2C12),demonstrate that these SCs have good perfusability and permeability and the ability to induce the formation of functional biostructures.These features support the uniqueness and potential applications of these BSCs as biomimetic blood vessels and bronchiole tissues in combination with tissue microstructures,with likely application possibilities in biomedical engineering.

Predicting impact forces on pipelines from deep-sea fluidized slides:A comprehensive review of key factors

Deep-sea pipelines play a pivotal role in seabed mineral resource development,global energy and resource supply provision,network communication,and environmental protection.However,the placement of these pipelines on the seabed surface exposes them to potential risks arising from the complex deep-sea hydrodynamic and geological environment,particularly submarine slides.Historical incidents have highlighted the substantial damage to pipelines due to slides.Specifically,deep-sea fluidized slides(in a debris/mud flow or turbidity current physical state),characterized by high speed,pose a significant threat.Accurately assessing the impact forces exerted on pipelines by fluidized submarine slides is crucial for ensuring pipeline safety.This study aimed to provide a comprehensive overview of recent advancements in understanding pipeline impact forces caused by fluidized deep-sea slides,thereby identifying key factors and corresponding mechanisms that influence pipeline impact forces.These factors include the velocity,density,and shear behavior of deep-sea fluidized slides,as well as the geometry,stiffness,self-weight,and mechanical model of pipelines.Additionally,the interface contact conditions and spatial relations were examined within the context of deep-sea slides and their interactions with pipelines.Building upon a thorough review of these achievements,future directions were proposed for assessing and characterizing the key factors affecting slide impact loading on pipelines.A comprehensive understanding of these results is essential for the sustainable development of deep-sea pipeline projects associated with seabed resource development and the implementation of disaster prevention measures.

An Efficient Long Short-Term Memory and Gated Recurrent Unit Based Smart Vessel Trajectory Prediction Using Automatic Identification System Data

Maritime transportation,a cornerstone of global trade,faces increasing safety challenges due to growing sea traffic volumes.This study proposes a novel approach to vessel trajectory prediction utilizing Automatic Identification System(AIS)data and advanced deep learning models,including Long Short-Term Memory(LSTM),Gated Recurrent Unit(GRU),Bidirectional LSTM(DBLSTM),Simple Recurrent Neural Network(SimpleRNN),and Kalman Filtering.The research implemented rigorous AIS data preprocessing,encompassing record deduplication,noise elimination,stationary simplification,and removal of insignificant trajectories.Models were trained using key navigational parameters:latitude,longitude,speed,and heading.Spatiotemporal aware processing through trajectory segmentation and topological data analysis(TDA)was employed to capture dynamic patterns.Validation using a three-month AIS dataset demonstrated significant improvements in prediction accuracy.The GRU model exhibited superior performance,achieving training losses of 0.0020(Mean Squared Error,MSE)and 0.0334(Mean Absolute Error,MAE),with validation losses of 0.0708(MSE)and 0.1720(MAE).The LSTM model showed comparable efficacy,with training losses of 0.0011(MSE)and 0.0258(MAE),and validation losses of 0.2290(MSE)and 0.2652(MAE).Both models demonstrated reductions in training and validation losses,measured by MAE,MSE,Average Displacement Error(ADE),and Final Displacement Error(FDE).This research underscores the potential of advanced deep learning models in enhancing maritime safety through more accurate trajectory predictions,contributing significantly to the development of robust,intelligent navigation systems for the maritime industry.

An Implementation of Multiscale Line Detection and Mathematical Morphology for Efficient and Precise Blood Vessel Segmentation in Fundus Images

Diagnosing various diseases such as glaucoma,age-related macular degeneration,cardiovascular conditions,and diabetic retinopathy involves segmenting retinal blood vessels.The task is particularly challenging when dealing with color fundus images due to issues like non-uniformillumination,low contrast,and variations in vessel appearance,especially in the presence of different pathologies.Furthermore,the speed of the retinal vessel segmentation system is of utmost importance.With the surge of now available big data,the speed of the algorithm becomes increasingly important,carrying almost equivalent weightage to the accuracy of the algorithm.To address these challenges,we present a novel approach for retinal vessel segmentation,leveraging efficient and robust techniques based on multiscale line detection and mathematical morphology.Our algorithm’s performance is evaluated on two publicly available datasets,namely the Digital Retinal Images for Vessel Extraction dataset(DRIVE)and the Structure Analysis of Retina(STARE)dataset.The experimental results demonstrate the effectiveness of our method,withmean accuracy values of 0.9467 forDRIVE and 0.9535 for STARE datasets,aswell as sensitivity values of 0.6952 forDRIVE and 0.6809 for STARE datasets.Notably,our algorithmexhibits competitive performance with state-of-the-art methods.Importantly,it operates at an average speed of 3.73 s per image for DRIVE and 3.75 s for STARE datasets.It is worth noting that these results were achieved using Matlab scripts containing multiple loops.This suggests that the processing time can be further reduced by replacing loops with vectorization.Thus the proposed algorithm can be deployed in real time applications.In summary,our proposed system strikes a fine balance between swift computation and accuracy that is on par with the best available methods in the field.

Vulnerability and Conservation of Nearshore Cetaceans to Increasing Vessel Traffic:The Indo-Pacific Humpback Dolphin in the South China Sea

A comprehensive risk assessment to evaluate the vulnerability of the nearshore cetaceans to increasing marine traffic is lacking.In this study,the risk to Indo-Pacific humpback dolphins(Sousa chinensis)in the main habitats in China was assessed based on a semiquantitative spatial vulnerability analysis.85%of the(sub)population which overlapped with the lanes of ferries and/or cargo vessels,with exposure scores of 1.23±0.31(calculated based on the proportion of sea routes that overlap the dolphin’s range).A combination of high exposure to the sea routes and sensitivity to marine traffic would render the(sub)populations to be highly vulnerable(EPRE:5.21 and XM:4.47).A low frequency of vessels and an awareness of the ecology assures a low vulnerability(SH:2.43,EZ:2.73).Uncertainty scores were commonly lower for the higher vulnerable populations,and higher for the lower vulnerable populations,suggesting additional field data and more monitoring are necessary.Six years of field data have been used to analyze the influences of various types of marine traffic on humpback dolphin behavior.Fishing and non-fishing vessels were significantly different(χ^(2)=65.19,p<0.01).The humpback dolphins were attracted by fishing vessels(83.1%)but avoided non-fishing vessels(95.2%).We recommend a management with seasonal and geographical constraints,to balance economic development and environmental conservation.

Multiparameter Numerical Investigation of Two Types of Moving Interactions Between the Deep-Sea Mining Vehicle Track Plate and Seabed Soil:Digging and Rotating Motions

To ensure the safe performance of deep-sea mining vehicles(DSMVs),it is necessary to study the mechanical characteristics of the interaction between the seabed soil and the track plate.The rotation and digging motions of the track plate are important links in the contact between the driving mechanism of the DSMV and seabed soil.In this study,a numerical simulation is conducted using the coupled Eulerian–Lagrangian(CEL)large deformation numerical method to investigate the interaction between the track plate of the DSMV and the seabed soil under two working conditions:rotating condition and digging condition.First,a soil numerical model is established based on the elastoplastic mechanical characterization using the basic physical and mechanical properties of the seabed soil obtained by in situ sampling.Subsequently,the soil disturbance mechanism and the dynamic mechanical response of the track plate under rotating and digging conditions are obtained through the analysis of the sensitivity of the motion parameters,the grouser structure,the layered soil features and the soil heterogeneity.The results indicate that the above parameters remarkably influence the interaction between the DSMV and the seabed soil.Therefore,it is important to consider the rotating and digging motion of the DSMV in practical engineering to develop a detailed optimization design of the track plate.

Experimental and numerical study of hypervelocity impact damage on composite overwrapped pressure vessels

Ground-based tests are important for studying hypervelocity impact(HVI)damage to spacecraft pressure vessels in the orbital debris environment.We analyzed the damage to composite overwrapped pressure vessels(COPVs)in the HVI tests and classified the damage into non-catastrophic damage and catastrophic damage.We proposed a numerical simulation method to further study non-catastrophic damage and revealed the characteristics and mechanisms of non-catastrophic damage affected by impact conditions and internal pressures.The fragments of the catastrophically damaged COPVs were collected after the tests.The crack distribution and propagation process of the catastrophic ruptures of the COPVs were analyzed.Our findings contribute to understanding the damage characteristics and mechanisms of COPVs by HVIs.

Meningeal lymphatic vessel crosstalk with central nervous system immune cells in aging and neurodegenerative diseases

Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain metabolites but also contribute to antigen delivery and immune cell activation. The advent of novel genomic technologies has enabled rapid progress in the characterization of myeloid and lymphoid cells and their interactions with meningeal lymphatic vessels within the central nervous system. In this review, we provide an overview of the multifaceted roles of meningeal lymphatic vessels within the context of the central nervous system immune network, highlighting recent discoveries on the immunological niche provided by meningeal lymphatic vessels. Furthermore, we delve into the mechanisms of crosstalk between meningeal lymphatic vessels and immune cells in the central nervous system under both homeostatic conditions and neurodegenerative diseases, discussing how these interactions shape the pathological outcomes. Regulation of meningeal lymphatic vessel function and structure can influence lymphatic drainage, cerebrospinal fluid-borne immune modulators, and immune cell populations in aging and neurodegenerative disorders, thereby playing a key role in shaping meningeal and brain parenchyma immunity.

A Deformable Network with Attention Mechanism for Retinal Vessel Segmentation

The intensive application of deep learning in medical image processing has facilitated the advancement of automatic retinal vessel segmentation research.To overcome the limitation that traditional U-shaped vessel segmentation networks fail to extract features in fundus image sufficiently,we propose a novel network(DSeU-net)based on deformable convolution and squeeze excitation residual module.The deformable convolution is utilized to dynamically adjust the receptive field for the feature extraction of retinal vessel.And the squeeze excitation residual module is used to scale the weights of the low-level features so that the network learns the complex relationships of the different feature layers efficiently.We validate the DSeU-net on three public retinal vessel segmentation datasets including DRIVE,CHASEDB1,and STARE,and the experimental results demonstrate the satisfactory segmentation performance of the network.

Repeatability,interocular correlation and agreement of optic nerve head vessel density in healthy eyes:a sweptsource optical coherence tomographic angiography study

AIM:To assess the repeatability,interocular correlation,and agreement of quantitative swept-source optical coherence tomography angiography(OCTA)optic nerve head(ONH)parameters in healthy subjects.METHODS:Thir ty-three healthy subjects were enrolled.The ONH of both eyes were imaged four times by a swept-source-OCTA using a 3 mm×3 mm scanning protocol.Images of the radial peripapillary capillary were analyzed by a customized Matlab program,and the vessel density,fractal dimension,and vessel diameter index were measured.The repeatability of the four scans was determined by the intraclass correlation coefficient(ICC).The most well-centered optic disc from the four repeated scans was then selected for the interocular correlation and agreement analysis using the Pearson correlation coefficient,ICC and Bland-Altman plots.RESULTS:All swept-source-OCTA ONH parameters exhibited certain repeatability,with ICC>0.760 and coefficient of variation(CoV)≤7.301%.The obvious interocular correlation was observed for papillary vessel density(ICC=0.857),vessel diameter index(ICC=0.857)and fractal dimension(ICC=0.906),while circumpapillary vessel density exhibited moderate interocular correlation(ICC=0.687).Bland-Altman plots revealed an agreement range of-5.26%to 6.21%for circumpapillary vessel density.CONCLUSION:OCTA ONH parameters demonstrate good repeatability in healthy subjects.The interocular correlations of papillary vessel density,fractal dimension and vessel diameter index are high,but the correlation for circumpapillary vessel density is moderate.

Clinical Value of the Quantitative Flow Ratio to Predict Long-term Target Vessel Failure in Patients with In-stent Restenosis after Drug-coated Balloon Angioplasty

Objective The study sought to investigate the clinical predictive value of quantitative flow ratio(QFR)for the long-term target vessel failure(TVF)outcome in patients with in-stent restenosis(ISR)by using drug-coated balloon(DCB)treatment after a long-term follow-up.Methods This was a retrospective study.A total of 186 patients who underwent DCB angioplasty for ISR in two hospitals from March 2014 to September 2019 were enrolled.The QFR of the entire target vessel was measured offline.The primary endpoint was TVF,including target vessel-cardiac death(TV-CD),target vessel-myocardial infarction(TV-MI),and clinically driven-target vessel revascularization(CD-TVR).Results The follow-up time was 3.09±1.53 years,and 50 patients had TVF.The QFR immediately after percutaneous coronary intervention(PCI)was significantly lower in the TVF group than in the no-TVF group.Multivariable Cox regression analysis indicated that the QFR immediately after PCI was an excellent predictor for TVF after the long-term follow-up[hazard ratio(HR):5.15×10−5(6.13×10−8−0.043);P<0.01].Receiver-operating characteristic(ROC)curve analysis demonstrated that the optimal cut-off value of the QFR immediately after PCI for predicting the long-term TVF was 0.925(area under the curve:0.886,95%confidence interval:0.834–0.938;sensitivity:83.40%,specificity:88.00;P<0.01).In addition,QFR≤0.925 post-PCI was strongly correlated with the TVF,including TV-MI and CD-TVR(P<0.01).Conclusion The QFR immediately after PCI showed a high predictive value of TVF after a long-term follow-up in ISR patients who underwent DCB angioplasty.A lower QFR immediately after PCI was associated with a worse TVF outcome.

Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography

AIM:To evaluate the predictive value of superficial retinal capillary plexus(SRCP)and radial peripapillary capillary(RPC)for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer(pRNFL)and ganglion cell complex(GCC).METHODS:This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery.Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness preand post-operatively and with healthy controls.Logistic regression models were used to assess the relationship between preoperative GCC,pRNFL,SRCP,and RPC parameters and visual field recovery after surgery.RESULTS:The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls.Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values.The best predictive GCC and pRNFL models were based on the superior GCC[area under the curve(AUC)=0.866]and the tempo-inferior pRNFL(AUC=0.824),and the best predictive SRCP and RPC models were based on the nasal SRCP(AUC=0.718)and tempo-inferior RPC(AUC=0.825).There was no statistical difference in the predictive value of the superior GCC,tempo-inferior pRNFL,and tempo-inferior RPC(all P>0.05).CONCLUSION:Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion.This reduction persists despite the recovery of the visual field after decompression surgery.GCC,pRNFL,and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.

Investigating the relationship between intracranial atherosclerotic plaque remodelling and diabetes using high-resolution vessel wall imaging

BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.

Nomogram prediction of vessels encapsulating tumor clusters in small hepatocellular carcinoma≤3 cm based on enhanced magnetic resonance imaging

BACKGROUND Vessels encapsulating tumor clusters(VETC)represent a recently discovered vascular pattern associated with novel metastasis mechanisms in hepatocellular carcinoma(HCC).However,it seems that no one have focused on predicting VETC status in small HCC(sHCC).This study aimed to develop a new nomogram for predicting VETC positivity using preoperative clinical data and image features in sHCC(≤3 cm)patients.AIM To construct a nomogram that combines preoperative clinical parameters and image features to predict patterns of VETC and evaluate the prognosis of sHCC patients.METHODS A total of 309 patients with sHCC,who underwent segmental resection and had their VETC status confirmed,were included in the study.These patients were recruited from three different hospitals:Hospital 1 contributed 177 patients for the training set,Hospital 2 provided 78 patients for the test set,and Hospital 3 provided 54 patients for the validation set.Independent predictors of VETC were identified through univariate and multivariate logistic analyses.These independent predictors were then used to construct a VETC prediction model for sHCC.The model’s performance was evaluated using the area under the curve(AUC),calibration curve,and clinical decision curve.Additionally,Kaplan-Meier survival analysis was performed to confirm whether the predicted VETC status by the model is associated with early recurrence,just as it is with the actual VETC status and early recurrence.RESULTS Alpha-fetoprotein_lg10,carbohydrate antigen 199,irregular shape,non-smooth margin,and arterial peritumoral enhancement were identified as independent predictors of VETC.The model incorporating these predictors demonstrated strong predictive performance.The AUC was 0.811 for the training set,0.800 for the test set,and 0.791 for the validation set.The calibration curve indicated that the predicted probability was consistent with the actual VETC status in all three sets.Furthermore,the decision curve analysis demonstrated the clinical benefits of our model for patients with sHCC.Finally,early recurrence was more likely to occur in the VETC-positive group compared to the VETC-negative group,regardless of whether considering the actual or predicted VETC status.CONCLUSION Our novel prediction model demonstrates strong performance in predicting VETC positivity in sHCC(≤3 cm)patients,and it holds potential for predicting early recurrence.This model equips clinicians with valuable information to make informed clinical treatment decisions.

Preoperatively predicting vessels encapsulating tumor clusters in hepatocellular carcinoma:Machine learning model based on contrast-enhanced computed tomography

BACKGROUND Recently,vessels encapsulating tumor clusters(VETC)was considered as a distinct pattern of tumor vascularization which can primarily facilitate the entry of the whole tumor cluster into the bloodstream in an invasion independent manner,and was regarded as an independent risk factor for poor prognosis in hepatocellular carcinoma(HCC).AIM To develop and validate a preoperative nomogram using contrast-enhanced computed tomography(CECT)to predict the presence of VETC+in HCC.METHODS We retrospectively evaluated 190 patients with pathologically confirmed HCC who underwent CECT scanning and immunochemical staining for cluster of differentiation 34 at two medical centers.Radiomics analysis was conducted on intratumoral and peritumoral regions in the portal vein phase.Radiomics features,essential for identifying VETC+HCC,were extracted and utilized to develop a radiomics model using machine learning algorithms in the training set.The model’s performance was validated on two separate test sets.Receiver operating characteristic(ROC)analysis was employed to compare the identified performance of three models in predicting the VETC status of HCC on both training and test sets.The most predictive model was then used to constructed a radiomics nomogram that integrated the independent clinical-radiological features.ROC and decision curve analysis were used to assess the performance characteristics of the clinical-radiological features,the radiomics features and the radiomics nomogram.RESULTS The study included 190 individuals from two independent centers,with the majority being male(81%)and a median age of 57 years(interquartile range:51-66).The area under the curve(AUC)for the combined radiomics features selected from the intratumoral and peritumoral areas were 0.825,0.788,and 0.680 in the training set and the two test sets.A total of 13 features were selected to construct the Rad-score.The nomogram,combining clinicalradiological and combined radiomics features could accurately predict VETC+in all three sets,with AUC values of 0.859,0.848 and 0.757.Decision curve analysis revealed that the radiomics nomogram was more clinically useful than both the clinical-radiological feature and the combined radiomics models.CONCLUSION This study demonstrates the potential utility of a CECT-based radiomics nomogram,incorporating clinicalradiological features and combined radiomics features,in the identification of VETC+HCC.

Quantifying peripapillary vessel density and retinal nerve fibre layer in type 1 diabetic children without clinically detectable retinopathy using OCTA

AIM:To quantify changes in radial peripapillary capillary vessel density(ppVD)and the peripapillary retinal nerve fiber layer(pRNFL)in children with type 1 diabetes without clinical diabetic retinopathy by optical coherence tomography angiography(OCTA),providing a basis for early retinopathy in children with type 1 diabetes.METHODS:This was a retrospective study.A total of 30 patients(3–14y)with type 1 diabetes without clinical diabetic retinopathy(NDR group)were included.A total of 30 age-matched healthy subjects were included as the normal control group(CON group).The HbA1c level in the last 3mo was measured once in the NDR group.The pRNFL thickness and ppVD were automatically measured,and the mean pRNFL and ppVD were calculated in the nasal,inferior,temporal,and superior quadrants.The changes in ppVD and pRNFL in the two groups were analyzed.RESULTS:Compared with CON group,the nasal and superior ppVDs decreased in the NDR group(all P<0.01).The thickness of the nasal pRNFL decreased significantly(P<0.01),while the inferior,temporal and superior pRNFLs slightly decreased but not significant in the NDR group(all P>0.05).Person and Spearman correlation analysis of ppVD and pRNFL thickness in each quadrant of the NDR group showed a positive correlation between nasal and superior(all P<0.01),while inferior and temporal had no significant correlation(all P>0.05).There was no significant correlation between the HbA1c level and ppVD and pRNFL in any quadrant(all P>0.05).There was no significant correlation between the course of diabetes mellitus and ppVD and pRNFL in any quadrant(all P>0.05).CONCLUSION:ppVD and pRNFL decrease in eyes of children with type 1 diabetes before clinically detectable retinopathy and OCTA is helpful for early monitoring.