Promises and challenges for the implementation of computational medical imaging (radiomics) in oncology

Medical image processing and analysis (also known as Radiomics) is a rapidly growing discipline that maps digital medical images into quantitative data, with the end goal of generating imaging biomarkers as decision support tools for clinical practice. The use of imaging data from routine clinical work-up has tremendous potential in improving cancer care by heightening understanding of tumor biology and aiding in the implementation of precision medicine. As a noninvasive method of assessing the tumor and its microenvironment in their entirety, radiomics allows the evaluation and monitoring of tumor characteristics such as temporal and spatial heterogeneity. One can observe a rapid increase in the number of computational medical imaging publications-milestones that have highlighted the utility of imaging biomarkers in oncology. Nevertheless, the use of radiomics as clinical biomarkers still necessitates amelioration and standardization in order to achieve routine clinical adoption. This Review addresses the critical issues to ensure the proper development of radiomics as a biomarker and facilitate its implementation in clinical practice.

[Research and development of digital design and fabrication of complete denture]

Removable complete denture are still the primary prosthetic solution for edentulous patients. Functional pressure impression obtaining, jaw relation recording, personalized balance occlusion and highly precise fabrication of denture are difficult. The digital restoration technique represented by intraoral three-dimensional scanning and three-dimensional (3D) printing compensates for the shortages of the manual techniques, but there are still many limitations in the application of complete dentures. At present, a few computer aided design and computer aided manufacture (CAD/CAM) complete denture systems have been developed both domestically and abroad, and these system are mainly focused on the digital design and manufacture of denture, and are seldom used for the recording of impression and jaw relation. This review is based on the main clinical procedures of the traditional complete denture restoration, elaborating the research and application status of digital technique in each steps, in order to provide reference for clinical application.

[Anatomy and histology characteristics of lymph node in nude mice]

OBJECTIVE

To compare the differences of anatomical and histological characteristics of lymph nodes between BALB/c nude mice and BALB/c mice.

METHODS

Firstly, twenty BALB/c nude mice and twenty BALB/c mice were dissected by using a surgical microscope. Secondly, the differences of T cells and B cells at the lymph node were compared by the expressions of CD₃ and CD₂₀ immunohistochemistry dyes.

RESULTS

There were, on average, 23 nodes per mouse contained within the large lymph node assembly in the BALB/c nude mouse. The anatomical features of the lymph node distribution in the nude mice were mainly found in the neck with relatively higher density. There were two lymph nodes both in the submandible lymph nodes group and in the superficial cervical lymph nodes group (the constituent ratios were 95% and 90%, respectively) in the BALB/c nude mice, but there were four lymph nodes (the constituent ratios were 95% and 90%, respectively) in the BALB/c mice. There were significant difference between the BALB/c nude mice and the BALB/c mice. Mostly there were two lymph nodes of deep cervical lymph nodes both in the BALB/c nude mice and the BALB/c mice (the constituent ratios were 95% and 100%, respectively). There were no significant difference between the BALB/c nude mice and the BALB/c mice. We confirmed that the number of CD₃-positive T lymphocytes in lymph nodes of the nude mice decreased greatly as compared with the BALB/c mice. Expressions of CD3 in T cells were 95% and 100% in the BALB/c nude mice and in the BALB/c mice, respectively. There were significant differences between the BALB/c nude mice and the BALB/c mice. Expressions of CD20 in B cells were 95% and 100% in the BALB/c nude mice and in the BALB/c mice, respectively. There was no significant difference between the BALB/c nude mice and BALB/c mice.

CONCLUSION

The anatomical pictures of lymph node distribution in the nude mouse will be benefit to those who are interested. The anatomical features of the lymph node local higher density in neck of the nude mouse and lack of CD3-positive T lymphocytes would be useful for obtaining a better understanding of localized lymph node metastasis of oral transplant tumors.

[The efficacy of thyroid hormone replacement therapy in patients with hypothyroidism and OSAHS: a Meta analysis]

Objective:To systematically evaluate the impact of thyroid hormone replacement in patients with OSAHS and hypothyroidism.Method:The related case-control study of thyroid hormone replacement in patients with OSAHS and hypothyroidism had been searched from Cochrane Library, PubMed, CNKI, Chinese Biomedical Literature Database, Wanfang Resource Database.The case-control study which were in line with the condition need to be evaluated the quality and to be extracted in literature. The RevMan 5.3 and STATA softwares were applied to carry out the Meta analysis.Result:Seven literatures of case-control study were included. The Meta analysis showed that: After the thyroid hormone replacement, the patient's AHI index, TSH index, LSaO₂ index were significantly improved (P< 0.05). The AHI index statistical results of the patients were [SMD= 3.15, 95%CI: (4.36-1.94), P< 0.000 01; I²= 96%], TSH index were [SMD= 4.15,95%CI: (1.15-7.15), P= 0.007; I²= 99%], LSaO₂ index were [SMD=-1.08, 95%CI: (-1.46--0.70), P< 0.000 01, I²= 68%].Conclusion:The use of thyroid hormone replacement can effectively reduce the patient's hypothyroidism symptoms and AHI symptoms.

Marsupialization facilitates movement of the cystic lesion-associated deeply impacted mandibular third molar in spite of its mature roots

Background

The odontogenic cystic lesions happened in the angle and ramus region are frequently associated with impacted mandibular third molars. The treatment plan was difficult to work out for the huge cystic lesions with deeply impacted third molars, since the enucleation with simultaneously removing the deeply impacted teeth may cause serious complications. Therefore, the marsupialization of the cystic lesions followed by enucleation with tooth removal has also been advocated. The aim of this study was to explore the movement of cystic lesion-associated deeply impacted mandibular third molars (IMTM) after marsupialization.

Material and Methods

Between July 2009 and December 2015, patients who had mandibular cystic lesion associated with IMTM and underwent marsupialization followed by enucleation with tooth extraction were included in our retrospective study. The clinical and pathological data was collected. The distance and direction of movement of the IMTM after marsupialization was measured on panoramic radiograph and computed tomography.

Results

Four male and six female patients whose ages ranged from 14 years to 67 years were enrolled in this study. Among the all impacted molars, there were 3 cases with mature roots. After marsupialization, all the cystic lesions shrunk and all impacted teeth moved toward the bony windows, and the distance of tooth movement were from 8.3mm to 12.1mm. The complications included swelling and pain, while no numbness of the ipsilateral lower lip was happened.

Conclusions

Marsupialization can promote the movement of impacted teeth with or without mature roots, and may be an optimal treatment approach for the huge posterior mandibular cystic lesions with deeply impacted third molar.

Key words:Mandibular cystic lesion, impacted third mandibular molar, marsupialization, mature root.

The effect of fibroblast growth factor 15 deficiency on the development of high fat diet induced non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis (NASH) is a form of non-alcoholic fatty liver disease (NAFLD) characterized by steatosis, inflammation, and fibrosis often associated with metabolic syndrome. Fibroblast growth factor 15 (FGF15), an endocrine factor mainly produced in the distal part of small intestine, has emerged to be a critical factor in regulating bile acid homeostasis, energy metabolism, and liver regeneration. We hypothesized that FGF15 alters the development of each of the listed features of NASH. To test this hypothesis, four-week old male Fgf15^-/- and their corresponding wild-type (WT) mice were fed either a high fat diet (HFD) or a control chow diet for six months. The results confirmed that HFD feeding for six months in WT mice recapitulated human NASH phenotype, including macrovesicular steatosis, inflammation, and fibrosis. Whereas FGF15 deficiency had no effect on the severity of liver steatosis or inflammation, it was associated with decreased liver fibrosis. Furthermore, FGF15 deficiency resulted in abnormal bile acid homeostasis, increased insulin resistance, increased HFD-induced serum triglycerides, decreased inductions of hepatic cholesterol content by HFD, and altered gene expression of lipid metabolic enzymes. These data suggest that FGF15 improves lipid homeostasis and reduces bile acid synthesis, but promotes fibrosis during the development of NASH.

How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence

Acute appendicitis is the most common condition that presents with an acute abdomen needing emergency surgery. Despite this common presentation, correctly diagnosing appendicitis remains a challenge as clinical signs or positive blood results can be absent in 55% of the patients. The reported proportion of missed diagnoses of appendicitis ranges between 20% and 40%. A delay or mis-diagnosis of appendicitis can result in severe complications such as perforation, abscess formation, sepsis, and intra-abdominal adhesions. Literature has shown that patients who had a negative appendectomy suffer post-op complications and infections secondary to hospital stays; there have even been reported cases of fatality. It is therefore crucial that timely and accurate diagnosis of appendicitis is achieved to avoid complications of both non-operating as well as unnecessary surgical intervention. The aim of this review is to systematically report and analyse the latest evidence on the different approaches used in diagnosing appendicitis. We include discussions of clinical scoring systems, laboratory tests, latest innovative bio-markers and radiological imaging.

Sclerotherapy for the recurrent granulomatous epulis with pingyangmycin

BACKGROUND

Relapse of granulomatous epulis is common after surgery because of local irritations, hormonal level in vivo, or incomplete resection. Currently, if recurrence occurs, then extraction of the teeth adjacent to the lesion is commonly performed, which may influence the aesthetics or masticatory function. Thus, a more effective and less aggressive treatment method is urgently demanded, particularly for the recurring lesion. This study investigated the effects of the intralesional pingyangmycin (PYM) injections for the recurrent granulomatous epulis and assessed the complications.

MATERIAL AND METHODS

A total of 16 patients with recurrent granulomatous epulis underwent intralesional PYM injections, between July 2010 and June 2014. The effects and complications of the treatment were retrospectively reviewed.

RESULTS

The total number of injections performed was 48 (for all patients). The median number of injections per patient was three (range, two to four). All cases completely recovered with no recurrence and resorption of the alveolar bone after a follow-up of more than 12 months. The complications included slight bleeding, local swelling and pain following injection. All these symptoms resolved 7 to 10 days after the injection.

CONCLUSIONS

In summary, intralesional PYM injections may be a preferred option for recurring granulomatous epulis.

A meta-analysis of serum p16 gene promoter methylation for diagnosis of nonsmall cell lung cancer

OBJECTIVES

To evaluate the diagnostic value of serum p16 gene promoter methylation for diagnosis of nonsmall cell lung cancer (NSCLC).

MATERIALS AND METHODS

By searching the databases of PubMed and CNKI, we included all the published articles related serum p16 gene promoter methylation and nonsmall lung cancer. The true positive, false positive, false negative, and true negative data for each included publication were extracted by the reviewers. The diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic (ROC) were pooled by MetaDiSc1.4 software.

RESULTS

Finally, 13 manuscripts with 1440 subjects were involving in this diagnostic meta-analysis. The pooled sensitivity and specificity were 0.25 (95% confidence interval [CI]: 0.18-0.32) and 0.95 (95% CI: 0.93-0.97), respectively, with randomized effect model. The pooled positive likelihood ratio and negative likelihood ratio were 5.08 (95% CI: 3.00-8.62) and 0.69 (95% CI: 0.62-0.77) with fixed effect model and randomized effect model, respectively. The diagnostic ROC curve for the included 13 publications was pooled by statistical software MetaDiSc14.0 according to the Bayes theorem. The pooled area under the ROC was 0.72 with its standard error of 0.10.

CONCLUSION

According to the published articles, high specificity and low sensitivity were found in this meta-analysis for the p16 gene promoter methylation in the diagnosis of NSCLC.

The Therapeutic Effect of Pancreatic Kininogenase on Treatment of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes

Background: To determine the therapeutic efficacy and cost-effective of pancreatic kininogenase (PKase) on treatment of diabetic peripheral neuropathy (DPN) compared with Prostaglandin E1 (PGE1) in patients with type 2 diabetes. Methods: 104 patients with DPN receiving standard glucose control therapy were randomly assigned into 3 groups: Group-A received PKase treatment, Group-B received PGE1 treatment, and Group-C received only standard glucose control therapy. Michigan neuropathy screening instrument (MNSI) score, neurophysiology examination, and nerve conduction velocity were measured. Results: Standard glucose control therapy significantly reduced hyperglycemia to a similar level in all groups. Questionnaire grading and neurophysiology examination both indicated that no significant difference was found at the end of treatment between Groups -A and -B. Except for the ulnar nerve sensory conduction velocity that was significantly improved in Group-B, the remaining nerve conduction velocity (regardless of sensory or motor nerve conduction velocities) was improved to a similar level in Groups -A and -B. Group-A had significantly reduced questionnaire grading and better improvement in motor nerve conduction velocity of the common peroneal nerve, ulnar nerve, and sensory nerve conduction velocity of the sural nerve as compared with Group-C. However, the medical cost of PKase was only 18.9% of that of PGE1 during one course of treatment. Conclusions: PKase has the similar therapeutic efficacy as PGE1 on treatment of DPN in patients with type 2 diabetes. However, the medical cost of PKase is one fifth of that of PGE1. Thus, PKase is a cost-effective drug for treatment of DPN.

CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy

Intensity-modulated radiotherapy (IMRT) is increasingly used in order to minimize the gastrointestinal, genitourinary, and hematological toxicity in cervical and uterine cancers. However, the benefit of this high-precision approach is detracted by the margins applied to the clinical target volume (CTV) to generate the planning tumor volume (PTV), taking into account tumor and surrounding organs movements, deformations, and volume changes. Adequate PTV margins should be large enough to prevent geographical misses, but not excessive, which might end the benefit from IMRT. The objectives of this review were: (a) to present the evidence available for the determination of CTV-PTV margin for uterine cancers; (b) to highlight the impact of these margins in the context of adaptive radiotherapy; and (c) to discuss the role of the PTV concept in intracavitary brachytherapy.

[Association between obstructive sleep apnea hypopnea syndrome and type 2 diabetes in Chinese:a Meta analysis]

Objective:The aim of this study is to assess the association between obstructive sleep apnea-hypopnea syndrome and type 2 diabetes (T2DM).Method:Databases such as Chinese Biomedical Literature Database,PubMed,Chinese Academic Journals full-text database,Wanfang Resource Database and Chongqing VIP have been searched to collect literatures about the relationship between OSAHS and type 2 diabetes.The papers and unpublished articles were also manually retrieved.Randomized controlled trial conformed to the condition were evaluated according to the standards of literature assessment,and the data has been extracted.The RevMan5.3 software was applied to carry out Meta-analysis.Result:Thirty studies are includedin the Meta-analysis.The fasting glucose content of OSAHS patients with T2DM is significantly higher than T2DM patients[WMD=1.01,95%CI(0.55,1.46), P<0.01];OSAHS with T2DM patients' apnea hypopnea index is significantly higher than OSAHS patients[WMD=3.78,95%CI(1.69,5.87),P<0.01];the fasting glucose content of OSAHS patients is also significantly higher than normal [WMD=1.16,95CI%(0.88,1.44),P<0.01];When stratified by rhe grades of OSAHS,we found fasting glucose content of all OSAHS patients is significantly higher than normal[WMD=1.09,95CI% (0.97,1.21),P<0.01];the funnel flot appeared to be symmetrical with little bias.Conclusion:The experimental results indicate that OSAHS is significantly related with T2DM ,and they may be the risk factorof each other.