This paper reports an experimental demonstration of moiré metalens which shows wide focal length tunability from negative to positive by mutual angle rotation at the wavelength of 900 nm. The moiré ...metalens was developed using high index contrast transmitarray meta-atoms made of amorphous silicon octagonal pillars, which is designed to have polarization insensitivity and full 2π phase coverage. The fabricated moiré metalens showed focal length tunability at the ranges between ±1.73 - ±5 mm, which corresponds to the optical power ranges between ±578 - ±200 m
at the mutual rotation between ±90 degrees.
Background
Ultrasonography (US) is widely used for the diagnosis of liver tumors. However, the accuracy of the diagnosis largely depends on the visual perception of humans. Hence, we aimed to ...construct artificial intelligence (AI) models for the diagnosis of liver tumors in US.
Methods
We constructed three AI models based on still B-mode images: model-1 using 24,675 images, model-2 using 57,145 images, and model-3 using 70,950 images. A convolutional neural network was used to train the US images. The four-class liver tumor discrimination by AI, namely, cysts, hemangiomas, hepatocellular carcinoma, and metastatic tumors, was examined. The accuracy of the AI diagnosis was evaluated using tenfold cross-validation. The diagnostic performances of the AI models and human experts were also compared using an independent test cohort of video images.
Results
The diagnostic accuracies of model-1, model-2, and model-3 in the four tumor types are 86.8%, 91.0%, and 91.1%, whereas those for malignant tumor are 91.3%, 94.3%, and 94.3%, respectively. In the independent comparison of the AIs and physicians, the percentages of correct diagnoses (accuracies) by the AIs are 80.0%, 81.8%, and 89.1% in model-1, model-2, and model-3, respectively. Meanwhile, the median percentages of correct diagnoses are 67.3% (range 63.6%–69.1%) and 47.3% (45.5%–47.3%) by human experts and non-experts, respectively.
Conclusion
The performance of the AI models surpassed that of human experts in the four-class discrimination and benign and malignant discrimination of liver tumors. Thus, the AI models can help prevent human errors in US diagnosis.
Although transcatheter arterial chemoembolization (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a ...subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be a more favorable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria (unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child-Pugh A liver function) were selected for the study. Propensity score matching was used to adjust for patient demographics. After propensity-score matching, the outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, one in an early access program and 15 in real world settings) and 60 patients treated with cTACE as the initial treatment was compared. The change of albumin-bilirubin (ALBI) score from baseline to the end of treatment were -2.61 to -2.61 for 30 patients in the lenvatinib group (
= 0.254) and -2.66 to -2.09 in the cTACE group (
< 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%;
< 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months;
< 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48,
< 0.01). In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child-Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides a more favorable outcome than TACE.
Conventionally, silicon is less often selected as the material of dielectric metasurfaces in the visible band than other lossless materials, including titanium dioxide, silicon nitride, and gallium ...nitride. The reason is its relatively high extinction coefficient and resulting low transmittance. This study demonstrated that accurately designed nanopillars made of single-crystal silicon could be used satisfactorily on a metasurface, even in the visible band. Four line-focusing metasurface lenses were designed to verify the lens performance effectiveness of silicon nanopillars in the visible band. In addition, a combination of the character projection and the variable-shaped beam modes in the electron beam lithography was operated to evaluate the compatibility between mass productivity and accuracy. We successfully obtained a highly efficient line-focusing metasurface lens composed of single crystalline silicon nanopillars. The parameters of the metasurface lens at a wavelength of 532 nm were as follows: lens thickness, 300 nm; focal length, 3.91 mm; square aperture, 2 mm; numerical aperture, 0.25; measured transmittance, 38.4% to 46.8%; and measured beam spot width, <inline-formula> <tex-math notation="LaTeX">3.68\,\, \mu \text{m} </tex-math></inline-formula> (full width at half maximum, FWHM) at the focal point. The results obtained in this study show a promising use of silicon metasurface for optical sensor applications in the visible band.
This study investigated the impact of baseline liver function according to the Child-Pugh score and ALBI (albumin-bilirubin) grade on the outcomes of patients with unresectable hepatocellular ...carcinoma treated with lenvatinib.
A total of 82 lenvatinib treated patients were included. The correlations of baseline liver function according to the Child-Pugh score and ALBI grade with treatment outcomes, including objective response rate per mRECIST (modified Response Evaluation Criteria in the Solid Tumor), time to treatment failure, treatment duration, and likelihood of treatment discontinuation due to adverse events, were assessed in patients with hepatocellular carcinoma treated with lenvatinib. Patients were divided into four groups: (1) Child-Pugh score 5 and ALBI grade 1 (group 1), (2) Child-Pugh score 5 and ALBI grade 2 (group 2), (3) Child-Pugh score 6 (group 3), and (4) Child-Pugh score ≥7 (group 4). Univariate and multivariate analyses were performed to identify the factors contributing to the objective response rate and likelihood of discontinuation due to adverse events.
Among the 82 patients analyzed, group 1 had the highest objective response rate (57.1%) and the lowest likelihood of treatment discontinuation because of adverse events (11.1%) among the four groups (
< 0.05 and
< 0.05). Multivariate analysis identified ALBI grade 1 and baseline AFP level <200 ng/mL as the significant predictors of a high objective response rate (
< 0.05 and
< 0.01), and confirmed that patients with ALBI grade 1 had the lowest probability of treatment discontinuation due to adverse events (
< 0.01).
Patients with Child-Pugh score of 5 and ALBI grade 1 predicted a higher response rate and lower treatment discontinuation due to adverse events by lenvatinib treatment.
Metasurface lenses (metalenses) offer an ultrathin and simple optical system with dynamic functions that include focal length tuning. In this study, a rotational varifocal (i.e., moiré) metalens ...based on octagonal single-crystal silicon pillars was designed and fabricated to realize a high transmittance, whole 2
phase coverage, and polarization insensitivity for visible wavelengths. The moiré metalens consists of a pair of cascaded metasurface-based phase lattices and the focal length can be adjusted from negative to positive by mutual rotation. The fabricated moiré metalens demonstrated a focal length that can be tuned from −36 mm to −2 mm and from 2 to 12 mm by mutual rotation from −90° to 90°, and the experimental measurements agreed well with theoretical values at the design wavelength of 633 nm. Imaging was demonstrated at three distinct wavelengths of 633, 532, and 440 nm.
Aim
Regorafenib is a second‐line treatment for unresectable hepatocellular carcinoma after sorafenib‐refractory treatment. This study examined the effects of regorafenib administration on hepatic ...functional reserve and the treatment course after regorafenib discontinuation.
Methods
This retrospective, multicenter study involved 51 patients treated with regorafenib after sorafenib‐refractory treatment for u‐HCC at seven institutions before March 2021.
Results
Fourteen, 13, and 24 patients were classified based on modified albumin–bilirubin (mALBI) grade 1, 2a, and 2b, respectively. The median survival time and progression‐free survival were 16.7 and 3.3 months, respectively. Only mALBI grade 2b or 3 was significantly associated with survival rate (hazard ratio, 2.13; 95% confidence interval, 1.01–4.49; p = 0.047). A comparison of median ALBI scores at the initiation of regorafenib (−2.35) with those at 4 weeks (−1.93) revealed a significant relative change (p = 0.0001). After 4 weeks, grade 1 or 2a persisted in 15 patients (Group 1); grade 1 or 2a deteriorated to 2b in 12 patients (Group 2); grade 2b or 3 before regorafenib administration was present in 22 patients (Group 3); and MST was 33.3, 12.8, and 11.3 months in the three groups, respectively (p = 0.05). Patients treated with lenvatinib (LEN) (n = 27, MST = 23.4 months) after regorafenib had a significantly longer survival time from regorafenib initiation than those not treated with LEN (n = 24, 11.8 months; p = 0.043).
Conclusions
Hepatic functional reserve significantly declined after regorafenib administration. During regorafenib treatment, favorable hepatic functional reserve before administration and maintenance of favorable hepatic reserve after administration lead to prolonged prognosis.
Background and Aim
We conducted a randomized, double‐blinded, placebo‐controlled trial to investigate the efficacy of Bifidobacterium longum 536 (BB536) supplementation for induction of remission in ...Japanese patients with active ulcerative colitis (UC).
Methods
Fifty‐six patients with mild to moderate UC were enrolled. Three patients had pancolitis, 36 had left‐sided colitis, and 17 had proctitis. Patients were randomly treated with 2–3 × 1011 freeze‐dried viable BB536 (28 patients) or placebo (28 patients) for 8 weeks.
Results
In total, 63% of patients receiving BB536 showed clinical remission (UC disease activity index UCDAI ≤2) at week 8 compared to 52% of those receiving placebo (P = 0.395). We observed a significant decrease of UCDAI scores (3.8 ± 0.4 at baseline to 2.6 ± 0.4 at week 8) in the BB536 group (P < 0.01), whereas there was no significant decrease in the placebo group (P = 0.88). There was also a significant decrease in the Rachmilewitz endoscopic index (EI) and the Mayo subscore at week 8 in the BB536 group, whereas there was no significant decrease in the placebo group. A single patient in the BB536 group complained of a mild side‐effect, but no other adverse effects were observed.
Conclusion
Supplementation with BB536 was well tolerated and reduced UCDAI scores, EI and Mayo subscores after 8 weeks in Japanese patients with mild to moderately active UC.
Background/Aim
Atezolizumab plus bevacizumab (Atez/Bev) treatment is recommended for unresechepatocellular carcinoma (u‐HCC) patients classified as Child‐Pugh A (CP‐A). This study aimed to elucidate ...the prognosis of patients treated with Atez/Bev, especially CP‐A and ‐B cases.
Materials/methods
From September 2020 to March 2022, 457 u‐HCC patients treated with Atez/Bev were enrolled (median age 74 years, male:female = 368:89, CP‐A:CP‐B = 427:30, Child‐Pugh score CPS 5:6:7:8:9 = 271:156:21:8:1). Therapeutic response was evaluated using RECIST ver.1.1. Clinical features and prognosis were retrospectively evaluated.
Results
There were no significant differences between CP‐A and ‐B patients in regard to best response (CR:PR:SD:PD = 16:91:194:81 vs. 0:7:13:8, p = 0.739; objective response rate/disease control rate = 28.0%/78.8% vs. 25.0%/71.4%). Analysis performed using inverse probability weighting adjustments of clinical factors other than those related to hepatic reserve function with a p value < 0.10 for comparisons between patients with CP‐A and ‐B showed that the progression‐free survival (PFS) rate for CP‐A cases was better (6‐/12‐/18‐month: 58.2%/36.1%/27.8% vs. 49.6%/8.7%/non‐estimable NE, p < 0.001), as was overall survival (OS) rate (6‐/12‐/18‐month: 89.9%/71.7%/51.4% versus 63.6%/18.4%/NE; p < 0.001). Median PFS (mPFS) and median OS (mOS) for the CPS‐5 were 9.5 months/NE, and 5.1/14.0 months for the CPS‐6 (both p < 0.001). Furthermore, for modified albumin‐bilirubin grade (mALBI)‐1/2a/2b, mPFS was 9.4/8.5/5.3 months (p < 0.001) and mOS was NE/17.8/13.4 months (p < 0.001).
Conclusion
Better hepatic function, such as mALBI grade 1 or 2a are thought to indicate a better condition for obtaining sufficient prognosis with Atez/Bev treatment for u‐HCC patients, whereas for CP‐B patients, who mainly shown an mALBI grade of 2b or 3, Atez/Bev might have less therapeutic efficacy.
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in ...the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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