Background
The preservation of parathyroid glands is crucial in endoscopic thyroid surgery to prevent hypocalcemia and related complications. However, current methods for identifying and protecting ...these glands have limitations. We propose a novel technique that has the potential to improve the safety and efficacy of endoscopic thyroid surgery.
Purpose
Our study aims to develop a deep learning model called PTAIR 2.0 (Parathyroid gland Artificial Intelligence Recognition) to enhance parathyroid gland recognition during endoscopic thyroidectomy. We compare its performance against traditional surgeon‐based identification methods.
Materials and methods
Parathyroid tissues were annotated in 32 428 images extracted from 838 endoscopic thyroidectomy videos, forming the internal training cohort. An external validation cohort comprised 54 full‐length videos. Six candidate algorithms were evaluated to select the optimal one. We assessed the model's performance in terms of initial recognition time, identification duration, and recognition rate and compared it with the performance of surgeons.
Results
Utilizing the YOLOX algorithm, we developed PTAIR 2.0, which demonstrated superior performance with an AP50 score of 92.1%. The YOLOX algorithm achieved a frame rate of 25.14 Hz, meeting real‐time requirements. In the internal training cohort, PTAIR 2.0 achieved AP50 values of 94.1%, 98.9%, and 92.1% for parathyroid gland early prediction, identification, and ischemia alert, respectively. Additionally, in the external validation cohort, PTAIR outperformed both junior and senior surgeons in identifying and tracking parathyroid glands (p < 0.001).
Conclusion
The AI‐driven PTAIR 2.0 model significantly outperforms both senior and junior surgeons in parathyroid gland identification and ischemia alert during endoscopic thyroid surgery, offering potential for enhanced surgical precision and patient outcomes.
Objective
To enhance the accuracy in predicting lymph node metastasis (LNM) preoperatively in patients with papillary thyroid microcarcinoma (PTMC), refining the “low‐risk” classification for ...tailored treatment strategies.
Methods
This study involves the development and validation of a predictive model using a cohort of 1004 patients with PTMC undergoing thyroidectomy along with central neck dissection. The data was divided into a training cohort (n = 702) and a validation cohort (n = 302). Multivariate logistic regression identified independent LNM predictors in PTMC, leading to the construction of a predictive nomogram model. The model's performance was assessed through ROC analysis, calibration curve analysis, and decision curve analysis.
Results
Identified LNM predictors in PTMC included age, tumor maximum diameter, nodule‐capsule distance, capsular contact length, bilateral suspicious lesions, absence of the lymphatic hilum, microcalcification, and sex. Especially, tumors larger than 7 mm, nodules closer to the capsule (less than 3 mm), and longer capsular contact lengths (more than 1 mm) showed higher LNM rates. The model exhibited AUCs of 0.733 and 0.771 in the training and validation cohorts respectively, alongside superior calibration and clinical utility.
Conclusion
This study proposes and substantiates a preoperative predictive model for LNM in patients with PTMC, honing the precision of “low‐risk” categorization. This model furnishes clinicians with an invaluable tool for individualized treatment approach, ensuring better management of patients who might be proposed observation or ablative options in the absence of such predictive information.
Objective
We aimed to investigate the value of exome sequencing (ES) in fetuses with callosal anomalies (CA) with or without other structural anomalies, but with normal findings by karyotyping and ...chromosome microarray analysis (CMA).
Methods
Cases with CA with or without other structural anomalies were screened for eligibility. Fetuses with abnormal karyotyping or CMA results were excluded. We performed ES on DNA samples from eligible fetus‐parental trios and identified diagnostic genetic variants based on the ultrasonographic features.
Results
A total of 50 eligible fetus‐parental trios were successfully analyzed by ES. We found 17 likely pathogenic or pathogenic variants in 14 genes from 17 fetuses, with a total proportion of diagnostic genetic variants equal to 34.0% (17/50). Of the 17 cases with a diagnosis, 10 (29.4%, 10/35) were isolated and 7 (43.8%, 7/15) were non‐isolated. Pregnancy outcome data showed that 70.0% (7/10) of the surviving isolated CA fetuses with negative ES results had a good prognosis in early childhood.
Conclusions
Our study used ES prenatally for CA and showed that ES can be used diagnostically to define the molecular defects that underlie unexplained CA. Most subjects with isolated CA with negative results for genetic causes will have a favorable prognosis in early childhood.
Key points
What is already known on this topic?
CNVs and monogenic causes have been shown to be associated with callosal anomalies (CA).
Approximately 28.8%–50% of children with CA experienced general intellectual, academic, executive, social and/or behavioral difficulties and approximately 20%–71.2% were functioning at a level comparable to typically developing children.
What does this study add?
This study analyzed the use of exome sequencing (ES) in a group of fetuses with CA and the total proportion of diagnostic genetic variants was 34.0%.
Most subjects with isolated CA with negative results for genetic causes will have a favorable prognosis in early childhood.
Objective
We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons' visual estimation.
...Methods
A total of 1,700 images of parathyroid glands from 166 endoscopic thyroidectomy videos were labeled. Data from 20 additional full‐length videos were used as an independent external cohort. The YOLO V3, Faster R‐CNN, and Cascade algorithms were used for deep learning, and the optimal algorithm was selected for independent external cohort analysis. Finally, the identification rate, initial recognition time, and tracking periods of PTAIR (Artificial Intelligence model for Parathyroid gland Recognition), junior surgeons, and senior surgeons were compared.
Results
The Faster R‐CNN algorithm showed the best balance after optimizing the hyperparameters of each algorithm and was updated as PTAIR. The precision, recall rate, and F1 score of the PTAIR were 88.7%, 92.3%, and 90.5%, respectively. In the independent external cohort, the parathyroid identification rates of PTAIR, senior surgeons, and junior surgeons were 96.9%, 87.5%, and 71.9%, respectively. In addition, PTAIR recognized parathyroid glands 3.83 s ahead of the senior surgeons (p = 0.008), with a tracking period 62.82 s longer than the senior surgeons (p = 0.006).
Conclusions
PTAIR can achieve earlier identification and full‐time tracing under a particular training strategy. The identification rate of PTAIR is higher than that of junior surgeons and similar to that of senior surgeons. Such systems may have utility in improving surgical outcomes and also in accelerating the education of junior surgeons.
Level of Evidence
3 Laryngoscope, 132:2516–2523, 2022
PTAIR is an artificial intelligence algorithm to identify parathyroid glands in the endoscopic thyroid. Artificial intelligence biopsies are on the horizon for us.
Epstein-Barr virus (EBV) is associated with a range of epithelial and B cell malignancies as well as autoimmune disorders, for which there are still no specific treatments or effective vaccines. ...Here, we isolate EBV gH/gL-specific antibodies from an EBV-infected individual. One antibody, 1D8, efficiently neutralizes EBV infection of two major target cell types, B cells and epithelial cells. In humanized mice, 1D8 provides protection against a high-dose EBV challenge by substantially reducing viral loads and associated tumor burden. Crystal structure analysis reveals that 1D8 binds to a key vulnerable interface between the D-I/D-II domains of the viral gH/gL protein, especially the D-II of the gH, thereby interfering with the gH/gL-mediated membrane fusion and binding to target cells. Overall, we identify a potent and protective neutralizing antibody capable of reducing the EBV load. The novel vulnerable site represents an attractive target that is potentially important for antibody and vaccine intervention against EBV infection.
SUMMARY
Floral patterns are unique to rice and contribute significantly to its reproductive success. SL1 encodes a C2H2 transcription factor that plays a critical role in flower development in rice, ...but the molecular mechanism regulated by it remains poorly understood. Here, we describe interactions of the SL1 with floral homeotic genes, SPW1, and DL in specifying floral organ identities and floral meristem fate. First, the sl1 spw1 double mutant exhibited a stamen‐to‐pistil transition similar to that of sl1, spw1, suggesting that SL1 and SPW1 may located in the same pathway regulating stamen development. Expression analysis revealed that SL1 is located upstream of SPW1 to maintain its high level of expression and that SPW1, in turn, activates the B‐class genes OsMADS2 and OsMADS4 to suppress DL expression indirectly. Secondly, sl1 dl displayed a severe loss of floral meristem determinacy and produced amorphous tissues in the third/fourth whorl. Expression analysis revealed that the meristem identity gene OSH1 was ectopically expressed in sl1 dl in the fourth whorl, suggesting that SL1 and DL synergistically terminate the floral meristem fate. Another meristem identity gene, FON1, was significantly decreased in expression in sl1 background mutants, suggesting that SL1 may directly activate its expression to regulate floral meristem fate. Finally, molecular evidence supported the direct genomic binding of SL1 to SPW1 and FON1 and the subsequent activation of their expression. In conclusion, we present a model to illustrate the roles of SL1, SPW1, and DL in floral organ specification and regulation of floral meristem fate in rice.
Significance Statement
The morphology of rice flowers is crucial for successful reproduction and grain yield. However, research on floral organ specification gene regulatory network (FOS‐GRN) in rice and other grass species is not as extensive as in Arabidopsis. In this study, we unveil the crucial role of the C2H2 zinc finger transcription factor SL1 in regulating flower organ development and floral meristem fate in rice. Our experimental evidence indicates that SL1 positively regulates the expression of SPW1, which, in turn, activates B‐class genes OsMADS2 and OsMADS4 to indirectly suppress DL expression, influencing the formation of floral organs. Additionally, we identify a cooperative role of SL1 and DL in terminating floral meristem fate.
Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. ...Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.
Anthracycline/taxane-based chemotherapy regimens are usually used as neoadjuvant chemotherapies to decrease tumour size and prevent metastasis of advanced breast cancer. However, patients have a high ...risk of developing chemo-resistance during treatment through still unknown mechanisms. Glutathione S-transferase P1 (GSTP1), which belongs to the family of phase II metabolic enzymes, has been reported to function in detoxifying several anti-cancer drugs by conjugating them with glutathione. Previous studies have identified GSTP1 as a predictor of prognosis and chemo-resistance in breast cancer patients, but the mechanisms governing GSTP1-dependent drug resistance are still unclear. We have found that GSTP1 expression is much higher in adriamycin-resistant cells and their corresponding exosomes. The role of GSTP1-containing exosomes in conferring drug resistance was analysed through cell apoptosis and immunofluorescence staining assays. Furthermore, we analysed 42 cases of paired breast cancer tissues collected before and after anthracycline/taxane-based neoadjuvant chemotherapy by immunohistochemistry. Higher GSTP1 expression was shown in the progressive disease (PD)/stable disease (SD) group than in the partial response (PR)/complete response (CR) group both in the samples collected before and after the chemotherapy treatment. Interestingly, GSTP1 partly re-localized from the cell nucleus to the cytoplasm upon treatment, and similar results were obtained for the exosomal marker Tumour susceptibility gene 101 protein (TSG101), which also increased in the cytoplasm after chemotherapy. After analysing the serum exosomes of 30 patients treated with anthracycline/taxane-based neoadjuvant chemotherapy, we discovered that the levels of GSTP1 in exosomes from patients in the PD/SD group were significantly higher than those in the PR/CR group. Here, for the first time, we investigated a novel role for GSTP1-containing exosomes and their capability to transfer drug resistance and evaluated their clinical use in predicting chemo-resistance.
•Up-regulation of GSTP1 expression level was observed in Adriamycin-resistant cells and their corresponding exosomes.•GSTP1 can be transferred to sensitive cells through exosomes, thus resulting in a switch to drug-resistance.•GSTP1 expression is higher in chemo-resistant group from neoadjuvant chemo-resistant breast cancer tissues.•GSTP1 partly re-localized from the cell nucleus to the cytoplasm upon chemotherapy.•Circulating GSTP1-containing exosomes predict clinical outcome of chemotherapy in breast cancer patients.
•Design flexible zinc ion hybrid capacitors for wearable devices.•3D porous H-Mxene films were constructed via simple engineering method.•The aqueous capacitor delivers a high specific ...capacitance.•The cycling stability remains 90% of specific capacitance after 20,000 cycles.
Flexible zinc ion hybrid capacitor (ZICs) as a kind of emerging energy storage devices have great prospect for grid-scale energy storage and wearable electronics due to some advantages such as appropriate density, superb power output, abundant zinc resources, and nontoxic nature. Currently, there are still great demands to seek and design novel electrodes for zinc ion hybrid capacitors, especially for flexible free-standing electrode. Herein, a novel rechargeable aqueous Zn-ion hybrid capacitor using 3D porous H-MXene film (3D-PHMF) as the cathode was reported. The 3D porous H-MXene film was constructed with an interlayer interaction engineering via freeze-casting method, wherein the hydrogen ion (H+) was introduced to weaken electrostatic repulsion of MXene interlayer. The aqueous Zn//3D-PHMF capacitor delivers a specific capacitance of 105.6 mAh g−1 at 0.2 A g−1 and good rate performance of 61.0 mAh g−1 at 5 A g−1 with remarkable cycling stability, which remains 90% of specific capacitance after 20,000 cycles. Besides, the capacitor also shows outstanding anti-self-discharge ability in which the self-discharge rate is 1.87 mV h−1. Remarkably, the as-obtained flexible cathode can be designed into a flexible quasi-solid-state device, which shows excellent flexibility and stability. This work demonstrates the promising possibility of MXene as free-standing electrode for energy storage applications.
•Co2Fe1-LDH/PAA system shows efficient performance for removing various pharmaceuticals.•R-O• is the dominant ROS with a high concentration in contaminants degradation.•Bimetallic synergistic effect ...is important and observed in PAA activation system.•Co2Fe1-LDH/PAA system can reduce biological toxicity of the wastewater.•The ability of Co2Fe1-LDH/PAA system to treat actual hospital wastewater was comprehensively evaluated.
As an oxidant, peracetic acid (PAA) is gradually applied in advanced oxidation processes (AOPs) for pollutants degradation due to its high oxidation and low toxicity. In this study, the prepared Co2Fe1-LDH showed excellent PAA activation ability for efficient degradation of various pharmaceuticals with a removal efficiency ranging from 82.3% to 100%. Taking sulfamethoxazole (SMX) as a model pharmaceutical, it's found that organic radical (R-O•) with high concentration of 5.27 × 10−13 M is the dominant ROS responsible for contaminants degradation. Further analysis demonstrated that bimetallic synergistic effect between Co and Fe can improve electron transfer ability of Co2Fe1-LDH, resulting in the accelerated conversion of Co from +3 to +2 valence state with a high reaction rate (4.3 × 101–1.483 × 102 M−1 s−1) in this system. Density functional theory (DFT) reveals that C1, C3, C5 and N11 with higher ƒ0 and ƒ−values concentrated on aniline group of SMX are the main attack sites, which is consistent with the results of degradation products. Besides, Co2Fe1-LDH/PAA system can effectively reduce biological toxicity after reaction, due to lower biotoxicity of degradation products and the carbon sources provided by PAA. In application, Co2Fe1-LDH/PAA system was capable of resisting the influence of water matrix and effectively removing pollutants in actual hospital wastewater. Importantly, this study comprehensively evaluated the ability of Co2Fe1-LDH/PAA system to remove organics and improve the biodegradability of actual hospital wastewater, providing guidance for application of PAA activation system.
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