Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of...Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of clinicians.Moreover,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical practice.In contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical endpoints.Studies have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized medicine.However,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical modeling.In this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with cancer.We focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical modeling.Furthermore,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of models.Finally,we offer possible solutions to current challenges in radiomics research.展开更多
BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper airway.We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total...BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper airway.We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor resection.CASE SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope episodes.Chest computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen obstruction.Flexible bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal obstruction.Because of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby VV-ECMO.Due to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy access.While transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation support.Femoral and internal jugular vein were catheterized to facilitate possible VV-ECMO deployment.During tracheostomy,progressive desaturation developed and VV-ECMO was instituted immediately.After tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative care.Two days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged uneventfully.CONCLUSION In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor excision.During anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintained at least initially,and ECMO deployment should be prepared for high-risk patients,such as those with obstructive symptoms,obstructed tracheal lumen>50%,or distal trachea location.展开更多
Gouty arthritis is an inflammatory disease that is caused by an accumulation of monosodium urate （MSU） crystals in the joints. MSU is capable of activating the nucleotide-binding oligomerization domain-like receptor...Gouty arthritis is an inflammatory disease that is caused by an accumulation of monosodium urate （MSU） crystals in the joints. MSU is capable of activating the nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 （NLRP3） inflammasome, leading to interleukin-lβ （IL-lβ） secretion. Reactive oxygen species （ROS） are major mediators of the NLRP3/IL-lβ interaction. Although nuclear factor E2-related factor 2 （Nrf2） is recognized as a transcription factor that is involved in the response to oxidative stress, the effect of MSU on Nrf2 and on Nrf2-mediated antioxidant enzymes remains unclear. The treatment of THP-1 monocytes using phorbol 12-myristate 13-acetate （PMA） was shown to initiate inflammatory responses. Here, we showed that THP-1 cells, following treatment with MSU crystals, significantly increased IL-1β release, NLRP3 inflammasome activation and ROS production. MSU also promoted the nuclear translocation of Nrf2 and activated lysosomal destabilization. Moreover, the levels of heme oxygenase-1 （HO-1） in gene and protein expressions were upregulated by MSU. MSU-induced IL-lβ secretion and NLRP3 inflammasome activation were inhibited by the knockdown of Nrf2 and via the HO-1 inhibitor zinc （11） protoporphyrin IX （ZnPP）. In addition, HO-1 inhibition increased the level of superoxide anion production and the consumption of glutathione. These findings suggest that Nrf2 and HO-1 mediate redox homeostasis and interact with pro-inflammatory factors in MSU-challenged THP-1 cells, thereby providing new insight into how MSU-induced gouty inflammation is mediated by specific mechanisms that are involved in the Nrf2/Ho-1 antioxidant signaling pathway.展开更多
基金supported in part by the National Natural Science Foundation of China(82072019)the Shenzhen Basic Research Program(JCYJ20210324130209023)+5 种基金the Shenzhen-Hong Kong-Macao S&T Program(Category C)(SGDX20201103095002019)the Mainland-Hong Kong Joint Funding Scheme(MHKJFS)(MHP/005/20),the Project of Strategic Importance Fund(P0035421)the Projects of RISA(P0043001)from the Hong Kong Polytechnic University,the Natural Science Foundation of Jiangsu Province(BK20201441)the Provincial and Ministry Co-constructed Project of Henan Province Medical Science and Technology Research(SBGJ202103038,SBGJ202102056)the Henan Province Key R&D and Promotion Project(Science and Technology Research)(222102310015)the Natural Science Foundation of Henan Province(222300420575),and the Henan Province Science and Technology Research(222102310322).
文摘Modern medicine is reliant on various medical imaging technologies for non-invasively observing patients’anatomy.However,the interpretation of medical images can be highly subjective and dependent on the expertise of clinicians.Moreover,some potentially useful quantitative information in medical images,especially that which is not visible to the naked eye,is often ignored during clinical practice.In contrast,radiomics performs high-throughput feature extraction from medical images,which enables quantitative analysis of medical images and prediction of various clinical endpoints.Studies have reported that radiomics exhibits promising performance in diagnosis and predicting treatment responses and prognosis,demonstrating its potential to be a non-invasive auxiliary tool for personalized medicine.However,radiomics remains in a developmental phase as numerous technical challenges have yet to be solved,especially in feature engineering and statistical modeling.In this review,we introduce the current utility of radiomics by summarizing research on its application in the diagnosis,prognosis,and prediction of treatment responses in patients with cancer.We focus on machine learning approaches,for feature extraction and selection during feature engineering and for imbalanced datasets and multi-modality fusion during statistical modeling.Furthermore,we introduce the stability,reproducibility,and interpretability of features,and the generalizability and interpretability of models.Finally,we offer possible solutions to current challenges in radiomics research.
文摘BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper airway.We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor resection.CASE SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope episodes.Chest computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen obstruction.Flexible bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal obstruction.Because of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby VV-ECMO.Due to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy access.While transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation support.Femoral and internal jugular vein were catheterized to facilitate possible VV-ECMO deployment.During tracheostomy,progressive desaturation developed and VV-ECMO was instituted immediately.After tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative care.Two days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged uneventfully.CONCLUSION In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor excision.During anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintained at least initially,and ECMO deployment should be prepared for high-risk patients,such as those with obstructive symptoms,obstructed tracheal lumen>50%,or distal trachea location.
文摘Gouty arthritis is an inflammatory disease that is caused by an accumulation of monosodium urate （MSU） crystals in the joints. MSU is capable of activating the nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 （NLRP3） inflammasome, leading to interleukin-lβ （IL-lβ） secretion. Reactive oxygen species （ROS） are major mediators of the NLRP3/IL-lβ interaction. Although nuclear factor E2-related factor 2 （Nrf2） is recognized as a transcription factor that is involved in the response to oxidative stress, the effect of MSU on Nrf2 and on Nrf2-mediated antioxidant enzymes remains unclear. The treatment of THP-1 monocytes using phorbol 12-myristate 13-acetate （PMA） was shown to initiate inflammatory responses. Here, we showed that THP-1 cells, following treatment with MSU crystals, significantly increased IL-1β release, NLRP3 inflammasome activation and ROS production. MSU also promoted the nuclear translocation of Nrf2 and activated lysosomal destabilization. Moreover, the levels of heme oxygenase-1 （HO-1） in gene and protein expressions were upregulated by MSU. MSU-induced IL-lβ secretion and NLRP3 inflammasome activation were inhibited by the knockdown of Nrf2 and via the HO-1 inhibitor zinc （11） protoporphyrin IX （ZnPP）. In addition, HO-1 inhibition increased the level of superoxide anion production and the consumption of glutathione. These findings suggest that Nrf2 and HO-1 mediate redox homeostasis and interact with pro-inflammatory factors in MSU-challenged THP-1 cells, thereby providing new insight into how MSU-induced gouty inflammation is mediated by specific mechanisms that are involved in the Nrf2/Ho-1 antioxidant signaling pathway.
