Deep Learning Nomogram for the Identification of Deep Stromal Invasion in Patients With Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma: A Multicenter Study

BACKGROUND

Deep stromal invasion (DSI) is one of the predominant risk factors that determined the types of radical hysterectomy (RH). Thus, the accurate assessment of DSI in cervical adenocarcinoma (AC)/adenosquamous carcinoma (ASC) can facilitate optimal therapy decision.

PURPOSE

To develop a nomogram to identify DSI in cervical AC/ASC.

STUDY TYPE

Retrospective.

POPULATION

Six hundred and fifty patients (mean age of 48.2 years) were collected from center 1 (primary cohort, 536), centers 2 and 3 (external validation cohorts 1 and 2, 62 and 52).

FIELD STRENGTH/SEQUENCE

5-T, T2-weighted imaging (T2WI, SE/FSE), diffusion-weighted imaging (DWI, EPI), and contrast-enhanced T1-weighted imaging (CE-T1WI, VIBE/LAVA).

ASSESSMENT

The DSI was defined as the outer 1/3 stromal invasion on pathology. The region of interest (ROI) contained the tumor and 3 mm peritumoral area. The ROIs of T2WI, DWI, and CE-T1WI were separately imported into Resnet18 to calculate the DL scores (TDS, DDS, and CDS). The clinical characteristics were retrieved from medical records or MRI data assessment. The clinical model and nomogram were constructed by integrating clinical independent risk factors only and further combining DL scores based on primary cohort and were validated in two external validation cohorts.

STATISTICAL TESTS

Student's t-test, Mann-Whitney U test, or Chi-squared test were used to compare differences in continuous or categorical variables between DSI-positive and DSI-negative groups. DeLong test was used to compare AU-ROC values of DL scores, clinical model, and nomogram.

RESULTS

The nomogram integrating menopause, disruption of cervical stromal ring (DCSRMR), DDS, and TDS achieved AU-ROCs of 0.933, 0.807, and 0.817 in evaluating DSI in primary and external validation cohorts. The nomogram had superior diagnostic ability to clinical model and DL scores in primary cohort (all P < 0.0125 [0.05/4]) and CDS (P = 0.009) in external validation cohort 2.

DATA CONCLUSION

The nomogram achieved good performance for evaluating DSI in cervical AC/ASC.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

CIRBP protects H9C2 cells against myocardial ischemia through inhibition of NF-κB pathway

Myocardial ischemia is a major cause of death and remains a disease with extremely deficient clinical therapies and a major problem worldwide. Cold inducible RNA-binding protein (CIRBP) is reported to be involved in multiple pathological processes, including myocardial ischemia. However, the molecular mechanisms of myocardial ischemia remain elusive. Here, we first overexpressed CIRBP by transfection of pc-CIRBP (pcDNA3.1 containing coding sequenced for CIRBP) and silenced CIRBP by transfection of small interfering RNA targeting CIRBP (siCIRBP). pcDNA3.1 and the negative control of siCIRBP (siNC) were transfected into H9C2 cells to act as controls. We then constructed a cell model of myocardial ischemia through culturing cells in serum-free medium with hypoxia in H9C2 cells. Subsequently, AlamarBlue assay, flow cytometry and western blot analysis were used, respectively, to assess cell viability, reactive oxygen species (ROS) level and apoptosis, and expression levels of IκBα, p65 and Bcl-3. We demonstrated that CIRBP overexpression promoted cell proliferation (P<0.001), inhibited cell apoptosis (P<0.05), reduced ROS level (P<0.001), down-regulated phosphorylated levels of IκBα and p65 (P<0.01 or P<0.001), and up-regulated expression of Bcl-3 (P<0.001) in H9C2 cells with myocardial ischemia. The influence of CIRBP knockdown yielded opposite results. Our study revealed that CIRBP could protect H9C2 cells against myocardial ischemia through inhibition of NF-κB pathway.

[Regulatory effect of ventral tegmental area on sleep-wakefulness in rats]

Experiments were performed on 31 male SD rats. The results were as follows: (1) The time of waking was increased during the second and third hours after microinjection of 3.3 and 6.6 nmol bromocriptine into bilateral VTA (P < 0.01), but the 1.33 nmol group was without significant effect. (2) The time of waking was decreased during the second and third hours after microinjection of 2 and 4 nmol SCH23390 into VTA (P < 0.01 and P < 0.05 respectively), while 3.4 nmol sulpiride group was without effect. (3) One week after administration of kainic acid (0.3 microgram), the rats presented less time of waking in the day (P < 0.05), while sleep-wakefulness cycle at night showed no change. The results suggest that bromocriptine could increase wakefulness by activating VTA DA neurons via D1 receptor and that the DA neurons might exert a tonic effect for maintaining the wakefulness at the daytime.

[Effects of bromocriptine microinjection into VTA on the DOPAC level in nucleus accumbens]

The experiment was performed in sodium pentobarbital anesthetized male SD rats. In vivo differential pulse voltammetry (DPV) was used to monitor a metabolite of dopamine-3,4-dihydroxyphenylacetic acid (DOPAC) level in the ipsilateral nucleus accumbens following microinjection of bromocriptine (2.5 micrograms/0.5 microliters, n = 5) into left ventral tegmental area (VTA). The results indicated that after microinjection the amplitude of DOPAC peak increased gradually and reached to 128% and 143% compared to the control at the 50th and 80th min respectively (P < 0.01). The duration of the effect was about two hours. One hundred and eighty min after injection, the amplitude of DOPAC decreased to 111% of control (P > 0.05). SCH23390 (2 nmol/0.5 microliters, n = 4), a selective D1 antagonist was given into left VTA 40 min prior to microinjection of bromocriptine. In this group, the above-mentioned effect of bromocriptine was blocked, the amplitude of DOPAC peak showed no increase. The results suggest that the microinjection of bromocriptine into VTA induces an increase of activity of mesolimbic dopaminergic neurons probably mediated by D1 receptor.

Thoracic hydatid cysts: a report of 842 cases treated over a thirty-year period

From 1957 to 1985, 842 patients were diagnosed as having thoracic hydatid cysts; 810 cysts were intrathoracic, 29 occurred on the "liver roof," 2 were cardiac, and 1 was on the chest wall. A total of 1,010 surgical procedures were performed in 807 patients (35 refused operation). There was a total operative mortality of 0.6% (5 deaths). Procedures became more conservative as experience was gained, and 79% of the procedures were endocystectomies. Intact endocystectomy (Barrett's technique) without preliminary aspiration was the approach of choice. Careful protection of the operating field, suturing of all the bronchial openings, and capitonnage were the keys to successful treatment. One hundred six patients with intact endocystectomies done before July, 1975, were followed for 3 to 20 years. Ruptures occurred during cyst manipulation in 35 patients (33%). Recurrence after operation was seen in 2 patients (1.9%). There were no deaths among the patients undergoing intact endocystectomy. In comparison, we followed 136 patients who underwent aspiration endocystectomy and the recurrence rate was 3.7% (5 patients).

Application of biotin-avidin system, determination of circulating immune complexes, and evaluation of antibody response in different hydatidosis patients

The avidin-biotin-peroxidase complex enzyme-linked immunosorbent assay (ABC-ELISA) and standard ELISA were used for the detection of Echinococcus granulosus antibody in sera of 101 patients operated on for hydatid disease, 40 patients with miscellaneous nonhydatid diseases, and 61 normal subjects. Sensitivity and specificity of the two procedures were comparable and the geometric mean antibody titer detected with ABC-ELISA was higher than with standard ELISA. The ABC-ELISA is a sensitive, specific, simple, and convenient method for diagnosing hydatidosis.