Nano-immunotherapy shows great promise in improving patient outcomes, as seen in advanced triple-negative breast cancer, but it does not cure the disease, with median survival under two years. Therefore, understanding resistance mechanisms and developing strategies to enhance its effectiveness in breast cancer is crucial. A key resistance mechanism is the pronounced desmoplasia in the tumor microenvironment, which leads to dysfunction of tumor blood vessels and thus, to hypoperfusion, limited drug delivery and hypoxia. Ultrasound sonopermeation and agents that normalize the tumor stroma have been employed separately to restore vascular abnormalities in tumors with some success. Here, we performed in vivo studies in two murine, orthotopic breast tumor models to explore if combination of ultrasound sonopermeation with a stroma normalization drug can synergistically improve tumor perfusion and enhance the efficacy of nano-immunotherapy. We found that the proposed combinatorial treatment can drastically reduce primary tumor growth and in many cases tumors were no longer measurable. Overall survival studies showed that all mice that received the combination treatment survived and rechallenge experiments revealed that the survivors obtained immunological memory. Employing ultrasound elastography and contrast enhanced ultrasound along with proteomics analysis, flow cytometry and immunofluorescene staining, we found the combinatorial treatment reduced tumor stiffness to normal levels, restoring tumor perfusion and oxygenation. Furthermore, it increased infiltration and activity of immune cells and altered the levels of immunosupportive chemokines. Finally, using machine learning analysis, we identified that tumor stiffness, CD8⁺ T cells and M2-type macrophages were strong predictors of treatment response.

Robotic central pancreatectomy is increasingly used for pre- or low-grade malignant tumors in the pancreatic body balancing preservation of pancreatic function while removing the target lesion.^1-3 Today, there is no established reconstruction method and high rates of postpancreatectomy fistulas (POPF) remain a significant concern. ^4,5 We developed novel technique involving transgastric pancreaticogastrostomy with an omental pedicle advancement flap to reduce the risk of POPF. Additionally, preoperative deep-learning 3D organ modeling plays a crucial role in enhancing spatial understanding to enhance procedural safety.^6,7 METHODS: A 76-year-old female patient with a 33-mm, biopsy-confirmed high-risk IPMN underwent robotic-assisted central pancreatectomy. Preoperative CT was processed with a deep-learning system to create a patient-specific 3D model, enabling virtual simulation of port configurations. The optimal setup was selected based on the spatial relationship between port site, tumor location, and anatomy A transgastric pancreaticogastrostomy with omental flap reinforcement was performed to reduce POPF leading to a simpler reconstruction compared to pancreaticojejunostomy. The procedure lasted 218 min with minimal blood loss (50 ml). No complications occurred, and the patient was discharged on postoperative Day 3 after drain removal. Final pathology showed low-grade dysplasia. This approach, facilitated by robotic assistance, effectively preserves pancreatic function while treating a low-grade malignant tumor. Preoperative 3D organ modeling enhances the spatial understanding with the goal to increase procedural safety. Finally, the omental pedicle advancement flap technique shows promise in possibly reducing the incidence or at least the impact of POPF.

Mesenteric malperfusion (MMP) is an uncommon but devastating complication of acute aortic dissection (AAD) that combines 2 life-threatening conditions-aortic dissection and acute mesenteric ischemia. The complex pathophysiology of MMP poses substantial diagnostic and management challenges. Currently, delayed diagnosis remains a critical contributor to poor outcomes because of the absence of reliable individualized risk assessment tools. This study aims to develop and validate a deep learning-based model that integrates multimodal data to identify patients with AAD at high risk of MMP. This multicenter retrospective study included 525 patients with AAD from 2 hospitals. The training and internal validation cohort consisted of 450 patients from Beijing Anzhen Hospital, whereas the external validation cohort comprised 75 patients from Nanjing Drum Tower Hospital. Three machine learning models were developed: the benchmark model using laboratory parameters, the multiorgan feature-based AAD complicating MMP (MAM) model based on computed tomography angiography images, and the integrated model combining both data modalities. Model performance was assessed using the area under the curve, accuracy, sensitivity, specificity, and Brier score. To improve interpretability, gradient-weighted class activation mapping was used to identify and visualize discriminative imaging features. Univariate and multivariate regression analyses were used to evaluate the prognostic significance of the risk score generated by the optimal model. In the external validation cohort, the integrated model demonstrated superior performance, with an area under the curve of 0.780 (95% CI 0.777-0.785), which was significantly greater than those of the benchmark model (0.586, 95% CI 0.574-0.586) and the MAM model (0.732, 95% CI 0.724-0.734). This highlights the benefits of multimodal integration over single-modality approaches. Additional classification metrics revealed that the integrated model had an accuracy of 0.760 (95% CI 0.758-0.764), a sensitivity of 0.667 (95% CI 0.659-0.675), a specificity of 0.783 (95% CI 0.781-0.788), and a Brier score of 0.143 (95% CI 0.143-0.145). Moreover, gradient-weighted class activation mapping visualizations of the MAM model revealed that during positive predictions, the model focused more on key anatomical areas, particularly the superior mesenteric artery origin and intestinal regions with characteristic gas or fluid accumulation. Univariate and multivariate analyses also revealed that the risk score derived from the integrated model was independently associated with inhospital mortality risk among patients with AAD undergoing endovascular or surgical treatment (odds ratio 1.030, 95% CI 1.004-1.056; P=.02). Our findings demonstrate that compared with unimodal approaches, an integrated deep learning model incorporating both imaging and clinical data has greater diagnostic accuracy for MMP in patients with AAD. This model may serve as a valuable tool for early risk identification, facilitating timely therapeutic decision-making. Further prospective validation is warranted to confirm its clinical utility. Chinese Clinical Registry Center ChiCTR2400086050; http://www.chictr.org.cn/showproj.html?proj=226129.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in China, highlighting the importance of early diagnosis and ongoing monitoring for effective management. In recent years, hyperpolarized 129Xe MRI technology has gained significant clinical attention due to its ability to non-invasively and visually assess lung ventilation, microstructure, and gas exchange function. Its recent clinical approval in China, the United States and several European countries, represents a significant advancement in pulmonary imaging. This review provides an overview of the latest developments in hyperpolarized 129Xe MRI technology for COPD assessment in China. It covers the progress in instrument development, advanced imaging techniques, artificial intelligence-driven reconstruction methods, molecular imaging, and the application of this technology in both COPD patients and animal models. Furthermore, the review explores potential technical innovations in 129Xe MRI and discusses future directions for its clinical applications, aiming to address existing challenges and expand the technology's impact in clinical practice.

Machine learning drives osteoporosis detection and screening with higher clinical accuracy and accessibility than traditional osteoporosis screening tools. This review takes a step-by-step view of machine learning for osteoporosis detection, providing insights into today's osteoporosis detection and the outlook for the future. The early diagnosis and risk detection of osteoporosis have always been crucial and challenging issues in the medical field. With the in-depth application of artificial intelligence technology, especially machine learning technology in the medical field, significant breakthroughs have been made in the application of early diagnosis and risk detection of osteoporosis. Machine learning is a multidimensional technical system that encompasses a wide variety of algorithm types. Machine learning algorithms have become relatively mature and developed over many years in medical data processing. They possess stable and accurate detection performance, laying a solid foundation for the detection and diagnosis of osteoporosis. As an essential part of the machine learning technical system, deep-learning algorithms are complex algorithm models based on artificial neural networks. Due to their robust image recognition and feature extraction capabilities, deep learning algorithms have become increasingly mature in the early diagnosis and risk assessment of osteoporosis in recent years, opening new ideas and approaches for the early and accurate diagnosis and risk detection of osteoporosis. This paper reviewed the latest research over the past decade, ranging from relatively basic and widely adopted machine learning algorithms combined with clinical data to more advanced deep learning techniques integrated with imaging data such as X-ray, CT, and MRI. By analyzing the application of algorithms at different stages, we found that these basic machine learning algorithms performed well when dealing with single structured data but encountered limitations when handling high-dimensional and unstructured imaging data. On the other hand, deep learning can significantly improve detection accuracy. It does this by automatically extracting image features, especially in image histological analysis. However, it faces challenges. These include the "black-box" problem, heavy reliance on large amounts of labeled data, and difficulties in clinical interpretability. These issues highlighted the importance of model interpretability in future machine learning research. Finally, we expect to develop a predictive model in the future that combines multimodal data (such as clinical indicators, blood biochemical indicators, imaging data, and genetic data) integrated with electronic health records and machine learning techniques. This model aims to present a skeletal health monitoring system that is highly accessible, personalized, convenient, and efficient, furthering the early detection and prevention of osteoporosis.

Anal injuries, such as lacerations and fissures, are challenging to diagnose because of their anatomical complexity. Endoanal ultrasound (EAUS) has proven to be a reliable tool for detailed visualization of anal structures but relies on expert interpretation. Artificial intelligence (AI) may offer a solution for more accurate and consistent diagnoses. This study aims to develop and test a convolutional neural network (CNN)-based algorithm for automatic classification of fissures and anal lacerations (internal and external) on EUAS. A single-center retrospective study analyzed 238 EUAS radial probe exams (April 2022-January 2024), categorizing 4528 frames into fissures (516), external lacerations (2174), and internal lacerations (1838), following validation by three experts. Data was split 80% for training and 20% for testing. Performance metrics included sensitivity, specificity, and accuracy. For external lacerations, the CNN achieved 82.5% sensitivity, 93.5% specificity, and 88.2% accuracy. For internal lacerations, achieved 91.7% sensitivity, 85.9% specificity, and 88.2% accuracy. For anal fissures, achieved 100% sensitivity, specificity, and accuracy. This first EUAS AI-assisted model for differentiating benign anal injuries demonstrates excellent diagnostic performance. It highlights AI's potential to improve accuracy, reduce reliance on expertise, and support broader clinical adoption. While currently limited by small dataset and single-center scope, this work represents a significant step towards integrating AI in proctology.

This study aims to determine the diagnostic performance of sub-5-min combined sixfold parallel imaging (PIx3)-simultaneous multislice (SMSx2)-accelerated deep learning (DL) super-resolution 3T knee MRI in children and adolescents. Children with painful knee conditions who underwent PIx3-SMSx2-accelerated DL super-resolution 3T knee MRI and arthroscopy between October 2022 and December 2023 were retrospectively included. Nine fellowship-trained musculoskeletal radiologists independently scored the MRI studies for image quality and the presence of artifacts (Likert scales, range: 1 = very bad/severe, 5 = very good/absent), as well as structural abnormalities. Interreader agreements and diagnostic performance testing was performed. Forty-four children (mean age: 15 ± 2 years; range: 9-17 years; 24 boys) who underwent knee MRI and arthroscopic surgery within 22 days (range, 2-133) were evaluated. Overall image quality was very good (median rating: 5 [IQR: 4-5]). Motion artifacts (5 [5-5]) and image noise (5 [4-5]) were absent. Arthroscopy-verified abnormalities were detected with good or better interreader agreement (κ ≥ 0.74). Sensitivity, specificity, accuracy, and AUC values were 100%, 84%, 93%, and 0.92, respectively, for anterior cruciate ligament tears; 71%, 97%, 93%, and 0.84 for medial meniscus tears; 65%, 100%, 86%, and 0.82 for lateral meniscus tears; 100%, 100%, 100%, and 1.00 for discoid lateral menisci; 100%, 95%, 96%, and 0.98 for medial patellofemoral ligament tears; and 55%, 100%, 98%, and 0.77 for articular cartilage defects. Clinical sub-5-min PIx3-SMSx2-accelerated DL super-resolution 3T knee MRI provides excellent image quality and high diagnostic performance for diagnosing internal derangement in children and adolescents.

Accurate liver-volume measurements from CT scans are essential for treatment planning, particularly in liver resection cases, to avoid postoperative liver failure. However, manual segmentation is time-consuming and prone to variability. Advancements in artificial intelligence (AI), specifically convolutional neural networks, have enhanced liver segmentation accuracy. We aimed to identify optimal CT phases for AI-based liver volume estimation and apply the model to track liver volume changes over time. We also evaluated temporal changes in liver volume in participants without liver disease. In this retrospective, single-center study, we assessed the performance of an open-source AI-based liver segmentation model previously reported, using non-contrast and dynamic CT phases. The accuracy of the model was compared with that of expert radiologists. The Dice similarity coefficient (DSC) was calculated across various CT phases, including arterial, portal venous, and non-contrast, to validate the model. The model was then applied to a longitudinal study involving 39 patients without liver disease (527 CT scans) to examine age-related liver volume changes over 5 to 20 years. The model demonstrated high accuracy across all phases compared to manual segmentation. Among the CT phases, the highest DSC of 0.988 ± 0.010 was in the arterial phase. The intraclass correlation coefficients for liver volume were also high, exceeding 0.9 for contrast-enhanced phases and 0.8 for non-contrast CT. In the longitudinal study, the model indicated an annual decrease of 0.95%. This model provides high accuracy in liver segmentation across various CT phases and offers insights into age-related liver volume reduction. Measuring changes in liver volume may help with the early detection of diseases and the understanding of pathophysiology.

The four-repeat (4R) tauopathies are a group of neurodegenerative diseases, including progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and globular glial tauopathy (GGT). This study aimed to characterize spatiotemporal atrophy progression using structural magnetic resonance imaging (MRI) and to examine its relationship with clinical course and neuropathology in a cohort of autopsy-confirmed 4R tauopathies. The study included 85 autopsied patients (54 with PSP, 28 with CBD, and 3 with GGT) who underwent multiple 3T MRI scans, as well as neuropsychological, neurological, and speech/language examinations, and standardized postmortem neuropathological evaluations. An unsupervised machine-learning algorithm, Subtype and Stage Inference (SuStaIn), was applied to the cross-sectional brain volumes to estimate spatiotemporal atrophy patterns and data-driven subtypes and stages in each patient. The relationships among estimated subtypes, pathological diagnoses, and longitudinal changes in clinical testing were examined. The SuStaIn algorithm identified 2 distinct subtypes: (1) the subcortical subtype, in which atrophy progresses from the midbrain to the cortex, and (2) the cortical subtype, in which atrophy progresses from the frontal cortex to the subcortical regions. The subcortical subtype was more associated with typical PSP, whereas the cortical subtype was more associated with atypical PSP with a cortical distribution of pathology and CBD (p < 0.001). The cortical subtype had a faster rate of change on the PSP Rating Scale than the subcortical subtype (p < 0.05). SuStaIn analysis revealed 2 MRI-driven subtypes with distinct spatiotemporal atrophy patterns, clinical courses, and neuropathology. Our findings contribute to a comprehensive and improved understanding of disease progression and its relationship to tau pathology in 4R tauopathies. ANN NEUROL 2025.

Differentiating major depressive disorder (MDD) from bipolar disorder (BD) remains a significant clinical challenge, as both disorders exhibit overlapping symptoms but require distinct treatment approaches. Advances in voxel-based morphometry and surface-based morphometry have facilitated the identification of structural brain abnormalities that may serve as diagnostic biomarkers. This study aimed to explore the relationships between brain morphological features, such as grey matter volume (GMV) and cortical thickness (CT), and demographic and clinical variables in patients with MDD and BD and healthy controls (HC) using multivariate analysis methods. A total of 263 participants, including 120 HC, 95 patients with MDD and 48 patients with BD, underwent T1-weighted MRI. GMV and CT were computed for standardised brain regions, followed by multivariate partial least squares (PLS) regression to assess associations with demographic and diagnostic variables. Reductions in frontotemporal CT were observed in MDD and BD compared with HC, but distinct trends between BD and MDD were also detected for the CT of selective temporal, frontal and parietal regions. Differential patterns in cerebellar GMV were also identified, with lobule CI larger in MDD and lobule CII larger in BD. Additionally, BD showed the same trend as ageing concerning reductions in CT and posterior cerebellar and striatal GMV. Depression severity showed a transdiagnostic link with reduced frontotemporal CT. This study highlights shared and distinct structural brain alterations in MDD and BD, emphasising the potential of neuroimaging biomarkers to enhance diagnostic accuracy. Accelerated cortical thinning and differential cerebellar changes in BD may serve as targets for future research and clinical interventions. Our findings underscore the value of objective neuroimaging markers in increasing the precision of mood disorder diagnoses, improving treatment outcomes.