This study aims to establish a radiomics analysis system for the diagnosis and clinical behaviour prediction of hepatocellular carcinoma (HCC) based on multi-parametric ultrasound imaging. A total of 177 patients with focal liver lesions (FLLs) were included in the study. Every patient underwent multi-modal ultrasound examination, including B-mode ultrasound (BMUS), shear wave elastography (SWE), and shear wave viscosity (SWV) imaging. The radiomics analysis system was built on sparse representation theory (SRT) and support vector machine (SVM) for asymmetric data. Through the sparse regulation from the SRT, the proposed radiomics system can effectively avoid over-fitting issues that occur in regular radiomics analysis. The purpose of the proposed system includes differential diagnosis between benign and malignant FLLs, pathologic diagnosis of HCC, and clinical prognostic prediction. Three biomarkers, including programmed cell death protein 1 (PD-1), antigen Ki-67 (Ki-67) and microvascular invasion (MVI), were included and analysed. We calculated the accuracy (ACC), sensitivity (SENS), specificity (SPEC) and area under the receiver operating characteristic curve (AUC) to evaluate the performance of the radiomics models. A total of 2560 features were extracted from the multi-modal ultrasound images for each patient. Five radiomics models were built, and leave-one-out cross-validation (LOOCV) was used to evaluate the models. In LOOCV, the AUC was 0.94 for benign and malignant classification (95% confidence interval [CI]: 0.88 to 0.98), 0.97 for malignant subtyping (95% CI: 0.93 to 0.99), 0.97 for PD-1 prediction (95% CI: 0.89 to 0.98), 0.94 for Ki-67 prediction (95% CI: 0.87 to 0.97), and 0.98 for MVI prediction (95% CI: 0.93 to 0.99). The performance of each model improved when the viscosity modality was included. Radiomics analysis based on multi-modal ultrasound images could aid in comprehensive liver tumor evaluations, including diagnosis, differential diagnosis, and clinical prognosis.

Treating biofilm infections on implanted medical devices is formidable, even with extensive antibiotic therapy. The aim of this study was to investigate whether ultrasound (US)-targeted microbubble (MB) destruction (UTMD) could enhance vancomycin activity against Staphylococcus epidermidis RP62A biofilms. Twelve-hour biofilms were treated with vancomycin combined with UTMD. The vancomycin and MB (SonoVue) were used at concentrations of 100 μg/ml and 30% (vol/vol), respectively, in studies in vitro . After US exposure (0.08 MHz, 1.0 W/cm ² , 50% duty cycle, and 10-min duration), the biofilms were cultured at 37°C for another 12 h. The results showed that many micropores were found in biofilms treated with vancomycin combined with UTMD. Biofilm densities ( A ₅₇₀ values) and the viable counts of S. epidermidis recovered from the biofilm were significantly decreased compared with those of any other groups. Furthermore, the highest percentage of dead cells was found, using confocal laser scanning microscopy, in the biofilm treated with vancomycin combined with UTMD. The viable counts of bacteria in biofilms in an in vivo rabbit model also confirmed the enhanced effect of vancomycin combined with UTMD. UTMD may have great potential for improving antibiotic activity against biofilm infections.

The biomedical applications of TiO₂-based nanosystems develop very slowly among diverse inorganic bio-nanosystems (e.g., Fe₃O₄, SiO₂, MnO, Au, etc.) due to the lack of adequate synthetic strategies to fabricate TiO₂ nanoparticles with desirable nanostructures and their specific light responses in the ultraviolet range with potential phototoxicity and low tissue-penetrating capability. In this work, we report on the rational design and fabrication of colloidal single-crystalline and mesoporous anatase TiO₂ nanoparticles (MTNs) with high dispersity, well-defined mesoporosity, uniform morphology and nanosized single-crystalline structure, employing a facile yet versatile bottom-up chemical strategy, i.e., pre-hydrolysis of titanium precursors combined with subsequent solvothermal treatment (PH-ST) simply using water as the additive. Highly biocompatible PEGylated MTNs have exerted their unique function as efficient sonosensitizers for sonodynamic therapy (SDT) of cancer, as systematically demonstrated both in vitro and in vivo. The production of reactive oxygen species (ROS) by MTN-sonosensitized SDT has been demonstrated to be the mechanism for efficient tumor SDT. The in vivo biocompatibility assay revealed that either a single dose at 150 mg kg⁻¹ or repeated doses at as high as a total of 400 mg kg⁻¹ exhibited no obvious in vivo toxicity. The ultrasound irradiation of MTNs in SDT is expected to break the depth shadow of light responsiveness of TiO₂-based nanosystems in the ultraviolet range, and the presence of well-defined mesoporous nanostructures of MTNs shows great potential for the delivery of therapeutic agents for combined cancer therapy.

Objectives: To establish a radiomic algorithm based on grayscale ultrasound images and to make preoperative predictions of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods: In this retrospective study, 322 cases of histopathologically confirmed HCC lesions were included. The classifications based on preoperative grayscale ultrasound images were performed in two stages: (1) classifier #1, MVI-negative and MVI-positive cases; (2) classifier #2, MVI-positive cases were further classified as M1 or M2 cases. The gross-tumoral region (GTR) and peri-tumoral region (PTR) signatures were combined to generate gross- and peri-tumoral region (GPTR) radiomic signatures. The optimal radiomic signatures were further incorporated with vital clinical information. Multivariable logistic regression was used to build radiomic models. Results: Finally, 1595 radiomic features were extracted from each HCC lesion. At the classifier #1 stage, the radiomic signatures based on features of GTR, PTR, and GPTR showed area under the curve (AUC) values of 0.708 (95 % CI, 0.603 - 0.812), 0.710 (95 % CI, 0.609 - 0.811), and 0.726 (95% CI, 0.625 - 0.827), respectively. Upon incorporation of vital clinical information, the AUC of the GPTR radiomic algorithm was 0.744 (95 % CI, 0.646 - 0.841). At the classifier #2 stage, the AUC of the GTR radiomic signature was 0.806 (95 % CI, 0.667 - 0.944). Conclusions: Our radiomic algorithm based on grayscale ultrasound images has potential value to facilitate preoperative prediction of MVI in HCC patients. The GTR radiomic signature may be helpful for further discriminating between M1 and M2 levels among MVI-positive patients.

As one of the most promising noninvasive therapeutic modalities, sonodynamic therapy (SDT) can focus the ultrasound energy on tumor sites located in deep tissue and locally activate the preloaded sonosensitizer to kill tumor cells. However, exploring sonosensitizers with high SDT efficacy and desirable biosafety is still a significant challenge. Herein, we utilized the hydrophilic–hydrophobic self-assembly technology to assemble the hydrophobic organic dye Ce6 and broad spectral anti-cancer agent Paclitaxel with hydrophilic organic dye IR783 to generate a nanoscale sonosensitizer, Ce6-PTX@IR783, without the introduction of extra nanomaterials into the fabrication to guarantee high therapeutic biosafety and further potential clinical translation. The constructed nanodrug was endowed with an external ultrasound-activatable chemo–sonodynamic effect and photoacoustic imaging performance via integrating multiple moieties into one nanosystem. Ce6 could enhance the sonodynamic effect, while PTX exerted a chemotherapeutic effect, and IR783 was applied to increase tumor-specific accumulation and assist in fulfilling photoacoustic imaging. In particular, the small particle size (70 nm) of Ce6-PTX@IR783 contributed to the increased tumor accumulation via the enhanced permeability and retention effect. The high synergistically chemo–sonodynamic therapeutic efficacy has been successfully demonstrated in vitro and in vivo, in addition to the demonstrated high biodegradability, biocompatibility and biosafety. This facile self-assembly procedure provides an intriguing strategy for highly efficient utilization of hydrophobic drugs and is liable to realize large-scale production and further clinical translation.