Objective: Microvascular invasion (MVI) is a significant adverse prognostic indicator of intrahepatic cholangiocarcinoma (ICC) and affects the selection of individualized treatment regimens. This study sought to establish a radiomics nomogram based on the optimal VOI of multi-sequence MRI for predicting MVI in ICC tumors. Methods: 160 single ICC lesions with MRI scanning confirmed by postoperative pathology were randomly separated into training and validation cohorts (TC and VC). Multivariate analysis identified independent clinical and imaging MVI predictors. Radiomics features were obtained from images of 6 MRI sequences at 4 different VOIs. The least absolute shrinkage and selection operator algorithm was performed to enable the derivation of robust and effective radiomics features. Then, the best three sequences and the optimal VOI were obtained through comparison. The MVI prediction nomogram combined the independent predictors and optimal radiomics features, and its performance was evaluated via the receiver operating characteristics, calibration, and decision curves. Results: Tumor size and intrahepatic ductal dilatation are independent MVI predictors. Radiomics features extracted from the best three sequences (T1WI-D, T1WI, DWI) with VOI_10mm (including tumor and 10 mm peritumoral region) showed the best predictive performance, with AUC_TC = 0.987 and AUC_VC = 0.859. The MVI prediction nomogram obtained excellent prediction efficacy in both TC (AUC = 0.995, 95%CI 0.987–1.000) and VC (AUC = 0.867, 95%CI 0.798–0.921) and its clinical significance was further confirmed by the decision curves. Conclusion: A nomogram combining tumor size, intrahepatic ductal dilatation, and the radiomics model of MRI multi-sequence fusion at VOI_10mm may be a predictor of preoperative MVI status in ICC patients.

Malalignment of the lower limbs is the main biomechanical factor for knee osteoarthritis (KOA). The static hip-knee-ankle angle (S-HKAA) measured from radiograph is regarded as the “gold standard” of the malalignment. However, many evidences showed that the S-HKAA has no significant correlation with the knee dynamic-load distribution, unlike the dynamic HKAA (D-HKAA). The purpose of this study was to quantitatively analyze the D-HKAA and investigate the relationship between D-HKAA and S-HKAA for both KOA and healthy participants. In this paper, twenty-five healthy subjects and twenty-five medial compartment KOA (M-KOA) patients were recruited. Three-dimensional motion analysis and standing lower-limbs-full-length radiograph were utilized to obtain the D-HKAA and S-HKAA, respectively. The results showed that the mean D-HKAA was more varus than the S-HKAA ( ). For the mean D-HKAA, larger varus angle was observed in swing phase than stance phase ( ). Compared with healthy subjects, the M-KOA patients had remarkably smaller S-HKAA and D-HKAA during gait cycle ( ). For the relationship between the S-HKAA and mean D-HKAA, no significant correlation was found for both healthy subjects and M-KOA patients ( , , , Spearman correlation analysis). In conclusion, the S-HKAA was limited to predict the D-HKAA for both M-KOA patients and healthy subjects. The D-HKAA should be given more attention to the orthopedist and the designer of knee brace and orthotics.

The effect of calcium sulfate/calcium phosphate composite for the treatment of chronic osteomyelitis compared with calcium sulfate Zihou Zhao, Guoliang Wang, Yong Zhang, Wen Luo, Shiyu Liu, Yunyan Liu, Yong Zhou, Yunfei Zhang

Heat shock proteins (HSPs), the most important type of molecular chaperone, are expressed in all eukaryotic cells and have multiple functions, including the folding and unfolding of other proteins and peptides, the transport of proteins and peptides and the support of antigen presentation processes. Due to these important properties, the use of HSPs has been explored as a promising tumor immunotherapy strategy. It has been previously demonstrated that HSP peptide complex (HSP.PC) derived from tumors is the immunogenic entity that elicits powerful antitumor immune responses. Previous animal studies and phase III clinical trials have demonstrated the efficacy, safety and feasibility of HSP-based tumor vaccines. However, the limitations are also apparent and specific alternatives have been developed. The present review focused on the history of HSP-based immunotherapy, the mechanism of its immunogenicity and the previous efforts to promote the efficacy. The current review may be useful for antitumor studies based on the tumor-derived HSPs.

Background: The incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial.Methods: A retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment.Results: We included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs.Conclusions: The most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.