To evaluate clinical outcomes and temporal bone remodeling after venous sinus stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD. This retrospective cohort study included 70 consecutive patients who underwent venous sinus stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n = 52). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone remodeling. Short-term clinical success was achieved in 65/70 patients (92.9

Objective To explore the diagnostic value of computed tomography angiography (angio-CT) in superior mesenteric artery-derived gastrointestinal hemorrhage, as well as the safety and efficacy of interventional embolization, and to compare its detection difference with digital subtraction angiography (DSA). Methods A retrospective analysis was performed on the clinical data of 25 patients with superior mesenteric artery-derived gastrointestinal hemorrhage admitted to our hospital from January 2023 to June 2025. All patients underwent DSA and angio-CT to confirm the bleeding site, followed by DSA-guided interventional embolization. The bleeding detection rates of the two examination methods, interventional embolization success rate, postoperative complication rate, and rebleeding rate during follow-up were compared, and the application value of angio-CT in preoperative evaluation was analyzed. Results Among the 25 patients, DSA identified 16 bleeding sites (detection rate 64.0%), while angio-CT accurately identified 25 bleeding sites (detection rate 100.0%), with a statistically significant difference (χ²=11.976, P < 0.05). The bleeding sites included 16 cases (64.0%) of main branches of the superior mesenteric artery, 5 cases (20.0%) of jejunal artery branches, and 4 cases (16.0%) of ileal artery branches. The technical success rate of interventional embolization was 100%, and the clinical hemostasis success rate was 92.0% (23/25). Postoperatively, 2 cases had mild abdominal pain and 1 case had fever, with no serious complications (such as intestinal necrosis or severe infection). During the 3 ~ 12 months of follow-up, 2 patients experienced rebleeding, which was successfully stopped by secondary embolization, resulting in a rebleeding rate of 8.0%. Conclusion Angio-CT can quickly and accurately locate the bleeding site of superior mesenteric artery-derived gastrointestinal hemorrhage, making up for the disadvantage of DSA in identifying low-flow or static-phase bleeding. It provides precise navigation for interventional embolization, improving the treatment success rate. Interventional embolization has the advantages of minimal invasiveness, high efficiency, and few complications, which is worthy of clinical promotion and application.

BACKGROUND:Sigmoid sinus wall reconstruction (SSWR) for unilateral pulsatile tinnitus (PT) has high initial success but a long-term recurrence rate of 13.5%-31.4%. The role of preoperative dural venous pressure in recurrence remains unclear. OBJECTIVE:To investigate the association between preoperative dural sinus pressure and long-term recurrence after SSWR. METHODS:This retrospective study included 93 patients with unilateral PT diagnosed with sigmoid sinus wall anomalies (SSWAs) with transverse sinus stenosis (TSS) using CT angiography/venography. All underwent preoperative digital subtraction angiography, manometry, and SSWR. During 12 month follow-up, patients were grouped into recurrence (n=31) and non-recurrence (n=62). Pressures were measured in superior sagittal sinus (SSS), transverse sinus (TS) origin, distal/proximal to stenosis, and the trans-stenotic pressure gradient (TPG) was calculated. Univariate and multivariate analyses identified factors independently associated with recurrence. Receiver operating characteristic (ROC) curves assessed predictive performance. RESULTS:TPG, pressures at SSS, TS origin, and distal TSS, and degree of TSS differed significantly between the two groups (P<0.001). Multivariate analysis identified TPG (OR=1.396, P=0.022), SSS pressure (OR=1.997, P=0.049), and degree of TSS (OR=0.010, P=0.030) as factors independently associated with recurrence. The area under the curve was 0.754 for SSS pressure, 0.772 for TPG, 0.779 for the degree of TSS, and 0.836 for their combination. CONCLUSION:Preoperative TPG, SSS pressure, and degree of TSS may be key factors correlated with SSWR recurrence. Patients with PT with SSWAs and more severe venous stenosis may be better treated with venous sinus stenting.

Background:The trans-stenotic pressure gradient (TPG) is a critical pathophysiological factor in symptomatic transverse sinus stenosis (TSS) and serves as a principal hemodynamic indicator for determining the necessity of stent placement. However, the gold standard of TPG measurement requires venous manometry guided by digital subtraction angiography, which is an invasive procedure associated with significant technical complexity, substantial cost, and procedural risks. In recent years, there has been growing interest in noninvasive image-based TPG estimation methodologies. However, a comprehensive multivariate analysis incorporating clinical parameters, laboratory biomarkers, and imaging indicators remains conspicuously absent in recent research. The purpose of this study was to investigate the clinical, laboratory, and imaging parameters that exhibit correlations with the TPG in TSS. Methods:Inpatients diagnosed with idiopathic intracranial hypertension or venous pulsatile tinnitus who underwent computed tomography venography (CTV) between September 2016 and October 2023 were retrospectively reviewed. Those with confirmed TSS and who subsequently underwent venous manometry were included. The comparison of parameters between genders was performed through the use of independent samples t-tests for continuous data and chi-squared tests for categorical data. We analyzed the correlation of the TPG with clinical characteristics (pulsatile tinnitus side, gender, age, and body mass index), laboratory results (blood glucose, blood lipid, routine blood examination, laboratory thyroid function test, coagulation test, and serum sex hormone levels), and CTV signs (the degree, length, and type of TSS; outflow laterality of the transverse sinus; and confluence point of the Labbé vein). Independent variables were determined, and a multivariate linear regression model was applied to assess their influences on TPG. Results:The study cohort comprised 95 participants (11 males and 84 females) with a median age of 38 years (interquartile range, 31-49 years). Body mass index (BMI) (P=0.004), hemoglobin (P=0.018), testosterone (P=0.004), and prolactin (P<0.001) were significantly different between genders, while the other parameters were not. The TPG was significantly correlated with age (R=-0.36; P<0.001), the degree of TSS (R=0.53; P<0.001), length of TSS (R=0.36; P<0.001), intrinsic stenosis (R=-0.21; P=0.038), an upstream location of the Labbé vein (R=-0.28; P=0.006), levels of free tetraiodothyronine (R=0.30; P=0.004), triiodothyronine (R=-0.27; P=0.008), D-dimer (R=-0.22; P=0.035), follicle-stimulating hormone (R=-0.28; P=0.006), luteinizing hormone (R=-0.29; P=0.004), and prolactin (R=0.25; P=0.016). After multicollinearity testing and variable adjustment, the degree of TSS, age, and triiodothyronine level were included in the final regression model, resulting in the following equation: y TPG = 7.42 + 11.04x degree of TSS - 0.12x age - 0.03x triiodothyronine (R=0.67; P<0.001). Conclusions:The degree of TSS, patient age, and triiodothyronine level are independently correlated with TPG in patients with symptomatic TSS.

BackgroundVessels encapsulating tumor clusters (VETC) constitute an aggressive morphological subtype of hepatocellular carcinoma (HCC), characterized by marked angiogenesis and immune infiltration, and can potentially be identified noninvasively using radiomics.ObjectiveThis study aimed to evaluate the predictive performance of pre-treatment contrast-enhanced MRI (CEMRI) habitat radiomics and deep learning models for identifying VETC in HCC, and to characterize the associated immune infiltration patterns.MethodsWe retrospectively analyzed CEMRI scans from 336 patients with HCC (336 lesions). Habitat features and deep learning (DL) features were extracted from the CEMRI scans, and the LASSO was applied for feature selection to construct an intratumoral heterogeneity (ITH) model and a deep learning (DL) model. Robust ITH and DL features were subsequently integrated to develop a fusion model with enhanced predictive capability, and model performance was assessed using the area under the receiver operating characteristic curve (AUC). Using radiomics features derived from the fusion model, 47 HCC patients with baseline liver MRI scans in The Cancer Imaging Archive (TCIA) and matched RNA-seq profiles in The Cancer Genome Atlas (TCGA) were stratified into a high-risk group (n = 23) and a low-risk group (n = 24). Transcriptomic profiles were then analyzed using gene set variation analysis (GSVA) to compare immune-related pathway activity between groups. Differential gene expression analysis (DGEA), gene set enrichment analysis (GSEA), and cell type identification by estimating relative subsets of RNA transcripts (CIBERSORT)-based immune infiltration analysis were further performed to elucidate potential differences in the tumor immune microenvironment and their biological implications.ResultsThe ITH model achieved AUCs of 0.845 and 0.806 in the training and validation cohorts, respectively, whereas the DL model yielded AUCs of 0.764 and 0.745. The fusion model demonstrated superior performance, with AUCs of 0.901 and 0.870 in the respective cohorts. Transcriptomic analyses identified significant differential gene expression between the high- and low-risk groups. GSEA indicated that the low-risk group was enriched in pathways related to the cell cycle, translation, and mitochondrial function. Immune profiling revealed a significant reduction in resting dendritic cells in the high-risk group (P < 0.05), suggesting potential immune evasion.ConclusionsA CEMRI-based fusion model integrating ITH and DL features enables accurate prediction of VETC in HCC and shows preliminary associations with immune-related transcriptomic and infiltration profiles linked to this vascular pattern.

Background:Mass-forming (MF) type is the most common, accounting for 57.1-83.6% of intrahepatic cholangiocarcinoma (ICC), with a poor prognosis. Transarterial chemoembolization (TACE) can induce necrosis of tumor cells, induce the release of tumor antigens, enhance the immune response of tumor-specific CD8+ T cells, and regulate the proliferation of Treg cells. However, real-world data directly comparing TACE combined with programmed cell death protein-1 (PD-1) versus programmed death ligand-1 (PD-L1) inhibitors in MF-ICC are lacking. Therefore, we aimed to evaluate the efficacy and safety between the different immune checkpoint inhibitors (ICIs) (PD-1/PD-L1 inhibitors) in MF-ICC, and to explore prognosis-related clinical factors and preliminary immune mechanisms underlying this combined therapy. Methods:A total of 50 patients with MF-ICC who underwent TACE combined with ICIs at Beijing Friendship Hospital and Beijing Ditan Hospital from May 2020 to December 2024 were retrospectively enrolled. Least absolute shrinkage and selection operator (LASSO) regression was used to screen the risk factors of overall survival (OS). Survival was estimated using the Kaplan-Meier method and compared by the log-rank test. Univariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between treatment regimen and survival. In parallel, we analyzed dynamic changes in immune cells before and after ICI treatment using the single-cell RNA sequencing dataset GSE208205 and further validated these findings by flow cytometry. Results:The median overall survival (mOS) and median progression-free survival (mPFS) for TACE-PD-L1 followed by therapy were 18 and 13 months, which were significantly longer than those with TACE-PD-1 sequential therapy (mOS: 12 months, HR: 0.42, 95% CI: 0.17-1.03, P=0.047; mPFS: 8 months, HR: 0.29, 95% CI: 0.12-0.73, P=0.006). In exploratory multivariable analysis, pre-treatment monocyte-to-lymphocyte ratio (MLR), Child-Pugh classification, total bilirubin (TBIL), and alanine aminotransferase (ALT) emerged as potential prognosis-related factors for OS. Single-cell analysis showed that CD4+ T and CD8+ T cells were markedly increased after treatment, while circulating tumor cells and vascular endothelial cells were decreased. This was further validated by the flow cytometry. Moreover, regardless of treatment status, ICC patients in the PD-L1 groups exhibited higher levels of CD4+ and CD8+ T cells compared to the PD-1 group, whereas B cells were lower in the PD-L1 group than in the PD-1 group. Conclusions:TACE combined with PD-L1 inhibitors was associated with longer survival than TACE combined with PD-1 inhibitors in patients with mass-forming ICC. The immune system, particularly lymphocytes, plays a critical role in the efficacy of combination therapy. In addition, several baseline inflammation- and liver function-related factors (MLR, Child-Pugh class, TBIL, ALT) were associated with OS in exploratory analyses.

BACKGROUND AND PURPOSE:Stent placement effectively relieves venous pulsatile tinnitus caused by transverse sinus stenosis with sigmoid sinus wall dehiscence. However, the spectrum of temporal bone remodeling remains poorly characterized. MATERIALS AND METHODS:This retrospective cohort study included consecutive patients who underwent transverse sinus stenting for venous pulsatile tinnitus with ipsilateral sigmoid sinus wall dehiscence, with or without a diverticulum. Clinical outcomes were recorded. Preoperative and postoperative CT were obtained (median follow-up 7 months; 18 patients had serial scans). Bone regeneration (graded as complete, major >50%, minor <50%, or absent) and new dehiscence were evaluated bilaterally. RESULTS:Ipsilateral bone regeneration occurred in 47/50 patients (94.0%): complete in 20.0%, major in 46.0%, minor in 28.0%, and absent in 6.0%. Contralateral bone regeneration was observed in 16/17 patients (94.1%). Among 18 patients with serial postoperative scans, 13 (72.2%) showed progressive regeneration. Follow-up duration correlated positively with regeneration degree (r = 0.51, P < 0.001). New bone dehiscence on the symptomatic side developed in 7 patients (14.0%): 3 adjacent to original sigmoid sinus wall dehiscence, 4 at jugular bulb. Complete resolution was achieved in 9/10 of complete regeneration (90.0%), 22/37 of partial regeneration (59.5%). Recurrence was observed in 5 of 37 patients (13.5%) with partial regeneration; notably, 3 of these 5 recurrences occurred among the 4 patients who had new jugular bulb dehiscence. CONCLUSIONS:Bone remodeling after stenting for venous pulsatile tinnitus is a dynamic, time-dependent process encompassing bilateral temporal bone regeneration and ipsilateral new dehiscence formation and correlates with clinical outcomes.

While multimodal large language models (LLMs) demonstrate significant potential in healthcare applications, their clinical utility is difficult to appraise. Current evaluations of medical-assisting LLMs are often limited by sparse human expertise, narrow specialty scope, and reliance on multiple-choice benchmarks or synthetic vignettes, which can inflate performance and obscure clinical utility. We conducted a multicenter, multidisciplinary study in which more than 400 physicians—spanning seven specialties, varied experience levels, and multiple geographic settings—evaluated LLM-generated free-text responses to real, de-identified clinical cases. In a matched-control design, we also deployed an equivalent number of AI agents configured to mirror physician characteristics to examine whether automated evaluators can supplement or replace human assessment. Our results demonstrated that physician assessments exhibited substantial heterogeneity by clinical seniority and practice environment, leading to notable shifts in relative model rankings across cohorts. While AI agents delivered highly efficient, directionally aligned assessments, they did not fully capture the nuances of human clinical judgment and could not substitute for physician-centered evaluation. Instead, they promise assistive tools that can triage or pre-screen outputs to reduce human burden.

Venous sinus stenting (VSS) is highly effective for pulsatile tinnitus (PT), yet up to 20

Environmental exposure to neonicotinoids (NEOs) is ubiquitous, yet epidemiological evidence linking them to non-alcoholic fatty liver disease (NAFLD) remains hindered by diagnostic limitations and linear modeling assumptions. This study analyzed 1281 adults from the NHANES 2017-2018 cycle, utilizing Vibration-Controlled Transient Elastography (VCTE) to objectively quantify hepatic steatosis. Through mutually adjusted multi-pollutant models, restricted cubic splines (RCS), and piecewise parallel mediation analyses, we evaluated the associations between five urinary NEO biomarkers and liver outcomes. Among the evaluated NEOs, only the imidacloprid metabolite 5-hydroxyimidacloprid (5OHIMI) exhibited a significant, independent association with NAFLD risk. This non-monotonic association was predominantly observed in males, displaying an inverted U-shaped dose-response trajectory with the highest odds at moderate exposure (OR = 3.17, 95% CI: 1.43 - 7.03, p = 0.016); no significant associations were found in females. Furthermore, piecewise mediation analysis indicated that systemic triglyceride dysregulation acted as a modest yet statistically significant potential mediator (9.13% proportion) during the initial positive association phase. These findings suggest that environmental 5OHIMI exposure is associated with early fatty liver disease predominantly in men, and disruptions in systemic lipid homeostasis may serve as a potential contributing pathway. This study provides population-based epidemiological evidence to refine neonicotinoid health risk assessment.

Background:The transstenotic pressure gradient (TPG) is closely associated with the pathogenesis, diagnosis, and treatment strategies of conditions such as idiopathic intracranial hypertension and pulsatile tinnitus. Currently, TPG assessment relies on invasive, complex, and costly digital subtraction angiography (DSA), and an efficient, noninvasive evaluation method remains lacking. We thus aimed to develop a machine learning model to predict the transverse sinus TPG using features derived from computed tomography angiography (CTA). Methods:We included 139 patients who underwent DSA for transverse sinus TPG measurement. Six feature indicators were extracted from their CTA data. Using TPG as the dependent variable, we applied six machine learning algorithms-logistic regression, adaptive boosting, k-nearest neighbor, naïve Bayes, light gradient boosting machine, and support vector machine-to construct classification models based on TPG thresholds of 4 and 8 mmHg via fivefold cross-validation. Model performance was assessed through use of accuracy, sensitivity, specificity, F1-score, Matthews correlation coefficient, and area under the curve (AUC). Shapley additive explanations analysis was used to interpret feature importance. Ultimately, 19 patients were included as an external validation dataset to assess model accuracy. Results:The six selected CTA features were residual area ratio, stenosis length, stenosis type, Labbé vein location, degree of drainage dominance, and contralateral stenosis. Logistic regression demonstrated the best performance at both thresholds, with AUC of 0.83 for 4 mmHg and 0.83 for 8 mmHg. Shapley additive explanations analysis revealed a positive correlation between the location of the Labbé vein and TPG, whereas the residual area ratio and stenosis type were negatively correlated. External validation showed good accuracy, reaching 0.89 for both thresholds. Conclusions:The developed machine learning model shows promising potential for the noninvasive prediction of transverse sinus TPG based on CTA-derived features.

BACKGROUND:This study aimed to evaluate the safety and efficacy of TACE combined with durvalumab for treating advanced and metastatic BTC. Research design and methods: Data were collected retrospectively from a single center. The TACE procedures were performed 1 to 19 times, with repetitions occurring every 4 to 12 weeks based on the patient's liver function and tumor shrinkage. Durvalumab was given as an intravenous injection every three weeks at a dose of 1000 to 1500 mg. RESULTS:The estimated median progression-free survival (PFS) was 9.0 months (95% CI: 6.8 to 11.2), with a 1-year PFS rate of 23.8%. The estimated median overall survival (OS) was 16.0 months (95% CI: 7.5 to 24.5), with a 1-year OS rate of 58.7%. The investigator-confirmed objective response rate (ORR) was 35.9%. Elevated baseline carcinoembryonic antigen (CEA) levels and neutrophil-to-lymphocyte ratio (NLR) ≥ 3 showed negative correlations with PFS (p = 0.035, CEA; p = 0.038, NLR) and OS (p = 0.040, NLR). Adverse events occurred in 36 patients (92.3%). Additionally, 7 patients (17.9%) experienced immune-mediated AEs (imAEs). CONCLUSIONS:These results indicate promising efficacy and acceptable safety for the combination of TACE and durvalumab as a first-line treatment for advanced and metastatic BTC.

Background:There is relatively scant evidence concerning the effects of Lenvatinib and Pembrolizumab together with TACE for advanced HCC Lenvatinib and pembrolizumab have been widely applied in clinical settings. PIVKA-II serving as the sensitive biomarker for evaluating liver cancer was employed by us to further assess the therapeutic effectiveness of TACE combined with Lenvatinib in the treatment of BCLC C. Methods:In this retrospective study, 260 patients with HCC BCLC C stage were included in the present study. TACE (TL group) included 126 patients, TACE-Lenvatinib-Pembrolizumab (TPB group) consisted of 134 patients. OS and PFS were compared between the two groups. Alternatively, the impact of PIVKA-II in TPB on the PFS of BCLC C stage was also assessed. Results:The median overall survival (OS) in the TL group was significantly prolonged compared to that in the TPB group (13.7 months versus 9.6 months). Conversely, the median progression - free survival (PFS) was extended in the TPB group as opposed to the TL group (9.3 months versus 6.2 months). The adverse events in the TPB group were controllable and tolerable. After six months of combined treatment, the change in PIVKA - II became less significant. This suggests that PIVKA-II is negatively correlated with PFS, meaning that the greater the decrease in PIVKA-II after 6 months of combined therapy, the longer the PFS time for the patient. Conclusion:TACE combined with Lenvatinib and Pembrolizumab exhibited remarkable survival benefits for HCC BCLC C patients. Given the extremely dismal prognosis of advanced HCC, the safety and efficacy of TACE in combination with Lenvatinib and Pembrolizumab justify its clinical application.

INTRODUCTION:The aim of this study was to investigate the impact of hepatic venous portal gradient (HVPG) on body composition (BC) values and the prognostic value of BC value in cirrhotic patients. METHODS:A total of 173 cirrhotic patients with HVPG and computed tomography scan were screened retrospectively from a binary-center database. Seven BC values, including skeletal muscle index, subcutaneous adipose tissue index (SATI), deep SATI (dSATI), superficial SATI (sSATI), visceral adipose tissue index, and ratio of visceral adipose tissue index and SATI along with skeletal muscle radiodensity, were analyzed. The correlation analyses and multiple linear regression were used to assess the impact of HVPG on BC values. The cumulative survival rate was assessed, and risk factors of survival were identified by competing risk analysis using Fine-Gray model. RESULTS:Among 173 patients with a mean age of 53.7 ± 10.5 years, there were 111 male patients (64.2%) and 62 female patients (35.8%). In male patients, SATI, dSATI, and sSATI inversely correlated with HVPG, respectively (SATI: rho = -0.227; dSATI: rho = -0.229; sSATI: rho = -0.219; all P < 0.05), especially in patients aged 60 years or younger or with compensated cirrhosis; male patients with clinically significant portal hypertension had a lower SATI, dSATI, sSATI, and skeletal muscle radiodensity than those without clinically significant portal hypertension. After adjusted multiple linear models, male sex, Child-Pugh class B or C, and elevated HVPG contributed to decreased SATI. Multiple competing survival analysis showed a lower SATI (male: <38 cm 2 /m 2 ; female: <23 cm 2 /m 2 ), and Child-Pugh B or C predict mortality. DISCUSSION:Decreased SATI, dSATI, and sSATI were more closely associated with increased HVPG. A lower SATI and Child-Pugh B or C predicted mortality.

BACKGROUND:Bronchial arterial chemoembolization (BACE), as a safe and effective minimally invasive treatment method, is increasingly being accepted by more and more patients with advanced nonsmall-cell lung cancer (NSCLC). In recent years, drug-eluting beads (DEB)-BACE has also been applied in the field of lung cancer. It is still unclear which is more recommended due to the limited number of comparative studies between conventional BACE (C-BACE) and DEB-BACE. PURPOSE:To compare the safety and efficacy of C-BACE (BACE with gelfoam particles) and DEB-BACE for advanced NSCLC. MATERIALS AND METHODS:From January 2021 to April 2023, 48 consecutive patients (37 males and 11 females) with advanced NSCLC treated with DEB-BACE (group A) or C-BACE (group B) at our center were collected retrospectively in this study. There were 18 patients in group A and 30 patients in group B. The technical success rate, adverse events, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were compared between the 2 groups. RESULTS:The technical success rate in both groups was 100%. The median OS times were 19.5 months and 12.5 months in group A and group B, respectively ( P =0.0062). The median PFS times were 13 months and 7 months in group A and group B, respectively ( P =0.0072). The ORRs at 6 months were 72.2% and 46.7% in group A and group B, respectively ( P =0.084). The DCRs at 6 months were 88.9% and 63.3% in group A and group B, respectively ( P =0.043). Grade 1 adverse events like chest pain, and cough were common, while serious adverse events did not occur. CONCLUSIONS:BACE with DEB or gelfoam particles were equally safe. The DEB-BACE showed better survival and tumor response than C-BACE for advanced NSCLC.

Objective:The long-term effects of transarterial chemoembolization (TACE) on liver function and their prognostic implications in hepatocellular carcinoma (HCC) have not been fully explored. The Albumin-Bilirubin (ALBI) score, an objective measure of liver function, is a validated prognostic tool in HCC. This study aims to characterize the longitudinal trajectories of ALBI-scores after TACE, evaluate their impact on clinical outcomes, and identify factors influencing these trajectories. Materials and Methods:This retrospective study included patients with BCLC stage B/C HCC who underwent TACE, with baseline and at least two post-TACE ALBI-score measurements. Group-Based Trajectory Modeling (GBTM) was used to identify distinct ALBI-score trajectories. Clinical outcomes and patient characteristics were compared across trajectory groups. A CatBoost-based clinical prediction model was developed to identify factors influencing ALBI-score trajectories, with Shapley Additive Explanations (SHAP) values providing feature importance interpretation. Results:Among 501 patients, three ALBI-score trajectories were identified: improve, stable, and decline. The improve group had better overall survival (OS) and progression-free survival (PFS) compared to the stable and decline groups. Multivariate analysis confirmed that ALBI-score trajectories were independent risk factors for OS. Subgroup analysis suggested that TACE plus systemic therapy reduced mortality risk in the stable and decline groups. The CatBoost model effectively distinguished distinct trajectory groups, with SHAP analysis highlighting ALBI-grade, Child-Pugh class, and tumor number as key predictors. Conclusion:Post-TACE ALBI-score trajectories are closely linked to clinical outcomes, with improved liver function associated with better prognosis. Monitoring these trajectories could guide personalized treatment strategies for HCC patients undergoing TACE.

Utilizing artificial intelligence methods for blood flow pressure estimation can significantly enhance the computational speed of blood flow pressure. However, current related research can only calculate the blood flow pressure parameters of vessels with different geometric shapes under fixed boundary conditions, thus fail to achieve transient flow field calculation and consider the hemodynamic differences formed by patients' varying physiological and pathological conditions. In view of this, this study proposes a method for relative pressure estimation based on four-dimensional flow magnetic resonance imaging (4D flow MRI) of patient blood flow and deep learning. 4D flow MRI was used to obtain the patient's blood flow velocity gradient data, and feature engineering processing is performed on the sampled data. Then, a novel neural network was proposed to acquire the characteristic relationship between velocity gradient and pressure gradient in the vicinity of the point to be measured and within adjacent sampling time periods, thereby achieving the calculation of the relative pressure in the vicinity of the point to be measured. Statistical analysis was performed to evaluate the efficacy of the method, comparing it with computational fluid dynamics methods and catheter pressure measurement techniques. The accuracy of the proposed method exceeded 96%, while computational efficiency was improved by several tens of times, and no manual setting of physiological parameters was required. Furthermore, the results were compared with clinical catheter-measured pressure results, r2 = 0.9053, indicating a significant consistency between the two methods. Compared to previous research, the method proposed in this study can take the blood flow velocity conditions of different patients at different times as input features via 4D flow MRI, thus enabling the calculation of pressure in transient flow fields, which significantly improved computational efficiency and reduced costs while maintaining a high level of calculation accuracy. This provides new direction for future research on machine learning prediction of blood flow pressure.

Both microcoils and hook-wires are commonly utilized for preoperative pulmonary nodule localization due to their convenience, but it remains unclear which one should be prioritized for recommendation. To compare the safety and efficacy of microcoils and hook-wires for pulmonary nodule localization. From January 2021 to December 2021, 310 consecutive patients (113 males and 197 females) with 341 pulmonary nodules who underwent CT-guided microcoil or hook-wire localization prior to video-assisted thoracoscopic surgery (VATS) at our center were retrospectively included in this study. There were 161 patients in the microcoil group and 149 patients in the hook-wire group. The successful localization rate, complication rate, radiation exposure, and medical costs were compared between the two groups. A total of 341 pulmonary nodules were localized, with a success rate of 99

Abstract Duplication of the portal vein is a rare type of congenital anomaly of the portal system. Herein, we present a rare type of complete portal vein duplication in a 71-year-old female patient complaining of longstanding abdominal distension and dyspepsia and illuminate the mechanism underlying severe complication in embryonic portal vein development. Interventional radiological procedures excluded other probable pathological alternations. Understanding the embryonic development of the portal vein and timely intervention are essential to manage such patients.