Abstract Objectives To develop a generalizable and robust deep learning model for bone tumor classification in radiographs by leveraging domain-specific medical image pretraining. Materials and methods This retrospective multi-center study included 2338 patients with histopathologically confirmed bone tumors from four centers. Four hundred seventy-one patients from one center were used for model development, and 1867 patients from the other three centers were used for the external test. Deep learning models (ResNet50 and InceptionV3) were developed using transfer learning with weights from either RadImageNet (medical images) or ImageNet (natural images). A radiomics model based on ElasticNet was also built. Model performance was evaluated using the area under the curve (AUC), and the paired DeLong test was used to evaluate statistical significance between AUCs. Robustness was assessed through tumor bounding box perturbation experiments. Gradient-weighted class activation mapping (Grad-CAM) was performed to localize the key area highlighted by the model for enhancing interpretability. Results ResNet50 pretrained on RadImageNet demonstrated improved performance on external test sets (AUC = 0.738, 95% CI: 0.714–0.762), outperforming ImageNet-pretrained models (ResNet50: AUC = 0.669, 95% CI: 0.639–0.699, p < 0.001; InceptionV3: AUC = 0.677, 95% CI: 0.647–0.708, p < 0.001) and the radiomics model (AUC = 0.518, 95% CI: 0.487–0.548, p < 0.001). RadImageNet-pretrained models showed higher stability under tumor bounding box perturbation conditions (p < 0.001), and appropriately focused on diagnostically relevant regions in correctly classified cases. Conclusion The deep learning model pretrained on domain-specific medical images demonstrated improved performance and robustness compared to the radiomics and natural image-pretrained models for bone tumor classification on radiographs. Critical relevance statement Domain-specific medical image pretraining enhanced deep learning model performance and robustness over radiomics and natural image approaches in bone tumor classification on radiographs. Key Points Domain-specific medical image pretraining (RadImageNet) significantly outperforms natural image pretraining (ImageNet) for bone tumor classification on radiographs. Deep learning models pretrained on medical images demonstrate superior performance compared to radiomics approaches for bone tumor classification. AI assistance effectiveness varies among radiologists, with performance improvements depending on individual experience and receptiveness to AI support. Graphical Abstract

Introduction:Transarterial chemoembolization (TACE) is the primary treatment modality for intermediate-stage hepatocellular carcinoma (HCC). However, the lack of standardization to optimal technique leads to a wide variation in outcomes. This study aimed to evaluate the impact of procedure quality of TACE on HCC management. Methods:This multicenter retrospective cohort study included HCC patients with ≤4 tumors (maximum diameter ≤7 cm) treated with TACE monotherapy as first-line treatment between January 2009 and December 2022. Patients were classified into precision TACE and non-precision TACE groups based on adherence to predefined technical criteria encompassing angiography, catheterization, embolic agents, embolization endpoints, and assessment. The procedural quality was further stratified using a scoring system (where points were deducted for technical deficiencies). The primary outcome was objective response rate (ORR) after first TACE (first ORR) based on modified Response Evaluation Criteria in Solid Tumors. Secondary outcomes included overall ORR, progression-free survival (PFS), overall survival (OS), and safety profiles. Results:The analysis included 3,059 patients (median age, 58.00 years [IQR: 49.00-66.00]; 2,592 males [84.7%]) with 2,286 patients included in precision TACE and 773 patients included in non-precision TACE group. First ORR was 59.4% (1,359/2,286) in the precision TACE group versus 47.0% (363/773) in the non-precision TACE group (p < 0.001), with overall ORR of 70.6% (1,615/2,286) versus 59.8% (462/773) (p < 0.001). Median PFS was 14.00 months (IQR: 7.13-32.80) versus 10.80 months (IQR: 5.00-25.30) (HR = 0.787 [95% CI: 0.719-0.861], p < 0.001), and median OS was 33.63 months (IQR: 16.13-78.21) versus 26.37 months (IQR: 13.00-55.57) (HR = 0.792 [95% CI: 0.716-0.876], p < 0.001). The quality scoring system demonstrated a direct correlation between procedural quality and treatment response. Patients in precision TACE group had lower rates of hepatobiliary toxicity (elevated total bilirubin, 17.4% [398/2,286] vs. 33.8% [261/773], p < 0.001). Conclusion:Precision TACE was associated with improved outcomes and safety in HCC. The proposed scoring system correlates with treatment outcomes, suggesting its utility as a quality assessment tool for TACE procedures.

AIM:To evaluate the safety and efficacy of cone-beam CT (CBCT) guided prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) compared with TURP alone in the management of large-volume (>80 mL) benign prostatic hyperplasia (BPH). MATERIALS AND METHODS:This retrospective propensity score matched study included 99 patients with large-volume BPH treated between January 2017 and June 2023. Thirty-three underwent CBCT-guided PAE followed by TURP, and 66 underwent TURP alone. Perioperative parameters, complication rates, and functional outcomes-including International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual urine (PVR)-were compared between groups at baseline and at 3, 6, 12, and 24 months after surgery. RESULTS:The combination group demonstrated significantly shorter operative time (78.9 ± 21.0 vs. 101.4 ± 25.7 min, P<0.001), smaller perioperative hemoglobin decline (10.0 ± 8.6 vs. 15.7 ± 13.3 g/L, P=0.027), shorter bladder irrigation (1.9 ± 0.6 vs. 2.5 ± 0.9 days, P<0.001), and fewer complications (9.1 % vs. 24.2 %, P=0.049). Total hospitalization costs (Chinese Yuan, CNY) did not differ significantly between the two groups (30,231.3 ± 7,946.2 vs.26,514.9 ± 9,954.4, P=0.065). Functional outcomes were significantly better in the combination group from 6 months onward, with lower IPSS and QoL scores, higher Qmax, and reduced PVR at 6, 12, and 24 months (P<0.05). CONCLUSION:CBCT-guided PAE combined with TURP is a safe and effective strategy for large-volume BPH, providing reduced perioperative morbidity and sustained long-term improvements in urinary function compared with TURP alone.

Transcatheter arterial chemoembolization (TACE) faces limitations in hepatocellular carcinoma (HCC) due to suboptimal drug pharmacokinetics and immunosuppression post-embolization. This study develops iron nanoparticles (FeNPs) with pH-responsive Fenton activity as surfactants for a Lipiodol Pickering emulsion (LPE) to deliver cariporide, targeting tumor acidity. Cariporide inhibits plasma membrane sodium-hydrogen exchangers, reducing intracellular pH to amplify FeNP-induced ferroptosis while suppressing extracellular acidosis by blocking proton extrusion. The cariporide-loaded FeNP-LPE (CFe-LPE) promotes immunogenic cell death and reverses immunosuppressive tumor microenvironments by alleviating acidity. In multiple orthotopic HCC models, CFe-LPE-based transarterial embolization outperforms conventional doxorubicin-Lipiodol TACE, demonstrating that dual modulation of intra/extracellular pH enhances Fenton-catalytic embolic agents by synergistically activating antitumor immunity.

To compare the efficacy of the 8F Zelante and 6F Solent Angiojet thrombectomy catheters in the treatment of acute pulmonary embolism (PE). A retrospective multicenter study was conducted, collecting data from patients with acute PE between January 2019 and December 2024. A total of 98 cases were included based on inclusion and exclusion criteria. Patients were divided into two groups based on the Angiojet catheter used: the 8F group and the 6F group, and then matched at a 1:1 ratio. The primary outcomes comprised 7-day all-cause mortality, the need for bailout thrombolysis, and perioperative changes in ancillary and laboratory parameters. The secondary outcome comprised treatment-related complications, including arrhythmias, hypotension, hemoptysis, aggravation of chest tightness, severe acute renal insufficiency, and hemoglobinuria. Twenty-seven patients were included in each group. The 7-day all-cause mortality did not differ significantly between the 8F and 6F group [(2/27) vs. (3/27), P = 1.000]. The need for bailout thrombolysis was significantly higher in the 6F group [(17/27) vs. (8/27), P = 0.028]. A statistically significant intergroup difference was found in the reduction of Miller index and mean pulmonary artery pressure (MPAP) during the perioperative period. The incidence of transient arrhythmias was significantly higher in the 8F group [(21/27) vs. (11/27), P = 0.012]. The incidence of other complications did not differ between groups. Compared to the 6F Solent catheter, the 8F Zelante catheter demonstrated superior thrombectomy efficacy in PE, reducing the need for bailout thrombolysis—a potential benefit for patients with contraindications to thrombolysis. This advantage, however, was accompanied by a higher incidence of transient arrhythmias.

Background: Colorectal cancer (CRC) remains a considerable public health burden worldwide, with hypoxia emerging as a key driver of tumor aggressiveness. Within the hypoxic tumor microenvironment (TME), exosomes function as vital vehicles for intercellular communication, especially through their cargo of microRNAs (miRNAs). Despite the growing recognition of this phenomenon, the specific functions of hypoxia-induced exosomal miRNAs in CRC remain inadequately defined. Methods: Human CRC cell lines (SW620 and HCT116) were subjected to normoxic or hypoxic conditions. Exosomes were isolated via ultracentrifugation and rigorously characterized by transmission electron microscopy (TEM) and dynamic light scattering (DLS). Quantitative real-time PCR (qRT-PCR) profiling identified miR-1225-5p as significantly enriched under hypoxia. The uptake of Cy3-labeled miR-1225-5p-loaded and PKH67-labeled exosomes by CRC cells was confirmed. The impact of these phenomena on cell progression capabilities was subsequently evaluated through the implementation of cell counting kit-8, colony formation, Transwell invasion, and wound-healing assays. The validation of the miR-1225-5p-carboxypeptidase M (CPM) regulatory axis was conducted through a series of rigorous methods, including luciferase reporter assays, Western blot analysis, and siRNAmediated knockdown. Bioinformatic assessments via UALCAN examined correlations between CPMexpression and clinical CRC prognosis. Results: Hypoxic CRC cell-derived exosomes exhibited markedly increased miR-1225-5p content. These exosomes effectively trans-ferred miR-1225-5p to recipient CRC cells, thereby enhancing their malignant behaviors. Mechanistically, miR-1225-5p directly suppressed CPM expression by interacting with its 3'UTR. Bioinformatics analysis demonstrated that lower CPM expression correlates with poor patient prognosis, indicating a tumor-suppressive role. The downregulation of CPM independently recapitulated the oncogenic phenotypes induced by miR-1225-5p, whereas the inhibition of miR-1225-5p reversed these effects, suppressing CRC cell malignancy. Conclusion: The present study identifies a novel hypoxia-driven exosome-mediated miRNA pathway, whereby miR-1225-5p promotes CRC progression through targeted inhibition of the tumor suppressor gene, CPM. These findings contribute to our expanded understanding of exosomal RNA signaling within a hypoxic TME, thus identifying potential therapeutic targets.

Hepatic arterial infusion chemotherapy (HAIC) delivers high local drug concentrations for hepatoma treatment but faces challenges such as catheter-related complications and systemic toxicity. To address these, we developed Mel-gel, an ultrasound-driven hydrogel system formed entirely by the chemotherapeutic agent Melphalan (Mel) without chemical modifications. Under ultrasound, Mel transitions from spherical to worm-like aggregates, rapidly forming a nanofiber-based hydrogel through non-covalent interactions. This innovative system offers sustained drug release, excellent bioavailability, and improved biosafety profiles. Mel-gel enables expedited catheter removal, reduces systemic toxicity, enhances local drug concentration, and prolongs drug-cell interaction time. Compared to conventional HAIC systems, Mel-gel’s unique in situ formation maximizes drug delivery and achieves superior targeting within complex vascular structures. In a rat orthotopic hepatoma model, Mel-gel-assisted HAIC demonstrated remarkable therapeutic efficacy, achieving a tumor inhibition rate of 98.09%, activating anti-tumor immune responses, and curing 60% of treated rats. This novel ultrasound-responsive hydrogel represents a promising advancement in hepatoma treatment, offering enhanced precision, efficacy, and safety. Additionally, Mel-gel’s versatile drug delivery capabilities may enhance the pharmacokinetics of various drugs and support synergistic therapies. This novel hydrogel system offers a promising advancement in hepatoma treatment, aiming to optimize outcomes and expand its application to other therapeutic agents.

Objective To investigate the incidence of complications and their effect on prognosis in patients with post pancreaticoduodenectomy hemorrhage (PPH) after transcatheter arterial embolization (TAE) or covered stent implantation (CSI). Methods The clinical data of patients who underwent common hepatic artery or proper hepatic artery intervention (TAE or CSI) due to PPH were retrospectively analyzed. The intervention method, hemostasis success rate, complications, and mortality were statistically analyzed. Results A total of 113 patients were included (TAE:81, CSI:32). (1) Success rate of hemostasis: 110 patients (97.35%) had successful hemostasis in both groups. (2) Complications: The liver function indexes in the TAE group were worse than those in the CSI group: 88.89% (TAE: 72/81) vs. 53.13% (CSI: 17/32). (3) Mortality: The total mortality rate during hospitalization was 31.86% (36/113). The total mortality rate 1 year after surgery was 40.71% (46/113). Conclusion The risk of liver injury (especially liver failure) and mortality in PPH patients after hepatic artery embolization are significantly higher than those in the CSI group. CSI can better protect liver function while effectively stopping bleeding, and may be a better choice for patients with relatively stable hemodynamics.

Purpose: To evaluate digital subtraction angiography (DSA) imaging features, interventional treatment efficacy, and risk factors for rebleeding in postpancreatectomy hemorrhage (PPH). Methods: This retrospective study analyzed PPH patients undergoing interventional therapy (2013-2022). DSA was performed in all cases, with positive findings prompting intervention. Statistical analysis of DSA angiography manifestations, bleeding sites, success rate of interventional treatment and hemostasis. Univariate and multivariate logistic regression analysis was used to analyze the independent risk factors for rebleeding after interventional treatment for PPH. Results: A total of 192 patients were included. (1) DSA Examination: All 192 patients underwent DSA examination, the positive rate of the initial DSA examination was 78.65 % (151/192). The primary imaging manifestations included contrast medium spillage and pseudoaneurysm formation, with hemorrhage sites being the gastroduodenal artery (60 cases), hepatic artery (35 cases), superior mesenteric artery (38 cases), etc. (2) Interventional Therapy: 142 patients underwent interventional therapy (108 embolizations and 34 stent placements), resulting in a success rate of 90.85 % (129/142). (3) Independent risk factors for rebleeding after intervention in patients with PPH included: the surgical duration (P = 0.035), bleeding volume(P < 0.001), pancreatic fistula(P = 0.001), ECOG score(P = 0.011), pre-interventional leukocyte counts(P = 0.012), and the neutrophil/lymphocyte ratio(P = 0.047). Conclusion: Interventional diagnosis and treatment of PPH can facilitate prompt diagnosis and intervention, resulting in a high success rate of hemostasis and notable outcomes. However, it is important to note that some patients remain at risk for rebleeding after successful interventional hemostasis, necessitating close monitoring of clinical indices and proactive intervention for patients experiencing rebleeding. (c) 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Background: To compare the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib vs TACE alone in intermediate-stage hepatocellular carcinoma (HCC) patients with hypovascular nodules. Methods: This retrospective study analyzed the clinical data of intermediate-stage HCC patients with hypovascular nodules who underwent TACE. Patients were categorized into the TACE-Lenv combination group and the TACE monotherapy group according to their receipt of lenvatinib therapy. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), progression of hypovascular nodules, and treatment-related adverse events were recorded and analyzed. Results: The study enrolled 75 patients, with 40 allocated to the TACE-Lenv group and 35 to the TACE group. The combination therapy group demonstrated significantly higher ORR and DCR (92.5% vs 74.3%, P = .032; 97.5% vs 82.9%, P = .030) compared with TACE monotherapy. The TACE-Lenv group exhibited significantly prolonged median OS and PFS (41.1 vs 19.7 months, P < .001; 20.2 vs 9.9 months, P < .001). In addition, compared with the TACE group, the TACE-Lenv group extended the median time to nodule progression (37.0 vs 16.5 months, P < .001). After propensity score matching, significant differences remained in the aforementioned outcomes between the 2 groups. No significant differences were observed in liver function parameters or the incidence of grade 3 to 4 AEs between the 2 groups after treatment. Conclusions: The combination therapy of TACE and lenvatinib demonstrated excellent clinical efficacy in intermediate-stage HCC with hypovascular nodules and may therefore emerge as a preferred treatment option for this specific patient population.

Transarterial embolization (TAE) efficacy in hepatocellular carcinoma (HCC) is limited by post-embolization hypoxia-driven angiogenesis and metabolic reprogramming. To address this, we develop pH-responsive gelatin microspheres (GMs) encapsulating zinc sulfide (ZnS) nanoparticles (ZnS-encapsulated gelatin microspheres [ZnS@GMs]) for the dual delivery of hydrogen sulfide (H2S) gas and Zn2+ ions. ZnS@GMs inhibit tumor growth through suppression of the hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) axis and glycolytic metabolism, alongside promoting vascular normalization and immune activation. Mechanistically, H2S disrupts mitochondrial respiration, increasing oxygen levels and destabilizing HIF-1α, whereas Zn2+ inhibits hexokinase and lactate dehydrogenase, depleting ATP and biosynthetic intermediates. Furthermore, ZnS@GMs induce immunogenic cell death, which triggers dendritic cell maturation, cytotoxic T cell infiltration, and macrophage repolarization, thereby enhancing the efficacy of anti-PD-1 therapy. In a rabbit orthotopic liver tumor model, intra-arterial infusion of ZnS@GMs confirms potent antitumor effects and effective embolic performance. This work establishes ZnS@GMs as a multifunctional platform to overcome TAE resistance in HCC.

Objective: To develop S1-4 aptamer-conjugated citric acid-coated Fe3O4 nanoparticles and evaluate their targeting ability and magnetic hyperthermia effect against MCF-7 breast cancer cells.Methods: Citric acid-coated Fe3O4 nanoparticles were synthesized by chemical co-precipitation and subsequently conjugated with the S1-4 aptamer to fabricate S1-4 aptamer-conjugated citric acid-coated Fe3O4 nanoparticles. The nanoparticles were characterized by X-ray diffraction, transmission electron microscopy, dynamic light scattering, zeta potential analysis, Fourier transform infrared spectroscopy, and vibrating sample magnetometry. Biocompatibility was assessed in MCF-7 and MEF cells; cellular targeting was examined by Prussian blue staining; and the magnetic hyperthermia effect under an alternating magnetic field was evaluated by cell viability, live/dead staining, and apoptosis assays.Results: Compared with citric acid-coated Fe3O4 nanoparticles, S1-4 aptamer-conjugated citric acid-coated Fe3O4 nanoparticles exhibited a larger hydrodynamic diameter (17 ± 4 nm vs. 8 ± 3 nm) and a more negative surface charge (-26.7 ± 0.3 mV vs. -19.7 ± 0.5 mV). Fourier transform infrared spectroscopy confirmed successful aptamer conjugation. Both nanoparticles demonstrated good biocompatibility in MCF-7 and MEF cells. Prussian blue staining demonstrated stronger cellular uptake of S1-4 aptamer-conjugated citric acid-coated Fe3O4 nanoparticles in MCF-7 cells. Under alternating magnetic field exposure, S1-4 aptamer-conjugated citric acid-coated Fe3O4 nanoparticles produced a significantly greater hyperthermia effect than the controls, resulting in reduced cell proliferation and increased apoptosis in MCF-7 cells (P < 0.01).Conclusions: S1-4 aptamer-mediated Fe3O4 nanoparticles demonstrated active targeting ability and enhanced the antitumor effect of alternating magnetic field-mediated magnetic hyperthermia in breast cancer cells and maintained low cytotoxicity under the tested conditions, suggesting that they may be a feasible platform for targeted magnetic hyperthermia.

The survival of patients with lung cancer bone metastases (LCBM) has improved considerably, making earlier prognostic models less applicable. This study aimed to develop and validate an updated prognostic nomogram for LCBM patients. This two-center retrospective cohort study included patients diagnosed with LCBM between January 2019 and June 2025. The primary endpoint was overall survival. Prognostic variables were first selected using least absolute shrinkage and selection operator (LASSO) penalized Cox regression with 10-fold cross-validation. The selected variables were subsequently entered into a multivariate Cox proportional hazards regression model to estimate hazard ratios (HRs) and 95

BACKGROUND AND AIMS:Endovascular treatment has improved Budd-Chiari syndrome (BCS) patient outcomes, but patients remain at risk for developing hepatocellular carcinoma (HCC). We aimed to analyse the characteristics and risk factors for HCC development in BCS patients after endovascular treatment. METHODS:Clinical data of BCS patients who had received endovascular treatment were retrospectively reviewed. Characteristics of BCS patients who developed HCC post-treatment were compared with those without HCC development. Univariable and multivariable Cox regression analyses were used to determine the risk factors. RESULTS:We enrolled 302 BCS patients. HCC was confirmed in 31 patients after treatment. Early-stage tumours were the most common (11/31, 35.5 %) according to the Barcelona Clinic Liver Cancer staging system. A serum alpha fetoprotein (AFP) cut-off level of > 15.7 ng/mL showed a sensitivity of 69.3 % and specificity of 97.4 % for detecting HCC in these patients. The presence of preoperative liver cirrhosis (hazard ratio (HR)=4.677; P = 0.043) and postoperative restenosis (HR=6.867; P < 0.001) were independent risk factors associated with HCC development in BCS patients after endovascular treatment. CONCLUSION:HCCs that develop after endovascular treatment in BCS patients are often detected at an early stage. Preoperative liver cirrhosis and postoperative restenosis were independent risk factors for HCC development in these individuals.

PURPOSE:To compare the safety and efficacy of hepatic arterial infusion chemotherapy followed by transarterial embolization (HAIC+TAE) to transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (uHCC). MATERIALS AND METHODS:The clinical data of patients who received HAIC+TAE or TACE between April 2020 and April 2022 was collected. Propensity score-matching was used to balance the baseline characteristics of the two groups. Tumor response according to mRECIST, median time to progression (TTP) and overall survival (OS) were investigated. ALBI score was applied to evaluate the changes of liver function and other relative adverse reactions were recorded. RESULTS:A total of 98 patients with uHCC were enrolled in the study, including 71 in the TACE group and 27 in the HAIC+TAE group. After propensity score matching, 23 pairs of patients were investigated. The HAIC+TAE group showed a longer median TTP and OS than TACE group (mTTP 316 vs. 235 days, P=0.023; mOS 580 vs. 493 days, P=0.020). Objective response rates in HAIC+TAE group and TACE group were 65.2% and 47.8% (P=0.234). Disease-control rates were 87.0% and 82.6% (P=1.000). No significant difference was found in the incidence of adverse events between the two groups (P>0.05). CONCLUSION:The combination treatment strategy of HAIC+TAE in patients with uHCC appears to be a safe regimen, with the potential to prolong mTTP and mOS relative to TACE. The sequential application of this therapy merits consideration as an innovative treatment strategy for individuals with uHCC.

The cGAS-STING pathway is pivotal in initiating antitumor immunity. However, tumor metabolism, particularly glycolysis, negatively regulates the activation of the cGAS-STING pathway. Herein, Mn galvanic cells (MnG) are prepared via liquid-phase exfoliation and in situ galvanic replacement to modulate tumor metabolism, thereby enhancing cGAS-STING activation for bidirectional synergistic H2-immunotherapy. The obtained MnG can be etched by water, enabling efficient and sustained generation of H2 gas and Mn2+. MnG not only activated and amplified the cGAS-STING pathway through the sustained release of Mn2+ but also regulated tumor glucose metabolism to inhibit the expression of three prime repair exonuclease 2 (TREX2), thereby synergistically enhancing the activation of the cGAS-STING pathway. The injection of MnG into tumors resulted in a robust immune response, thereby providing favorable support for antitumor therapy. Consequently, the combination of MnG with immune checkpoint blockade therapy resulted in significant suppression of both primary tumors and distant tumors. Furthermore, the MnG-lipiodol dispersion exhibited remarkable efficacy in combination with transarterial embolization (TAE)-gas-immunotherapy in a rabbit orthotopic liver tumor model. The present study underscores the significance of employing a metal galvanic cell strategy for enhanced immunotherapy, thereby offering a novel approach for rational design of bioactive materials to augment immunotherapeutic effectiveness.

To establish and validate a novel prognostic model to predict outcomes for intermediate hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Clinical data from intermediate-stage HCC patients who underwent TACE between January 2007 and December 2020 were retrospectively analyzed. Patients were divided into a training cohort and a validation cohort. Univariate and multivariate analyses identified risk factors associated with overall survival (OS), leading to the development of a predictive model. The model's accuracy, consistency, and clinical utility were validated both internally and externally and compared with the Albumin-Bilirubin (ALBI) grading, Platelet-Albumin-Bilirubin (PALBI) grading, Child-Pugh grading, mChild-Pugh grading, and the Model for End-Stage Liver Disease (MELD). A total of 737 intermediate-stage HCC patients were included, with 481 in the training cohort and 256 in the validation cohort. Multivariate analysis identified maximum tumor diameter, tumor number, prealbumin, and total bilirubin as independent factors for OS. A prealbumin-bilirubin (PABI) predictive model was developed. The PABI model's concordance indices (C-index) in the training and validation cohorts were 0.730 (95% CI 0.701-0.759) and 0.706 (95% CI 0.661-0.751), respectively. The area under the curve (AUC) values at 6, 12, 18, and 24 months in both cohorts were above 0.7. Among the six models, the PABI model had the highest C-index (0.713) and the lowest Akaike information criterion (AIC) value (5897.814) and the best performance in clinical decision curve analysis, suggesting better predictive performance and potential clinical utility. The PABI nomogram model appears to accurately predict survival in intermediate-stage HCC patients treated with TACE, providing clinicians with a valuable tool for candidate selection and prognosis stratification.

BACKGROUND:Hemorrhage following pancreaticobiliary surgery is a high-risk complication, with a mortality rate of 16%-38%. At present, minimally invasive endovascular intervention comprising superselective arterial embolization (SAE) and covered stent implantation (CSI) is the treatment of choice. However, in certain cases, both SAE and CSI become infeasible. AIM:To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate (NBCA) embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary-pancreatic surgery when SAE is infeasible. METHODS:Ninety-eight continuous patients (n = 105 cases; mean age, 58.4 years) with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization (NBCA group, n = 45) and/or CSI (CSI group, n = 60) were retrospectively evaluated between March 2014 and December 2023. Data on technical and clinical success, 30-day mortality, and severe intervention-related adverse events were collected and analyzed. RESULTS:The technical and clinical success rates in the NBCA group (100% and 93.3%, respectively) were significantly higher than those in the CSI group (88.3% and 73.3%, respectively), with a statistically significant difference between the two groups (P = 0.019 and 0.010, respectively). The 30-day mortality rates and major intervention-related complications were 17.8% and 0%, respectively, in the NBCA group and 18.3% and 1.7% in the CSI group, respectively, with no statistically significant difference between the two groups. CONCLUSION:In terms of technical and clinical success, coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary-pancreatic surgery when SAE was not feasible.

Transarterial chemoembolization (TACE) plays a critical role in the treatment of hepatocellular carcinoma (HCC), yet variability in its performance leads to inconsistent prognostic outcomes, with objective response rates (ORRs) ranging from below 10% to over 60% for intermediate HCC. Published evidence and recommendations emphasize that TACE should be executed with precise targeting and accessibility to superselective catheterization. To enhance quality control and standardize TACE procedures, the concept of "precision TACE" is introduced by an international expert panel of International Society of Multidisciplinary Interventional Oncology (ISMIO), emphasizing the inclusion of standardized angiography, superselective catheterization and embolization, appropriate selection of embolic agents, determination of optimal embolization endpoints, and evaluation for efficacy immediately post-TACE. Precision TACE is divided into superior precision TACE (SP-TACE) and moderate precision TACE (MP-TACE). SP-TACE aims at achieving complete response (CR) or close to CR for all treated intrahepatic lesions in one session, while minimizing damage to normal liver tissue as much as possible. For SP-TACE, ideal candidates are intermediate HCCs with moderate intrahepatic tumor burden (maximum diameters of lesions no more than 5 cm, possibly up to 7 cm, with less than 5 intrahepatic lesions) and early HCCs who are unable or unwilling to receive curative approaches. MP-TACE aims at achieving partial response (PR) or stable disease (SD) for treated intrahepatic lesions with one or repeated sessions of TACE. For MP-TACE, ideal candidates are intermediate HCCs with high intrahepatic tumor burden and locally-advanced HCCs (with vascular invasion). Besides, precision TACE combined with other therapies such as ablation, systemic therapies, and hepatic resection, is discussed. Lastly, a scoring system for quantifying the precision of TACE is proposed to evaluate its effectiveness.

Background Osteoporosis progresses through stages characterized by declining bone mineral density, vertebral deterioration, and muscle atrophy, with bone-muscle interactions driving synergistic degeneration. Methods This study retrospectively collected data from 444 patients aged 50 and older, who underwent DXA, CT, and MRI scans at the First Affiliated Hospital of Soochow University. CT values were measured for 6 vertebrae (L1-S1) and 30 adjacent muscle groups (psoas major, erector spinae, quadratus lumborum) to assess vertebral and muscle density. After analyzing changes in CT values across osteoporosis stages development to capture vertebrae and muscles degeneration pattern, we use multiple interpretable machine learning models to construct classification model and construct bone-muscle interaction network. Results This study found that osteoporosis progresses with age, with faster degeneration in females. Early stages show significant bone degradation, especially in L5 and S1 vertebrae, while later stages highlight muscle atrophy. Machine learning models, enhanced by Recursive Feature Elimination (RFE), effectively predicted disease progression (with Normal vs. Osteopenia 0.788, Normal vs. Osteoporosis 0.909, Normal vs. Osteoporotic fracture 0.942, Osteopenia vs. Osteoporosis 0.708, Osteopenia vs. Osteoporotic fracture 0.820 and Osteoporosis vs. Osteoporotic fracture 0.770). The Combined bone muscle interaction network reveals that vertebrae dominate early interactions, shifting to the muscle-clustered module in advanced stages, reflecting the complex degeneration of both bone and muscle. Conclusion This study develops classification models and analyze bone-muscle interactions in osteoporosis, uncovering synergistic degradation patterns across disease stages. The innovative BMINet toolkit offers an efficient, interpretable framework for personalized analysis, advancing precision medicine and integrated care for osteoporosis patients. Keywords Osteoporosis, CT, Machine Learning, Bone-muscle Interaction, Network Analysis ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Natural Science Foundation of China (Grant No. 82102609, 81701649, 82373688 and 81773541), Suzhou Basic Research Pilot Project (SSD2024084) and The First Affiliated Hospital of Soochow University Boxi Youth Natural Science Foundation (BXQN2023011). Funding was provided by K.L. (Grant No. 82102609) and J.D. (Grant Nos. 81701649, SSD2024084, and BXQN2023011). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the institutional reviewboard of the First Affiliated Hospital of Soochow University (#2024-612), and individual informed consent for retrospective data collection was waived. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes BMINet package is available on the Python Package Index (PyPI) platform, allowing users to easily download using the following command: pip install BMINet. The specific project page for the Python package can be found at https://pypi.org/project/bminet. Additionally, the source code and original data related to this study can be accessed for free at https://github.com/Spencer-JRWang/BMINet.