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While mobile apps are becoming more accurate at identifying vascular plants, it is unclear whether accuracy is maintained when doing plot-based surveys, where image acquisition is limited to a small pool of individuals that often lack ideal identification features. We evaluated two free plant identification apps, Flora Incognita and iNaturalist, using 5291 field images of 119 species from 54 plots of 0.8 m2, from graminoid-dominated grassland and forested sites. We examined the top-1 identification (ID) accuracy as a function of botanical (growth form and reproductive state) and photographic (image quality and background) parameters. We used score fusion to test whether combining multiple images of the same individual (perspective combination) improved ID accuracy. Top-1 ID accuracy was consistently higher in Flora Incognita (79.2% overall) as compared to 66.5% in iNaturalist. No groups reached the reference expert accuracy of plot-based surveys (90%-95%). Images featuring reproductive structures significantly improved ID accuracy, particularly for graminoids (overall +8.9% in Flora Incognita, +17.1% in iNaturalist), and high-quality images increased accuracy significantly for graminoids and herbs in iNaturalist. Combining multiple images improved the overall ID accuracy of vascular plants in iNaturalist by 6% and 1.7% in Flora Incognita, with significant improvement for herbs and shrubs in iNaturalist. We provide recommendations for ID success in the field for app users as well as app developers to optimize image acquisition for species identification in surveying and monitoring efforts.
Developing computer-aided detection (CADe) algorithms in colonoscopy requires high-quality databases sourced from real-world data. However, such databases demand costly investments and display imbalanced distributions that underrepresent flat adenomas. Therefore, we evaluated whether StyleGAN2-ADA, a generative adversarial network, can generate synthetic images as alternative training resources for CADe, and whether a modified StyleGAN2-ADA can enhance synthesis control for better balanced datasets. Two synthetic datasets were generated using the original StyleGAN2-ADA and our modified version with feature-clustered conditioning vectors. Generative adversarial networks were trained on images from our local colonoscopy database, and their outputs were evaluated through Fréchet Inception Distance where lower scores indicate more realistic and diverse data. Three CADe models were trained using synthetic or real-world data and tested in two external databases comprising only polyp images. CADe performance included mean average precision (mAP) score as critical metric for polyp identification. The modified StyleGAN2-ADA achieved a lower Fréchet Inception Distance-score (7.54 vs. 13.68) than the original StyleGAN2-ADA. During external testing, CADe trained on synthetic data from the modified version achieved performance comparable to the model trained on real-world data across all metrics (p > 0.05). It also outperformed the model trained on synthetic data from the original StyleGAN2-ADA, achieving mAP-scores of 0.77 ± 0.03 vs. 0.64 ± 0.02 in the first test set (p < 0.001) and 0.91 ± 0.02 vs. 0.87 ± 0.02 in the second (p = 0.012). StyleGAN2-ADA incorporating feature-clustered conditioning vectors can synthesize better balanced colonoscopy databases that offer alternative training resources to real-world data for CADe training and validation.
Breast cancer is a leading cause of death for women worldwide. There is a critical need for an early and accurate diagnosis to improve survival rates. This study evaluates the performance of transfer learning-based MobileNetV2 and ResNet50 architectures for binary breast cancer classification using mammography images. To enhance channel-wise feature learning, the Squeeze-and-Excitation (SE) attention mechanism was integrated into the network and partial fine tuning was performed by only freezing the early layers of the model. Furthermore, gradient-weighted class activation mapping was applied to visualize the important regions of mammogram images responsible for the model's predictions. The performance evaluation was carried out on the Contrast Limited Adaptive Histogram Equalization (CLAHE) binary, Digital Database for Screening Mammography (DDSM), INbreast, and Mammographic Image Analysis Society (MIAS) datasets using stratified k-fold cross-validation. The experimental results demonstrate that one of the proposed frameworks, MobileNetV2-SE, achieved mean classification accuracies of 99.14%, 93.53%, 92.35%, and 96.33% on the DDSM, INbreast, MIAS, and CLAHE-binary datasets, respectively. In comparison, the ResNet50-SE model attained mean accuracies of 100%, 88.89%, 71.60%, and 97.98% on the same datasets. The experimental results demonstrate that the frameworks achieve reliable and competitive performance for breast cancer detection under realistic evaluation conditions and improve the diagnostic accuracy of mammogram classification. This work contributes to the field of medical image analysis and computer-aided diagnosis. Future work should focus on applying advanced class balancing methods to improve diagnostic accuracy and model robustness in a variety of medical imaging applications.
Objective: To improve image quality in multispectral optoacoustic tomography (MSOT) under conditions of strong noise and extreme sparse sampling. Impact Statement: This work provides a practical solution to enhance MSOT image quality while reducing hardware requirements, which may help expand its use in preclinical and clinical imaging. Introduction: MSOT provides useful biochemical and molecular contrast in tissues. However, image quality is often limited by system noise and sparse sampling. Methods: We propose the optoacoustic universal denoising network (OA-UDNet), a hybrid diffusion-based framework for sparse MSOT data. The model is trained on more than 250,000 in vivo images. It performs joint denoising and high-fidelity image restoration by combining an edge-aware module with diffusion-based generation to preserve structural boundaries. Results: With data from only 32 detectors, the method improves image quality and increases peak signal-to-noise ratio (PSNR) by nearly 14 dB. Evaluated against the standard 256-detector reference, the framework consistently preserves structural fidelity under extreme undersampling. Validation on whole-body mouse imaging, tumor models, and human samples shows reduced artifacts and improved recovery of anatomical and functional features. Conclusion: OA-UDNet improves MSOT image quality under sparse conditions. It offers a simple and effective way to accelerate imaging while reducing hardware complexity.
Herein, this study reports the production of fiber mats obtained by electrospinning, produced by mixing tamoxifen (TAM) drug with polycaprolactone (PCL), polyvinylpyrrolidone (PVP), and poly-(ethylene oxide) (PEO), with the aim of eliminating cancer cells through controlled drug release. The fabricated fiber mats were thoroughly characterized by several analytical techniques. FTIR analysis indicated strong intermolecular interactions between polymer molecules of the fiber. XRD analysis revealed that fibers are semicrystalline in nature. Scanning electron microscopy verified the uniform nanofibers with bead-free morphology and the average fiber diameter ranged from 346 to 418 nm with drug loading. An increase in tensile strength (TS) and elongation at break (EAB) values of the fibers was observed after drug loading. TS and EAB was obtained up to 0.35 MPa and 88.69%, which are desired for the application. The release of TAM from the fabricated fibers strongly depended on pH value and the drug was fully released in 100 h at pH 5.5. Moreover, Higuchi, Hixson-Crowell, and Korsmeyer-Peppas kinetics confirmed the controlled release of the drug from the fiber mats via diffusion. After 24, 48, and 72 h, the cell viability rates in L929 cells were determined to be 69.7%, 88.5%, and 63.7%, respectively, while cell viability rates were calculated as 69.9%, 68.9%, and 57.7%, respectively, in MCF-7 cells. Additionally, acridine orange (AO)/ethidium bromide (EB) staining was used to detect apoptosis, and fluorescent staining images revealed apoptotic effects. Taken together, these findings suggested that the produced fiber mats could be a promising candidate for controlled TAM release in breast cancer treatment.
Background Differentiating pancreatic cancer from chronic pancreatitis remains clinically challenging due to the overlap of symptoms, biochemical abnormalities and imaging characteristics. Carbohydrate antigen 19-9 (CA 19-9) is a very common marker employed in the assessment of pancreatic cancer but is not sufficiently specific because it has been shown to be elevated in cases of inflammatory and obstructive pancreaticobiliary disease. A new and easy-to-obtain platelet-derived inflammatory marker, mean platelet volume to platelet ratio (MPR), may provide further utility in the differentiation of malignant and benign inflammatory pancreatic disease. Objective We aimed to assess the MPR value in the diagnosis of pancreatic cancer versus chronic pancreatitis in patients undergoing pancreatic surgery. Materials and methods This was a prospective diagnostic accuracy study carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangladesh Medical University, Dhaka, from September 2023 to August 2024. Adult patients who underwent pancreatic surgery for suspected pancreatic cancer or chronic pancreatitis were included. The final histopathological diagnosis of the surgical specimen was used as the reference standard. Patients who had an acute medical condition or psychiatric condition were excluded. A total of 35 patients were included (18 with pancreatic cancer and 17 with chronic pancreatitis). A structured checklist was used to obtain demographic, clinical and laboratory data. Preoperative laboratory parameters within seven days of surgery were used to calculate MPR, which is defined as mean platelet volume (MPV) divided by platelet count. The accuracy of diagnosis was determined by receiver operating characteristic curve analysis. Results There was no significant difference between the two groups in terms of age, sex, or body mass index (BMI). Chronic pancreatitis was significantly more likely to have endocrine and exocrine insufficiency. Significantly elevated concentrations of serum amylase, lipase, MPV, MPR, total bilirubin and CA 19-9, along with decreased platelet counts, were seen in individuals with pancreatic cancer. Chronic pancreatitis was more often associated with diabetes mellitus, whereas an American Society of Anaesthesiologists (ASA) score of 1 was associated with pancreatic cancer. MPR demonstrated high diagnostic performance, with an AUC of 0.908, sensitivity of 83.3%, specificity of 100.0%, a Youden index of 0.833, and a cutoff value of 0.053. MPV showed good discriminatory performance, CA 19-9 showed fair discriminatory performance, platelet count showed strong inverse discriminatory ability, and CEA had little diagnostic utility. Conclusions MPR may serve as a low-cost and easily available adjunctive preoperative marker for differentiating pancreatic cancer from chronic pancreatitis; however, its cutoff value and clinical applicability require validation in larger, multicentre prospective cohorts.
Selection of optimal chemotherapy regimens remains a complex clinical challenge due to interpatient heterogeneity, evolving therapeutic options, and the limitations of population-based clinical guidelines. AI has emerged as a promising tool to support precision oncology by integrating multidimensional data to guide individualized treatment decisions. This systematic review evaluates the role of AI-based models in chemotherapy regimen selection, focusing on their impact on treatment efficacy and adverse drug reactions compared with conventional physician-driven decision-making. A systematic literature search was conducted up to March 21, 2026. Studies evaluating AI-guided chemotherapy selection or treatment decision-support systems in cancer patients were included. The population, exposure, comparison, and outcomes (PECO) framework included cancer patients receiving AI-guided chemotherapy selection versus physician judgment or guideline-based care, with outcomes including survival, treatment response, and toxicity. A total of 1,409 records were identified, with 15 studies meeting the inclusion criteria after screening and eligibility assessment. The included studies encompassed diverse malignancies, including breast, prostate, pancreatic, lung, head and neck, glioblastoma (GBM), hepatocellular carcinoma (HCC), nasopharyngeal carcinoma (NPC), and acute myeloid leukemia (AML). AI models utilized multimodal data sources, such as clinical variables, histopathology, imaging, and multi-omics datasets. Across studies, AI-guided treatment selection was associated with improvements in several clinical outcomes, including overall survival, progression-free survival, and pathological response rates. Several models showed an enhanced ability to identify patients unlikely to benefit from specific chemotherapies, thereby enabling treatment de-escalation. Limited but notable evidence suggested reductions in treatment-related toxicity, particularly cardiotoxicity, when AI-guided strategies were employed. Most studies compared AI performance against physician clinical judgment or guideline-based approaches. AI-assisted chemotherapy regimen selection shows considerable potential to improve treatment efficacy and personalize oncology care while reducing unnecessary toxicity. Although current evidence is largely retrospective and heterogeneous, findings consistently support AI as a valuable adjunct to clinical decision-making. Prospective validation and integration into real-world workflows are essential to establish its role in routine cancer care.
In recent decades, the monitoring of volcanoes has been revolutionized by the launch of Earth-observing satellites and advances in thermal infrared remote sensing. These developments have revealed a wide range of thermal responses of volcanic surfaces to subsurface processes, even demonstrating that eruptions are often preceded by measurable thermal anomalies. This recognition highlights the need for robust tools to systematically detect and track such anomalies, making full use of existing satellite datasets and maximizing the value of current instruments in orbit. To address this challenge, we present the Subtle Surface Thermal Anomalies Recognizer (SSTAR), a versatile and user-friendly application designed to analyze diffuse thermal anomalies, i.e., subtle thermal unrest (~ 1 K) across large areas (several km2). SSTAR leverages data from NASA's Terra and Aqua satellites, which host the Moderate Resolution Imaging Spectroradiometers (MODIS), and builds upon a robust statistical framework. By processing pixel-level data, SSTAR tracks the temporal evolution of diffuse thermal anomalies at specific target sites and maps their spatiotemporal distribution across extended areas. Key features include filtering tools that distinguish between long-term (years) and short-term (weeks) anomalies, as well as uncertainty quantification using bootstrapping. The application is standalone, features an interactive interface for streamlined analysis, and is accessible to newcomers to satellite-based thermal remote sensing. At the same time, specialized users can customize the underlying scripts for other specific research needs. As a demonstration, we apply SSTAR to Shishaldin volcano (Alaska), revealing the emergence of significant thermal anomalies around the summit crater and flanks prior to eruptions. We envision SSTAR as a valuable resource for studying subtle thermal unrest at active volcanoes and hydrothermal systems, where the detection of faint and spatially coherent anomalies may help identify subsurface fluid pathways. Its flexible design enables integration with additional satellite datasets, positioning SSTAR as a forward-looking tool for advancing space-based volcanic thermal monitoring. Building on this capability, daily updated diffuse thermal anomalies are provided for target volcanoes through an open web platform hosted at Geosciences Barcelona-CSIC (https://sstar.geo3bcn.csic.es/), to support surveillance agencies and expert committees in alert-level assessments. The online version contains supplementary material available at 10.1186/s40623-026-02497-6.
Locoregional and regional nodal recurrence remains a major therapeutic challenge in cervical cancer, particularly in patients previously treated with pelvic radiotherapy, where salvage options are limited by cumulative toxicity to surrounding organs at risk. In selected patients with limited-volume recurrent disease, stereotactic body radiotherapy (SBRT) has emerged as a highly conformal salvage approach capable of delivering ablative radiation doses while minimizing exposure to adjacent normal tissues. We report two cases of limited-volume regional nodal recurrence from cervical squamous cell carcinoma successfully managed with SBRT. The first patient, a 32-year-old woman initially diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC1 disease, developed multifocal pelvic and para-aortic lymph node recurrence 12 months after completion of definitive treatment. The second patient, a 48-year-old woman with FIGO 2018 stage IIB disease, presented with isolated para-aortic nodal recurrence after a 33-month disease-free interval. In both cases, recurrence was identified by fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) and discussed in a multidisciplinary tumor board. Histological confirmation was not obtained because of the deep location of the lesions, their proximity to major vascular structures, the procedural risks of biopsy, and the highly suggestive PET-CT findings in patients with previous cervical squamous cell carcinoma. Salvage surgery was considered technically challenging because of previous irradiation and fibrosis. SBRT was delivered using volumetric modulated arc therapy (VMAT) with daily image guidance. The first patient received 40 Gy in five fractions for pelvic and para-aortic nodal recurrence, whereas the second received 30 Gy in three fractions for isolated para-aortic nodal recurrence. Treatment was well tolerated, with no acute grade ≥2 toxicity and no late grade ≥3 toxicity observed. Follow-up PET-CT demonstrated a complete metabolic response in both patients. At the last follow-up, the first patient remained disease-free 38 months after SBRT, and the second patient remained disease-free 40 months after SBRT, without evidence of progression or significant late toxicity. SBRT appears to be a feasible and well-tolerated salvage option for selected patients with limited-volume regional nodal recurrence of cervical cancer after prior definitive chemoradiotherapy. PET-CT-guided SBRT allows delivery of ablative doses with durable local control while limiting toxicity to previously irradiated normal tissues. These findings support further prospective evaluation of curative-intent local treatment strategies in this setting.
The modest neoadjuvant response in early-stage HR+/HER2- breast cancer necessitates novel treatment intensification strategies. While radiotherapy can enhance systemic efficacy via immune modulation, the optimal fractionation for integration with immunochemotherapy remains unknown. This multicenter phase II study aims to evaluate the feasibility, safety, and preliminary efficacy of Toripalimab combined with chemotherapy and tumor-directed radiotherapy, specifically investigating three distinct fractionation schedules. This prospective, multicenter, three-cohort exploratory study enrolls treatment-naïve patients with early-stage HR+/HER2- breast cancer. Participants receive neoadjuvant Toripalimab plus chemotherapy alongside image-guided radiotherapy restricted to the primary tumor. Cohorts are differentiated by fractionation regimen: Arm 1 (8 Gy × 3 fractions, total 24 Gy); Arm 2 (16 Gy single fraction); Arm 3 (0.5 Gy twice daily for 8 cycles, cumulative 8 Gy). A total of 45 patients (15 per cohort) will be enrolled. The primary endpoint is pathological complete response (pCR). Secondary endpoints include objective response rate, recurrence, survival outcomes (OS, EFS, DMFS, IDFS, IBTR), and safety. This exploratory study will provide feasibility, tolerability, and preliminary efficacy data for a novel multimodal neoadjuvant strategy combining different radiotherapy fractionation patterns with immunotherapy and chemotherapy. Given the descriptive analytical framework, findings are expected to be hypothesis generating and will inform the selection of radiotherapy schedules for future larger-scale randomized trials aimed at improving outcomes in HR+/HER2- breast cancer. http://www.chictr.org.cn, identifier NCT06639672.
Neurofibromatosis type 1 (NF1) is a multisystemic disorder predisposing to various neoplasms and vasculopathies. While optic pathway gliomas (OPGs) are hallmarks of pediatric NF1, their incidental discovery in adults, especially when associated with persistent unidentified bright objects (UBOs), mesenchymal malignancies, and rare venous anomalies, is exceptional. A 49-year-old female with NF1 and a history of cervical synovial sarcoma underwent routine oncological surveillance. Brain MRI incidentally revealed a WHO Grade 1 OPG, multiple persistent UBOs in the brainstem and cerebellar peduncles, and a focal parietal venous aneurysm. Despite being asymptomatic, multimodal ophthalmological imaging was performed. Optical coherence tomography (OCT) showed significant asymmetric axonal loss. The left eye (OS) exhibited marked peripapillary retinal nerve fiber layer (pRNFL) thinning (69 µm, p < 0.01). Notably, while the right eye (OD) had normal pRNFL thickness (83 µm), macular ganglion cell layer (GCL) analysis detected early focal neuro-retinal suffering (54 µm minimum thickness). Automated perimetry confirmed functional correlation in both eyes. This case highlights the "multi-tumor challenge" in NF1, suggesting a high-penetrance phenotype driven by RAS/MAPK hyperactivation. The persistence of UBOs into the fifth decade and the discovery of a rare venous aneurysm likely due to medial dysplasia underscore a unique systemic vasculopathy. Unlike sporadic adult OPGs, NF1-associated forms often follow an indolent course, justifying a "watch-and-wait" strategy. Managing complex adult NF1 phenotypes requires a multidisciplinary approach. This case demonstrates that GCL-OCT can serve as a sensitive "early warning system" for axonal loss before clinical symptoms arise, facilitating non-invasive surveillance in genetically vulnerable individuals.
Infections of the hand are encountered across emergency medicine, primary care, and surgical practice, and their outcomes depend heavily on early recognition. The complex anatomy of the hand, with its multiple fascial planes, tendon sheaths, and confined spaces, allows infection to spread rapidly and produce lasting functional impairment when treatment is delayed. This pictorial review presents a series of clinically important hand infections drawn from the archive of a board-certified hand surgeon, spanning common superficial conditions to uncommon but limb-threatening deep-space, articular, and osseous disease. For each entity, we summarize characteristic clinical features, useful diagnostic and imaging findings, likely causative organisms, and initial management, illustrated with representative clinical photographs and imaging. By organizing these conditions across tissue planes, the review offers a practical, pattern-based reference that clinicians can use at the point of care to triage urgency, select empiric therapy, and identify patients who require early referral or operative intervention.
Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors that typically exhibit a low malignant potential and an indolent clinical course; however, up to 10-15% of cases can manifest aggressive features, including vascular invasion and synchronous distant metastases. We report the case of a patient diagnosed with an aggressive pancreatic SPN associated with extensive local invasion, a 5 cm portal vein tumor thrombus, and synchronous hepatic metastases. The patient underwent an extensive, aggressive multi-visceral resection encompassing a distal pancreatectomy, splenectomy, superior hemigastrectomy, distal esophagectomy, and a portal vein thrombectomy with primary vascular repair. Follow-up imaging demonstrated stable hepatic disease with an increase in cystic-appearing lesions, while follow-up laboratory evaluations confirmed the complete normalization of biochemical and hematological parameters. Clinically, the patient experienced a satisfactory postoperative course, presenting with no compromise in nutritional status, adequate tolerance of oral intake, and optimal functional capacity, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0, performing all activities of daily living autonomously and without limitations. This case underscores that aggressive multi-visceral surgical resection with cytoreductive intent is a technically feasible and highly beneficial strategy for metastatic SPN, as it can favorably modify the disease's biological behavior, reduce overall tumor burden, and achieve remarkable clinical and functional stability.
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary emergency that may occur as a manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We report a rare case of perinuclear antineutrophil cytoplasmic antibody (p-ANCA)-positive vasculitis presenting with severe DAH without renal involvement, preceded by acute bilateral hearing loss. A previously healthy 21-year-old woman presented with hemoptysis, severe hypoxemia, and respiratory failure requiring mechanical ventilation. Chest imaging showed bilateral diffuse infiltrates and ground-glass opacities. Bronchoalveolar lavage findings were consistent with DAH. Serologic workup revealed positive p-ANCA with negative cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and anti-glomerular basement membrane (anti-GBM) antibodies. Renal function and urinalysis remained normal throughout admission. The patient was treated with pulse intravenous methylprednisolone followed by oral corticosteroids, leading to rapid clinical improvement and successful extubation within five days. Further history revealed bilateral hearing loss one week before presentation, which may represent a possible early otologic manifestation of vasculitis. This case highlights that ANCA-associated vasculitis may present as isolated DAH without renal involvement, while unexplained hearing loss may provide an early clue to underlying AAV before the onset of life-threatening pulmonary manifestations. Early recognition and prompt immunosuppressive therapy are essential to improve outcomes.
Erosion and fracture caused by repeated water-droplet impacts are often attributed to splash-mediated material removal, high-pressure impulsive loading, or cavitation. Yet, the mechanical response during the earliest instant of impact remains difficult to capture. Using a high-temporal-resolution polyvinylidene fluoride (PVDF) piezoelectric sensor combined with high-speed imaging, we directly measure substrate-coupled mechanical transients during a single water-droplet impact. A strong impulsive strain response appears within the first 2 ms after contact, followed by coherent 100-500 Hz oscillations at the water-solid interface during the first 20 ms, before any rebound occurs. The oscillation frequency is modulated by an effective interfacial stiffness, whereas the impulsive peak-to-peak response scales with droplet size and impact velocity. The experimentally captured signals provide direct experimental evidence of ultrafast substrate-coupled mechanical transients during droplet impact and establish a minimal inertial-capillary framework for understanding mechanical signatures that may contribute to low- to moderate-speed droplet-induced erosion and fatigue.
Non-operative management (NOM) of acute appendicitis has been validated by trials such as Appendicitis Acuta and Comparison of Outcomes of Antibiotic Drugs and Appendectomy, with treatment failure rates of approximately 25-30% within one year, raising hopes that a less invasive approach could become the standard of care. However, the conditions underpinning these trials, such as early presentation, reliable imaging, uninterrupted access to antibiotics, structured follow-up, and immediate surgical backup, are not consistently available in Honduras. Up to 54% of patients at a Honduran tertiary centre present with gangrenous or perforated disease, considerably reducing the proportion of patients eligible for NOM, while sociocultural practices such as abdominal manipulation (sobada), weak referral networks, and limited diagnostic capacity further delay access to care. We argue that NOM cannot currently be recommended as a standard approach across the Honduran health system, although it may have a role in well-resourced tertiary centres. Importantly, this is not a rejection of NOM evidence: the primary drivers of poor outcomes in Honduras, late presentation and limited system capacity, are not addressed by NOM and could worsen if applied without adequate infrastructure. We propose that strengthening point-of-care diagnostics, referral pathways, antibiotic supply chains, and follow-up capacity should be the immediate priority, both to improve outcomes directly and to build the foundations for selective NOM implementation as the health system evolves.
Despite recent advances in multimodal management, pancreatic ductal adenocarcinoma remains a fatal malignancy. Early detection of indirect findings of pancreatic ductal adenocarcinoma is essential to improve treatment outcomes, drawing attention to pancreatic parenchymal atrophy. Pancreatic parenchymal atrophy, defined as the narrowing of the parenchyma below a line connecting the cephalic and caudal margins of the lesion on computed tomography, can predict early-stage pancreatic ductal adenocarcinoma and its intraductal extension. Computed tomography with three-directional imaging is the ideal initial modality for diagnosing pancreatic parenchymal atrophy. In patients with early pancreatic ductal adenocarcinoma, pancreatic parenchymal atrophy exhibits a significantly longer intraductal lateral tumor extension. Pancreatic parenchymal atrophy can be resected using an appropriate-margin pancreatectomy with a low risk of positive surgical margins. However, the appropriate surgical margin length for each case remains unclear. Carcinoma in situ may be present only within a focal pancreatic parenchymal atrophy region, and pancreatic duct changes may not be present. For such patients, a surgical strategy of limited pancreatectomy with a smaller surgical margin, combined with additional intraoperative resection based on frozen-section results, is acceptable. Although the relationship between carcinoma in situ and fatty replacement of the pancreatic parenchyma has been investigated, the underlying mechanism remains unclear.
Liver metastases are associated with systemic immune tolerance and primary resistance to immune checkpoint inhibitors (ICIs) by establishing complex physical and metabolic barriers within the tumor immune microenvironment (TIME). We developed a non-invasive macroscopic fractal dynamics framework to map these microenvironmental barriers across scales, aiming to predict ICI efficacy in colorectal cancer liver metastases (CRLM) and lung squamous cell carcinoma (SCC). This single-center, retrospective, proof-of-concept cohort study consecutively enrolled 472 patients with CRLM or SCC liver metastases. Patients were divided into a training cohort (n=400, 2019-2024) and an independent validation cohort (n=72, 2025). Vascular fractal acceleration (Afd ) and metabolic fractal dimension (Df ) were extracted from contrast-enhanced magnetic resonance imaging (CE-MRI) and 18F-FDG PET, respectively. To eliminate baseline histological confounding, macroscopic fractal probes were Z-score normalized strictly within their respective histological cohorts. Cross-scale validation utilized digital pathology and platelet-poor plasma (PPP) cytokine profiling. An extreme gradient boosting (XGBoost) model was explicitly trained to predict a composite "High TIME Barrier" phenotype-defined by restricted CD8+ infiltration and low PD-L1 expression-to generate the Immuno-Radiomics Joint Score (IRJS). An exploratory survival analysis was subsequently conducted to evaluate its association with progression-free survival (PFS) among the 185 patients receiving ICI therapy. We evaluated early dynamic drift (ΔAfd ) at week 3 for its utility in tracking physical barrier remodeling. CRLM and SCC displayed distinct fractal trajectories indicative of metabolic and physical barriers, respectively. High Afd correlated with dense fibrovascular stroma and severe spatial exclusion of CD8+ T cells. High Df corresponded to severe hypoxia, CD163-enriched macrophage infiltration, and systemic immune exhaustion, characterized by elevated circulating TGF-β and exhausted IFN-γ. The IRJS demonstrated strong diagnostic performance for the High TIME barrier phenotype (temporal validation AUC: 0.912). In the ICI sub-cohort, multivariable Cox regression confirmed that an increase in the continuous baseline IRJS was a robust, independent risk factor associated with primary ICI resistance and shorter PFS. Macroscopic fractal dynamics offer a non-invasive, cross-scale method to evaluate the "physical-metabolic" dual microenvironmental barriers in liver metastases. The combined IRJS and dynamic ΔAfd tracking system show potential as exploratory, non-invasive surrogates to identify the systemic immune exhaustion phenotype. Pending external multi-center validation, these tools may generate hypotheses for associating macroscopic spatial barriers with primary ICI resistance and informing multidisciplinary interventions.
A nitrogen-rich triazine-based covalent organic polymer (COP) was made from melamine and cyanuric chloride through a solid-state grinding process. The poor electrochemical performance due to low nitrogen content and structural instability has been overcome in this process. To enhance active sites, nickel was doped into the COP. Fourier transform infrared (FTIR) analysis confirmed successful polymerization, the release of chlorine, and the presence of nickel oxide. X-ray diffraction (XRD) patterns indicated that the crystalline form of the COP remained intact after nickel incorporation. Scanning electron microscopy (SEM) images displayed a change from smooth to a rough, granular texture due to nickel's interaction within the polymer matrix. Electrochemical tests demonstrated the better performance of the nickel-doped COP, showing a specific capacitance of 40 Fg-1 at 5 mVs-1 (cyclic voltammetry, CV) and 23 Fg-1 at 0.1 Ag-1 (galvanostatic charge/discharge, GCD), with a maximum power density of 835 Wkg-1 at 5 mVs-1. Notably, the electrode showed great cycling stability, maintaining almost 70% of its initial capacitance after repeated charge and discharge cycles. The results show that triazine-based COPs doped with nickel have potential for application in the use of supercapacitors due to their stability, efficiency, and duration.
This work describes the development of a sustainable and biocompatible drug delivery system using halloysite nanotubes (HNTs). The goal was to create a material that could both deliver the chemotherapy drug doxorubicin (DOX) and selectively target the tumor cells. The synthesis process was made environmentally friendly by using tetrahydropyran (Thp) as a solvent. The HNTs were first functionalized with an amino group using (3-aminopropyl)-triethoxysilane (APTES), followed by the conjugation of two different peptides, P1 and P2, via EDC coupling. Successful functionalization was confirmed by FTIR spectroscopy, and through thermogravimetric analysis (TGA), we determined the degree of functionalization (%f). The DOX loading efficiency was found to be 8.8% for all composites, indicating that the peptides did not interfere with drug loading. Drug release studies showed that HNT-NH-P1 exhibited a faster release rate, releasing 9% of DOX in 24 h, while HNT-NH-P2 showed a much slower release of only 3.5% over the same period. Furthermore, in vitro scratch assays revealed a selective antimigratory effect of HNT-NH-P1-DOX on c-Met-positive adenocarcinoma cells, suggesting a receptor-mediated targeting potential. Finally, as a feasibility proof-of-concept for potential radiopharmaceutical applications, the HNT-NH-P1 platform was successfully extended with a THP chelator, demonstrating a high coordination capacity for trivalent Ga. These results demonstrate the potential of HNTs as versatile platforms for targeted drug delivery and imaging applications.