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Automatic medical image segmentation plays a critical role in scientific research and medical care. Existing high-performance deep learning methods typically rely on large training datasets with high-quality manual annotations, which are difficult to obtain in many clinical applications. Here, we introduce Annotation-effIcient Deep lEarning (AIDE), an open-source framework to handle imperfect training datasets. Methodological analyses and empirical evaluations are conducted, and we demonstrate that AIDE surpasses conventional fully-supervised models by presenting better performance on open datasets possessing scarce or noisy annotations. We further test AIDE in a real-life case study for breast tumor segmentation. Three datasets containing 11,852 breast images from three medical centers are employed, and AIDE, utilizing 10% training annotations, consistently produces segmentation maps comparable to those generated by fully-supervised counterparts or provided by independent radiologists. The 10-fold enhanced efficiency in utilizing expert labels has the potential to promote a wide range of biomedical applications. Existing high-performance deep learning methods typically rely on large training datasets with high-quality manual annotations, which are difficult to obtain in many clinical applications. Here, the authors introduce an open-source framework to handle imperfect training datasets.

A continuous-flow Anaerobic/Anoxic/Oxic (A2/O) system was operated at different organic concentrations to systematically investigate the effect on the nutrient removal, secretion characteristics of extracellular polymer, phosphorus forms transformation and changes in functional flora in this system. The results showed that high organic loading was more conducive to promote the secretion of extracellular polymeric substance (EPS), the increase of polysaccharide content was more obvious compared with protein, the impact of organic loading on the components of loosely bound EPS (LB-EPS) was higher than that of tight-bound EPS (TB-EPS). Phosphorus in sludge floc mainly existed in the form of inorganic phosphorus (IP), and IP mainly existed in the form of apatite inorganic phosphorus (AP). High organic load showed higher phosphorus storage in EPS, and the phosphorus content in EPS was positively correlated with the content of EPS. Non-apatite phosphorus (NAIP) content played an important role in the extracellular dephosphorization. The abundance of Nitrosomonas and Nitrospira responsible for nitrification decreased with the increase in organic loading. The group of denitrifiers was large, and Azospira was the most abundant genus among them. Dechloromonas, Acinetobacter, Povalibacter, Chryseolinea and Pirellula were the functional genera closely associated with phosphorus removal.

Phytoplankton face numerous pressures resulting from chemical and physical stressors, primarily induced by human activities. This study focuses on investigating the interactive effects of widely used antifouling agent Irgarol 1051 and UV radiation on the photo-physiology of marine diatoms from diverse latitudes, within the context of global warming. Our findings clearly shown that both Irgarol and UV radiation have a significant inhibitory impact on the photochemical performance of the three diatoms examined, with Irgarol treatment exhibiting more pronounced effects. In the case of the two temperate zone diatoms, we observed a decrease in the inhibition induced by Irgarol 1051 and UVR as the temperature increased up to 25°C. Similarly, for the subarctic species, an increase in temperature resulted in a reduction in the inhibition caused by Irgarol and UVR. These results suggest that elevated temperatures can mitigate the short-term inhibitory effects of both Irgarol and UVR on diatoms. Furthermore, our data indicate that increased temperature could significantly interact with UVR or Irgarol for temperate diatoms, while this was not the case for cold water diatoms, indicating temperate and subarctic diatoms may respond differentially under global warming.

Objectives To construct a prediction model based on deep learning (DL) and radiomics features of diffusion weighted imaging (DWI), and clinical variables for evaluating TP53 mutations in endometrial cancer (EC). Methods DWI and clinical data from 155 EC patients were included in this study, consisting of 80 in the training set, 35 in the test set, and 40 in the external validation set. Radiomics features, convolutional neural network-based DL features, and clinical variables were analyzed. Feature selection was performed using Mann-Whitney U test, LASSO regression, and SelectKBest. Prediction models were established by gaussian process (GP) and decision tree (DT) algorithms and evaluated by the area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), calibration curves, and decision curve analysis (DCA). Results Compared to the DL (AUC training = 0.830, AUC test = 0.779, and AUC validation = 0.711), radiomics (AUC training = 0.810, AUC test = 0.710, and AUC validation = 0.839), and clinical (AUC training = 0.780, AUC test = 0.685, and AUC validation = 0.695) models, the combined model based on the GP algorithm, which consisted of four DL features, five radiomics features, and two clinical variables, not only demonstrated the highest diagnostic efficacy (AUC training = 0.949, AUC test = 0.877, and AUC validation = 0.914) but also led to an improvement in risk reclassification of the TP53 mutation (NIR training = 66.38%, 56.98%, and 83.48%, NIR test = 50.72%, 80.43%, and 89.49%, and NIR validation = 64.58%, 87.50%, and 120.83%, respectively). In addition, the combined model exhibited good agreement and clinical utility in calibration curves and DCA analyses, respectively. Conclusions A prediction model based on the GP algorithm and consisting of DL and radiomics features of DWI as well as clinical variables can effectively assess TP53 mutation in EC.

Controllable optical properties are important for optoelectronic applications. Based on the unique properties and potential applications of two-dimensional Janus WSSe, we systematically investigate the strain-modulated electronic and optical properties of WSSe bilayer through the first-principle calculations. The preferred stacking configurations and chalcogen orders are determined by the binding energies. The bandgap of all the stable structures are found sensitive to the external stress and could be tailored from semiconductor to metallicity under appropriate compressive strains. Atomic orbital projected energy bands reveal a positive correlation between the degeneracy and the structural symmetry, which explains the bandgap evolutions. Dipole transition preference is tuned by the biaxial strain. A controllable transformation between anisotropic and isotropic optical properties is achieved under an around − 6%~− 4% critical strain. The strain controllable electronic and optical properties of the WSSe bilayer may open up an important path for exploring next-generation optoelectronic applications.

TGF-β is an immunosuppressive cytokine that is upregulated in colorectal cancer. TGF-β blockade improved response to chemoradiotherapy in preclinical models of colorectal adenocarcinoma. We aimed to test the hypothesis that adding the TGF-β type I receptor kinase inhibitor galunisertib to neoadjuvant chemoradiotherapy would improve pathological complete response rates in patients with locally advanced rectal cancer. This was an investigator-initiated, single-arm, phase 2 study done in two medical centres in Portland (OR, USA). Eligible patients had previously untreated, locally advanced, rectal adenocarcinoma, stage IIA–IIIC or IV as per the American Joint Committee on Cancer; Eastern Cooperative Oncology Group status 0–2; and were aged 18 years or older. Participants completed two 14-day courses of oral galunisertib 150 mg twice daily, before and during fluorouracil-based chemoradiotherapy (intravenous fluorouracil 225 mg/m2 over 24 h daily 7 days per week during radiotherapy or oral capecitabine 825 mg/m2 twice per day 5 days per week during radiotherapy; radiotherapy consisted of 50·4–54·0 Gy in 28–30 fractions). 5–9 weeks later, patients underwent response assessment. Patients with a complete response could opt for non-operative management and proceed to modified FOLFOX6 (intravenous leucovorin 400 mg/m2 on day 1, intravenous fluorouracil 400 mg/m2 on day 1 then 2400 mg/m2 over 46 h, and intravenous oxaliplatin 85 mg/m2 on day 1 delivered every 2 weeks for eight cycles) or CAPEOX (intravenous oxaliplatin 130 mg/m2 on day 1 and oral capecitabine 1000 mg/m2 twice daily for 14 days every 3 weeks for four cycles). Patients with less than complete response underwent surgical resection. The primary endpoint was complete response rate, which was a composite of pathological complete response in patients who proceeded to surgery, or clinical complete response maintained at 1 year after last therapy in patients with non-operative management. Safety was a coprimary endpoint. Both endpoints were assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02688712, and is active but not recruiting. Between Oct 19, 2016, and Aug 31, 2020, 38 participants were enrolled. 25 (71%) of the 35 patients who completed chemoradiotherapy proceeded to total mesorectal excision surgery, five (20%) of whom had pathological complete responses. Ten (29%) patients had non-operative management, three (30%) of whom ultimately chose to have total mesorectal excision. Two (67%) of those three patients had pathological complete responses. Of the remaining seven patients in the non-operative management group, five (71%) had clinical complete responses at 1 year after their last modified FOLFOX6 infusion. In total, 12 (32% [one-sided 95% CI ≥19%]) of 38 patients had a complete response. Common grade 3 adverse events during treatment included diarrhoea in six (16%) of 38 patients, and haematological toxicity in seven (18%) patients. Two (5%) patients had grade 4 adverse events, one related to chemoradiotherapy-induced diarrhoea and dehydration, and the other an intraoperative ischaemic event. No treatment-related deaths occurred. The addition of galunisertib to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer improved the complete response rate to 32%, was well tolerated, and warrants further assessment in randomised trials. Eli Lilly via ExIST program, The Providence Foundation.

Background Evaluate the efficacy and safety of different chemotherapy regimens concurrent with radiotherapy in treating locally advanced cervical cancer (LACC). Methods Retrospective data was collected from LACC patients who were treated at our institution. These patients were categorized into three groups: the single-agent cisplatin (DDP) chemoradiotherapy group, the paclitaxel plus cisplatin (TP) chemoradiotherapy group, and the nanoparticle albumin-bound (nab-) paclitaxel combined with cisplatin (nPP) chemoradiotherapy group. The primary endpoints were overall survival (OS) and progression-free survival (PFS) and the secondary endpoints were objective response rate (ORR) and incidence of adverse events (AEs). Results A total of 124 patients were enrolled (32 in the DDP group, 41 in the TP group, and 51 in the nPP group). There were differences in OS ( P  = 0.041, HR 0.527, 95% CI 0.314–0.884) and PFS ( P  = 0.003, HR 0.517, 95% CI 0.343–0.779) between the three groups. Notably, the 2-year OS rate was significantly higher in the nPP group compared to the DDP group (92.2% vs. 85.4%, P  = 0.012). The 2-year PFS rates showed a marked increase in the TP group (78.0% vs. 59.4%, P  = 0.048) and the nPP group (88.2% vs. 59.4%, P  = 0.001) relative to the DPP group, with multiple comparisons indicating that the 2-year PFS rate was significantly superior in the nPP group versus the DDP group (88.2% vs. 59.4%, P  = 0.001). Moreover, the ORR was also significantly higher in the nPP group than in the DDP group ( P  = 0.013); and no statistically significant differences were found in the incidence of AEs among the groups ( P  > 0.05). Conclusions In LACC treatment, the two cisplatin-based doublet chemotherapy regimens are associated with better outcomes, with the nab-paclitaxel plus cisplatin regimen showing better efficacy than the paclitaxel plus cisplatin regimen. Furthermore, the AEs associated with these regimens were deemed tolerable. These findings could provide a reference for the clinical treatment of LACC. However, further prospective studies are needed to verify it.

Background Node Reporting and Data System (Node-RADS) was proposed and can be applied to lymph nodes (LNs) across all anatomical sites. This study aimed to investigate the diagnostic performance of Node-RADS in cervical cancer patients. Methods A total of 81 cervical cancer patients treated with radical hysterectomy and LN dissection were retrospectively enrolled. Node-RADS evaluations were performed by two radiologists on preoperative MRI scans for all patients, both at the LN level and patient level. Chi-square and Fisher’s exact tests were employed to evaluate the distribution differences in size and configuration between patients with and without LN metastasis (LNM) in various regions. The receiver operating characteristic (ROC) and the area under the curve (AUC) were used to explore the diagnostic performance of the Node-RADS score for LNM. Results The rates of LNM in the para-aortic, common iliac, internal iliac, external iliac, and inguinal regions were 7.4%, 9.3%, 19.8%, 21.0%, and 2.5%, respectively. At the patient level, as the NODE-RADS score increased, the rate of LNM also increased, with rates of 26.1%, 29.2%, 42.9%, 80.0%, and 90.9% for Node-RADS scores 1, 2, 3, 4, and 5, respectively. At the patient level, the AUCs for Node-RADS scores > 1, >2, > 3, and > 4 were 0.632, 0.752, 0.763, and 0.726, respectively. Both at the patient level and LN level, a Node-RADS score > 3 could be considered the optimal cut-off value with the best AUC and accuracy. Conclusions Node-RADS is effective in predicting LNM for scores 4 to 5. However, the proportions of LNM were more than 25% at the patient level for scores 1 and 2, which does not align with the expected very low and low probability of LNM for these scores.

Ocean acidification is changing the nature of inorganic carbon availability in the global oceans. Diatoms account for ~ 40% of all marine primary productivity and are major contributors to the export of atmospheric carbon to the deep ocean. Larger diatoms are more likely to be stimulated by future increases in CO₂ availability as a result of their low surface area to volume ratio and lower diffusive flux of CO₂ relative to their carbon demand for growth. Here we quantify the effect of the partial pressure of carbon dioxide (PCO₂), at levels of 190, 380, and 750 μL L−1, on the growth rate, photosystem II electron transport rate (ETR), and elemental composition for five diatom species ranging over five orders of magnitude in cell volume. Growth rates for all species were enhanced under 750 relative to 190 and 380 μL L−1, with little change in ETR or elemental stoichiometries, indicating an enhanced allocation of photochemical energy to growth under elevated PCO₂. PCO₂ enhancement of growth rates was size dependent. Under 750 vs. 190 mL L21 partial pressures, growth rate was enhanced by , 5% for the smaller diatom species to ~ 30% for the largest species examined. The size dependence of CO₂-stimulated growth enhancement indicates that ocean acidification may selectively favor an increase in the growth rates of larger vs. smaller phytoplankton species in the sea, with potentially significant consequences for carbon biochemistry.

Background Free gingival graft (FGG) is considered as a well-established periodontal surgical technique to achieve sufficient keratinized tissue width and thickness and subsequently enhance gingival health and stability. This bibliometric research aims to reveal research focuses and trends about FGG. Methods Articles published on FGG were retrospectively retrieved from the Web of Science Core Collection database from 2000 to 2023. Statistical and visual analyses were performed to characterize their quantity, journals, countries and regions, institutions, authors and keywords by CiteSpace software. Results The top 100 most cited articles comprised 80 original research papers and 20 reviews, with an average citation count of 56. Notably, 75% of these works ( n  = 75) were classified in the Q1 category of the Journal Citation Reports (JCR). The most influential article authored by Dr. Cairo F. in 2014 has received 251 citations. Specifically, 27 high-level papers published in Journal of Periodontology accounted for 1,849 citations. The United States with 30 articles published and the University of Michigan with 11 articles were the most productive country and institution, respectively. Prof. Wang Hom-lay published 6 articles with a total of 608 citations. Additionally, collagen matrix and dental implants have garnered significant attention over the past decades. Conclusion Our analysis offers a comprehensive overview and in-depth analysis of the future development trends and potential research directions of FGG, which can inspire both clinical and scientific researchers.