Shilin Li

This study aims to develop and validate an interpretable machine learning (ML) model for predicting post-procedural hemorrhage (PH) after ultrasound-guided percutaneous renal biopsy (PRB), aiding perioperative management. A retrospective analysis was conducted using data from 664 patients to develop and internally validate the predictive model. Key ultrasound parameters and clinical data were collected. The Boruta algorithm selected predictive factors. Eight ML models underwent hyperparameter tuning with 5-fold cross-validation, using the area under the curve (AUC) to determine the best model, which was further validated externally (n = 137). Model interpretation was enhanced using SHAP values. Important predictive factors identified included renal parenchymal thickness (RPT), distance from the puncture point to the lower edge of the kidney (D1), and the ratio of D1 to the Renal length (R1), disease course, eGFR and prothrombin time (PT). The random forest model outperformed others with AUCs of 0.831, 0.784, and 0.776 for the training, internal validation, and external validation sets, respectively, displaying an accuracy of 0.742, sensitivity of 0.675, specificity of 0.805, and F1 score of 0.691. SHAP analysis highlighted prolonged PT, thinner RPT, smaller D1, lower eGFR, and extended disease course as increasing PH risk. The random forest model effectively predicts PH post-PRB, supporting early diagnosis and decision-making.

Background: Sarcopenic obesity (SO), characterized by the coexistence of reduced skeletal muscle mass and increased fat mass, impairs physical function and mental health. It is commonly associated with comorbidities such as atherosclerotic heart disease, diabetes mellitus, and hypertension. These conditions elevate the risk of osteoporosis and fractures, which may serve as early clinical indicators of SO. With global economic development and an aging population, the prevalence of SO is rising rapidly. Summary: This narrative review explores recent advances in the clinical diagnosis of SO, with a particular focus on the application of auxiliary imaging techniques in both qualitative and quantitative assessments. The review synthesizes findings from current clinical research and evaluates the role of imaging tools in improving diagnostic accuracy and treatment strategies for SO. Despite significant progress, challenges remain in terms of accessibility, cost-efficiency, and practical implementation of these technologies in routine clinical practice. Key Messages: SO is a growing public health concern due to population aging and increasing comorbidities. Diagnostic imaging plays a vital role in enhancing the detection and management of SO. There is a pressing need to develop affordable and accessible diagnostic tools to meet clinical demands.

Fetal growth restriction (FGR) and late-onset preeclampsia (late-onset PE) reflect placental dysfunction but exhibit distinct maternal hemodynamics within the “maternal cardiovascular-placental-fetal unit”. Our objective was to investigate the correlation between fetal-placental Doppler indices and maternal cardiac function in pregnant women with late-onset PE or FGR. A total of 90 pregnant women at 35–39⁺⁶ weeks of gestation were enrolled and divided into three groups: Control (n = 30), FGR (n = 30), and late-onset PE (n = 30). Doppler ultrasonography was used to measure uterine artery pulsatility indices(UtA-PI), umbilical artery pulsatility indices(UA-PI) Z-scores, and middle cerebral artery pulsatility indices(MCA-PI) Z-scores, alongside maternal hemodynamic parameters, including cardiac output (CO), peripheral vascular resistance (PVR), left ventricular mass (LVM), and left atrial anteroposterior diameter (LAAPD).The Kruskal-Wallis test was used to compare characteristics among the three groups. Spearman’s rank correlation analysis was employed to assess relationships between maternal cardiac output/peripheral vascular resistance and fetal-placental Doppler indices in the three subgroups. Partial Spearman rank correlation analysis adjusting for maternal age and BMI was used to evaluate independent associations. FGR neonates had the lowest birth weights (p < 0.05). The FGR group showed reduced CO, LVM, LAAPD (p < 0.05) but elevated PVR, UtA-PI, UA-PI Z-scores (p < 0.05). Late-onset PE exhibited preserved cardiac function (CO, LVM, LAAPD comparable to controls, p > 0.05) but significantly higher CO, LVM, LAAPD than FGR (p < 0.05). No significant differences in MCA-PI Z-scores were observed across groups. UtA-PI negatively correlated with CO (ρ=−0.396, p < 0.001) but positively with PVR (ρ = 0.371, p < 0.001). UA-PI Z-score negatively correlated with CO (ρ=−0.257, p = 0.015). However, MCA-PI Z-scores showed no correlation with CO and PVR.Notably, 90% of FGR cases clustered in the low-CO/high-UtA-PI quadrant. In direct response to our primary aim investigating maternal-fetal hemodynamic coupling, we conclude that: FGR manifests as maternal hemodynamic failure (low-CO/high-UtA-PI) causing placental hypoperfusion; Late-onset PE presents volume overload with preserved uteroplacental function; Dual UtA-PI and CO assessment provides phenotype-specific biomarkers to guide targeted therapy.

Objectives: Hyperuricaemia has been linked to cognitive decline, yet cerebral structural and haemodynamic changes in this population remain poorly defined. We evaluated transcranial colour-coded duplex (TCCD) sonography as a non-invasive screening tool for early mild cognitive impairment (MCI) in elderly hyperuricaemic men. Methods: In this cross-sectional study, 195 men aged ≥ 60 years with hyperuricaemia were stratified by the Montreal Cognitive Assessment (MoCA) into HUA + MCI (MoCA < 26, n = 46) and HUA (MoCA ≥ 26, n = 149) groups. TCCD measured third-ventricle width (TVW) and peak systolic/end-diastolic velocities to calculate resistive (RI) and pulsatility (PI) indices in the middle (MCA) and posterior (PCA) cerebral arteries. Serum uric acid was recorded. Kernel density plots and receiver operating characteristic (ROC) curves assessed diagnostic performance. Results: The HUA + MCI group exhibited higher serum uric acid (508.5 ± 36.3 vs. 492.9 ± 44.0 µmol/L; p = 0.031), greater TVW (0.55 ± 0.11 vs. 0.51 ± 0.08 cm; p = 0.037), and elevated left PCA RI (0.69 ± 0.07 vs. 0.64 ± 0.06) and PI (1.05 ± 0.17 vs. 0.95 ± 0.12; both p < 0.001). ROC analysis identified left PCA PI as the most specific marker (AUC = 0.701; specificity 90.6%; sensitivity 45.7%). Kernel density plots confirmed distinct distributions of key parameters. Conclusions: TCCD-detected ventricular enlargement and raised PCA pulsatility accurately distinguish MCI among hyperuricaemic men. As a non-invasive, accessible technique with high specificity, TCCD may complement MRI and cognitive testing in early screening of at-risk populations.

Background: Hyperuricemia and non-alcoholic fatty pancreas disease (NAFPD) are prevalent metabolic diseases, but the relationship between them remains underexplored.Methods: Eighteen Sprague–Dawley rats were randomly assigned to three groups: normal (CON), high-fat (PO), and high-fat high-uric acid (PH). After 12 weeks, serum uric acid (SUA) and triacylglycerol levels were measured. Pathological changes in the pancreas were assessed using hematoxylin–eosin (HE) staining. Serum samples were analyzed using lipidomics technology, and multivariate statistical analysis was employed to identify differences in lipid metabolism.Results: SUA levels in the PO group were not significantly different from those in the CON group (p > 0.05). However, from the 4th week onward, SUA levels in the PH group were significantly higher than those in both the PO and CON groups (p < 0.05). HE staining revealed that most rats in the CON group exhibited normal pancreatic islet and acinar cell morphology. The pathological NAFPD score in the PH group was higher than that in the PO group. Lipidomics analysis identified 34 potential serum biomarkers in the CON and PO groups, 38 in the CON and PH groups, and 32 in the PH and PO groups. These metabolites primarily included sphingolipids, cholesterol esters, fatty acids, triacylglycerols, phosphatidylcholines, lysophosphatidylcholine, phosphatidylethanolamine, and lysophosphatidylethanolamine.Conclusion: Hyperlipidemia combined with hyperuricemia might exacerbates NAFPD. Glycerophospholipids may serve as key biomarkers in this process, potentially linked to a chronic inflammatory response mediated by glycerophospholipids.

Background: Prostate biopsies are primarily conducted using either the transrectal or transperineal approach, with the ultrasound probe positioned in the rectum to obtain a clear view of the prostate. Reports on the utilization of transperineal prostate biopsies with the ultrasound probe placed on the perineal skin are limited. Methods: A retrospective investigation was conducted on 119 patients who underwent transperineal ultrasound guided transperineal prostate biopsy (TP-TPPB). Additionally, 85 patients who underwent transrectal ultrasound guided transperineal prostate biopsy (TR-TPPB) were included as controls. The prostate cancer detection rates (PCDRs) and postoperative complication rates were compared between the two groups, and their application values were also evaluated. Results: The overall PCDRs were 35.3% (42/119) in the TP-TPPB and 32.9% (28/85) in the TR-TPPB group (χ2 = 0.122, p = 0.727). When categorized by PSA level, there was no significant difference between the two groups in PCDRs in any category (p > 0.05). However, the single-needle PCDRs in some regions (L4, L5, R2, and apex) showed significant differences (p < 0.05). There was no difference in postoperative complication rates between the groups. Conclusion: The PCDRs and the postoperative complication rates of TP-TPPB and TR-TPPB are similar. However, TP-TPPB requires simpler equipment and does not require intestinal preparation, which is especially useful for patients with rectal contraindications, such as those with severe hemorrhoids and rectal/anal diseases.