Fujian Provincial Hospital

The annual thyroid cancer incidence has been increasing. Thyroid cancer is categorized as a malignant neoplasm within the endocrine system. Fine-needle aspiration cytology remains the benchmark for thyroid cancer detection; however, the accuracy of the procedure depends on the practitioner's expertise. Numerous challenges are associated with this process, such as obtaining inadequate cellular samples, mispuncturing the target lesion, and collecting nonrepresentative cell samples. These issues hinder proper cellular evaluation and increase the likelihood of misdiagnosis, ultimately impacting patient outcomes and the treatment trajectory. This research primarily aims to improve the diagnostic accuracy of thyroid cancer by introducing an innovative computer-aided diagnostic tool that leverages advanced deep learning techniques. Second-harmonic microscopy enables the fine extraction of morphological characteristics of collagen fibers within thyroid tissues, revealing significant differences in the distribution and organization of collagen fibers between normal and malignant tissues. In this study, we quantified the morphological alterations of collagen fibers by initially analyzing second-harmonic generation (SHG) images through a collagen scoring system based on feature extraction via least absolute shrinkage and selection operator regression. Model efficacy was assessed using receiver operating characteristic curves. Furthermore, we classified normal and malignant thyroid tissues in the validation cohort through three distinct deep-learning architectures (Mobile Neural Networks Version 3 (MobileNetV3), Visual Geometry Group 16(VGG16), and Pyramid Vision Transformer v2 (PVTv2) in combination with SHG image data. Overall, MobileNetV3 achieved the best classification performance (87.4%). This study provides preliminary evidence for the effectiveness of deep-learning algorithms in differentiating between malignant and normal thyroid tissues. This significant advancement offers valuable technological support for detecting thyroid cancer in clinical environments and is expected to enhance both the accuracy and efficiency of diagnostic practices.

Dear Editor, We recently read with great interest the article entitled “FANS-UAS under local anesthesia for urinary stones with high risk postoperative urosepsis” by Zhang et al in your prestigious journal[1]. In this study, nephrolithiasis accompanied by asymptomatic bacteriuria (ASB) or asymptomatic pyuria (ASP) are considered urinary stones associated with a high risk of postoperative urosepsis (HR-POU). They found that retrograde intrarenal surgery (RIRS) assisted by flexible and navigable suction ureteral access sheath (FANS-UAS) under local anesthesia (LA) is feasible and safe for these HR-POU patients, and preliminary results indicate it may reduce the incidence of postoperative fever. These findings provide an attractive new option for stones with HR-POU. However, several issues merit further discussion. This study is compliant with the TITAN Guidelines 2025 – governing declaration and use of AI[2]. For patients with stone obstruction complicated by pyonephrosis or perinephric abscess, clinical priority is given to drainage methods such as ureteral stent placement or percutaneous nephrostomy[3]. Stone management is deferred to a second-stage procedure once the local infection has improved. However, this study performed first-stage FANS-UAS assisted RIRS on all 28 patients with kidney stones complicated by pyonephrosis without any discussion. Given the potential increased risk of infection following first-stage surgery, preoperative risk assessment and personalized treatment are particularly critical for these patients when opting for a primary surgery treatment plan. Based on the above, we recommend conducting a detailed analysis and discussion of the preoperative assessment and postoperative outcomes for patients with renal calculi complicated by pyonephrosis in this study. In most studies, general anesthesia (GA) is the preferred anesthetic type for RIRS[4]. The advantages of GA in kidney stone surgery include high patient compliance, controlled duration of anesthesia, and control over patient respiratory movements[5]. However, there are few studies evaluating the efficacy of LA during RIRS. This study found no significant differences between the two types of anesthesia in terms of surgical success rate, intraoperative bleeding, and operating time; however, patients in the LA group had a lower risk of postoperative fever. Furthermore, through comparative analysis of postoperative blood immune cells, the authors speculate that the cause may be attributed to the lack of significant impairment in immune function. It is our view that analyzing postoperative immune cells alone cannot fully elucidate the impact of primary surgical treatment under different anesthetic modalities on the immune function of patients with kidney stones. Instead, preoperative immune status should serve as the baseline, and different anesthetic techniques should be evaluated by comparing the degree of change in immune function before and after surgery between the two patient groups. During procedures performed under non-general anesthesia, unstable spontaneous breathing, uncontrollable coughing and sneezing reflexes, or patient movement that cannot be prevented during surgery due to inadequate analgesia may all negatively impact the successful completion of the surgical procedure. According to a study by Sahan et al, mucosal tears and hemorrhage occurred in 4.4% and 2.2% of patients in the regional anesthesia group, respectively[4]. In this study, three cases (0.8%) of patients undergoing LA experienced ureteral perforation. It is conceivable that the surgeon’s comfort level during procedures under local anesthesia would also be significantly reduced. Therefore, the safety and efficacy of RIRS assisted by FANS-UAS under LA require further discussion. In conclusion, this study pioneers an attractive new treatment option for patients with HR-POU kidney stones, but further prospective randomized controlled trials are needed to evaluate its safety and efficacy.

MicroRNAs are promising liquid biopsy biomarkers, but their clinical translation is hindered by detection challenges, including low abundance, high sequence similarity, and background interference. Here we present SE-SPTM-PCR, a detection platform integrating selective miRNA enrichment using locked nucleic acid probes with specific probe terminal mediated RT-qPCR. We show that SE-SPTM-PCR eliminates nonspecific amplification and achieves 100-fold higher sensitivity than conventional stem-loop RT-qPCR. In clinical studies, SE-SPTM-PCR significantly improves hsa-miR-92a-3p performance for colorectal cancer detection, increasing its AUC from 0.72 to 0.85 in 48 patients versus 48 controls. Additionally, SE-SPTM-PCR also restores utility to two abandoned biomarkers: For HCMV reactivation monitoring in 32 DNA positive and 32 DNA negative hematopoietic stem cell transplant recipients, hcmv-miR-UL22A-5p achieves an AUC of 0.95. For nasopharyngeal carcinoma, ebv-miR-BART3-3p reaches a perfect AUC of 1.0 in 40 patients and 40 controls. This platform provides a robust tool for miRNA-based liquid biopsy, offering enhanced diagnostic accuracy to support early disease detection and personalized treatment strategies.

Indium phosphide quantum dots (InP QDs) are premier candidates for environmentally friendly displays, yet their industrial utility is limited by complex, multistep synthesis methods requiring intermediate purification. Here, we present a kinetic control and ligand synergy strategy enabling the centrifugation-free, one-pot synthesis of high-performance green InP/GaP/ZnS QDs. By pinpointing the nucleation temperature (250 °C) and optimizing the In:myristic acid ratio (1:4), we establish a dynamic ligand environment that successfully suppresses oxidized indium species (InPOx) formation and nonradiative recombination, as validated by X-ray photoelectron spectroscopy. The resulting green-emitting InP/GaP/ZnS QDs achieved an outstanding photoluminescence quantum yield (PLQY) of 86% and a narrow full width at half-maximum of 44 nm, representing the highest reported PLQY for one-pot synthesized InP QDs with GaP intermediate shells. Quantum dot light-emitting diodes fabricated with these QDs demonstrate stable electroluminescence at 535 nm, achieving a maximum external quantum efficiency of 3.02% and a current efficiency of 12.14 cd A–1. This scalable, centrifugation-free approach effectively bridges the performance gap between one-pot and multistep synthesis, offering a viable pathway toward the industrial manufacturing of environmentally benign QDs for display and lighting applications.

The prognostic value of hemoglobin-combined Geriatric Nutritional Risk Index (H-GNRI) in older adult septic patients remain unexplored. This study aimed to investigate the association between H-GNRI and both short-term and long-term mortality in older adult patients with sepsis. This retrospective cohort study analyzed older adult with sepsis from the MIMIC-IV database. Patients aged ≥ 65 years meeting sepsis-3 criteria were included, excluding those with chronic kidney disease or severe liver disease. The H-GNRI scoring system was developed by combining optimal cutoff values for GNRI and hemoglobin determined through X-tile analysis. Propensity score matching (1:1) was performed to minimize confounding. The primary outcome was 28-day mortality. Cox proportional hazards models and ROC analysis were used to evaluate prognostic performance and discriminatory ability. The 28-day mortality rates increased significantly across risk groups (45.0%, 61.7%, and 72.5% for low, intermediate, and high-risk groups, respectively; P < 0.001). This trend persisted for 180-day and 1-year mortality. After adjusting for confounders, higher-risk H-GNRI groups remained independently associated with increased mortality risk. However, H-GNRI demonstrated poor discriminatory performance with an AUC of 0.58 for 28-day mortality prediction. While H-GNRI demonstrated significant associations with mortality in older adult sepsis patients, it exhibited poor discriminatory performance, limiting its utility as a standalone risk prediction tool. Further studies are needed to develop more sophisticated nutritional risk stratification approaches for critically ill patients.