Purpose To investigate the predictive performance of machine learning-based CT radiomics for differentiating between low- and high-nuclear grade of clear cell renal cell carcinomas (CCRCCs). Methods This retrospective study enrolled 406 patients with pathologically confirmed low- and high-nuclear grade of CCRCCs according to the WHO/ISUP grading system, which were divided into the training and testing cohorts. Radiomics features were extracted from nephrographic-phase CT images using PyRadiomics. A support vector machine (SVM) combined with three feature selection algorithms such as least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE), and ReliefF was performed to determine the most suitable classification model, respectively. Clinicoradiological, radiomics, and combined models were constructed using the radiological and clinical characteristics with significant differences between the groups, selected radiomics features, and a combination of both, respectively. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. Results SVM-ReliefF algorithm outperformed SVM-LASSO and SVM-RFE in distinguishing low- from high-grade CCRCCs. The combined model showed better prediction performance than the clinicoradiological and radiomics models (p < 0.05, DeLong test), which achieved the highest efficacy, with an area under the ROC curve (AUC) value of 0.887 (95% confidence interval [CI] 0.798–0.952), 0.859 (95% CI 0.748–0.935), and 0.828 (95% CI 0.731–0.929) in the training, validation, and testing cohorts, respectively. The calibration and decision curves also indicated the favorable performance of the combined model. Conclusion A combined model incorporating the radiomics features and clinicoradiological characteristics can better predict the WHO/ISUP nuclear grade of CCRCC preoperatively, thus providing effective and noninvasive assessment.

Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital emergency medical services (EMS) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT) with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.

Vascular hyperpermeability induced by lipopolysaccharide (LPS) is a common pathogenic process in cases of severe trauma and sepsis. Vascular endothelial cadherin (VE-cad) is a key regulatory molecule involved in this process, although the detailed mechanism through which this molecule acts remains unclear. We assessed the role of clathrin-mediated and caveolae-mediated endocytosis of VE-cad in LPS-induced vascular hyperpermeability in the human vascular endothelial cell line CRL-2922 and determined that vascular permeability and VE-cad localization at the plasma membrane were negatively correlated after LPS treatment. Additionally, the loss of VE-cad at the plasma membrane was caused by both clathrin-mediated and caveolae-mediated endocytosis. Clathrin-mediated endocytosis was dominant early after LPS treatment, and caveolae-mediated endocytosis was dominant hours after LPS treatment. The caveolae-mediated endocytosis of VE-cad was activated through the LPS-Toll-like receptor 4 (TLR4)-Src signaling pathway. Structural changes in the actin cytoskeleton, specifically from polymerization to depolymerization, were important reasons for the switching of the VE-cad endocytosis pathway from clathrin-mediated to caveolae-mediated. Our findings suggest that clathrin-mediated and caveolae-mediated endocytosis of VE-cad contribute to LPS-induced vascular hyperpermeability, although they contribute via different mechanism. The predominant means of endocytosis depends on the time since LPS treatment.

As a new surgical technique, "one-stop hybrid procedure" is rarely applied in trauma patients. This paper aims to explore its role in vascular injury of the lower extremity. Vascular intervention combined with open surgery was performed to treat three cases of vessel injuries of the lower extremity in our hybrid operating room. One patient with stab injury to the left femoral vein was treated by temporary artery blocking after excluding arterial injury by angiography, followed by blocking surgery and debridement and repair of the injured vein. The other two patients with drug addiction history, who were found to have pricking injuries to the femoral artery combined with local infection, were successfully treated by endovascular techniques and open debridement. One-stop hybrid procedure in treating vascular injury patients could simplify the operation procedure, reduce operative risk, and achieve good curative effect.