ObjectiveTo evaluate the predictive performance of a model integrating ultrasound radiomics features combined with clinical variables for postoperative recurrence in patients with papillary thyroid cancer (PTC) with concomitant Hashimoto thyroiditis (HT). MethodsPatients with PTC with concomitant HT treated at Handan First Hospital from May 2021 to May 2023 were retrospectively enrolled, and the occurrence of postoperative recurrence within two years was assessed. Univariate and multivariate logistic regression models were used to identify risk factors for postoperative recurrence. Ultrasound radiomic features were extracted using the PyRadiomics package. Stable features were selected based on an intraclass correlation coefficient (≥0.75), followed by Z-score normalization on the entire dataset. The Mann-Whitney U test and least absolute shrinkage and selection operator regression were applied to select ultrasound radiomic features, and the radiomics score (Rad-score) was calculated. The clinical variables screened via a multivariate logistic regression model were combined with the Rad-score to develop a nomogram. Internal validation was performed using 1 000 Bootstrap resampling. The predictive performance of the nomogram was quantified using receiver operating characteristic (ROC) curves; calibration performance was verified via calibration curves, and net clinical benefit was determined by decision curve analysis (DCA). ResultsA total of 316 patients were enrolled in this study, among whom 57 experienced recurrence, yielding a recurrence rate of 18.04%. Multivariate logistic regression analysis identified five clinical variables as risk factors for postoperative recurrence in patients with PTC with concurrent HT (all P<0.05): tumor multifocality, maximum nodule diameter > 1 cm, lymph node metastasis, positive thyroglobulin antibody, and thyroid stimulating hormone ≥ 0.38 mU/L. Multicollinearity analysis showed that all variance inflation factors were ＜10, indicating no significant multicollinearity among the independent variables. Through the radiomic feature extraction and selection procedure, 8 key radiomic features with non-zero regression coefficients were selected. Based on these 8 features, the Rad-score was calculated and was significantly higher in patients with recurrence than in those without recurrence [(0.56±0.14) points vs. (0.37±0.09) points, t=12.890, P<0.001]. A nomogram was constructed by incorporating the 5 clinical variables selected by multivariate logistic regression and the Rad-score. The area under the ROC curve of this nomogram was 0.886 [95%CI (0.837, 0.935)]. Internal validation was performed using the Bootstrap method (1 000 resamplings), and the bias-corrected C-index was 0.871. The calibration curve, as assessed by the Hosmer-Lemeshow test (χ2=2.182, P=0.134), demonstrated good agreement between the predicted and actual recurrence probabilities, with a Brier score of 0.088. DCA showed that patients with PTC and HT could benefit from intervention guided by the nomogram within a threshold probability range of 0.21 to 0.84. ConclusionThe nomogram integrating ultrasound radiomic features and clinical variables achieves favorable predictive performance and net clinical benefit for postoperative recurrence in patients with PTC with concomitantT, enabling early postoperative risk stratification and individualized follow-up.
Objective To explore the effect of chitosan (CS) hydrogel loaded with tendon-derived stem cells (TDSCs; hereinafter referred to as TDSCs/CS hydrogel) on tendon-to-bone healing after rotator cuff repair in rabbits. Methods TDSCs were isolated from the rotator cuff tissue of 3 adult New Zealand white rabbits by Henderson step-by-step enzymatic digestion method and identified by multidirectional differentiation and flow cytometry. The 3rd generation TDSCs were encapsulated in CS to construct TDSCs/CS hydrogel. The cell counting kit 8 (CCK-8) assay was used to detect the proliferation of TDSCs in the hydrogel after 1-5 days of culture in vitro, and cell compatibility of TDSCs/CS hydrogel was evaluated by using TDSCs alone as control. Another 36 adult New Zealand white rabbits were randomly divided into 3 groups (n=12): rotator cuff repair group (control group), rotator cuff repair+CS hydrogel injection group (CS group), and rotator cuff repair+TDSCs/CS hydrogel injection group (TDSCs/CS group). After establishing the rotator cuff repair models, the corresponding hydrogel was injected into the tendon-to-bone interface in the CS group and TDSCs/CS group, and no other treatment was performed in the control group. The general condition of the animals was observed after operation. At 4 and 8 weeks, real-time quantitative PCR (qPCR) was used to detect the relative expressions of tendon forming related genes (tenomodulin, scleraxis), chondrogenesis related genes (aggrecan, sex determining region Y-related high mobility group-box gene 9), and osteogenesis related genes (alkaline phosphatase, Runt-related transcription factor 2) at the tendon-to-bone interface. At 8 weeks, HE and Masson staining were used to observe the histological changes, and the biomechanical test was used to evaluate the ultimate load and the failure site of the repaired rotator cuff to evaluate the tendon-to-bone healing and biomechanical properties. Results CCK-8 assay showed that the CS hydrogel could promote the proliferation of TDSCs (P<0.05). qPCR results showed that the expressions of tendon-to-bone interface related genes were significantly higher in the TDSCs/CS group than in the CS group and control group at 4 and 8 weeks after operation (P<0.05). Moreover, the expressions of tendon-to-bone interface related genes at 8 weeks after operation were significantly higher than those at 4 weeks after operation in the TDSCs/CS group (P<0.05). Histological staining showed the clear cartilage tissue and dense and orderly collagen formation at the tendon-to-bone interface in the TDSCs/CS group. The results of semi-quantitative analysis showed that compared with the control group, the number of cells, the proportion of collagen fiber orientation, and the histological score in the TDSCs/CS group increased, the vascularity decreased, showing significant differences (P<0.05); compared with the CS group, the proportion of collagen fiber orientation and the histological score in the TDSCs/CS group significantly increased (P<0.05), while there was no significant difference in the number of cells and vascularity (P>0.05). All samples in biomechanical testing failed at the repair site during the testing process. The ultimate load of the TDSCs/CS group was significantly higher than that of the control group (P<0.05), but there was no significant difference compared to the CS group (P>0.05). Conclusion TDSCs/CS hydrogel can induce cartilage regeneration to promote rotator cuff tendon-to-bone healing.
