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Multi-phase liver contrast-enhanced computed tomography (CECT) images convey the complementary multi-phase information for liver tumor segmentation (LiTS), which are crucial to assist the diagnosis of liver cancer clinically. However, the performances of existing multi-phase liver tumor segmentation (MPLiTS)-based methods suffer from redundancy and weak interpretability, resulting in the implicit unreliability of clinical applications. In this paper, we propose a novel trustworthy multi-phase liver tumor segmentation (TMPLiTS), which is a unified framework jointly conducting segmentation and uncertainty estimation. The trustworthy results could assist the clinicians to make a reliable diagnosis. Specifically, Dempster–Shafer Evidence Theory (DST) is introduced to parameterize the segmentation and uncertainty with evidence following Dirichlet distribution. The reliability of segmentation results among multi-phase CECT images is quantified explicitly. Meanwhile, a multi-expert mixture scheme (MEMS) is proposed to fuse the multi-phase evidences, which can guarantee the effect of fusion procedure based on theoretical analysis. Experimental results demonstrate the superiority of TMPLiTS compared with the state-of-the-art methods. Meanwhile, the robustness of TMPLiTS is verified, where the reliable performance can be guaranteed against the perturbations. [Display omitted] • A novel trustworthy multi-phase liver tumor segmentation. • The first method for the multi-phase liver tumor segmentation toward trustworthiness. • Performance of the method is verified in terms of validity and reliability. [ABSTRACT FROM AUTHOR]

Efficient, robust and low-cost hydrogen evolution reaction (HER) electrodes are highly desirable for realizing the hydrogen economy. Transition metal nitrides with suitable hydrogen adsorption energy have been demonstrated as excellent HER catalysts. Here, we report a simple one-step nitridation method to fabricate Ni 3 N nanorod arrays on nickel foam (NF) for electrocatalytic water splitting. Large specific surface area and good conductivity endow the self-supported Ni 3 N/NF electrode extremely low overpotential of η 10 = 45 mV and excellent cycle stability for the HER in 1 M KOH aqueous solution. Based on theoretical calculations, it is further verified that nitridation effectively endows NF more suitable free energy for hydrogen adsorption, which leads to an advanced HER activity of Ni 3 N/NF. • The Ni 3 N nanorods on Ni foam was fabricated through one-step nitridation method. • The self-supported Ni 3 N/NF electrode exhibited an excellent HER catalytic activity. • DFT calculations demonstrated Ni 3 N/NF owned more suitable ΔG H∗ for HER. [ABSTRACT FROM AUTHOR]

Objectives To investigate potential interferences of two pre-analytical variables, the storage time and the vacutainer tube, on the quantification of 20 amino acids using a UHPLC-MS/MS method. Design and methods Blood samples from 25 apparently healthy subjects were collected into duplicate sets of EDTA-2K, EDTA-3K, coagulation, heparin and citrate tubes, and stored in capped vacutainer tubes at 4 °C for 6 h, 12 h and 24 h before sample analysis. A UHPLC-MS/MS method was established for simultaneous quantification of 20 amino acids. ANOVA for repeated measurement was conducted based on the model of Mauchly's test of Sphericity. Student's t -test was applied for comparison between amino acid concentrations obtained from different vacutainer tubes, and consistency of the results was checked through Bland-Altman difference plots and Passing-Bablok regression analysis. Results Most of the 20 amino acids showed a least concentration fluctuation with storage time in heparin plasma, followed by EDTA-3K and citrate plasma. The amino acid concentrations were significantly lower in citrate plasma and slightly higher in serum, compared with those in heparin plasma. No fixed bias was observed for amino acid concentrations in EDTA and heparin plasma, but the differences were mostly of statistical significance. Amino acid concentrations in EDTA-3K plasma achieved a good consistency with those in heparin plasma by UHPLC-MS/MS analysis. Conclusions Storage time and vacutainer tube were important variables for amino acid analysis. They should draw researchers' attention and then be controlled in good laboratory practice to reduce pre-analytical errors. [ABSTRACT FROM AUTHOR]

Background: Acute lung injury (ALI) is a serious health issue which causes significant morbidity and mortality. Inflammation is an important factor in the pathogenesis of ALI. Even though ALI has been successfully managed using a traditiomal Chinese medicine (TCM), Huanglian Jiedu Decoction (HLD), its mechanism of action remains unknown.Purpose: This study explored the therapeutic potential of HLD in lipopolysaccharide (LPS)-induced ALI rats by utilizing integrative pharmacology.Methods: Here, the therapeutic efficacy of HLD was evaluated using lung wet/dry weight ratio (W/D), myeloperoxide (MPO) activity, and levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β and IL-6. Network pharmacology predictd the active components of HLD in ALI. Lung tissues were subjected to perform Hematoxylin-eosin (H&E) staining, metabolomics, and transcriptomics. The acid ceramidase (ASAH1) inhibitor, carmofur, was employedto suppress the sphingolipid signaling pathway.Results: HLD reduced pulmonary edema and vascular permeability, and suppressed the levels of TNF-α, IL-6, and IL-1β in lung tissue, Bronchoalveolar lavage fluid (BALF), and serum. Network pharmacology combined with transcriptomics and metabolomics showed that sphingolipid signaling was the main regulatory pathway for HLD to ameliorate ALI, as confirmed by immunohistochemical analysis. Then, we reverse verified that the sphingolipid signaling pathway was the main pathway involed in ALI. Finally, berberine, baicalein, obacunone, and geniposide were docked with acid ceramidase to further explore the mechanisms of interaction between the compound and protein.Conclusion: HLD does have a better therapeutic effect on ALI, and its molecular mechanism is better elucidated from the whole, which is to balance lipid metabolism, energy metabolism and amino acid metabolism, and inhibit NLRP3 inflammasome activation by regulating the sphingolipid pathway. Therefore, HLD and its active components can be used to develop new therapies for ALI and provide a new model for exploring complex TCM systems for treating ALI. [ABSTRACT FROM AUTHOR]

Erzhi Pill (EZP) is a traditional Chinese prescription that has marked effects in treating type 2 diabetes mellitus and diabetic nephropathy. However, its underlying pharmacological mechanisms in the treatment of diabetic cardiomyopathy (DCM), remain to be elucidated. This study aimed to apply an integrative pharmacological strategy to systematically evaluate the pharmacological effects and molecular mechanisms of EZP, and provide a solid theoretical basis for the clinical application of EZP in the treatment of DCM. In this study, the potential targets and key pathways of EZP were predicted and validated using network pharmacology and molecular docking, respectively. Changes in cardiac metabolites and major metabolic pathways in rat heart samples were examined using 1H-nuclear magnetic resonance (NMR) metabolomics. Finally, biochemical analysis was conducted to detect the protein expression levels of key pathways. We found that EZP decreased fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), and low-density lipoprotein (LDL) levels, increased high-density lipoprotein (HDL) levels in the serum, and alleviated the morphological abnormalities of the heart tissue in diabetic rats. Furthermore, EZP effectively restored superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), caspase-3, caspase-8, and caspase-9 activity levels, as well as the levels of reactive oxygen species (ROS), malondialdehyde (MDA), B-cell lymphoma (Bcl)-2, and Bcl-2-associated X protein (Bax) in the heart tissue. Network pharmacology prediction results indicated that the mechanism of EZP in treating DCM was closely related to apoptosis, oxidative stress, and the HIF-1, PI3K-Akt, and FoxO signaling pathways. In addition, 1H-NMR metabolomics confirmed that EZP primarily regulated both energy metabolism and amino acid metabolism, including the tricarboxylic acid (TCA) cycle, ketone bodies metabolism, glutamine and glutamate metabolism, glycine metabolism, and purine metabolism. Finally, immunohistochemistry results indicated that EZP reduced the expression levels of p-AMPK, p-PI3K, p-Akt, and p-FoxO3a proteins, in the heart tissue of DCM rats. The results confirmed that the overall therapeutic effect of EZP in the DCM rat model is exerted via inhibition of oxidative stress and apoptosis, alongside the regulation of energy metabolism and amino acid metabolism, as well as the AMPK and PI3K/Akt/FoxO3a signaling pathways. This study provides an experimental basis for the use of EZP in DCM treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Physalis alkekengi L. var. franchetii (Mast.) Makino (PAF) (Chinese name Jin-Deng-Long) from the Solanaceae family is a traditional Chinese medicine with various pharmacological effects, such as removing heat, detoxification, improving throat conditions, removing phlegm, and ameliorating diuresis.Purpose: This paper reviews the existing literature and patents and puts forward some suggestions for future PAF research.Methods: Using the PubMed, Google Scholar, Web of Science, and China National Knowledge Infrastructure databases, we performed comprehensive search of literature and patents published before April 2022 on PAF and its active ingredients.Results: We comprehensively reviewed the research progress of PAF from aspects of the traditional application, botany, chemical composition, pharmacological effects, and toxicology, and first discussed quality control and modern applications, which have not been explored in previous reviews. Thereafter, we reviewed the limitations of pharmacological mechanism and quality control studies and proposed appropriate solutions, which is of great practical significance to subsequent studies.Conclusion: In this review, we present a comprehensive overview on PAF, and put forward new insights on studies regarding quality control, material basis, and mechanisms in classical prescription, providing theoretical guidance for the clinical application and development of Chinese medicine. [ABSTRACT FROM AUTHOR]

Physalin B (PB) is an active constituent of Physalis alkekengi L. var. Franchetii , which is a traditional medicine for clearing heat and detoxification, resolving phlegm, and diuresis. It has been commonly applied to treat sore throat, phlegm-heat, cough, dysuria, pemphigus, and eczema. Physalin B has shown efficacy as an anti-acute lung injury (ALI) agent previously; however, its mechanisms of action remain unclear. In the present study, we established a lipopolysaccharide-induced septic ALI model using BALB/c mice to further confirm the therapeutic potential of PB and to assess the underlying molecular mechanisms. We used 75% ethanol and macroporous resin for extraction, separation, and enrichment of PB. The LPS-induced ALI mouse model was used to determine anti-inflammatory effects of PB. The severity of acute lung injury was evaluated by hematoxylin and eosin staining, wet/dry lung ratio, and myeloperoxidase (MPO) activity in lung tissue. An automatic analyzer was used to measure the arterial blood gas index. Protein levels of pro-inflammatory cytokines in serum, bronchoalveolar lavage fluid (BALF), and lung tissue was measured using an ELISA. Quantitative RT-PCR was used to measure changes in RNA levels of pro-inflammatory cytokines in the lungs. A fluorometric assay kit was used for determination of apoptosis-related factors to assess anti-apoptotic effects of PB. Western blotting was used to assess levels of key pathway proteins and apoptosis-related proteins. Connections between the pathways were tested through inhibitor experiments. Pretreatment with PB (15 mg kg-1 d-1, i.g.) significantly reduced lung wet/dry weight ratios and MPO activity in blood and BALF of ALI mice, and it alleviated LPS-induced inflammatory cell infiltration in lung tissue. The levels of pro-inflammatory factors TNF-α, IL-6, and IL-1β and their mRNA levels in blood, BALF, and lung tissue were reduced following PB pretreatment. PB pretreatment also downregulated the apoptotic factors caspase-3, caspase-9, and apoptotic protein Bax, and it upregulated apoptotic protein Bcl-2. The NF-κB and NLRP3 pathways were inhibited through activation of the PI3K/Akt pathway due to PB pretreatment, whereas administration of PI3K inhibitors increased activation of these pathways. Taken together, our results suggest that the anti-ALI properties of PB are closely associated with the inactivation of NF-κB and NLRP3 by altering the PI3K/Akt pathway. Furthermore, our findings provide a novel strategy for application of PB as a potential agent for treating patients with ALI. To the best of our knowledge, this is the first study to elucidate the underlying mechanism of action of PB against ALI. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • Using life history strategy to evaluate microbe in rice straw compost. • Bacillus inoculation promotes lignocellulose degradation. • Bacillus inoculation affects indigenous microorganisms. • Indigenous bacterial with complex interrelationships have stability. • The bacteria with stronger degradation ability were affected by inoculation. Bacillus is the classic inoculant in rice straw composting. However, there has been no in-depth study of the mechanism promoting the degradation of lignocellulose and the change of indigenous bacterial communities after Bacillus inoculation. Moreover, the stability of bacterial communities is a significant challenge in achieving the efficacy of inoculation. In this study, the ecological succession and yield-resource acquisition-stress tolerance (Y-A-S) framework were combined with Redundancy analysis (RDA) and changes in relative abundance, Bacillus was found to be a pioneer bacterium that adopts a resource acquisition-stress tolerance strategy. The structural equation model (SEM) revealed that in addition to exerting a degradation effect, Bacillus inoculation could also indirectly affect lignocellulose degradation by changing the bacterial community. Random forest model and network analysis indicated a change in bacterial communities after inoculation, and bacteria with more complex relationships and weaker decomposition ability were key to the stability of bacterial communities. [ABSTRACT FROM AUTHOR]

[Display omitted] • Fenton pretreatment increased the concentration of HA components. • Microbial community composition and diversity were changed. • The shikimic acid metabolism genes were strengthened by Fenton pretreatment. • NH 4 --N, pH, cellulose and bacterial diversity were key driving factors to form HA. • Functional bacteria were core driving factors to promote formation of HA. The aims of this study were to identify the driving factors of humic acid (HA) during rice straw composting based on Fenton pretreatment with bacterial inoculation. Rice straw was pretreated by Fenton reactions and then inoculated during composting, which was set up CK (control), FeW (Fenton pretreatment) and FeWI (Fenton pretreatment + functional bacterial agents). Results indicated that Fenton pretreatment and inoculation of functional bacteria increased the concentration of HA components, which was due to that bacterial composition was changed and bacterial diversity was decreased. Moreover, Fenton pretreatment and inoculation of functional bacteria increased the bacterial amounts of shikimic acid metabolism genes and the correlation between HA components and shikimic acid metabolism genes. Therefore, the functional bacteria were core driving factors, and NH 4 --N, pH, cellulose and bacterial diversity as key environmental factors to promote the formation of HA components. [ABSTRACT FROM AUTHOR]

Purpose: We aim to investigate the risk factors influencing the growth of residual nodule (RN) in surgical patients with adenocarcinoma presenting as multifocal ground-glass nodules (GGNs).Method: From January 2014 to June 2018, we enrolled 238 patients with multiple GGNs in a retrospective review. Patients were categorized into growth group 63 (26.5%), and non-growth group 175 (73.5%). The median follow-up time was 28.2 months (range, 6.3-73.0 months). To obtain the time of RN growth and find the risk factors for growth, data such as age, gender, history of smoking, history of malignancy, type of surgery, pathology and radiological characteristics were analyzed to use Kaplan-Meier method with the log-rank test and Cox regression analysis.Results: The median growth time of RN was 56.0 months (95% CI, 45.0-67.0 months) in all 238 patients. Roundness (HR 4.62, 95% CI 2.20-9.68), part-solid nodule (CTR ≥ 50%) (HR 4.39, 95% CI 2.29-8.45), vascular convergence sign (HR 2.32, 95% CI 1.36-3.96) of RN, and age (HR 1.04, 95% CI 1.01-1.07) were independent predictors of further nodule growth. However, radiological characteristics and pathology of domain tumour (DT) cannot be used as indicators to predict RN growth.Conclusions: RN showed an indolent growth pattern in surgical patients with multifocal GGNs. RN with a higher roundness, presence of vascular convergence sign, more solid component, and in the elder was likely to grow. However, the growth of RN showed no association with the radiological features and pathology of DT. [ABSTRACT FROM AUTHOR]

Background: Timosaponin BⅡ (TBⅡ), one of the primary bioactive compounds from Anemarrhena asphodeloides Bunge, possesses potential cardioprotective effects. However, the mechanism underlying TBⅡ-mediated cardioprotection, especially the involvement of endoplasmic reticulum stress, remains largely unknown.Purpose: This study was designed to evaluate the role of TBⅡ in myocardial injury protection and explore its possible mechanisms.Methods: In vivo models of isoproterenol-induced myocardial injury and H2O2-induced cytotoxicty were established to investigate the effect of anti-myocardial injury of TBⅡ. The potential mechanisms were investigated in vitro and in vivo using multiple detection methods like electrocardiography, histo-pathological examination, JC-1 staining, TUNEL staining, ELISA technology, and western blot analysis.Results: In vivo study revealed that TBⅡ improved electrocardiography and heart vacuolation, reduced myocyte apoptosis, and improved the antioxidant potential. In vitro investigation demonstrated that TBⅡ pretreatment inhibited ER stress-mediated apoptosis pathways. Further investigation of the underlying mechanisms revealed that TBⅡ prevented H2O2-induced H9c2 cardiomyocytes injury by the PI3K/Akt pathways, whereas the addition of LY294002, the pharmacologic antagonist of PI3K, attenuated TBⅡ-induced expression of apoptotic protein and cytoprotective effects.Conclusion: These results suggested that TBⅡ protects against myocardial injury in vitro and enhances cellular defense capacity by inhibiting ER stress-mediated apoptosis pathways in vivo by activating the PI3K/Akt pathways. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common, chronic, and recurring inflammatory skin disease. Physalis alkekengi L. var. franchetii (Mast) Makino (PAF), a traditional Chinese medicine, is primarily used for the clinical treatment of AD. In this study, a 2,4-dinitrochlorobenzene-induced AD BALB/c mouse model was established, and a comprehensive pharmacological method was used to determine the pharmacological effects and molecular mechanisms of PAF in the treatment of AD. The results indicated that both PAF gel (PAFG) and PAFG+MF (mometasone furoate) attenuated the severity of AD and reduced the infiltration of eosinophils and mast cells in the skin. Serum metabolomics showed that PAFG combined with MF administration exerted a synergistic effect by remodeling metabolic disorders in mice. In addition, PAFG also alleviated the side effects of thymic atrophy and growth inhibition induced by MF. Network pharmacology predicted that the active ingredients of PAF were flavonoids and exerted therapeutic effects through anti-inflammatory effects. Finally, immunohistochemical analysis confirmed that PAFG inhibited the inflammatory response through the ERβ/HIF-1α/VEGF signaling pathway. Our results revealed that PAF can be used as a natural-source drug with good development prospects for the clinical treatment of AD. [Display omitted] • PAF combined with MF plays a synergistic therapeutic effect and alleviates the side effects caused by MF alone. • PAF suppresses AD-induced inflammatory response by suppressing Th2 immune response. • The active components of PAF in improving skin inflammation are flavonoids. • PAF treats AD by activating the ERβ/HIF-1α/VEGF pathway. [ABSTRACT FROM AUTHOR]

• It lays the foundation for the future development of new CMM-based anti-ALI and other drug formulations. • It provides fundamental theoretical support for the discovery and use of CMM resources through the comprehensive analysis of various anti-ALI CMM report databases. • It augments the anti-ALI theory of CMM and establishes the clinical significance and the prospects for the development of CMM-based treatments for ALI and other disorders. • It compiles and presents empirical evidence for comparative efficacy and safety of Chinese Materia Medica in the treatment of acute lung injury. Acute lung injury (ALI) is a common and serious disease. Numerous treatment options are available but they do not improve quality of life or reduce mortality for ALI patients. Here, we review the treatments for ALI to provide basic data for ALI drug therapy research and development. Chinese Materia Medica (CMM) has long been the traditional clinical approach in China for the treatment of ALI and it has proven efficacy. The continued study of CMM has disclosed new potential therapeutic ingredients for ALI. However, few reviews summarize the currently available CMM-based anti-ALI drugs. Therefore, the systematic analysis of research progress in anti-ALI CMM is of great academic and clinical value. The aim of the present review is to describe CMM-based research progress in ALI treatment. Data were compiled by electronic retrieval (CNKI, SciFinder, PubMeds, Google Scholar, Web of Science) and from articles, patents and ethnopharmacological literature in university libraries were systematically studied. This review introduces progress in research on the etiology and mechanisms of ALI, the anti-ALI theory and modes of action in traditional Chinese medicine (TCM), anti-ALI active constituents of CMM, research progress in experimental methods of CMM anti-ALI, the anti-ALI molecular mechanisms of CMM, the anti-ALI efficacy of CMM formulae, and the potential toxicity of CMM and the antidotes for it. Scholars have investigated the anti-ALI molecular mechanism of CMM from various direction and have made substantial progress. This research explored the above aspects, enriched the anti-ALI theory of CMM and established the clinical significance and developmental prospects of ALI treatment by CMM. Because of the high frequency of drugs such as glucocorticoids or antibiotics, Western medicine lacks the advantages of CMM in terms of overall anti-ALI efficacy. In the future, the development of CMM-based anti-ALI therapies will become a major trend in the field of ALI drug development. Successful clinical safety and efficacy validations will promote and encourage the use of CMM. It provides fundamental theoretical support for the discovery and use of CMM resources through the comprehensive analysis of various anti-ALI CMM report databases. [ABSTRACT FROM AUTHOR]

Influenza virus-induced pneumonia (IVP) is a high morbidity and contagiousness pulmonary infectious disease caused by invasion of the influenza virus into the lower respiratory tract. Currently, the treatment of IVP is mainly based on an anti-influenza virus infection strategy, which includes the use of anti-influenza vaccines and drugs. However, the clinical use of these treatment options is limited as the influenza virus has a high level of variability and drug resistance may occur. Traditional Chinese medicines (TCMs) for the treatment of IVP have unique advantages, a variety of precise curative effects and have been widely used in clinical practice in China both historically and in the present day. However, there are only few literature reviews on the prevention and treatment of IVP using TCMs. Therefore, we conducted a review of relevant literature from the past 10 years and a comprehensive analysis of various databases containing reports on TCMs used for IVP prevention and treatment to provide basic data for future research and development of drugs against IVP. Herein, we summarize research progress on the pathogenesis of IVP, the TCMs effective in prevention or treatment of IVP, their underlying molecular mechanisms and active components. Overall, we provide a theoretical basis for the clinical use of TCM in the prevention and treatment of IVP. Furthermore, we provide a reference for the development of new multi-component, multi-target, low-toxicity drugs, which is of great academic and clinical significance. [Display omitted] • It provides guidance for the study of experimental methods of TCMs used in the prevention and treatment of IVP. • It expounds the molecular mechanism of TCMs anti-IVP from various aspects. • It summarizes and provides empirical evidence on the efficacy and safety of TCMs in the treatment of IVP. • It establishes the clinical significance and development prospect of TCMs in the treatment of IVP. [ABSTRACT FROM AUTHOR]

As a traditional Chinese medicine, Dalbergia tsoi Merr.et Chun (JZX) has been used for the treatment of wounds since ancient times. However, the active compounds and molecular mechanisms of JZX in the acceleration of wound healing are still unknown. Herein, we explored the main active compounds and key molecular mechanisms by which JZX accelerates wound healing. The ethanol extract of JZX was subjected to UPLC-Q-Orbitrap HRMS analysis to identify the main compounds. The pharmacological effect of JZX on wound healing was evaluated using a mouse excision wound model. Network pharmacology was utilized to predict the effective compounds and related signal transduction pathways of JZX that were involved in accelerating wound healing. The predicted key signaling pathways were then validated by immunohistochemical analysis. Interactions between the active compounds and therapeutic targets were confirmed by molecular docking analysis. JZX accelerated wound healing, improved tissue quality, and inhibited inflammation and oxidative stress. Moreover, our results suggested that the active components of JZX, such as butin, eriodyctiol, and formononetin, are the key compounds that facilitate wound treatment. Our studies also indicated that JZX accelerated wound healing by regulating the PI3K/Akt signaling pathway and inducing the expression of TGF-β1, FGF2, VEGFA, ECM1, and α-SMA at different stages of skin wound healing. The JZX extract accelerates wound healing by reducing inflammation and inhibiting oxidative stress, regulating the PI3K/Akt signaling pathway, and promoting the expression of growth factors, suggesting that JZX has potential clinical applicability in wound treatment. [Display omitted] • Dalbergia tsoi Merr. et Chun (JZX) has been traditionally used in wound treatment. • UPLC-Q-Orbitrap HRMS analysis was used to identify main components of JZX. • JZX accelerates wound healing by reducing inflammation and oxidative stress. • JZX regulates the PI3K/Akt signaling pathway. • JZX promotes the expression of TGF-β1, FGF2, VEGFA, ECM1, and α-SMA. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the risk factors of invasive pulmonary adenocarcinoma, especially to report and validate the use of our newly identified arc concave sign in predicting invasiveness of pure ground-glass nodules (pGGNs).Methods: From January 2015 to August 2018, we retrospectively enrolled 302 patients with 306 pGGNs ≤ 20 mm pathologically confirmed (141 preinvasive lesions and 165 invasive lesions). Arc concave sign was defined as smooth and sunken part of the edge of the lesion on thin-section computed tomography (TSCT). The degree of arc concave sign was expressed by the arc chord distance to chord length ratio (AC-R); deep arc concave sign was defined as AC-R larger than the optimal cut-off value. Logistic regression analysis was used to identify the independent risk factors of invasiveness.Results: Arc concave sign was observed in 65 of 306 pGGNs (21.2 %), and deep arc concave sign (AC-R > 0.25) were more common in invasive lesions (P = 0.008). Under microscope, interlobular septal displacements were found at tumour surface. Multivariate analysis indicated that irregular shape (OR, 3.558; CI: 1.374-9.214), presence of deep arc concave sign (OR, 3.336; CI: 1.013-10.986), the largest diameter > 10.1 mm (OR, 4.607; CI: 2.584-8.212) and maximum density > -502 HU (OR, 6.301; CI: 3.562-11.148) were significant independent risk factors of invasive lesions.Conclusions: Arc concave sign on TSCT is caused by interlobular septal displacement. The degree of arc concave sign can reflect the invasiveness of pGGNs. Invasive lesions can be effectively distinguished from preinvasive lesions by the presence of deep arc concave sign, irregular shape, the largest diameter > 10.1 mm and maximum density > -502 HU in pGGNs ≤ 20 mm. [ABSTRACT FROM AUTHOR]