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PurposeDiagnosis of lymph node metastasis (LNM) is critical for patients with pancreatic ductal adenocarcinoma (PDAC). We aimed to build deep learning radiomics (DLR) models of dual-energy computed tomography (DECT) to classify LNM status of PDAC and to stratify the overall survival before treatment.MethodsFrom August 2016 to October 2020, 148 PDAC patients underwent regional lymph node dissection and scanned preoperatively DECT were enrolled. The virtual monoenergetic image at 40 keV was reconstructed from 100 and 150 keV of DECT. By setting January 1, 2021, as the cut-off date, 113 patients were assigned into the primary set, and 35 were in the test set. DLR models using VMI 40 keV, 100 keV, 150 keV, and 100 + 150 keV images were developed and compared. The best model was integrated with key clinical features selected by multivariate Cox regression analysis to achieve the most accurate prediction.ResultsDLR based on 100 + 150 keV DECT yields the best performance in predicting LNM status with the AUC of 0.87 (95% confidence interval [CI]: 0.85–0.89) in the test cohort. After integrating key clinical features (CT-reported T stage, LN status, glutamyl transpeptadase, and glucose), the AUC was improved to 0.92 (95% CI: 0.91–0.94). Patients at high risk of LNM portended significantly worse overall survival than those at low risk after surgery (P = 0.012).ConclusionsThe DLR model showed outstanding performance for predicting LNM in PADC and hold promise of improving clinical decision-making.

Background Metastatic breast carcinoma is commonly considered during differential diagnosis when metastatic disease is detected in females. In addition to the tumor morphology and documented clinical history, sensitive and specific immunohistochemical (IHC) markers such as GCDFP-15, mammaglobin, and GATA3 are helpful for determining breast origin. However, these markers are reported to show lower sensitivity in certain subtypes, such as triple-negative breast cancer (TNBC). Materials and methods Using bioinformatics analyses, we identified a potential diagnostic panel to determine breast origin: matrix Gla protein (MGP), transcriptional repressor GATA binding 1 (TRPS1), and GATA-binding protein 3 (GATA3). We compared MGP, TRPS1, and GATA3 expression in different subtypes of breast carcinoma of ( n  = 1201) using IHC. As a newly identified marker, MGP expression was also evaluated in solid tumors ( n  = 2384) and normal tissues ( n  = 1351) from different organs. Results MGP and TRPS1 had comparable positive expression in HER2-positive (91.2% vs. 92.0%, p  = 0.79) and TNBC subtypes (87.3% vs. 91.2%, p  = 0.18). GATA3 expression was lower than MGP ( p  < 0.001) or TRPS1 ( p  < 0.001), especially in HER2-positive (77.0%, p  < 0.001) and TNBC (43.3%, p  < 0.001) subtypes. TRPS1 had the highest positivity rate (97.9%) in metaplastic TNBCs, followed by MGP (88.6%), while only 47.1% of metaplastic TNBCs were positive for GATA3. When using MGP, GATA3, and TRPS1 as a novel IHC panel, 93.0% of breast carcinomas were positive for at least two markers, and only 9 cases were negative for all three markers. MGP was detected in 36 cases (3.0%) that were negative for both GATA3 and TRPS1. MGP showed mild-to-moderate positive expression in normal hepatocytes, renal tubules, as well as 31.1% (99/318) of hepatocellular carcinomas. Rare cases (0.6–5%) had focal MGP expression in renal, ovarian, lung, urothelial, and cholangiocarcinomas. Conclusions Our findings suggest that MGP is a newly identified sensitive IHC marker to support breast origin. MGP, TRPS1, and GATA3 could be applied as a reliable diagnostic panel to determine breast origin in clinical practice.

Objective To investigate the occurrence rate and risk factors of postoperative nausea and vomiting (PONV) in lung cancer patients following lobectomy and application of analgesic pumps. Methods This retrospective study reviewed clinical data from patients that had undergone lobectomy for lung cancer under general anaesthesia. The risk factors of PONV were analysed using binary logistic regression models. Results A total of 203 patients (97 females) were enrolled. The rate of PONV was 29.6% (60 of 203 patients) for all patients, 42.3% (41 of 97 patients) for female patients and 17.9% (19 of 106 patients) for male patients. Female patients undergoing thoracotomy (odds ratio [OR] 7.770, 95% confidence interval [CI] 1.747, 34.568) or having surgery durations ≥120 min (OR 4.493, 95% CI 1.502, 12.851) were significantly more susceptible to PONV. The risk of PONV in female patients that received postoperative dolasetron (100 mg, once a day) was significantly lower (OR 0.075, 95% CI 0.007, 0.834). For male patients, the risk of PONV was significantly lower in those with a body mass index ≥24 kg/m2 (OR 0.166; 95% CI 0.035, 0.782). Conclusion Female and male patients have different risk factors for PONV following lobectomy for lung cancer and application of analgesic pumps.

Background Male breast cancer (MBC) is rare and often treated using evidence from female breast cancer (BC) trials due to limited male participation. Previous estimates lacked global coverage and completeness. We aimed to quantify the global MBC burden from 1990 to 2021 and evaluate its current status and trends. Methods Based on the global burden of disease (GBD) database, we gathered and analyzed data on the incidence, death, and disability‐adjusted life years (DALYs) of MBC while utilizing age‐standardized rates (ASRs) as indicators for these measurements. Our study calculated the estimated annual percentage change (EAPC), aiming at measuring the average change in ASRs. Additionally, we evaluated the attributable risk factors (RFs) and trends of MBC across different regions and age groups worldwide. Results In 2021, the global MBC age‐standardized incidence rates (ASIR), age‐standardized death rates (ASDR), and age‐standardized DALY rates (ASDALY) per 100,000 persons were 0.941 (95% UI, 0.605–1.155), 0.335 (95% UI, 0.232–0.409), and 9.157 (95% UI, 6.116–11.423), respectively. In comparison to 1990, these rates have increased by 2.212 (95% UI, 2.047–2.378), 0.664 (95% UI, 0.562–0.767), and 0.853 (95% UI, 0.750–0.956) respectively. In Uganda 2021, the ASIR and ASDR of MBC were the highest at 4.541 (95% UI, 3.028–6.808) and 3.510 (95% UI, 2.301–5.195) per 100,000 persons, respectively. Moreover, the burden of MBC exhibited an increase with age. Globally, dietary risk was the most important attributable RF for MBC deaths, with a death percentage of 11.690% (95% UI, −0.003%–24.838%), followed by alcohol use and tobacco. Conclusion From 1990 to 2021, the ASIR, ASDR, and ASDALY of MBC have shown significant disparities and an increasing trend. Committing to healthy lifestyle choices, such as decreasing tobacco and alcohol consumption and making positive changes to dietary habits, can assist in reducing MBC risk. The development and execution of robust and effective public health policies are crucial for alleviating the global disease burden.

Epigenetics denotes heritable alterations in gene expression patterns independent of changes in DNA sequence. Epigenetic therapy seeks to reprogram malignant cells to a normal phenotype and has been extensively investigated in oncology. This study conducts a bibliometric analysis of epigenetic therapy in cancer, providing a comprehensive overview of current research, identifying trends, and highlighting key areas of investigation. Publications concerning epigenetic inhibitors in cancer spanning 2004 to 2023 were retrieved from the Web of Science Core Collection (WoSCC). Co-occurrence analysis using VOSviewer assessed current status and focal points. Evolutionary trends and bursts in the knowledge domain were analyzed using CiteSpace. Bibliometrix facilitated topic evolution and revealed trends in keywords. National, institutional, and author affiliations and collaborations were also examined. A total of 2,153 articles and reviews on epigenetic therapy in oncology were identified, demonstrating a consistent upward trend over time. The United States (745 papers), University of Texas MD Anderson Cancer Center (57 papers), and Stephen B. Baylin (27 papers) emerged as the most productive country, institution, and author, respectively. Keyword co-occurrence analysis identified five primary clusters: tumor, DNA methylation, epigenetic therapy, expression, and immunotherapy. In the past 5 years, newly emerging themes with increased centrality and density include \"drug resistance,\" \"immunotherapy,\" and \"combination therapy.\" The most cited publication reviewed current understanding of potential causes of epigenetic diseases and proposed future therapeutic strategies. In the past two decades, the importance of epigenetic therapy in cancer research has become increasingly prominent. The United States occupies a key position in this field, while China, despite having published a large number of related papers, still has relatively limited influence. Current research focuses on the \"combination therapy\" of epigenetic drugs. Future studies should further explore the sequencing and scheduling of combination therapies, optimize trial designs and dosing regimens to improve clinical efficacy.

Breast cancer is the most common malignant tumor among women worldwide, and the tumor microenvironment (TME) has become a hot research field in contemporary oncology. Understanding the TME is essential for elucidating the mechanisms of breast cancer progression and identifying novel therapeutic targets for metastasis and recurrence. This study performed a bibliometric analysis of TME research for breast cancer, providing a comprehensive overview of current research hotspots, development trends, and directions. We retrieved for literature on TME for breast cancer published during 2014-2023 from the Web of Science database and performed bibliometric analysis. CiteSpace was used for co-citation analysis of references to assess the evolution and bursts in the knowledge base. VOSviewer was used for co-occurrence analysis of author keywords, countries/regions, institutions, and authors to reveal the knowledge structure and collaborative networks in this research area. Thematic evolution trends were analyzed using the bibliometrix package to reveal research hotspots, thematic evolution and dynamic changes of this research. A total of 9683 documents were included in this study, and the keyword co-occurrence analysis displayed five clusters: immunotherapy, metastasis, diagnosis and prognosis, metabolic regulation, and therapeutic approaches, with the first two keywords, immunotherapy and metastasis, being the most frequently mentioned. The most productive country/region, institution, and author were China (3266 publications), Shanghai Jiao Tong University (208 publications), and Takahashi, Kazuaki (37 publications). In breast cancer TME research, cancer-associated fibroblasts have attracted widespread attention, while cancer immunotherapy has emerged as a key focus in contemporary studies.

Objective To investigate the diagnostic value of dual-energy computed tomography (DECT) quantitative parameters in the identification of regional lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC). Methods This retrospective diagnostic study assessed 145 patients with pathologically confirmed pancreatic ductal adenocarcinoma from August 2016–October 2020. Quantitative parameters for targeted lymph nodes were measured using DECT, and all parameters were compared between benign and metastatic lymph nodes to determine their diagnostic value. A logistic regression model was constructed; the receiver operator characteristics curve was plotted; the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of each energy DECT parameter; and the DeLong test was used to compare AUC differences. Model evaluation was used for correlation analysis of each DECT parameter. Results Statistical differences in benign and metastatic lymph nodes were found for several parameters. Venous phase iodine density had the highest diagnostic efficacy as a single parameter, with AUC 0.949 [95% confidence interval (CI):0.915–0.972, threshold: 3.95], sensitivity 79.80%, specificity 96.00%, and accuracy 87.44%. Regression models with multiple parameters had the highest diagnostic efficacy, with AUC 0.992 (95% CI: 0.967–0.999), sensitivity 95.96%, specificity 96%, and accuracy 94.97%, which was higher than that for a single DECT parameter, and the difference was statistically significant. Conclusion Among all DECT parameters for regional lymph node metastasis in PDAC, venous phase iodine density has the highest diagnostic efficacy as a single parameter, which is convenient for use in clinical settings, whereas a multiparametric regression model has higher diagnostic value compared with the single-parameter model. Key Points • In order to ascertain the presence of regional lymph node metastasis in pancreatic ductal adenocarcinoma, a regression diagnostic model was constructed utilizing various dual-energy computed tomography parameters. • The dual-energy CT multi-parameter regression model demonstrates a notable diagnostic efficacy in detecting lymph node metastasis of PDCA, thereby providing valuable assistance in clinical decision-making.

Purpose Brain metastases (BMs) occur in 15–30% of breast cancer patients, particularly in HER2-positive and triple-negative(TN) subtypes, and signify poor prognosis. This study aimed to identify vulnerable BM locations through voxel-wise analysis of clinical characteristics. Method We retrospectively analyzed 161 breast cancer patients with BMs (2007–2019) and performed voxel-wise MRI analysis using standardized templates. Segmentation results were superimposed on standard brain templates to construct stereo-specific frequency thermograms and compared under the same voxel. Two-tailed Fisher’s exact test was performed. Overall survival (OS) and post-progression survival (PPS) after confirmation of brain metastases were tested by Kaplan-Meier, Cox regression analysis calculation, and log-rank test. Result The frequency heat map shows lesions of patients with breast cancer brain metastases were more inclined to the cerebellar hemisphere. Older patients’ lesions mainly occurred in the right frontal lobe, the left parietal lobe, and adjacent meninges compared with white matter of the right parietal lobe and cerebellar vermis among younger patients. ER-positive and PR-positive and HER2-overexpressed patients presented significance in the parieto-occipital lobe, cerebellum and adjacent meninges. Metastases with high levels of CEA were found in areas around the central anterior gyrus. HER2-overexpressed in primary sites and a normal level of serum CA15-3 were two independent protective factors in determining prognostic outcomes. Conclusion The preferred locations of breast cancer with brain metastases could be observed based on different clinical and biological characteristics, which could be clues for further study and helpful for clinical strategies.

In the early stages of the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, many cross-infections occurred due to the limited number of wards and insufficient medical staff, which could not cope with the large number of patients visiting the hospital. A series of new infection control measures were implemented in our institution and a Wuhan hospital supported by our medical team, mainly including temporarily transforming the general ward into a passage for the staff to enter the infectious ward and standardizing the procedure for the wearing and removal of personal protection equipment (PPE). These measures significantly improved the situation, and no member of our medical staff was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the middle and late stages of the disease epidemic. We hope that these experiences can provide references for medical institutions that may face an outbreak of COVID-19, especially those in underdeveloped countries and regions.

An important step in the induction of an immune response to vaccines is the internalization of antigens by antigen presenting cells, such as dendritic cells (DCs). Many current vaccines are formulated with antigens adsorbed to an aluminum-containing adjuvant. Following injection of the vaccine the antigens may either elute or stay adsorbed to the adjuvant surface. Antigens, which elute from the adjuvant surface, are internalized by dendritic cells through macropinocytosis while those that remain adsorbed are internalized with the adjuvant particle by phagocytosis. The relative efficiency of these two routes of internalization was studied. Alpha casein (AC) labeled with a green fluorescent dye was selected as the model antigen. In order to model vaccine antigens that elute from aluminum-containing adjuvants following administration, dendritic cells were incubated with a solution of fluorochrome-labeled alpha casein. To model vaccine antigens that do not elute from aluminum-containing adjuvants following administration, dendritic cells were exposed to fluorochrome-labeled alpha casein adsorbed to aluminum hydroxide adjuvant (AH). Alpha casein has eight phosphate groups and adsorbs to aluminum hydroxide adjuvant through ligand exchange. Alpha casein does not elute from aluminum hydroxide adjuvant upon exposure to cell culture media. The uptake of antigen by dendritic cells was determined at 0.5, 1, 2 and 3 h by confocal microscopy and flow cytometry. Dendritic cells internalized both alpha casein in solution and alpha casein adsorbed to aluminum hydroxide adjuvant. However, the mean fluorescence intensity of dendritic cells incubated with adsorbed alpha casein was four times greater than dendritic cells incubated with alpha casein in solution. In addition, the internalization of alpha casein was enhanced when the mean aggregate diameter of the adjuvant in the cell culture media was reduced from 17 μm to 3 μm. It was concluded that antigen internalization by dendritic cells was enhanced when the antigen remained adsorbed to the aluminum-containing adjuvant following administration and the aggregate size of the adjuvant was smaller than dendritic cells which are approximately 10 μm in diameter.