[Construction of prediction model combined dual-energy CT quantitative parameters and conventional CT features for assessing the Ki-67 expression levels in invasive breast cancer].

Objective: To develop a model combined with dual-energy CT quantitative parameters and conventional CT features for evaluating the expression level of Ki-67 in invasive breast cancer. Methods: A total of 191 patients with histologically confirmed invasive breast cancer in Lishui Central Hospital from March 2019 to December 2020, were retrospectively enrolled, all of them were females, aged from 25 to 77 (53.2±11.3) years. All patients underwent preoperative non-contrast chest and contrast-enhanced Dual energy CT scans, and the normalized iodine concentration (NIC) of lesions on arterial and venous phase, spectral curve slope (λHU), and normalized effective atomic number (nZeff) were measured and calculated, and their conventional CT characteristics were assessed. According to the results of immunohistochemistry (IHC), the patients were divided into Ki-67 high expression group (n=129 patients) and low expression group (n=62 patients) level. The differences in clinical data, conventional CT characteristics and dual-energy CT quantitative parameters between the two groups were analyzed. The receiver operating characteristic curve (ROC) curve was conducted to assess the efficacy of each individual model and joint model in evaluating Ki-67 expression levels, and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated, respectively. Results: In the analysis of CT features, the longest diameter, shape and enhancement pattern of the tumor were significantly difference between the two groups (all P<0.05). The NIC, nZeff on the arterial phase and NIC, nZeff and λHU [M(Q1,Q3)] on the venous phase were higher in the high Ki-67 expression group compared to the low expression group [0.13 (0.12, 0.16) vs 0.11 (0.08, 0.14), 0.71 (0.70, 0.75) vs 0.70 (0.67, 0.72), 0.40 (0.32, 0.48) vs 0.23 (0.17, 0.32), 3.10 (2.58, 3.63) vs 2.86 (2.19, 3.48), 0.88 (0.85, 0.92) vs 0.85 (0.84, 0.86), all P<0.05]. The logistic regression model, which integrated significant conventional CT features and dual-energy CT quantitative parameters, demonstrated the highest diagnostic performance for assessing Ki-67 expression levels, with an AUC of 0.924, sensitivity of 88.37%, specificity of 83.87%, and accuracy of 86.91%; the AUC of the dual-energy CT parameter model was 0.908, sensitivity of 82.17%, specificity of 88.71%, and accuracy of 84.29%. Though the diagnostic efficacy was no significant difference (P=0.238), both models showed superior to the conventional CT feature model (all P<0.001). Conclusion: A dual-energy CT quantitative parameter combined with a conventional CT feature model was successfully constructed, which has a good evaluation performance on the expression level of Ki-67 in invasive breast cancer.

MicroRNA-185 inhibits cell proliferation and epithelial-mesenchymal transition in hepatocellular carcinoma by targeting Six2.

The article "MicroRNA-185 inhibits cell proliferation and epithelial-mesenchymal transition in hepatocellular carcinoma by targeting Six2, by S.-M. Zhu, C.-M. Chen, Z.-Y. Jiang, B. Yuan, M. Ji, F.-H. Wu, J. Jin, published in Eur Rev Med Pharmacol Sci 2016; 20 (9): 1712-1719-PMID: 27212161" has been withdrawn from the authors due to some technical reasons. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/10739.

[Prediction of short-term prognosis of hepatocellular carcinoma after TACE surgery based on MRI texture analysis technology].

Objective: To explore the feasibility of short-term efficacy prognosis prediction model for HCC patients undergoing transcatheter arterial chemoembolization (TACE) based on MRI-based radiomics technique. Methods: A total of 123 patients with liver cancer who received TACE treatment in Lishui Central Hospital from June 2016 to July 2018 were retrospectively collected, including 90 males and 33 females, with an average age of 24-83 (58±10) years. All the patients were pathologically confirmed as hepatocellular carcinoma and underwent MRI scan before surgery.All patients were followed up 3-4 months after TACE, and further divided into training group (n=85, 42 of which were effective and 43 cases were ineffective) and the validation group (n=38, 19 of which were effective and 19 were ineffective) according to the modified response evaluation criteria in solid tumors (mRECIST). There was no statistical difference in the general information between the two groups of patients, which was comparable. Then, preoperative T(2)WI images were used for radiomics analysis, texture parameters were screened based on R language, and short-term efficacy prediction model of TACE for training group and verification group was constructed. Results: T(2)WI image analysis of each patient received 396 different texture parameters, and further used Lasso dimensionality reduction and 10 times cross-validation screening to obtain 5 characteristic texture parameters, specifically stdDeviation, ClusterProminence_angle135_offset4, Correlation_angle135_offset4, Inertia_angle135_offset4, InverseDifferenceMoment_angle45_offset4. According to the above five texture parameters and their corresponding coefficient values, the corresponding radiomics scores (Radscore) were calculated, and the prediction models of the training group and the verification group were further constructed.It was found that the area under the ROC curve of the training group was 0.812 (95%CI: 0.722-0.901), the sensitivity and specificity were 83.7% and 69.0%, respectively. The area under the ROC curve of the validation group was 0.801 (95%CI:0.654-0.947), and the sensitivity and specificity were 89.5% and 63.2%, respectively. Conclusion: The constructed TACE prediction model in the present study has high prediction accuracy, sensitivity and specificity.The short-term efficacy prognosis prediction model for HCC based on MRI is constructed, stable and reliable.

The presence probability of mandibular lingla and antilingula.

PURPOSE: The lingula and antilingula are crucial surgical landmarks for mandibular setback surgery. The purpose of study was to investigate the correlation of presence probability between lingual and antilingula. MATERIALS AND METHODS: A total of 180 cone-beam computed tomography sides were collected from 90 patients. The probability of absence of the lingula and antilingula was recorded with respect to the gender, mandible (unilateral and bilateral), and skeletal patterns (Class I, II, III); in addition, the correlations between these variables were analysed. RESULTS: Of the 180 sides, 9 sides showed the absence of the lingula (5%) and 34 sides showed the absence of the antilingula (18.9%). Pearson's test revealed that the presence of the lingula and antilingula differed nonsignificantly with respect to gender and skeletal patterns, respectively. The bilateral presence of the lingula was observed in 16 sides (91.1%), and that of the antilingula was observed in 122 sides (67.8%). Pearson's test verified a significant correlation between the presence of the left and right lingula (P<0.05). By contrast, gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. CONCLUSION: Gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula, respectively. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. Consequently, lingula and antilingula cannot serve as the absolute standards for mandibular setback surgery.

[Percutaneous full-endoscopic removalof lumbar dumbbell tumors viatransforaminal approach].

Objective: To investigate the novel application and effectof Percutaneous Full-Endoscopic transforaminal approach for lumbar dumbbell tumors. Methods: A retrospective analysis of 12 cases of lumbar dumbbell tumors was conducted by Percutaneous full-endoscopic transforaminal approach in the Department of Neurosurgery, Fujian Medical University Union Hospital from Feb, 2018 to Jul, 2019. According to Eden classification, 5 cases in type Ⅲ and 7 cases in type Ⅳ. The Japanese Orthopaedic Association (JOA) score and Pain Visual analogue Scale (VAS) were used to compare the recovery of neurological function before and after surgery. Results: All the 12 tumors were completely removed in one stage. The pathological reports were all schwannomas (WHO grade Ⅰ). The VAS scores were significantly decreased compared with preoperative ones (P<0.001). The JOA scores were significantly improved without obvious complications and spinal instability. Median length of follow-up was 14 months with a range of 4 months to 20 months, there is no tumor recurrence and spinal instability. Conclusion: In the treatment of lumbar dumbbell spinal tumor, the full endoscopic transforaminal approach is a novel, safe and effective surgical procedure which removes the tumors intra-foramen and extra-foramen with less damage of spine, smaller possibility of instability and faster recovery.

[The correlation between functional magnetic resonance imaging features and expression of Her-2 in breast cancer].

Objective: To explore the correlation between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), magnetic resonance diffusion-weighted imaging (DWI) images of breast cancer and human epidermal growth factor receptor-2 (Her-2) expression. Methods: A retrospective analysis of 84 patients with breast cancer confirmed by biopsy from January 2012 to December 2016 in Zhejiang University Lishui Hospital was conducted. The data of DCE-MRI, DWI scanning were collected before surgery and Her-2 was detected by immunohistochemistry (IHC). Then, all the patients were divided into Her-2 positive group and Her-2 negative group according to Her-2 expression. There were 44 cases in the Her-2 positive group and 40 cases in the Her-2 negative group. The differences in the characteristics of the lesion morphology, time-signal intensity curve (TIC), early enhancement rate and apparent diffusion coefficient (ADC) were compared, and their correlation with Her-2 expression was analyzed. Results: Of the 84 lesions, 12 were orthotopic ductal carcinoma, 6 were lobular carcinoma, and 66 were invasive ductal carcinoma. There were significant differences in lesion morphology (P=0.012) and TIC curve morphology (P=0.038) between Her-2 positive group and negative group. At the same time, the early enhancement rate (P=0.012) and ADC value (P=0.038) of Her-2 positive group were significantly higher than those of negative group. Except morphology of segmental lesions and TIC curve morphology, other characteristic parameters were correlated to Her-2 (all P<0.05). The correlation coefficients between early enhancement rate, ADC value and Her-2 expression were as high as 0.758 and 0.809 (all P<0.05). Conclusions: The morphology of breast cancer lesions, time-signal intensity curve, early enhancement rate and ADC value are all correlated with Her-2 expression.The early enhancement rate and ADC value are significantly positively correlated with Her-2 expression.

Routine chest CT for staging of gastric cancer.

BACKGROUND: International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer. METHODS: This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size. RESULTS: Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X-ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively. CONCLUSION: This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected.

Improvement in lip appearance (lateral and frontal aspects) following mandibular setback surgery.

INTRODUCTION: The post-operative facial profile is critical for patients who undergo orthognathic surgery. The present study investigated the improvement in lip appearance (lateral and frontal aspects) following mandibular setback surgery. MATERIAL AND METHODS: Thirty-one patients with mandibular prognathism underwent mandibular setback surgery. Lateral and posteroanterior cephalograms were obtained before surgery (T0) and more than 1 year after surgery (T1). The landmarks (soft and hard tissues) and linear distances were compared by statistical analysis. RESULTS: The lateral cheilion (Ch), point B (B), and pogonion (Pog) were significantly setbackin the horizontal plane: 5.59, 11.49, and 12.35 mm, respectively. In the vertical plane, B and Pog did not move significantly. The Ch moved significantly downward by 3.23 mm on average. The setback ratios of soft tissue/hard tissue, soft tissue of B/B, and soft tissue of Pog/Pog were 0.96. The Ch/Pog ratio was 0.45. The width of the frontal Ch was significantly reduced by 3.17 mm. CONCLUSIONS: The relationship between the corresponding soft and hard tissues of the chin was approximately 1. The relationship between the lip corner and chin bone was nearly 50%. The width of the lip corner was also significantly reduced.

Correlation between changes in the gonial area and postoperative stability in the treatment of mandibular prognathism.

INTRODUCTION: The present study was to investigate the relationship between the post-operative area of the gonial region (lateral and frontal) and post-operative relapse. MATERIAL AND METHODS: Thirty-seven patients, treated for mandibular prognathism were followed with serial lateral cephalograms [pre-operatively (T1), immediately after surgery (T2), and at least 2 years post-operatively (T3)]. The surgical changes (T21), post-operative stability (T32) and 2-year surgical change (T31) were evaluated by the Student's t-test. Pearson's correlation coefficient analysis was used to determine the correlations between the cephalometric parameters. Multiple linear regression analysis was used to assess the association between the risk factors and post-operative relapse. RESULTS: The immediate post-operative changes (T21), mean setback of the Me was 12.3 mm and the frontal gonial area (T2) was increased by 138.7 mm2. The final post-operative changes (T31), lateral gonial area was significantly reduced by 190.5 mm2. CONCLUSION: Relapse was significantly correlated with the amount of setback. However, changes in the area of the gonial region (lateral and frontal) showed weak correlation with relapse. Multiple regression analysis also showed poor predictability of relapse. In conclusion, the results of this study showed that significant changes in the area of the gonial region (lateral and frontal) did not affect the maintenance of post-operative stability.

Dementia predicted one-year mortality for patients with first hip fracture: a population-based study.

Aims: We aimed to determine the effect of dementia and Parkinson's disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population. Patients and Methods: Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson's disease or both, adjusting for demographic, clinical, treatment, and provider factors. Results: Among 6626 hip fracture patients, 10.20% had dementia alone, 5.60% had Parkinson's disease alone, and 2.67% had both. Corresponding one-year mortality rates were 15.53%, 11.59%, and 15.82%, compared with 9.22% for those without neurological illness. Adjusted hazard ratio for one-year mortality was 1.45 (95% confidence intervals (CI) 1.17 to 1.79) for those with dementia, and 1.57 (95% CI 1.07 to 2.30) with both dementia and Parkinson's disease versus patients with neither. There was no significant association with death for Parkinson's disease alone. Age, male gender and comorbidities were also associated with a higher risk of mortality. Conclusion: Dementia, with or without Parkinson's disease, is an independent predictor of mortality following surgery for fractures of the hip. Age, male gender and comorbidities also increase the risk of death. Parkinson's disease alone has no significant effect. Cite this article: Bone Joint J 2018;100-B:1220-6.

Appearance on face reading (cheek line) after orthognathic surgery.

The cheek line (face reading) is an aesthetic element of the facial profile. The purpose of our study was to investigate the changes in the cheek line after mandibular setback surgery. Forty patients (20 female and 20 male, mean (SD) age 22 (5) years) were diagnosed with mandibular prognathism and treated by intraoral vertical ramus osteotomy alone. Cephalograms were obtained before operation (T1), at least a year postoperatively (T2), and final surgical changes over a year (T2-T1). The cheek line and landmarks (soft and hard tissues) were compared using the paired t test. The hypothesis was that the cheek line did not change significantly after mandibular setback. At the time of the final follow-up (T2-T1), the mean (SD) horizontal setback of pogonion (Pog) was 12.3 (3.5) mm for women and 11.7 (4.3) mm for men. The ratios of soft:hard tissue, labrale inferius:incisor inferius, labiomental sulcus:point B, soft tissue Pog:Pog, and cheek point:Pog in women were 0.96, 0.98, 0.98, and 0.08, and in men 0.91, 1.01, 0.94, and 0.13, respectively. The nasolabial and cervicomental angles in women were significantly increased by 11.1° and 11.4°, respectively, and in men the nasolabial angle was significantly increased by 11.1° and the mentolabial angle reduced by 9.9°. The cheek line (T2-T1) was moved significantly forwards. The hypothesis was therefore rejected. In conclusion, the cheek line was advanced significantly after isolated mandibular setback.

Factors related to skeletal relapse in the two-jaw surgery treatment of mandibular prognathism.

This study identified factors contributing to skeletal relapse in the two-jaw surgery treatment of mandibular prognathism. A set of three standardized lateral cephalograms (T1: before surgery, T2: immediately after surgery, T3: final follow-up after surgery) were obtained from 35 patients. The surgical changes were defined as follows: postsurgical immediate change (T2-T1), postoperative stability (T3-T2) and the final surgical change (T3-T1). The occlusal plane and gonial angles were also measured. Relapse was defined as the reverse movements of the menton point (Me) and point A, with the null hypothesis stating that Me and point A do not significantly change at the postoperative stability (T3-T2). A paired t test and Pearson's correlation were used for statistical analysis. The immediate postoperative changes (T2-T1) in Me and point A were significant, and were measured to be 8.5mm backward and 3.0mm forward, respectively. Additionally, the occlusal plane and gonial angles significantly increased by 2° and decreased by 2°, respectively. The final postoperative changes (T3-T1) in Me and point A were also significant, and were measured to be 5.2mm backward and 2.5 forward, respectively; the occlusal plane and gonial angles also increased nonsignificantly by 0.6° and 0.7°, respectively. Upon investigating postoperative stability (T3-T2), Me was measured to be significantly 3.3mm forward and 1.4mm upward, whereas point A was measured to be nonsignificantly 0.5mm backward and 0.9mm upward. Therefore, the null hypothesis was rejected. Pearson's correlation showed that horizontal Me (T3-T2) and point A (T3-T2) were significantly correlated with the amounts of setback Me (T2-T1) and advancement A (T2-T1), respectively. In conclusion, skeletal relapses are significantly correlated with the amounts of mandibular setback and maxillary advancement.

The lack of Raf-1 kinase feedback regulation enhances antiapoptosis in cancer cells.

Raf-1 has an important role in cellular antiapoptosis. So far, there is no solid evidence that shows that Raf-1 mutation is associated with cancer development. In the course of further study of Raf-1 signaling, we have reported that Raf-1 hyperphosphorylation inhibits its kinase activity toward its downstream mitogen-activated protein kinase kinase 1/2 (MEK1/2) and proposed a model for negative feedback regulation of Raf-1. Here, we show that there is no hyperphosphorylation in some cancer cells, which results in increased kinase activity and enhances the antiapoptotic ability. Inhibition of either Raf-1 or ALG-2 (apoptosis-linked gene 2) expression results in apoptosis signal-regulating kinase 1/c-Jun N-terminal kinase (ASK1/JNK) signaling activation, and cell sensitivity to chemotherapeutic reagents, indicating that inhibition of ASK1/JNK apoptotic signaling by Raf-1 is mediated by ALG-2. A previous report indicated that extracellular signal-regulated kinase 1/2 (ERK1/2) were responsible for Raf-1 hyperphosphorylation. However, our evidence shows that when ERK1/2 are activated and the Raf-1 gene is not mutated, Raf-1 is not hyperphosphorylated in these cells, indicating that ERK1/2 are not responsible for the Raf-1 hyperphosphorylation in these cancer cell lines. Surprisingly, we also found that Raf-1 is not a necessary kinase for MEK1/2 activation under normal tissue culture conditions, but is required for MEK1/2 activation under apoptosis-inducing conditions. Our research demonstrates that although Raf-1 gene is not mutated, an abnormality of Raf-1 kinase feedback regulation enhances its antiapoptotic function, and Raf-1 can still be a pharmaceutical target to increase chemotherapy or radiotherapy sensitivity in these cancer cells.

MicroRNA-185 inhibits cell proliferation and epithelial-mesenchymal transition in hepatocellular carcinoma by targeting Six2.

OBJECTIVE: Epithelial-mesenchymal transition (EMT) plays an important role in the malignant transformation of cancer. MicroRNAs are a group of small non-coding RNA molecules that down-regulate the expression of genes involved in tumorigenesis. Although microRNA-185 (miR-185) participates in the pathogenesis of several types of cancer, its relationship with EMT in human hepatocellular carcinoma (HCC) has not been investigated. The present study aims to elucidate the regulatory effects of miR-185 on EMT in HCC cells. MATERIALS AND METHODS: MTT and an in vitro wound-healing assay were performed to determine cell growth and metastasis potential, respectively. Real-time PCR was used to measure the mRNA expression of miR-185 and Six2. In addition, protein expression levels of Six2 and EMT-related markers were determined by western blot. RESULTS: Our study showed that miR-185 was significantly down-regulated in HCC cells. Also, a luciferase reporter gene assay confirmed Six2 as a direct target of miR-185. Functional analyses indicated that miR-185 up-regulation remarkably suppressed cell growth and the metastatic potential of HCC cells. We also found that ectopic expression of miR-185 reversed EMT via the up-regulation of E-cadherin and down-regulation of vimentin in epithelial and mesenchymal HCC cells. CONCLUSIONS: miR-185 suppresses cell growth and EMT progression by targeting Six2, providing a novel target for the molecular treatment of liver malignancies.

CT-guided percutaneous core-needle biopsy of pancreatic masses: comparison of the standard mesenteric/retroperitoneal versus the trans-organ approaches.

AIM: To compare the safety and efficacy of percutaneous computed tomography (CT)-guided core-needle biopsy (CNB) of pancreatic masses traversing the gastrointestinal tract or solid viscera versus trans-mesenteric and retroperitoneal approaches. MATERIALS AND METHODS: CT-guided CNB of pancreatic lesions performed between May 2004 and December 2014 were retrospectively analysed at a single centre. Biopsies were performed using 18- or 20-G needles with a coaxial system. CT images, histopathology reports, medical records, and procedural details for all patients were reviewed to evaluate the biopsy route, complications, and diagnostic accuracy. According to the routes, biopsies were divided into trans-mesenteric, retroperitoneal and trans-organ approaches for comparison. RESULTS: A total of 85 patients, who had undergone 89 CNBs for pancreatic masses were reviewed. The overall sensitivity, specificity, and accuracy of CNB for detecting malignancy via various routes were 88.8%, 100%, and 89.9%, respectively, with a complication rate of 20.2%. Trans-organ biopsies of pancreatic masses (n=22) were performed safely via a direct pathway traversing the stomach (n=14), colon (n=3), small bowel (n=2), liver (n=2), and spleen (n=1). The sensitivity, specificity, and accuracy were 90.5%, 100%, and 90.9%, respectively. In the trans-organ biopsy group, three biopsies (13.6%) resulted in minor haematomas, but no major complications occurred. There were no statistically significant differences in the diagnostic efficacy or complication rate among the different biopsy routes. CONCLUSION: Percutaneous CT-guided CNB using a trans-organ approach is a feasible technique for diagnosing pancreatic malignancy; however, as this series was small, more data is required.

Mitochondrial dysfunction in resveratrol-induced apoptosis in QGY-7701 cells.

This study aims to evaluate the cytotoxicity of resveratrol on QGY-7701 cells via a cell viability assay, and determine the cytological alterations and damages that result. Resveratrol was found to inhibit QGY-7701 cell growth and decrease their viability in a remarkably dose-dependent manner. Resveratrol exposure also induced an increase in Caspase-3 activity and a decrease in Bcl-2, which caused an increase in membrane permeability, and the opening of mitochondrial permeability transition pores and mitochondrial depolarization. Cellular ATP is thus exhausted, and apoptosis is induced via the change in mitochondrial membrane permeability and mitochondrial dysfunction.