First-principles study of the surface energies and electronic structures of γ-CsSnI3 surfaces.

All-inorganic perovskite CsSnI3 has attracted intense research interests due to its prominent optoelectronic properties, high thermal stability, and environmentally friendly character. The surface energies and electronic structures of black orthorhombic (γ) CsSnI3 surfaces are investigated by using first-principles methods. The anisotropic and termination-dependent surface energies of low-index surfaces (i.e., the (110), (001), (100) and (101) surfaces) are obtained, providing important data for CsSnI3, since these values are difficult to be measured in experiments. The CsI-terminated (110) and (001) surfaces are predicted to be the most stable and their surface energies are close, making the cube-shape of nanocrystals favorable at thermodynamic equilibrium, which is consistent with the experimental observations. Calculated surface electronic structures show that the quantum confinement effect is orientation dependent. The band gaps of the (100) and (101) surfaces are significantly larger than those of the (110) and (001) surfaces by using slabs with similar thickness. This distinction can be attributed to different 'electronic dimensionalities' of these surfaces. Our results provide physical insights into the thermodynamic stability and electronic properties of CsSnI3 surfaces.

Surface energy and surface stability of cesium tin halide perovskites: a theoretical investigation.

Lead halide perovskites have been widely studied in the fields of photovoltaics and optoelectronics for over a decade. The toxicity of lead poses a big challenge to the potential applications of the materials. In recent years, lead-free halide perovskites have received significant attention due to their excellent optoelectronic properties and environment-friendly character. Tin halide perovskites have emerged as one of the most promising candidates for lead-free optoelectronic materials. It is of fundamental importance to understand the surface properties of tin halide perovskites that remain largely unknown. Using the density functional theory (DFT) method, we explore the surface energy and surface stability of low-index surfaces of cubic CsSnX3 (X = Cl, Br, I), i.e., (100), (110), and (111) surfaces. We calculate the stability phase diagrams of these surfaces and find that the (100) surface is more stable than the (110) and (111) surfaces. Interestingly, Br2-terminated (110) and CsBr3-terminated (111) polar surfaces are relatively more stable in CsSnBr3 than those in CsPbBr3 due to a higher level of valence band maximum and thus lesser energy cost in removing electrons to compensate for the polarity of the former. We calculate the surface energies of CsSnX3 surfaces that are difficult to access from experiments. The surface energies are very low in comparison with that of oxide perovskites. The origin of this lies in the relatively low binding strength of halide perovskites because of the soft nature of their structures. Furthermore, the connection between exfoliation energy and the cleavage energy in CsSnX3 is discussed.

Risk factors for inpatient malnutrition and length of stay assessed by 'NutritionDay' in China.

BACKGROUND AND OBJECTIVES: NutritionDay is a yearly global point-prevalence study of malnutrition or nutritional risk in hospitals. We aimed to provide a comprehensive nutritional survey of hospitalized patients and analyze the risk factors of malnutrition and prolonged hospitalization in Chinese inpatients. METHODS AND STUDY DESIGN: The international daylong cross-sectional survey was performed on November 07th, 2019. Ten hospitals were invited to participate in this NutritionDay survey. Nutritional risk was identified by nutritional risk screening 2002, and malnutrition was identified by the ESPEN criteria. We measured the incidence of malnutrition and nutritional risk. And we analysed risk factors for malnutrition and length of stay in Chinese hospitalized patients. RESULTS: 875 hospitalized patients from 6 departments were included in the analysis. The malnutrition rate was 11.6% and the incidence of nutritional risk was 17.8%. It was analyzed that tumor load, end-stage disease, motility, self-rated health, types of oral medicine, and food intake during the past week were independent risk factors for malnutrition or nutritional risk. 56.2% (118/210) of patients at nutritional risk or malnutrition received extra nutritional support, whereas 22.5% (88/391) well-nourished patients did. Moreover, nutrition status, ever stayed in ICU and self-rated health were associated with prolonged length of stay. CONCLUSIONS: In a word, the prevalence of malnutrition or nutritional risk was about 29.4%. Patients with malnutrition or nutritional risk had a higher transfer rate, lower rehabilitation rate and longer hospital stays. The attention to malnutrition patients needs to be further strengthened.

Cascading detection model for prediction of apnea-hypopnea events based on nasal flow and arterial blood oxygen saturation.

PURPOSE: Sleep apnea and hypopnea syndrome (SAHS) seriously affects sleep quality. In recent years, much research has focused on the detection of SAHS using various physiological signals and algorithms. The purpose of this study is to find an efficient model for detection of apnea-hypopnea events based on nasal flow and SpO2 signals. METHODS: A 60-s detector and a 10-s detector were cascaded for precise detection of apnea-hypopnea (AH) events. Random forests were adopted for classification of data segments based on morphological features extracted from nasal flow and arterial blood oxygen saturation (SpO2). Then the segments' classification results were fed into an event detector to locate the start and end time of every AH event and predict the AH index (AHI). RESULTS: A retrospective study of 24 subjects' polysomnography recordings was conducted. According to segment analysis, the cascading detection model reached an accuracy of 88.3%. While Pearson's correlation coefficient between estimated AHI and reference AHI was 0.99, in the diagnosis of SAHS severity, the proposed method exhibited a performance with Cohen's kappa coefficient of 0.76. CONCLUSIONS: The cascading detection model is able to detect AH events and provide an estimate of AHI. The results indicate that it has the potential to be a useful tool for SAHS diagnosis.

Safety of percutaneous vertebroplasty for the treatment of metastatic spinal tumors in patients with posterior wall defects.

PURPOSE: To assess the clinical effect of percutaneous vertebroplasty (PVP) in the treatment of metastatic spinal tumors in patients with posterior wall defect. METHODS: The treated vertebrae bodies were divided into four groups: group A, non-posterior vertebral wall defect; group B, posterior vertebral wall with cribriform defects; group C, posterior vertebral wall with local fragmentation defects; group D, posterior vertebral wall with severe defects. The injected volume of bone cement, visual analogue scale (VAS) score, Karnofsky Performance Scale (KPS), cement leakage and survival were analyzed. RESULTS: The injected volume of bone cement for group A was significantly higher than posterior wall defect group (including group B, C, and D). No significant differences about the injected volume of bone cement among the posterior wall defect groups. The incidence of bone cement leakage for group A was not significantly different as compared to posterior vertebral wall defect group. However, there were significant differences with respect to the incidence of bone cement leakage among the posterior wall defect groups. In four groups the postoperative VAS pain scores and KPS were statistical different as comparison to the preoperative values. No statistical difference with respect to the VAS pain scores and KPS was observed at any time point between the non-posterior wall defect group and posterior wall defect group. CONCLUSION: PVP can be an effective treatment for metastatic spinal tumors in patients with posterior wall deficiency; however, care should be taken to control the distribution of the bone cement due to the relatively high risk of cement leakage.

Status and prospects of percutaneous vertebroplasty combined with ¹²5I seed implantation for the treatment of spinal metastases.

Metastatic spinal tumours are the most common type of bone metastasis. Various methods have been used to treat metastatic spinal lesions, including radiotherapy, chemotherapy, isotope therapy, bisphosphonate therapy, analgesics, and surgery. Conservative treatments such as radiotherapy and chemotherapy are not appropriate and usually are ineffective in patients with vertebral fractures and/or spinal instability. Minimally invasive surgical treatments using non-vascular interventional technology, such as percutaneous vertebroplasty (PVP), have been successfully performed in the clinical setting. PVP is a non-invasive procedure that creates small wounds and is usually associated with only minor complications. In the present study, we will review the clinical status and prospects for the use PVP combined with (125)I seed implantation (PVPI) to treat spinal metastases. The scientific evidence for this treatment, including safety, efficacy, and outcome measures, as well as comparisons with other therapies, was analysed in detail. PVPI effectively alleviates pain in metastatic spinal tumour patients, and the use of interstitial (125)I seed implants can enhance the clinical outcomes. In conclusion, PVPI is a safe, reliable, effective, and minimally invasive treatment. The techniques of PVP and (125)I seed implantation complement each other and strengthen the treatment's effect, presenting a new alternative treatment for spinal metastases with potentially wide application.

Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review.

STUDY DESIGN: The study design of this paper is a systematic review of literature published in the recent 10 years. OBJECTIVE: It is the objective of this paper to compare the clinical efficacy and safety of minimal access (MIS) spinal surgery and open spinal surgery for treating painful spine metastasis. METHODS: Two research questions below were determined through a consensus among a panel of spine experts. A systematic review of literature on spinal surgery was conducted by searching PubMed with a combination of keywords including "metastatic", "metastasis", "metastases", "spinal", and "spine". Independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows: 1. In patients with spine metastatic disease, what is the impact of different surgical approaches (MIS versus open) on pain relief and functional outcome? 2. In patients with metastatic disease, what is the impact of different surgical approaches (MIS versus open) on local recurrence, survive rate, and complication? RESULTS: A total of 1,076 abstracts were identified using various keywords. 5 prospective (level II) and 12 retrospective articles (level III) were eligible for inclusion, involving a total of 979 cases of spine metastasis. There were 345 cases in 8 studies regarding the clinical evaluation of MIS spinal surgery and 634 cases in 9 studies regarding the clinical evaluation of open spinal surgery for spine metastasis. CONCLUSION: Both open spinal surgery and MIS seem to achieve the improvement of pain and neurological dysfunction through decompression and stabilization for patients with spine metastasis, but open surgery may involve more major complications with a trend of lower survival rates and higher recurrence rates compared to MIS.

Meta-analysis of differentially expressed genes in osteosarcoma based on gene expression data.

BACKGROUND: To uncover the genes involved in the development of osteosarcoma (OS), we performed a meta-analysis of OS microarray data to identify differentially expressed genes (DEGs) and biological functions associated with gene expression changes between OS and normal control (NC) tissues. METHODS: We used publicly available GEO datasets of OS to perform a meta-analysis. We performed Gene Ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Protein-Protein interaction (PPI) networks analysis. RESULTS: Eight GEO datasets, including 240 samples of OS and 35 samples of controls, were available for the meta-analysis. We identified 979 DEGs across the studies between OS and NC tissues (472 up-regulated and 507 down-regulated). We found GO terms for molecular functions significantly enriched in protein binding (GO: 0005515, P = 3.83E-60) and calcium ion binding (GO: 0005509, P = 3.79E-13), while for biological processes, the enriched GO terms were cell adhesion (GO:0007155, P = 2.26E-19) and negative regulation of apoptotic process (GO: 0043066, P = 3.24E-15), and for cellular component, the enriched GO terms were cytoplasm (GO: 0005737, P = 9.18E-63) and extracellular region (GO: 0005576, P = 2.28E-47). The most significant pathway in our KEGG analysis was Focal adhesion (P = 5.70E-15). Furthermore, ECM-receptor interaction (P = 1.27E-13) and Cell cycle (P = 4.53E-11) are found to be highly enriched. PPI network analysis indicated that the significant hub proteins containing PTBP2 (Degree = 33), RGS4 (Degree = 15) and FXYD6 (Degree = 13). CONCLUSIONS: Our meta-analysis detected DEGs and biological functions associated with gene expression changes between OS and NC tissues, guiding further identification and treatment for OS.

[Effect of Panax notoginseng saponins on liver drug metablic enzyme activity, mRNA and protein expressions in rats].

To study the effect of Panax notoginseng saponins (PNS) on liver drug metabolic enzyme activity, mRNA and protein expressions in rats. Male Wistar rats were randomly divided into nine groups. After administration of the test drugs, their liver microsomes, liver total RNA and total protein were extracted to detect the regulating effect of PNS on liver drug metabolic enzyme activity-related subtype enzymatic activity, mRNA and protein expression by substrate probe, quantitative PCR and Western Blot technology. The result of this experiment was that PNS could significantly induce CYP1A2 and CYP2E1 enzyme activity, mRNA expression, CYP2E1 protein expression level. PNS significantly induced CYP3A mRNA expression, but with no significant effect in CYP3A enzyme activity level. PNS had no significant effect CYP1A1 and CYP2B mRNA expressions and enzyme activity levels. PNS had selective regulations on different P450 subtypes, and the major subtypes were CYP1A2 and CYP2E1. In clinical practice, particularly in the combination with CYP1A2 and CYP2E1 metabolism-related drugs, full consideration shall be given to the possible drug interactions in order to avoid potential toxic and side effects. Meanwhile, whether the induction effect of CYP2E1 gets involved in ginsenoside's effect incavenging free radicals deserves further studies.

Semantic-Electromagnetic Inversion With Pretrained Multimodal Generative Model.

Across diverse domains of science and technology, electromagnetic (EM) inversion problems benefit from the ability to account for multimodal prior information to regularize their inherent ill-posedness. Indeed, besides priors that are formulated mathematically or learned from quantitative data, valuable prior information may be available in the form of text or images. Besides handling semantic multimodality, it is furthermore important to minimize the cost of adapting to a new physical measurement operator and to limit the requirements for costly labeled data. Here, these challenges are tackled with a frugal and multimodal semantic-EM inversion technique. The key ingredient is a multimodal generator of reconstruction results that can be pretrained, being agnostic to the physical measurement operator. The generator is fed by a multimodal foundation model encoding the multimodal semantic prior and a physical adapter encoding the measured data. For a new physical setting, only the lightweight physical adapter is retrained. The authors' architecture also enables a flexible iterative step-by-step solution to the inverse problem where each step can be semantically controlled. The feasibility and benefits of this methodology are demonstrated for three EM inverse problems: a canonical two-dimensional inverse-scattering problem in numerics, as well as three-dimensional and four-dimensional compressive microwave meta-imaging experiments.

Semantic regularization of electromagnetic inverse problems.

Solving ill-posed inverse problems typically requires regularization based on prior knowledge. To date, only prior knowledge that is formulated mathematically (e.g., sparsity of the unknown) or implicitly learned from quantitative data can be used for regularization. Thereby, semantically formulated prior knowledge derived from human reasoning and recognition is excluded. Here, we introduce and demonstrate the concept of semantic regularization based on a pre-trained large language model to overcome this vexing limitation. We study the approach, first, numerically in a prototypical 2D inverse scattering problem, and, second, experimentally in 3D and 4D compressive microwave imaging problems based on programmable metasurfaces. We highlight that semantic regularization enables new forms of highly-sought privacy protection for applications like smart homes, touchless human-machine interaction and security screening: selected subjects in the scene can be concealed, or their actions and postures can be altered in the reconstruction by manipulating the semantic prior with suitable language-based control commands.

Percutaneous vertebroplasty combined with interstitial implantation of 125I seeds in banna mini-pigs.

BACKGROUND: Although brachytherapy is one of the most effective ways to treat metastatic spinal tumor with little damage to surrounding healthy tissue, it may cause radiation myelopathy if an overdose occurs. Establishing a valuable animal model can help to find a method to overcome its complications. In the current study, we set up a banna mini-pig model to mimic percutaneous vertebroplasty with 125I seed implantation. METHODS: Percutaneous vertebroplasty (PVP) combined with interstitial implantation of 125I seeds, 125I seeds were transplanted into the vertebral body at the T13 level of the spine in banna mini-pigs. After raising them for up to eight months, the spinal cord and vertebral body were collected for pathological analysis. RESULTS: A potential animal model had been successfully established, no case of radiation myelopathy was found in any of the treated banna pigs, and no significant cellular impairment was noted by pathological analysis. CONCLUSIONS: It proves that PVP with 125I brachytherapy is an effective method to treat metastasis spinal tumor, and that the banna mini-pig can be a suitable model to investigate the mechanism of brachytherapy complications.

The electrophysiological features of X-linked juvenile retinoschisis in a young male: a case report.

This case report describes the detailed electrophysiological features and the corresponding relationship with the structural changes in a case of X-linked juvenile retinoschisis (XLRS). A 25-year-old male presented with a history of several years of decreased visual acuity in both eyes. The best corrected visual acuity was 20/200 in oculus dexter (OD) and 20/80 in oculus sinister. Retinoschisis was found in the macula by optical coherence tomography, which was more severe in OD. Electroretinogram revealed a similar electronegative waveform in both eyes. Visual evoked potential detected a reduced amplitude and delayed phase in P100-wave, which was worse in OD. The patient was diagnosed as XLRS and advised to undergo continuous medical observation. He was followed up for the next year, with no significant change in retinal function and structure being observed. These current findings suggest that electrophysiology permits the detailed analysis of the clinical picture of XLRS and helps to gain a deeper understanding of the pathogenesis.

Diagnosis of keratoconus in a young male by electrophysiological test findings: A case report.

RATIONALE: The purpose of this report was to describe the diagnostic process of a case of keratoconus (KCN) after electrophysiological examination. PATIENT CONCERNS: A 23-year-old male army officer presented with decreased visual acuity (VA) in the left eye for 5 months. Best-corrected VA was 20/20 in the right eye and 20/300 in the left eye. The cornea and lens were clear in both eyes with a normal anterior chamber. No specific abnormalities were found on fundus photography, optical coherence tomography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), or full-field electroretinography (ffERG) of both eyes. Pattern visual-evoked potentials (PVEP) detected a reduced amplitude and delayed peak time of the P100-wave in both eyes, which was more severe in the left eye. The amplitude and peak time of the P2-wave in flash VEP (FVEP) were comparable in both eyes and were within the normal ranges. DIAGNOSIS: Corneal topography was performed, and KCN was diagnosed by the presence of an asymmetrical bowtie pattern in both eyes, which was worse in the left eye. INTERVENTIONS: Transepithelial corneal collagen cross-linking was performed. OUTCOMES: The BCVA of both eyes remained stable after treatment at follow-up. LESSONS: KCN should be suspected in cases of unimproved VA and significant irregular stigmatism, while no obvious lesions exist in other parts of the eyes. The evidence of lesion location by electrophysiological examinations could sometimes be of favor in diagnosing KCN.

Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review.

This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt-Koyanagi-Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.

A systematic review of opioid overdose interventions delivered within emergency departments.

BACKGROUND: People with opioid use disorders are at higher risk of fatal opioid overdose and attend emergency departments (ED) more frequently compared to the general population. This review aimed to synthesise evidence on the ED-based delivery of opioid overdose prevention interventions. METHODS: Using the PRISMA guidelines, four databases (Medline; Embase; Scopus; PsycINFO) were searched for peer-reviewed articles on ED based interventions to prevent opioid overdose, published January 1998 to October 2018. RESULTS: The 13 identified studies were grouped into four main intervention types. Seven focused on provision of take-home naloxone (THN) and overdose education. These described the successful delivery of THN by ED staff; in collaboration with community partners; and barriers to delivery. Three studies examined medication safety interventions. These generally delivered positive outcomes on overdose-risk knowledge, but not consistently on behaviour change. One study examined buprenorphine-naloxone treatment initiation within the ED, finding positive outcomes on reported illicit drug use and treatment engagement compared to those randomised to brief intervention and referral, or referral only. Two studies explored psychosocial interventions, including motivational interviewing, which demonstrated lower non-medical prescription opioid use at follow up compared to control. CONCLUSIONS: ED provision of a range of opioid overdose prevention interventions is feasible, acceptable to patients and ED personnel. Interventions require adequate staffing/role responsibility for sustainable implementation. Most evidence was for THN, with an emerging evidence base for other intervention types reducing opioid-overdose risks in ED settings. Further research on implementation and sustainability may assist in translation of effective interventions into the ED setting.

Guidelines for parenteral and enteral nutrition in geriatric patients in China.

Based on the expert consensus on parenteral and enteral nutrition support for geriatric patients in China in 2013, domestic multidisciplinary experts were gathered to summarize the new evidence in the field of elderly nutritional support at home and abroad. The 2013 consensus was comprehensively updated and upgraded to a guideline by referring to the World Health Organization (WHO) guidelines for the Grading of Recommendations Assessment, Development, and Evaluation system for grading evidence. These guidelines were divided into two parts: general conditions and common diseases. After discussion by all members of the academic group and consultation with relevant experts, 60 recommendations were ultimately established as standardized nutritional support in the field of geriatrics in China.

Fluvastatin Prevents Lung Adenocarcinoma Bone Metastasis by Triggering Autophagy.

Bone is one of the most preferred sites of metastasis in lung cancer. Currently, bisphosphonates and denosumab are major agents for controlling tumor-associated skeletal-related events (SREs). However, both bisphosphonates and denosumab significantly increase the risk for jaw osteonecrosis. Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and the most frequently prescribed cholesterol-lowering agents, have been reported to inhibit tumor progression and induce autophagy in cancer cells. However, the effects of statin and role of autophagy by statin on bone metastasis are unknown. In this study, we report that fluvastatin effectively prevented lung adenocarcinoma bone metastasis in a nude mouse model. We further reveal that fluvastatin-induced anti-bone metastatic property was largely dependent on its ability to induce autophagy in lung adenocarcinoma cells. Atg5 or Atg7 deletion, or 3-methyadenine (3-MA) or Bafilomycin A1 (Baf A1) treatment prevented the fluvastatin-induced suppression of bone metastasis. Furthermore, we reveal that fluvastatin stimulation increased the nuclear p53 expression, and fluvastatin-induced autophagy and anti-bone metastatic activity were mostly dependent on p53.

Cell apoptosis, autophagy and necroptosis in osteosarcoma treatment.

Osteosarcoma is the most common primary bone tumor in children and adolescents. Although combined therapy including surgery and multi-agent chemotherapy have resulted in great improvements in the overall survival of patients, chemoresistance remains an obstacle for the treatment of osteosarcoma. Molecular targets or effective agents that are actively involved in cell death including apoptosis, autophagy and necroptosis have been studied. We summarized how these agents (novel compounds, miRNAs, or proteins) regulate apoptotic, autophagic and necroptotic pathways; and discussed the current knowledge on the role of these new agents in chemotherapy resistance in osteosarcoma.

Increased levels of ß-catenin, LEF-1, and HPA-1 correlate with poor prognosis for acral melanoma with negative BRAF and NRAS mutation in BRAF exons 11 and 15 and NRAS exons 1 and 2.

To determine the expression of ß-catenin, lymphoid enhancer-binding protein-1 (LEF-1), and heparanase-1 (HPA-1) and to evaluate these proteins' potential prognostic values in malignant acral melanoma without mutations in BRAF exons 11 and 15 and NRAS exons 1 and 2, specimens from 90 patients with wild-type BRAF and NRAS were assessed and analyzed by immunohistochemistry and western blotting. The positive expression of ß-catenin, lymphoid enhancer-binding protein-1, and heparanase-1 was observed in 36 (72%), 31 (62%), and 32 (64%) of the detected acral melanomas, respectively. The expression of ß-catenin, lymphoid enhancer-binding protein-1, and heparanase-1 was not correlated with gender, age, or diseased body parts (p>0.05), but was significantly positively correlated with the tumor node metastasis (TNM) stage and metastasis (correlation=0.406 and 0.716, 0.397 and 0.582, 0.353 and 0.579; p=0.040 and 0.0001, 0.0040 and 0.0001, 0.0120 and 0.0001, respectively). We also observed that the increased expression of ß-catenin, lymphoid enhancer-binding protein-1, and heparanase-1 was significantly correlated with decreased survival and poor prognosis (p=0.001, 0.010, and 0.023, respectively). A multifactorial analysis using Cox's regression model revealed that ß-catenin, lymphoid enhancer-binding protein-1, heparanase-1, and the TNM stage were all independent factors in malignant melanoma (risk ratios were 7.294, 5.550, 5.622, and 4.794; p-values were 0.007, 0.018, 0.018, and 0.029, respectively). This study may provide the basis for the use of ß-catenin, lymphoid enhancer-binding protein-1, and heparanase-1 as novel targets in the treatment of malignant invasion and metastasis in acral melanoma cancer. The expression of ß-catenin, LEF-1, and HPA-1 was assessed and compared in malignant melanoma with that of peritumoral tissue and benign nevus in the patients with negative mutations in BRAF exons 11 and 15 and NRAS exons 1 and 2. The study may provide the basis for ß-catenin, LEF-1, and HPA-1 as new targets in the treatment of malignant invasion and metastasis in melanoma cancer.