Objective To explore the feasibility of radiomics nomogram based on magnetic resonance diffusion weighted imaging for predicting the expression of Ki-67 in breast cancer.Methods A retrospective study was conducted on patients with breast cancer confirmed by surgery and pathology in the Second Affiliated Hospital of Guangdong Medical University.All patients were detected by Ki-67 expression staining,and then divided into group A(n=28,low-level expression of Ki-67)and group B(n=73,high-level expression of Ki-67).The apparent diffusion coefficient(ADC)graph was generated from diffusion weighted images,and the two groups were compared for radiomics features of ADC images and clinical data.The expression level of Ki-67 in breast cancer was predicted using the features of LASSO after dimensionality reduction,and a nomogram model was established,whose diagnostic efficiency was analyzed with receiver operating characteristic curve.Results No significant difference was observed in ADC value,age,carbohydrate antigen 199,carbohydrate antigen 153,carbohydrate antigen 125 and carcinoembryonic antigen between two groups(P>0.05).LASSO regression identified two radiomics features as predictors for the expression level of Ki-67 in breast cancer.The best tuning Lambda of LASSO was-0.125 690 135 478 682,and the included radiomics features for nomogram establishment were MinIntensity and Quantile95.The established nomogram had an area under ROC curve of 0.917,achieving a sensitivity of 91.7%and a specificity of 83.3%.Conclusion The expression of Ki-67 in breast cancer can be predicted based on the radiomics features of ADC images,which can provide a noninvasive detection method for evaluating the proliferation degree and treatment prognosis of breast cancer.

Objective:To investigate the differences in cross-frequency coupling (CFC) characteristics of electroencephalography (EEG) between narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2).Methods:A total of 23 NT1 and 31 NT2 patients were included from the Chinese Clinical Sleep Database (CCSD) between October 2022 and September 2023. All participants underwent overnight polysomnography and a multiple sleep latency test. CFC features were extracted from EEG signals during polysomnography, encompassing various combinations of sleep stages, electrode pairs, frequency bands, and coupling types. Feature selection was performed using elastic net regularization. The Spearman correlation between key CFC features and the Epworth Sleepiness Scale (ESS) scores was analyzed. Finally, a support vector classification (SVC) model was constructed to distinguish NT1 from NT2, and leave-one-out cross-validation was used to assess the generalization performance.Results:Among all coupling features during non-rapid eye movement sleep stage 1 (N1), the fronto-occipital θ-α1 and central δ-α1 couplings showed the highest absolute coefficients, reaching 1.13 and 1.10, respectively. In the NT1 group, the α1-β2 imaginary part of phase-locking value (iPLV) of the F3-C3 pair during N1 was significantly positively correlated with ESS scores ( r=0.52, P=0.012). In the machine learning classification task, the SVC model achieved an accuracy of 85% using leave-one-out cross-validation. Conclusion:The CFC features during the sleep-wake transition stage play an important role in distinguishing NT1 from NT2 and show a significant correlation with excessive daytime sleepiness (EDS) in NT1. CFC may serve as a potential biomarker for differentiating narcolepsy subtypes and provide new insights into the mechanisms and clinical evaluation of EDS.

Objective To explore the feasibility of radiomics nomogram based on magnetic resonance diffusion weighted imaging for predicting the expression of Ki-67 in breast cancer.Methods A retrospective study was conducted on patients with breast cancer confirmed by surgery and pathology in the Second Affiliated Hospital of Guangdong Medical University.All patients were detected by Ki-67 expression staining,and then divided into group A(n=28,low-level expression of Ki-67)and group B(n=73,high-level expression of Ki-67).The apparent diffusion coefficient(ADC)graph was generated from diffusion weighted images,and the two groups were compared for radiomics features of ADC images and clinical data.The expression level of Ki-67 in breast cancer was predicted using the features of LASSO after dimensionality reduction,and a nomogram model was established,whose diagnostic efficiency was analyzed with receiver operating characteristic curve.Results No significant difference was observed in ADC value,age,carbohydrate antigen 199,carbohydrate antigen 153,carbohydrate antigen 125 and carcinoembryonic antigen between two groups(P>0.05).LASSO regression identified two radiomics features as predictors for the expression level of Ki-67 in breast cancer.The best tuning Lambda of LASSO was-0.125 690 135 478 682,and the included radiomics features for nomogram establishment were MinIntensity and Quantile95.The established nomogram had an area under ROC curve of 0.917,achieving a sensitivity of 91.7%and a specificity of 83.3%.Conclusion The expression of Ki-67 in breast cancer can be predicted based on the radiomics features of ADC images,which can provide a noninvasive detection method for evaluating the proliferation degree and treatment prognosis of breast cancer.

Objective:To investigate the differences in cross-frequency coupling (CFC) characteristics of electroencephalography (EEG) between narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2).Methods:A total of 23 NT1 and 31 NT2 patients were included from the Chinese Clinical Sleep Database (CCSD) between October 2022 and September 2023. All participants underwent overnight polysomnography and a multiple sleep latency test. CFC features were extracted from EEG signals during polysomnography, encompassing various combinations of sleep stages, electrode pairs, frequency bands, and coupling types. Feature selection was performed using elastic net regularization. The Spearman correlation between key CFC features and the Epworth Sleepiness Scale (ESS) scores was analyzed. Finally, a support vector classification (SVC) model was constructed to distinguish NT1 from NT2, and leave-one-out cross-validation was used to assess the generalization performance.Results:Among all coupling features during non-rapid eye movement sleep stage 1 (N1), the fronto-occipital θ-α1 and central δ-α1 couplings showed the highest absolute coefficients, reaching 1.13 and 1.10, respectively. In the NT1 group, the α1-β2 imaginary part of phase-locking value (iPLV) of the F3-C3 pair during N1 was significantly positively correlated with ESS scores ( r=0.52, P=0.012). In the machine learning classification task, the SVC model achieved an accuracy of 85% using leave-one-out cross-validation. Conclusion:The CFC features during the sleep-wake transition stage play an important role in distinguishing NT1 from NT2 and show a significant correlation with excessive daytime sleepiness (EDS) in NT1. CFC may serve as a potential biomarker for differentiating narcolepsy subtypes and provide new insights into the mechanisms and clinical evaluation of EDS.

Objective To analyze the correlation of interferon-induced protein with tetratricopeptide repeats 1(IFIT1)with immune infiltration and prognosis of ovarian cancer(OC).Methods GEO database was employed to select the tumor immune related genes,and Kaplan-Meier and Prognoscan databases were used to identify the genes significantly associated with OC prognosis.The differential expression of IFIT1 between OC tissue and normal tissue were confirmed with GEPIA,Human Protein Atlas,and Timer databases.The expression level of IFIT1 in OC tissues with different grades and stages were analyzed in the UALCAN database.In addition,based on David database,GO enrichment analysis was used to analyze the interacting genes and proteins of IFIT1 in the String and Genemania databases.Timer and Tisidb databases verified the correlation between IFIT1 and immune cells mutually.Finally,after IFIT1 knockdown xenograft model was constructed based on lentiviral vector of IFIT1 shRNA,the tumor growth was observed in the transplanted nude mice,and infiltration of neutrophils was observed with immunohistochemical assay.Results FIT1,a tumor immune gene,selected from the GEO database,Kaplan-Meier and Prognoscan databases,was negatively correlated with the OC prognosis.GEPIA,Human Protein Atlas,Timer database,and UALCAN database indicated that the expression level of IFIT1 was significantly higher in the OC tissues than the normal ovarian tissues,and had no obvious correlation with tumor stage and grade.Analysis in String,Genemania,and David database found the interaction genes and proteins of IFIT1 were enriched in activation of 2'-5'oligonucleotide synthase,virus defense,and innate immunity,and other processes.The Timer database presented that IFIT1 was positively correlated with the infiltration of CD8+T cells,B cells,dendritic cells,neutrophils,and macrophage in OC,with neutrophils having the most significant correlation.Tisidb and GSCA also confirmed the positive correlation between IFIT1 and neutrophil infiltration in OC(P＜0.05).RT-qPCR and Western blotting confirmed that IFIT1 knockdown resulted in suppressed tumor growth in OC cells xenograft nude mice(P＜0.05)and reduced neutrophil infiltration in the xenograft tissues.Conclusion IFIT1 may influence the malignant progression of OC by promoting neutrophil infiltration.

Objective This study aimed to explore the effects of bone morphogenetic protein 2(BMP-2)encapsula-ted in poly(lactic-co-glycolic acid)(PLGA)microcap-sules with different molecular weights on the osteogenic ability of osteoblasts.Methods PLGA microcapsules with different molecular weights(12 000,30 000)encap-sulating BMP-2,were prepared using a dual-channel mi-croinjection pump.The morphology and structure of the microcapsules were characterized by optical microscopy and scanning electron microscopy.The sustained-release performance of the microcapsules was characterized by phosphate buffered saline immersion method.The cell compatibility of the microcapsules was detected by the Calcein-AM/PI stain-ing and CCK-8 method.The chemotactic effect of BMP-2-encapsulated microcapsules on MC3T3-E1 cells after 48 h of treatment was detected by the Transwell assay.The alkaline phosphatase activity assay and Alizarin Red S staining were used to characterize the effect of microcapsules on the osteogenic ability of MC3T3-E1 cells.Results Both types of mi-crocapsules with different molecular weights exhibited smooth surfaces,as well as uniform and good cell compatibility.The chemotactic effect of the 12 000 microcapsules was outstanding.The 30 000 microcapsules had a longer sustained-release time,and the initial burst release was reduced by approximately 25%compared with the 12 000 microcapsules.In addition,30 000 microcapsules performed better in long-term osteogenesis induction than 12 000 microcapsules.Conclu-sion In this study,the release of BMP-2 is regulated by adjusting the molecular weight of PLGA,and the results indi-cate that 30 000 microcapsules can better induce the long-term osteogenic ability of MC3T3-E1 cells.

Objective:To investigate the factors affecting the prognosis of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy (LRH), and to compare the prognosis and recurrence sites of patients with different colpotomy paths.Methods:The clinical data of 965 patients with stage Ⅰa2-Ⅱa2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected. The median age was 47.0 years of all patients with a median follow-up of 62 months (48-74 months). Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival (DFS) and overall survival (OS). Patients were categorized into LRH through vaginal colpotomy (VC group, n=475) and LRH through intracorporeal colpotomy (IC group, n=490) according to the colpotomic approaches. The prognosis and recurrence sites of patients in each group were compared. Results:(1) During the follow-up period, 137 cases recurred (14.2%, 137/965) and 98 cases died (10.2%, 98/965). The 5-year DFS and OS were 85.8% and 89.9%, respectively. In univariate analysis, positive vaginal margin (PVM) was significantly affected the 5-year OS of patients with cervical cancer ( P=0.023), while clinical stage, maximum diameter of tumor, degree of pathological differentiation, lymph node metastasis (LNM), depth of cervical stromal invasion, parametrium involvement, and uterine corpus invasion (UCI) were significantly associated with 5-year DFS and OS in patients with cervical cancer (all P<0.05). In multivariate analysis, clinical stage ( HR=1.882, 95% CI: 1.305-2.716), LNM ( HR=2.178, 95% CI: 1.483-3.200) and UCI ( HR=3.650, 95% CI: 1.906-6.988) were independent risk factors of 5-year DFS (all P<0.001). Clinical stage ( HR=2.500, 95% CI: 1.580-3.956), LNM ( HR=2.053, 95% CI: 1.309-3.218), UCI ( HR=3.984, 95%C I: 1.917-8.280), PVM ( HR=3.235, 95% CI: 1.021-10.244) were independent risk factors of 5-year OS (all P<0.05). (2) Different colpotomy paths did not significantly affect the 5-year DFS and OS of patients with stage Ⅰa2-Ⅱa2 cervical cancer. The 5-year DFS in VC group and IC group were 85.9% and 85.6% ( P=0.794), and the 5-year OS were 90.8% and 89.3% ( P=0.966), respectively. Recurrence patterns consisted of intraperitoneal recurrence, pelvic recurrence, vaginal stump recurrence, and lymph node and distant metastasis. The intraperitoneal recurrence rate of VC group was significantly lower than that of IC group [0.6%(3/468) vs 2.3% (11/485), P=0.037], while the rates of pelvic recurrence, vaginal stump recurrence, lymph node and distant metastasis and overall recurrence were not significantly different between two groups (all P>0.05). Subgroup analysis of patients with different clinical stages, LNM and UCI showed that statistical differences of the intraperitoneal recurrence rates between two groups were only in patients without LNM (0.5% vs 2.3%, P=0.030) or without UCI (0.7% vs 2.3%, P=0.037). Conclusions:Clinical stage, LNM, PVM and UCI are independent risk factors for the prognosis of patients with stage Ⅰa2-Ⅱa2 cervical cancer. For patients without LNM or UCI, LRH through VC could reduce the intraperitoneal recurrence rate, while it is not enough to improve 5-year DFS and OS of patients. Low proportion of intraperitoneal recurrence, intra-operative tumor cells spillage to vagina stump and pelvic cavity might be the explanation.

Objective:To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy.Methods:From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study.Results:There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （ P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （ P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （ P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （ P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively ( P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions:The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.

Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.

OBJECTIVE: To investigate the mental health status and its influencing factors among general population and healthcare professionals in Guangdong Province during COVID-19 pandemic. METHODS: A online questionnaire-based survey was conducted from March 11st to March 15th, 2020.The questionnaire consisted of 4 parts to survey the participants'basic information, understanding of COVID-19 outbreak-associated information, cognition of COVID-19 pandemic and status of anxiety and depression.A total of 1433 valid responses were collected, including 706 from the general population and 727 from healthcare professionals.Cronbach's α coefficient and exploratory factor analysis were used for reliability and validity assessment.Chi-square, Wilcoxon and Kruskal-Wallis test were used for univariate analysis and ordinal or nominal logistic regression was used for multivariate analysis of the data. RESULTS: There was no significant difference between the general population and the healthcare professionals in terms of anxiety, depression and cognition of COVID-19 outbreak after adjustment for demographic variables, but the levels of anxiety and depression of these participants were both higher than those before the pandemic.In the participants from the general population, multivariate logistic regressions showed an OR for anxiety of 1.93(1.18, 3.17) among those who spent 1-2 h a day in reading COVID-19-related news, while those who spent over 3 h had an OR value for anxiety of 1.88(1.14, 3.11);the unmarried individuals had a depression OR of 2.19(1.51, 3.18). Inaccurate cognition of COVID-19 outbreak was positive correlated with the occurrence of anxiety and depression.Unmarried individuals and those with higher educational levels had better cognition of COVID-19 outbreak.Among the healthcare professionals, multivariate logistic regressions suggested that insufficient rest time and worries about contracting the virus contributed to the occurrence of anxiety and depression.Among the nursing staff, the OR of obvious depression was 2.99(1.45, 6.18).Compared to healthcare professionals not working in designated hospital for COVID-19, those who work in the designated hospitals had ORs for obvious and severe depression of 0.48(0.25, 0.93) and 0.39(0.17, 0.89), respectively.Concerns over contracting the virus increased the possibility of incorrect cognition of COVID-19. CONCLUSIONS Psychological interventions are essential for both the general population and healthcare professionals, especially for unmarried individuals in the general population and the nursing staff.An excessive exposure to COVID-19-related information may have detrimental effects on the mental health.For healthcare professionals, sufficient rest needs to be ensured, and education programs on COVID-19 should be implemented among both residents and healthcare professionals to improve their mental health.
Anxiety/epidemiology* ; Betacoronavirus ; COVID-19 ; China/epidemiology* ; Coronavirus Infections ; Health Status ; Humans ; Pandemics ; Pneumonia, Viral ; Reproducibility of Results ; SARS-CoV-2