Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.

Self-organized blastoids from extended pluripotent stem (EPS) cells possess enormous potential for investigating postimplantation embryo development and related diseases. However, the limited ability of postimplantation development of EPS-blastoids hinders its further application. In this study, single-cell transcriptomic analysis indicated that the "trophectoderm (TE)-like structure" of EPS-blastoids was primarily composed of primitive endoderm (PrE)-related cells instead of TE-related cells. We further identified PrE-like cells in EPS cell culture that contribute to the blastoid formation with TE-like structure. Inhibition of PrE cell differentiation by inhibiting MEK signaling or knockout of Gata6 in EPS cells markedly suppressed EPS-blastoid formation. Furthermore, we demonstrated that blastocyst-like structures reconstituted by combining the EPS-derived bilineage embryo-like structure (BLES) with either tetraploid embryos or tetraploid TE cells could implant normally and develop into live fetuses. In summary, our study reveals that TE improvement is critical for constructing a functional embryo using stem cells in vitro.
Pregnancy ; Female ; Animals ; Mice ; Tetraploidy ; Blastocyst ; Embryo, Mammalian ; Cell Differentiation ; Embryonic Development

Objective To investigate the effect of RhoC expression in vascular endothelial cells on the proliferation and invasion of myeloma RPMI8226 cells and its possible mechanism. Methods RhoC shRNA lentivirus vector was constructed and transfected into myeloma vascular endothelial cells (MVECs) and human umbilical vein endothelial cells (HUVECs). The effects of conditioned medium on the proliferation, cell cycle and invasion of RPMI8226 cells were detected by CCK-8 test, flow cytometry and Transwell test. The expression of CDK, CyclinD1, AKT, PI3K, MMP2 and MMP9 were detected by Western blot. Results The expression of RhoC in MVECs and HUVECs were downregulated. The proliferation and invasion of RPMI8226 cells in RhoC shRNA group were lower than those in negative control group, and the cell cycle was blocked in G₀/G₁ phase (P < 0.05). The expressions of CDK, CyclinD1, AKT, PI3K, MMP2 and MMP9 in RhoC shRNA group were lower than those in negative control group (P < 0.05). Conclusion The expression of RhoC in MVECs can regulate the proliferation and invasion of myeloma RPMI8226 cells, and the mechanism may be related to the participation of CDK, CyclinD1, AKT, PI3K, MMP2 and MMP9.

外泌体是由细胞分泌的内含蛋白或核酸等活性物质、直径为35~120 nm的脂质双分子层囊泡。外泌体通过调控细胞 间通讯，不仅参与调控细胞的正常生理过程，同时参与包括肿瘤在内的多种疾病的病理过程。肿瘤来源的外泌体参与肿瘤细胞 与微环境的相互作用，并通过与转移、免疫抑制等相关信号通路刺激肿瘤的发生与发展。多发性骨髓瘤（multiple myeloma，MM） 是最为常见的血液系恶性肿瘤之一，其具体发病机制尚未完全清楚，且缺乏安全、高效的诊疗手段。而外泌体因携带丰富的生物 学信息，为肿瘤的治疗提供了一个新的靶点。因此，本文就外泌体在MM发生和发展中的作用及其以外泌体为基础的诊疗新方 向作一综述。

Objective To evaluate the feasibility and safety of modified laparoscopic pyloroplasty (LP) during laparoscopic splenectomy and azygoportal disconnection (LSD) for the prevention of postoperative gastroparesis.Methods A total of 31 cirrhotic patients with bleeding portal hypertension admitted to our department between Jan 2015 and Aug 2015 were retrospectively reviewed.Patients were divided into LP group (n =14) and non-LP group (n =17).Results One month postoperatively,the incidence of bloating was significantly lower in the LP group than in the non-LP group [21％ vs.88％,P ＜0.05].Three months postoperatively,the LP group had significantly lower incidences of nausea (0 vs.35％,P ＜ 0.05) and bloating (14 ％ vs.76％,P ＜ 0.05) than the non-LP group.The incidence of gastric retention confirmed by electronic gastroscopy at 3 and 6 months postoperatively in the LP group was significantly lower than that in the non-LP group (14％ vs.94％,P ＜ 0.01;14％ vs.88％,P ＜ 0.01,respectively).Conclusion It is safe,feasible and with good therapeutic effect for modified laparoscopic pyloroplasty during laparoscopic splenectomy and azygoportal disconnection for the prevention of postoperative gastroparesis.

Purpose To investigate the expression of c-myc and MDM2 protein in multiple myeloma (MM) and their correlation with clinical stage.Methods Immunohistochemical SP three-step method was used to detect the expression of MDM2 and c-myc protein in 60 cases of MM with different clinical stages and 10 cases of nontumorous bone marrow tissue.Results The positive rate of c-myc protein in MM and nontumorous bone marrow tissue were 71.7％ and 10.0％;the positive rate of MDM2 protein in two tissues were 80.0％ and 20.0％,respectively.The expression difference of two proteins between MM and nontumorous bone marrow tissue was statistically significant (P ＜ 0.05).The expression of c-myc and MDM2 protein was positively correlated with MM clinical ISS stage (P ＜ 0.05),but irrelevant with the age and gender.The expression of c-myc and MDM2 protein in MM was positively correlated (P ＜ 0.05).Conclusion The c-myc and MDM2 protein have a highly expression in MM,and it may be relative to the occurrence of MM and clinical stage.In the MM,c-myc and MDM2 protein may have synergetic functions and promote the development of tumor.

Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis (PVT) after modified laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014.The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen.Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively.All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage.The treatments were as follows : from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio (INR) of 2.0-3.0 for 1 year;patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year;and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin (LMWH) once daily for 5 days.Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months.Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices.The patients were followed up till February 2015.The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test, and measurement data with skewed distribution were presented as M(range) and analyzed by the rank-sum test.Comparison of the mean INR at different time points between the 2 groups was analyzed by the repeated measures ANOVA.Comparison of count data was analyzed by the Fisher's Exact Probility.Results There were no gastrointestinal hemorrhage or perioperative death in the 2 groups.(1) The overall incidences of PVT at postoperative week 1 were 9/17 and 6/15 in the warfarin and the aspirin groups, respectively, with no significant difference (P ＞ 0.05).However, the overall incidences of PVT at postoperative month 1 and 3 were 7/17 and 3/17 in the warfarin group, which was significantly different from 12/15 and 12/15 in the aspirin group (P ＜ 0.05).(2)The incidences of main portal vein thrombosis (MPVT) at postoperative week 1 and postoperative month 1 were 5/17 and 6/17 in the warfarin group, 4/15 and 5/15 in the aspirin group, showing no significant difference (P ＞ 0.05).The incidence of MPVT at postoperative month 3 was 3/17 in the warfarin group, which was significantly different from 9/15 in the aspirin group (P ＜ 0.05).(3) The INR was changed from 1.30 ± 0.17 before operation to 1.55 ± 0.38 at postoperative month 3 in the warfarin group, and from 1.33 ±0.14 before operation to 1.21 ±0.11 at postoperative month 3 in the aspirin group, showing significant difference in the changing trend between the 2 groups (F =713.908, P ＜ 0.05).(4) All the 32 patients were followed up for a median time of 7 months (range, 3-11 months).The results of electronic gastroscopy at postoperative month 3 showed that the esophageal and gastric-fundus varices were obviously improved or disappeared.Conclusion Warfarin in preventing PVT after modified laparoscopic splenectomy combined with pericardial devascularization is safe and feasible, with a good short-term outcome.

Objective To detect the expression of tumor‐associated macrophages(TAM) in esophageal squamous cell carci‐noma ,and to study the clinical pathological characteristics of T AM in the esophageal squamous cell carcinoma .Methods Patients with esophageal squamous cell carcinoma who accepted operation were chosen as study subjects ,and tissue samples of esophagus were collected ,including 90 squamous cell carcinoma tissues ,20 paracancerous atypical hyperplasia and 20 normal mucosa tissues , and the expression of CD206 ,MCP‐1 were detected by immunohistochemisty .Results The positive expression of CD206 was sig‐nificantly increased in tissues of esophageal squamous cell carcinoma (P<0 .01) ,and it was positively correlated with clinical stage , invasion depth and lymph node metastasis in esophageal squamous cell carcinoma (P<0 .05) .The expression of MCP‐1 was signifi‐cantly increased in esophageal squamous carcinoma tissues (P<0 .05) ,and its positive expression was closely correlated with depth of invasion and lymph node metastasis in esophageal squamous cell carcinoma (P< 0 .05) .There was a positive relation between ATM infiltration quantity and the expression of MCP‐1(r=0 .617 ,P<0 .05) .Conclusion The positive expression of TAM was up‐regulated in esophageal squamous cell carcinoma tissues ,and its number was positively correlated with clinical stage ,invasion depth and lymph node metastasis .

Objectives To explore the pathological characteristics, treatment and prognosis of medulloblastoma (MB) in children. Methods Pathological characteristics, treatment outcomes and other clinical data were retrospectively analyzed in 60 children with MB. Results The MB in all 60 children were high-grade tumor. The pathological type was mainly classic (45 cases, 75.00%) and other subtypes were seen in 15 cases (25.00%). Forty-eight (80.00%) children had total resection by micro-surgery, 9 children (15.00%) subtotal resection, and 3 children (5.00%) partial resection. Twenty-seven children were treated by radiotherapy after surgery, 6 children were treated by chemotherapy after surgery, and 5 children were treated with radiotherapy combined chemotherapy after surgery. Thirty-eight cases were followed up. The 2-year survival and disease-free survival rates were 63.16%and 55.26%. The 5-year survival and disease-free survival rates were 26.32%and 18.42%. The children with des-moplastic/nodular type survived significantly longer than the children with large cell anaplastic. The children with total resection survived significantly longer than the children with partial resection. The children with radiotherapy or chemotherapy survived significantly longer than the children without chemotherapy (P<0.05). Conclusions MB in most of children is high-grade tu-mors and the prognosis is poor. The pathological type is related with prognosis. Microsurgical total resection is the first choice of treatment. Postoperative radiotherapy and chemotherapy can increase the survival rate.

Objective To study the effect of NEDD9 silence by using siNEDD9-2 on the apoptosis,proliferation and migration or invasion of gastric cancer cell lines BGC823.Methods Three pairs of NEDD9 siRNA primer were designed and synthesized,and then transfected into BGC823 cells respectively,it was found that siNEDD9-2 was the most powerful siRNA interference.The effect of siNEDD9-2 on BGC823 cell's proliferation,apoptosis,migration and invasion was observed.Results The relative quantity expression of mRNA and protein of BGC823 cells transfected with siNEDD9-2 significantly decreased and IR increased in both time and concentration dependent manner compared with control groups.Cell apoptosis and apoptosis index significantly increased compared with control groups.Cell migration and invasion assay showed that siNEDD9-2 inhibits BGC823 cells migration and invasion in vitro.Conclusions NEDD9 siRNA down-regulates expression of NEDD9,induces apoptosis,suppresses proliferation,migration or invasion of BGC823 cells.