Abstract:Objective To explore the value of the ratio of C-reactive protein to albumin(CAR)combined with Epstein-Barr virus DNA(EBV DNA)in predicting the prognosis of patients with locally advanced nasopharyngeal carcinoma(LA-NPC)receiving concurrent chemoradiotherapy(CCRT).Methods A total of 86 patients with LA-NPC admitted to Baoshan People's Hospital from January 2022 to December 2023 were retrospectively included.Data of C-reactive protein and albumin before treatment were collected to calculate CAR,and the level of plasma EBV DNA was detected by real-time fluorescence quantitative PCR(qPCR).The overall survival(OS),distant metastasis-free survival(DMFS),and progression-free survival(PFS)of the patients were followed up.The survival curve was plotted by the Kaplan-Meier method,and the survival difference was tested by Log-rank.Results During the follow-up period,local/regional recurrence occurred in 30 patients,distant metastasis occurred in 16 patients,and 7 patients died.The plasma EBV DNA levels[24 735.00(4 907.50,51 872.50)copies/mL]and CAR[3.16(2.12,5.04)]of the deceased patients were significantly higher than those of the survival group[950.00(600.00,3 597.50)copies/mL],Z=-2.960,P=0.003;0.18(0.07,0.72),Z=-5.018,P<0.001).The risk score was constructed based on the EBV DNA logarithmic transformation value and CAR,and was divided into the high-risk group(n=43)and the low-risk group(n=43)according to the cutoff value.The OS in the high-risk group was significantly worse(1-year survival rate:91.0%vs.100.0%;3-year survival rate:83.0%vs.100.0%;Log-rank χ2=8.129,P=0.004).The AUC of this model for predicting patient death,recurrence and metastasis was 0.902,0.797 and 0.817 respectively;time-dependent ROC showed that the AUC of its 1-year and 3-year predictive efficacy was both greater than 0.700.Plasma EBV DNA levels in LA-NPC patients with local/regional recurrence[5 235.00(627.50,37 462.50)vs.940.00(600.00,2 912.50)copies/mL;Z=-2.633,P=0.008 and the CAR value[1.87(0.43,3.86)vs.0.14(0.06,0.57);Z=-5.337,P<0.001]were significantly higher than those of patients without recurrence.The plasma EBV DNA level of LA-NPC patients with distant metastasis[5 235.00(3 327.50,43 217.50)vs.950.00(592.50,3,517.50)copies/mL;Z=-2.725,P=0.006)and CAR values[2.31(0.93,4.32)vs.0.18(0.07,0.89);Z=-4.206,P<0.001),both significantly higher than those of patients without distant metastasis.Conclusion The prognostic model constructed by CAR combined with EBV DNA has good clinical predictive value and can be used for individualized prognostic assessment of patients with LA-NPC.

Abstract:Objective To investigate the role of degradation in endoplasmic reticulum proteim 1(Derlin-1),a key protein of endoplasmic reticulum-associated degradation(ERAD),in the formation of paclitaxel resistance in hypopharyngeal carcinoma and its regulatory mechanism on the PI3K/Akt signaling pathway and autophagy.Methods The drug-resistant hypopharyngeal carcinoma Fadu cell line was constructed by paclitaxel gradient induction,and the IC50 and resistance index(RI)were determined by CCK-8.The experiment was divided into the control group,the paclitaxel group(80 nmol/L),the Derlin-1 silencing group(siRNA interference),and the Derlin-1 silencing+paclitaxel group.Cell viability was detected by the CCK-8 method,and the apoptosis rate was detected by flow cytometry.Western blotting was used to detect the protein expressions of Derlin-1,Bax,Bcl-2,p-PI3K/PI3K,p-Akt/Akt,LC3-Ⅱ/Ⅰ and Beclin-1.Observation of autophagosome and autophagolysosome formation by mCherry-GFP-LC3B dual-fluorescence adenovirus combined with confocal microscopy.Results The IC50 of drug-resistant cells increased from 8.438 nmol/L in parental cells to 73.330 nmol/L,the RI was 8.69,and the Derlin-1 protein was significantly upregulated.The cell viability in the paclitaxel group decreased to approximately 65%,and the apoptosis rate was about 18.6%.Cell viability in the Derlin-1 silencing+paclitaxel group further decreased to approximately 42%,and the apoptosis rate increased to approximately 36.2%.Compared with the control group,in the paclitaxel group,Bax increased,Bcl-2 decreased,p-Akt/Akt and p-PI3K/PI3K decreased,and LC3-Ⅱ/Ⅰ and Beclin-1 increased.In the Derlin-1 silencing+paclitaxel group,these differences were all greater than those in the paclitaxel group,manifested as a further increase in Bax,a further decrease in Bcl-2,a lower phosphorylation level of the PI3K/Akt signaling pathway,a higher expression of autophagy-related proteins,and a significant increase in the number of autophagosomes and autophagolysosomes.Conclusion Derlin-1 may promote paclitaxel resistance in hypopharyngeal cancer by activating the PI3K/Akt signaling pathway and regulating the autophagy process.Silencing the expression of Derlin-1 can reverse the drug resistance phenotype and enhance paclitaxel-induced apoptosis and autophagy,suggesting that Derlin-1 may serve as a potential therapeutic target to overcome drug resistance.

Abstract:Over 50%of malignant tumor patients require radiotherapy(RT)at various stages of antitumor therapy.RT can both induce an immunosuppressive environment in tumor-bearing hosts and break the body's immune tolerance to tumors,initiating specific anti-tumor immune responses,thereby playing the role of an immune adjuvant.In recent years,the systemic anti-tumor immune responses induced by RT show encouraging clinical application prospects.This article examines the optimal time window,dosage,and fractionated dose for RT-induced systemic antitumor responses,along with the challenges associated with the integration of radiotherapy and immunotherapy.

Abstract:Objective To investigate the efficacy and safety of Shengbai Oral Solution in the prevention and treatment of myelosuppression after chemotherapy.Methods Fifty patients with malignant tumors from June 2021 to October 2023 were collected.On the basis of conventional Western medicine treatment,chemotherapy was given in the previous cycle,and oral administration of Shengbai Oral Solution was started 3 days before the same chemotherapy regimen application in the latter cycle and continued for 14 days.The values of peripheral blood cells,the incidence and grade of myelosuppression,KPS score,and TCM symptom score at the same time points in the two chemotherapy cycles were compared.Results Compared with the previous cycle,the values of white blood cells,neutrophil,and platelet on the 14th day of the latter cycle were significantly higher,with statistically significance(P<0.05);The incidence of grade 3/4 hematopoietic suppression in the latter cycle was 4.0%,which was significantly lower than the incidence of 22.0%in the previous cycle,resulting in a significant reduction in the use of G-CSF(P<0.05).The effective rate of improvement in TCM symptoms in the latter cycle was 98.0%,significantly higher than 54.0%in the previous cycle,with statistical significance(P<0.05),and the total score of TCM symptoms in the latter cycle was significantly lower and the change was more significant,with statistical differences(P<0.001).The effective rate of KPS score improvement in the latter cycle was 92.0%,significantly higher than 72.0%in the previous cycle,and the improvement of KPS score in the latter cycle was significantly better than that in the previous cycle,with statistical significance(P<0.001).Conclusion Shengbai Oral Solution can significantly increase the values of peripheral blood cells in patients with malignant tumors after chemotherapy,reduce the incidence of grade 3/4 myelosuppression,decrease the dosage of G-CSF,effectively improve the TCM symptoms of spleen-kidney yang deficiency,and enhance the quality of life of patients.

Abstract:Objective To explore the correlation between preoperative CT measurement of pelvic parameters and early complications after laparoscopic intersphincter resection(Lap-ISR).Methods A total of 119 patients who underwent Lap-ISR due to ultra-low rectal cancer at the Rocket Force Characteristic Medical Center from April 2023 to June 2024 were collected,and the occurrence of complications within 30 days after the operation was recorded.Patients were grouped based on whether complications occurred.Univariate analysis was used to screen for relevant risk factors.Multivariate Logistic regression and receiver operating characteristic(ROC)curve were used to analyze the relationship between pelvic parameters measured by CT and early postoperative complications.The results of univariate analysis showed that The operation time was≥204 min(P=0.001),the anteroposterior diameter of the pelvic entrance was<115 mm(P=0.001),the sacrococcygeal pubic Angle was<49°(P<0.001),the sacrococcygeal distance was≥130 mm(P<0.001),and the interspinous diameter of the ischium in the middle pelvis was≥102 mm(P=0.028)was significantly associated with early postoperative complications.Multivariate Logistic regression analysis confirmed that a sacrococcygeal distance of≥130 mm was a risk factor for early postoperative complications(P=0.003,OR=0.095,95%CI:0.02-0.459).ROC curve analysis indicated that the sacrococcygeal distance had a good predictive efficacy for the occurrence of complications(AUC=0.829,95%CI:0.741-0.917,P<0.001).Conclusion The sacrococcygeal distance measured by preoperative CT is a reliable indicator for predicting early complications after Lap-ISR.Evaluating and formulating individualized surgical plans based on this before surgery is helpful to improve the safety and quality of the surgery and improve the prognosis of patients.

Abstract:Objective To reveal the benefits of using autologous tissue for pelvic floor reconstruction after laparoscopic transperineal resection(LAPR),and to share the surgical experience.Methods A retrospective analysis was conducted on 78 patients with low rectal cancer in our hospital from January 2022 to July 2024.Propensity score matching was used to match the initial data at a 1∶1 ratio,including 39 patients who did not undergo pelvic floor reconstruction(control group)and 39 patients who completed pelvic floor reconstruction using autologous tissue(observation group).All patients underwent postoperative intestinal function assessment,and defecation function was evaluated using the special scale for low anterior resection syndrome.The quality of life 6 months after the operation was evaluated by using the European Organization for Research and Treatment of Cancer(EORTC)Quality of Life Questionnaire-C30(QoQ-C30).In addition,record the short-term postoperative complications of the patients and the incidence of no events during the follow-up period.Results The time for the first liquid diet after surgery in the observation group was slightly shorter than that in the control group(P=0.043).Through repeated measures analysis of variance,with the extension of postoperative recovery time,the decrease in the low anterior resection syndrome score in the observation group was greater(F=66.984,P<0.001).Furthermore,at 6 months after the operation,20 cases(51.28%)in the control group and 7 cases(17.95%)in the observation group were diagnosed with low anterior resection syndrome,respectively(χ2=9.573,P=0.002).At 6 months after the operation,the total EORTC QoQ-C30 scores of the control group and the observation group were 66.67(58.33,75.0)points and 75.0(66.67,83.33)points respectively,and the difference between the two groups was statistically significant(Z=-2.951,P=0.003).The total number of postoperative complications in the control group and the observation group was 13 cases(33.33%)and 5 cases(12.82%)respectively.The difference between the two groups was statistically significant(χ2=4.622,P=0.032).No pelvic infection occurred in the observation group,while the incidence of pelvic abscess was significantly higher in the control group(15.38%vs.0,P=0.025).The average event-free survival time of the observation group was longer than that of the control group(not reached vs.31.29 months,P<0.001).Proximity to the anal margin,radiotherapy and anastomotic leakage are risk factors for the occurrence of low anterior resection syndrome 6 months after surgery,while autologous tissue pelvic floor reconstruction is a protective factor.Conclusion Autologous tissue pelvic floor reconstruction reduces the incidence of complications after LAPR in patients with low-risk rectal cancer,and improves the quality of life and prognosis of patients.

Abstract:Multiple myeloma(MM)is the second most common hematological malignancy and remains incurable to date.As China's population ages at an accelerating pace,the disease burden associated with MM continues to grow.CD38 has emerged as a key therapeutic target in MM,and anti-CD38 monoclonal antibodies have progressively become cornerstone treatments in its management.As a novel anti-CD38 monoclonal antibody approved in China in early 2025,isatuximab currently has limited real-world clinical experience,and its mechanism of action warrants further elucidation.A deeper understanding of the differences in the mechanisms of action among various anti-CD38 antibodies may enhance the comprehension of this drug class and offer valuable insights for clinical decision-making.Among currently available anti-CD38 monoclonal antibodies,isatuximab and daratumumab are the two agents with the most substantial and systematically documented mechanistic and clinical evidence.Therefore,this review employs daratumumab as a key comparator to systematically outline the mechanistic features of isatuximab in the treatment of MM and to highlight its distinctions from other anti-CD38 monoclonal antibodies,with the goal of providing a theoretical foundation for individualized MM therapy.

Abstract:Objective To compare the clinical value of magnetic resonance diffusion-weighted imaging(DWI)combined with dynamic contrast-enhanced scanning(DCE-MRI)and methylene blue cervical injection in predicting sentinel lymph node(SLN)metastasis of early cervical cancer.Methods A total of 40 patients with stage IA2 to IIA of early cervical cancer who were admitted to the First Affiliated Hospital of Shaoyang University from January 2023 to February 2025 were prospectively included.All patients underwent radical hysterectomy and systematic pelvic lymph node dissection.Before the operation,they all underwent multi-parameter magnetic resonance examinations,including DCE-MRI and DWI,and methylene blue was injected into the cervix for SLN tracing.Results Intraoperative pathological biopsy of SLN showed that 8 cases(20.0%)of patients were SLN positive(SLN+group),and the remaining 32 cases were SLN negative(SLN-group).Eight cases(20.0%)of SLN positive patients were identified by methylene blue tracing,including 6 cases with positive intraoperative biopsy and 2 cases with negative biopsy.Univariate and multivariate analyses showed that tumor diameter>2.0 cm(OR=37.800,P=0.002),lymph node diameter>10 mm(OR=7.222,P=0.021),and heterogeneous enhancement within the mass(OR=25.000,P=0.005),the ratio of the minimum ADC value to the intratumoral ADC(OR=1.134,P=0.037),and lymphovascular space infiltration(OR=5.400,P=0.049)were influencing factors for SLN metastasis.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve model constructed based on the heterogeneity characteristics of internal signals and the minimum ADC/intratumoral ADC ratio in DCE-MRI for predicting SLN metastasis was 0.896,with a specificity of 100.0%and a sensitivity of 75.0%.Consistency analysis showed that the diagnosis of SLN metastasis by DCE-MRI combined with DWI was highly consistent with the pathological diagnosis results(kappa=0.918,P<0.001;sensitivity 100.0%,specificity 96.97%,accuracy 97.50%).The sensitivity and specificity of methylene blue tracer in diagnosing SLN metastasis were 75.0%and 93.75%respectively,the accuracy was 90.0%,and the consistency was moderate(kappa=0.688,P<0.001).Conclusion DCE-MRI combined with DWI shows good diagnostic performance in preoperative prediction of SLN metastasis in early cervical cancer,has high consistency with pathological diagnosis,and has higher sensitivity and accuracy compared with methylene blue tracer.

Abstract:Objective To evaluate the clinical value of the modified prognostic nutritional index(mPNI)in predicting intensity-modulated radiotherapy(IMRT)-related adverse reactions and survival prognosis in patients with nasopharyngeal carcinoma.Methods A retrospective collection was made of 128 patients with non-keratinized nasopharyngeal carcinoma who received radical IMRT at Yongzhou Central Hospital from January 2020 to June 2022.The clinical medical records and pre-treatment hematological indicators of the patients were collected,and the scores of the Global Leadership in Malnutrition Initiative(GLIM),Controlled Nutritional Status(CONUT),Nutritional Risk Index(NRI),Prognostic Nutritional Index(PNI),and Modified Prognostic Nutritional Index(mPNI)were calculated.The calculation formula of mPNI is:4.8×total cholesterol(mmol/L)-1.5×albumin(g/L)-7.7×total lymphocyte count(×109/L)+126.The adverse reactions of IMRT were evaluated using the Common Adverse Events Evaluation Criteria(CTCAE)version 5.0 standard.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each nutritional index in predicting serious adverse reactions.The overall survival(OS)and progression-free survival(PFS)curves were plotted using Kaplan-Meier survival analysis,and the survival differences were subjected to Log-rank test.The Cox proportional hazards regression model was used to analyze the factors influencing the OS and PFS of patients.Results The median follow-up time for all patients in the group was 44.5 months.The 5-year PFS rate and 5-year OS rate of the patients were 70.31%and 86.72%respectively,and the incidence of grade 3 and above adverse reactions was 33.59%.Among GLIM,CONUT,NRI,PNI and mPNI,mPNI has the best efficacy in predicting adverse reactions.The area under the ROC curve(AUC)is 0.794,the optimal cut-off value is 82.608,and the sensitivity and specificity are 81.40%and 74.12%,respectively.In the high mPNI group,the age was≥50 years old(58.73%vs.40.0%,P=0.034),N2-N3(28.57%vs.13.85%,P=0.041),and skull base invasion(61.90%vs.43.08%)The proportion(P=0.033)and the median platelet count/total lymphocyte count ratio(144.38 vs.120.39,P=0.005)were both higher than those in the low mPNI group.The incidences of grade 3 and above adverse reactions(P<0.001),hematological toxicity(P<0.001),oral mucositis(P=0.038),elevated liver enzymes(P=0.023),and nausea/vomiting(P<0.001)were also significantly higher in the high mPNI group.The results of the multivariate Cox model showed that mPNI>92.06 was a risk factor affecting PFS(HR=1.088-1.158,P<0.001).The Kaplan-Meier results showed that the PFS and OS of patients in the high mPNI group were significantly lower than those in the low mPNI group(P<0.01).Conclusion As a comprehensive indicator integrating nutritional and inflammatory status,mPNI can effectively predict radiotherapy-related serious adverse reactions and survival prognosis in patients with nasopharyngeal carcinoma,and has high clinical application value.

Abstract:Objective To investigate the utility of a technetium-99m-labeled large-particle polymerized human serum albumin(99m Tc-MAA)SPECT/CT-based dosimetry model for quantifying the actual absorbed dose(AAD)in patients with advanced hepatocellular carcinoma(HCC)who underwent transarterial radioembolization(TARE)with yttrium-90(90 Y)and to determine the critical value for predicting TRAE tumor response thresholds.Methods A prospective study was conducted on 67 patients with advanced HCC between January 2023 and May 2024,99m Tc-MAA liver penetration imaging was used to calculate the standard tumor-to-nontumoral liver ratio(sTNR1)before radioembolization and the sTNR2 after radioembolization based on tissue volume and radioactivity.corrected mTNR=γ radiation counts at ROIs of target liver tumors/γ radiation counts at ROIs of target liver tumors.The predicted absorbed dose(PAD)and actual tumor absorbed dose(AAD)after radioembolization was calculated before radioembolization based on the TNR.RECIST 1.1 criteria were used to assess treatment response.Patient deaths were recorded during the period up to July 2025.Results The mTNR1 was slightly lower than the sTNR1 value(tpaired=-7.791,P<0.001);however,the concordance between the two was very low,with a correlation coefficient of rho=0.106(P=0.289).By Spearman's correlation analysis,before radioembolization,mPAD(rho=-0.452,-0.432)and mAAD(rho=-0.415,-0.415)were significantly negatively correlated with the maximum tumor diameter and the volume of the target liver lesion(P<0.001).Forty-two patients achieved objective remission at 3 months after TARE(complete response or partial response on tumor evaluation).The objective remission group had higher mTNR1(3.12 vs.2.93,P=0.011),mPAD(106.50 Gy vs.87.91 Gy,P=0.016),and mTNR2(2.20 vs.1.50,P<0.001),and mAAD(100.50 Gy vs.72.50 Gy,P<0.001)than the no objective remission group.After further correction for relevant clinical factors,mTNR2(OR=2.012,95%CI=1.149-11.474,P=0.001)and mAAD(OR=1.059,95%CI=1.013-1.107,P=0.011)remained predictors of objective tumor remission.Receiver Operating Characteristic(ROC)curves showed that mTNR2 and mAAD predicted objective tumor remission with cut-off values of 2.015 and 75.47 Gy.During a median follow-up of 6.77 months,25 patients(37.31%)died.Kaplan-Meier curves showed that the median OS of patients with mAAD≥75.47 Gy was 6.97 months,which was longer than the median OS of patients with mAAD<75.47 Gy(5.13 months;Log-rank=9.059,P=0.003).Conclusion The mTNR calculated based on 99m Tc-MAA and 90Y SPECT/CT,as well as the derived dosimetric parameters PAD and AAD,can be used as predictors of TARE outcomes in patients with advanced hepatocellular carcinoma.When AAD was greater than 75.47 Gy,the overall survival time of patients was relatively prolonged.

Abstract:Objective To explore the effects of erector spinae plane block(ESPB)and thoracic paravertebral nerve block(TPVB)on the postoperative recovery quality of lung cancer patients undergoing video-assisted thoracoscopic surgery(VATS).Methods A total of 106 lung cancer patients who underwent VATS radical resection of lung cancer in Zibo 148 Hospital from November 2023 to December 2024 were selected and divided into the ESPB group(n=53)and the TPVB group(n=53).The main observation indicators were the Numerical Rating Scale(NRS)at rest and in the cough state 24 hours after surgery(H24),as well as the Quality of Recovery-15(QoR-15)scores 1 day before surgery and 48 hours after surgery(H48).Results The median NRS scores at rest for H24 in the ESPB group and the TPVB group[2.00(1.00,2.00)points vs.1.00(1.00,2.00)points,Z=-1.075,P=0.282]and the median NRS scores for cough[3.00(2.00,4.00)points vs.3.00(2.00,4.00)points,Z=-0.482,P=0.630].There were no statistically significant differences.At H48,the total score of QoR-15 in the ESPB group was higher than that in the TPVB group[(133.51±14.12)pointsvs.(127.60±16.98)points,t=2.005,P=0.048],and the improvement of the total score of △QoR-15 was more significant[15.00(3.00,32.00)points vs.12.00(0,25.00)points,Z=-2.158,P=0.027].There was no statistically significant difference in the NRS scores at rest and cough at 6 hours(H6)after surgery and the rate of remedial analgesia between the two groups(P>0.05).The dosage of sufentanil for H24 in the ESPB group was higher than that in the TPVB group(56.05±4.39 μg vs.53.86±5.01 μg,t=2.393,P=0.019).There was no statistically significant difference in postoperative complications between the two groups(P>0.05).The incidence of chronic postoperative pain(CPSP)at 3 months after the operation was 35.0%(35/100).Univariate and multivariate Logistics regression analyses showed that high H24 resting NRS score,high H24 cough NRS score,and low H48 QoR-15 total score were risk factors for CPSP 3 months after surgery(P<0.05),while the anesthesia method had no significant correlation with the occurrence of CPSP.Conclusion Compared with TPVB,ultrasound-guided ESPB can provide comparable analgesic effects for VATS lung cancer patients and achieve better overall postoperative recovery quality.However,the perioperative opioid consumption in the TPVB group is lower.

Abstract:Objective To investigate the expression and clinical significance of cytokeratin 20(CK20)and Villin in colorectal cancer tissues.Methods A total of 73 patients with colorectal cancer admitted to the First People's Hospital of Yibin from January 2021 to December 2021 were collected as the research subjects and divided into the good prognosis group(n=46)and the poor prognosis group(n=27).The expressions of CK20 and Villin proteins in tissues were detected by immunohistochemical staining,and the relationship between their expressions and the clinicopathological characteristics of colorectal cancer was analyzed.The receiver operating characteristic curve was used to evaluate the value of both expressions in prognosis assessment.The Cox proportional hazards regression model was used to analyze the factors influencing the prognosis of colorectal cancer.Results The positive expression rates of CK20 and Villin in colorectal cancer tissues were significantly higher than those in adjacent tissues(CK20:69.9%vs.41.1%;Villin:67.1%vs.38.4%).Poor prognosis of patients was related to positive expression of CK20(χ2=5.168,P=0.023),positive expression of Villin(χ2=6.648,P=0.010),degree of differentiation(χ2=6.367,P=0.012),and T stage(χ2=4.528,P=0.033),N stage(χ2=5.013,P=0.025)and tumor size(χ2=7.138,P=0.008)were related.The ROC curve results showed that both positive expressions of CK20 and Villin had good predictive value for the poor prognosis of colorectal cancer,with the areas under the curve(AUC)being 0.838 and 0.823,respectively.The results of multivariate Cox regression showed that positive expression of CK20,positive expression of Villin,N stage,tumor size and degree of differentiation were factors affecting the poor prognosis of patients with colorectal cancer.Conclusion The expression levels of CK20 and Villin can be used as effective indicators for predicting adverse clinical outcomes in patients with colorectal cancer.

Abstract:Objective To obtain the transcription factor prognosis model of colon adenocarcinoma(COAD),providing a theoretical basis for evaluating the survival risk of patients with COAD.Methods the clinical information and RNA seq data of patients with COAD from the Cancer Genome Atlas(TCGA)database was downloaded to obtain differential transcription factor genes and perform GO and KEGG function enrichment analysis.Univariate and multivariate Cox proportional risk regression models were used to develop transcription factor models with prognostic value.Kaplan Meier method was used to analyze the survival status of high-risk and low-risk patients.ROC curve was used to assess the accuracy of risk scores and the sensitivity and specificity of clinical pathological parameters and risk models for predicting the prognosis of colon adenocarcinoma patients.50%of the cases were randomly selected from the sample for internal validation.Independent prognostic factors such as patient's age,sex,TNM stage,T stage,N stage and risk score were verified by using univariate and multivariate Cox regression analysis,and multivariate Cox regression analysis was used to evaluate the nomograph model of clinical pathological parameters and risk score.Results A total of 131 differentially expressed TFs were identified.Through univariate and multivariate Cox regression analysis,three transcription factors(FOXS1,HSF4,and LBX2)were identified as risk factors affecting the prognosis of COAD patients.The linkage analysis of risk factors using multiple Cox regression showed that high-risk patients had higher risk scores,while low-risk patients had higher risk scores,and similar results were obtained in the internal testing group.The risk score of the model showed that the overall survival time of patients in the high-risk group was shorter than that in the low-risk group(P<0.001),which was also validated in the internal testing group(P<0.001).The area under the ROC curve(AUC value)of this risk scoring model was 0.719,0.773,0.773,and 0.694 at 1 year,3 years,5 years,and 10 years,respectively.The internal validation group had areas of 0.714,0.783,0.783,and 0.668,and the AUC value of clinical pathological features such as TNM stage,age,gender,T stage,and N stage was 0.783,0.278,0.773,0.655,0.627,and 0.639 at 3-year survival rates,while the internal validation group had areas of 0.773,0.339,0.657,0.577,0.609,and 0.706 at 3-year survival rates.The results of the multivariate Cox regression analysis showed that the risk score was an independent prognostic factor for COAD(HR=2.160,95%CI:1.370-3.406,P=0.001).The concordance index of the nomogram prediction model constructed based on the multivariate Cox regression analysis was 0.878.Conclusion The development and validation of transcription factor prognostic risk models are of great significance for identifying subgroups of patients with high or low risk of COAD.

Abstract:Objective To analyze the role of amitochondrial creatine kinase 1A(CKMT1A)in the occurrence and development of endometrial cancer(EC),and explore its pathophysiological mechanism and prognostic significance.Methods The microarray datasets(GSE17025,GSE39099,and GSE63678)in the GEO database were analyzed using GEO2R to screen for potential target genes.Transcriptome data was downloaded from TCGA-UCEC to analyze CKMT1A mRNA expression profile and to plot Kaplan-Meier curve.Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology(GO)pathway annotations were performed on the CKMT1A related target genes identified through screening.In the clinical trial section,from September 2021 to June 2024,a retrospective collection was conducted on EC patients diagnosed and undergoing primary surgery in the Gynecology Department of Lianyungang Hospital Affiliated with Xuzhou Medical University.A total of 88 EC tissue samples and corresponding 88 adjacent tissue samples were obtained.By immunohistochemical staining,the immunoreactivity of CKMT1A was divided into high CKMT1A expression group and low CKMT1A expression group according to the degree and intensity of staining.The prognostic significance of CKMT1A in postoperative recurrence of EC patients was analyzed.Results By mining the GEO database and using P<0.05 and log2(fold change)as screening criteria,CKMT1A was identified as a candidate gene.Based on TCGA data,the expression of CKMT1A in EC tissue was significantly higher than that in normal endometrial tissue(P=0.005).The higher the expression of CKMT1A,the shorter the overall survival time(P<0.001).GO and KEGG revealed that CKMT1A was involved in numerous metabolic processes.In clinical samples,the high expression rate of CKMT1A was 45.45%,while the low expression rate of CKMT1A in adjacent cancer tissues was 85.23%.Compared with the low CKMT1A expression group,the high CKMT1A expression group had a higher clinical stage(P=0.043),a higher proportion of G3 nuclear grading,a higher proportion of lymphatic vessel infiltration,a greater proportion of muscle infiltration depth≥1/2,a higher proportion of cervical stromal invasion(all P<0.05),and a larger tumor diameter(P=0.002).In addition,the high CKMT1A expression group had higher levels of triglycerides and blood glucose(P<0.05).The median follow-up period was 24.50 months,with a total recurrence rate of 27.27%(24/88).The Cox regression analysis results revealed that G3 grading(HR=6.629,P=0.003),muscle infiltration depth≥1/2(HR=10.412,P<0.001),and high CKMT1A expression(HR=9.022,P<0.001)were independent predictive indicators for recurrence in EC patients.In EC cases,patients in the high CKMT1A expression group had a shorter median recurrence free survival compared to those in the low CKMT1A expression group(21.38 months vs.45.16 months,P=0.006).Conclusion The high expression of CKMT1A is significantly associated with the progression and poor prognosis of EC disease,and is a promising biomarker and therapeutic target for EC.As a candidate target,the metabolic mechanism of CKMT1A in EC deserves further investigation.

Abstract:Multiple myeloma(MM)is a common malignant tumor of plasma cells,accounting for approximately 10%of hematologic malignancies,and its incidence is steadily increasing.Nearly all cases of MM eventually progress to relapsed/refractory multiple myeloma(RRMM),and with the number of treatment lines increases,therapeutic challenges escalate,imposing a substantial social burden.Anti-CD38 monoclonal antibodies,represented by daratumumab and isatuximab,have become a cornerstone of standard therapy.These agents target myeloma cells through multiple mechanisms and have shown high response rates and survival benefits in numerous clinical studies.Nevertheless,their treatment-related adverse effects require standardized management and monitoring.Looking ahead,anti-CD38 monoclonal antibodies continue to offer broad potential for further exploration in areas including combination therapies,novel target development,and formulation innovation.This comprehensive review summarizes the latest research progress,efficacy,safety,and future direction of anti-CD38 monoclonal antibodies in the treatment of RRMM,aiming to provide clinicians with an up-to-date reference.

Abstract:Cell competition is a pivotal quality control mechanism that plays essential roles in embryonic development,tissue homeostasis maintenance,and the progression of cancer.Recent investigations have shed light on the role of stress-induced cell competition,specifically mechanical cell competition,as a novel form of cellular competition that significantly impacts the promotion or suppression of tumor growth.Consequently,it assumes a critical function in both the genesis and advancement of cancer.This comprehensive review article aims to delve into the regulatory mechanisms governing stress-induced cell competition and elucidate its significance in the process of cellular elimination.Moreover,we will explore its potential as a promising target for therapeutic interventions in the context of cancer treatment.

Abstract:Objective To build a breast cancer lung metastasis risk prediction model based on 9 machine learning algorithms.Based on the optimal performance model,the algorithm is optimized to further improve the prediction effect of the model,and finally the visual risk assessment tool is constructed.Methods Patients in the Surveillance,Epidemiology,and End Results(SEER)database were screened according to inclusion criteria and exclusion criteria.Logistic regression model and least absolute shrinkage and selection operator(LASSO)regression analysis were used to select clinical features.Based on decision tree(DT),Logistic regression(LR),random forest(RF),K-nearest neighbor(KNN),support vector machine(SVM),naive bayes(NB),extreme gradient boosting(XGBoost),stochastic gradient boosting tree(SGBT),artificial neural network(ANN),9 machine learning algorithms were used to construct the prediction model.Through the introduction of cost sensitive learning,the optimal predictive performance of the model was improved,and the breast cancer lung metastasis risk calculator was established.Results A total of 11 166 breast cancer patients were included in this study,and 15 characteristics with statistical significance were selected.SGBT with the best predictive performance(AUC=0.717)was selected for subsequent algorithm improvement,and the results showed that the improved model was the best comprehensive predictive performance of CS-SGBT(accuracy rate:0.713,recall rate:0.710,F-measure:0.602,AUC:0.788).SHAP analysis results showed that the contribution order of the 15 characteristics was as follows:distant lymph node metastasis,bone metastasis,T stage,surgery,grade,N stage,tumor site,radiotherapy,age,marital status,subtype,brain metastasis,race,estrogen receptor expression and sex.Finally,the risk calculator of breast cancer lung metastasis was constructed based on CS-SGBT and verified by 63 advanced breast cancer patients in Beijing Electric Power Hospital(accuracy rate:0.639,recall rate:0.406,F-measure:0.542,AUC:0.798).Conclusion In this study,an interpretable CS-SGBT-based prediction model was constructed through machine learning and algorithm improvement,which provides a good reference value for clinically assessing the risk of breast cancer lung metastasis.

Abstract:Objective To investigate the correlation between the ultrasonic manifestations and clinical features of ovarian thecoma-fibroma groups(OTFG)tumors,and analyze the causes of misdiagnosis.Methods A retrospective study was conducted on the preoperative clinical data of 60 patients who were diagnosed with OTFG by transvaginal and/or transabdominal ultrasound examination and confirmed by surgical pathology in Liangxiang Hospital of Fangshan District of Beijing from June 2016 to October 2024.The clinical manifestations were analyzed,and the ultrasonic imaging features were summarized.Results OTFG was more common in elderly women,with an average age of(48.9±14.6)years.Fifteen patients with OTFG had elevated carbohydrate antigen(CA)125 levels(42.7-369.3 U/mL).One case of follicular membrane cell tumor showed elevated CA199(210.4 U/mL).In terms of clinical symptoms,abdominal pain is the most common,followed by abdominal masses and irregular vaginal bleeding.There were 28 cases of combined effusion.The maximum diameter range of the tumor was 4.5-16.8 cm,with clear boundaries.Fifty-two cases had a regular circular shape,while 8 cases had an irregular lobulated shape.Among 36 cases of solid tumors,10 cases showed relatively uniform hypoechogenicity internally,and 26 cases showed uneven hypoechogenicity internally.Among 24 cases of cystic and solid tumors,22 cases were mainly characterized by uneven solid echoes,and 2 cases were mainly characterized by uneven cystic echoes.Posterior acoustic attenuation of varying degrees was observed in 30 cases.Fibroadenoma was mostly characterized by no blood flow signal(75.0%),while follicular membrane fibroadenoma presented as sparse and few peripheral grade 2 blood flow signals(76.5%),and follicular membrane cell tumor showed grade 3 blood flow signals in color blood flow signals(33.3%).The differences in cystic echogenicity,CA125,and fluid accumulation exhibited by tumors of different sizes were significant.Conclusion OTFG is a gynecological tumor with endocrine function.The ultrasonic features combined with clinical symptoms can assist in the ultrasonic diagnosis of such tumors,and further combined with the patient's laboratory tests,the preoperative diagnostic accuracy can be improved.

Abstract:Objective To investigate the expression of microRNA-17-5p(miR-17-5p)and transforming growth factor beta receptor 2(TGFBR2)in colorectal cancer tissue and their relationship with clinical pathological features and prognosis.Methods A total of 158 colorectal cancer patients who underwent surgery in Zhangjiakou First Hospital from January 2019 to January 2021 were regarded as the study subjects,and their cancerous and adjacent tissues(>2 cm away from the cancerous tissue)were collected.The quantitative real time-PCR(qRT-PCR)experiment was applied to determine the relative expression levels of miR-17-5p and TGFBR2 genes in tissues.Immunohistochemistry was applied to detect the expression of TGFBR2 protein in tissues.TargetScanHuman website was applied to predict the targeting relationship between miR-17-5p and TGFBR2.Pearson method was applied to analyze the correlation between miR-17-5p and TGFBR2 expression levels in cancer tissues of colorectal cancer patients.Kaplan-Meier survival curve method was applied to analyze the relationship between miR-17-5p,TGFBR2 expression and the 3-year survival rates in colorectal cancer tissues.Cox proportional hazard regression model was applied to explore the risk factors affecting the prognosis of colorectal cancer patients.Results The expression level of miR-17-5p in cancer tissues of colorectal cancer patients was lower than that in adjacent tissues(0.78±0.20 vs.0.99±0.12,P<0.001),while the expression level of TGFBR2 was higher than that in adjacent tissues(1.31±0.35 vs.1.01±0.21,P<0.001).The positive expression rate of TGFBR2 in cancer tissues was 69.62%(110/158),significantly higher than that in the adjacent tissues(31.65%,50/158),with a statistically significant difference(P<0.05).There was a targeted binding site between miR-17-5p and TGFBR2,and there was a negative correlation between the two(r=-0.582,P<0.001).The expression levels of miR-17-5p and TGFBR2 in tissues were correlated with infiltration depth,TNM staging,lymph node metastasis,and tissue differentiation degree(P<0.05).The survival rates of patients with low expression of miR-17-5p and high expression of TGFBR2 were lower than those of patients with high expression of miR-17-5p and low expression of TGFBR2(P<0.05).Multivariate Cox regression analysis reveled that the independent risk factors for prognosis in colorectal cancer patients included infiltration depth≥1/2,TNM stage Ⅲ/Ⅳ,lymph node metastasis,poor differentiation,high expression of TGFBR2,and low expression of miR-17-5p(P<0.05).Conclusion In colorectal cancer patients,miR-17-5p expression is decreased in tumor tissues,whereas TGFBR2 expression is increased,with a negative correlation between them.These changes are associated with clinicopathological features and patient prognosis.

Abstract:Objective To investigate the risk factors associated with postoperative complications after radical gastrectomy and evaluate the clinical value of 6-minutes walk test in perioperative assessment.Methods A retrospective analysis was conducted on the clinical data of 118 patients who underwent radical gastrectomy in the Department of General Surgery at Jianhu County People's Hospital between January 2020 and January 2023.Baseline characteristics,laboratory test results,6-minute walking distance(6MWD),surgical-related indicators,and postoperative complications were recorded.Logistics regression analysis was performed to explore the risk factors associated with postoperative complications,and Spearman correlation analysis was further employed to examine the relationship between 6MWD and related perioperative indicators.Results A total of 118 patients were included,comprising 76 males and 42 females,with an median age of 67 years.Among them,29 underwent total gastrectomy,and 89 underwent subtotal gastrectomy.The incidence of postoperative complications was as follows:delayed gastric emptying in 16 patients(13.6%),wound infection in 13(11.0%),pulmonary complications in 12(10.2%),abdominal infection in 11(9.3%),anastomotic leakage in 8(6.8%),and postoperative bleeding in 4(3.4%).The Comprehensive Complication Index(CCI)was 12.2(6.5,24.2).Logistic regression analysis revealed that age(OR=0.864,95%CI:0.783-0.953,P=0.004)and 6MWD(OR=0.905,95%CI:0.863-0.949,P=0.001)were independent risk factors for high CCI.Spearman correlation analysis showed that 6MWD was strongly correlated with age(r=0.748,P=0.001),ASA grade(r=0.746,P=0.001),and total hospital stay(r=0.781,P=0.001).Conclusion 6MWD is significantly correlated with the occurrence of postoperative complications and total hospital stay in gastric cancer patients.Routine preoperative implementation of the 6-minute walk test can help identify high-risk patients and provide valuable reference for improving clinical outcomes.