Classification of congenital cataracts based on multidimensional phenotypes and its association with visual outcomes

●AIM:To establish a classification for congenital cataracts that can facilitate individualized treatment and help identify individuals with a high likelihood of different visual outcomes.●METHODS:Consecutive patients diagnosed with congenital cataracts and undergoing surgery between January 2005 and November 2021 were recruited.Data on visual outcomes and the phenotypic characteristics of ocular biometry and the anterior and posterior segments were extracted from the patients’medical records.A hierarchical cluster analysis was performed.The main outcome measure was the identification of distinct clusters of eyes with congenital cataracts.●RESULTS:A total of 164 children(299 eyes)were divided into two clusters based on their ocular features.Cluster 1(96 eyes)had a shorter axial length(mean±SD,19.44±1.68 mm),a low prevalence of macular abnormalities(1.04%),and no retinal abnormalities or posterior cataracts.Cluster 2(203 eyes)had a greater axial length(mean±SD,20.42±2.10 mm)and a higher prevalence of macular abnormalities(8.37%),retinal abnormalities(98.52%),and posterior cataracts(4.93%).Compared with the eyes in Cluster 2(57.14%),those in Cluster 1(71.88%)had a 2.2 times higher chance of good best-corrected visual acuity[<0.7 logMAR;OR(95%CI),2.20(1.25–3.81);P=0.006].●CONCLUSION:This retrospective study categorizes congenital cataracts into two distinct clusters,each associated with a different likelihood of visual outcomes.This innovative classification may enable the personalization and prioritization of early interventions for patients who may gain the greatest benefit,thereby making strides toward precision medicine in the field of congenital cataracts.

新冠疫情期间眼病患者线上问诊模式与影响因素分析

目的:新型冠状病毒疫情期间,中山大学中山眼科中心在严格防控疫情的前提下及时开展免费线上“专家问诊”服务,眼科医师在线答疑以满足眼病诊疗需求。本研究对疫情期间眼科患者线上问诊的需求与模式进行分析,为眼科互联网诊疗体系的优化提供依据。方法:前瞻性观察性研究。本研究分析了2020-02-01/03-15期间,使用中山眼科中心互联网医院“专家问诊”服务患者的基线特征。针对其中重复问诊的患者,随机抽取等量单次问诊患者作为对照,比较单次问诊与重复问诊患者的基线特征、就诊目的、疾病类型、眼病数量,并对患者问诊次数的影响因素进行分析。结果:研究期间“专家问诊”共线上服务患者9831人次,其中单次问诊3919人次,5912人次来源于1967人的重复问诊。随机抽取1967名单次问诊者与上述重复问诊者对比,单次问诊与重复问诊患者的年龄、性别分布无统计学差异(P=0.897,0.482)。两组就诊目的均以“旧病复诊”占比最高(59.7%,64.9%)。从构成比上看,与单次问诊患者相比,重复问诊患者中,就诊目的为新发不适者较少,旧病复诊与术后复查者较多,眼表、眼底、葡萄膜疾病患者较多,患有两种及以上眼病者占比较多。回归分析显示屈光患者倾向单次问诊,而旧病复诊、术后短期复诊患者,眼底、葡萄膜疾病患者倾向重复问诊。旧病复诊、术后随访较新发不适患者重复问诊的次数更多;晶状体与青光眼/疑似青光眼疾病重复问诊次数较少,眼表疾病重复问诊次数较多。结论:疫情期间眼科患者线上就诊主要目的为旧病复诊。疾病种类、就诊目的与眼病数量均影响患者是否重复问诊及问诊次数,应根据患者的就诊需求与模式调整眼科不同亚专科线上接诊医生的数量与排班。互联网医疗对新发不适患者的诊疗能力有待进一步提高。

自然光照对眼部的影响（英文）

自然光照由连续光谱、不同能量的光组成,光的波长越短能量越大,故其中紫外线和蓝光具有更高能量。暴露在高强度光照下可能导致眼部组织细胞损伤,进而引起各种眼部结构的病理变化。我们回顾了近年来有关光照在角结膜、晶状体、前房结构、视网膜、视神经相关疾病中的作用的研究,综述了光照在眼部可能触发的信号通路和作用机制。眼组织过度暴露在光照下会导致DNA损伤增加、蛋白质的异常修饰和聚集,以及过度的氧化应激,从而导致眼部疾病的发生发展。因此,可根据所接触的光照特性与强度,以及需要保护的眼组织类型,针对性地单独或联合使用物理保护、局部和/或口服抗氧化剂和光照活化信号通路的小分子抑制剂,以防止和减少光照引起的眼部损害。

Recovery of vanadium and molybdenum from spent petrochemical catalyst by microwave-assisted leaching

The study of the leaching of vanadium(V) and molybdenum(Mo) from spent petrochemical catalysts in sodium hydroxide(NaO H) medium was performed using two approaches, namely, conventional leaching and microwave-assisted leaching methods. The influence of microwave power, leaching time, leaching temperature, and NaOH concentration on the leaching efficiency of spent petrochemical catalyst was investigated. Under microwave-assisted conditions(600 W, 10 min, 90°C, 2.0 mol·L^(-1) NaOH, and 0.20 g·mL^(-1) solid–liquid ratio), the leaching efficiencies of V and Mo reached 94.35% and 96.23%, respectively. It has been confirmed that microwave energy has considerable potential to enhance the efficiency of the leaching process and reduce the leaching time. It is suggested that the enhancement of the leaching efficiencies of V and Mo can be attributed to the existence of a thermal gradient between solid and liquid and the generation of cracks on the mineral surface.

Study on the strength of cold-bonded high-phosphorus oolitic hematite-coal composite briquettes

Composite briquettes containing high-phosphorus oolitic hematite and coal were produced with a twin-roller briquette machine using sodium carboxymethyl cellulose, molasses, starch, sodium silicate, and bentonite as binders. The effect of these binders on the strength of the composite briquettes, including cold strength and high-temperature strength, was investigated by drop testing and compression testing. It was found the addition of Ca（OH）2 and Na2CO3 not only improved the reduction of iron oxides and promoted dephosphorization during the reduction-separation process but also provided strength to the composite briquettes during the briquetting process; a compressive strength of 152.8 N per briquette was obtained when no binders were used. On this basis, the addition of molasses, sodium silicate, starch, and ben- tonite improved the cold strength of the composite briquettes, and a maximum compressive strength of 404.6 N per briquette was obtained by using starch. When subjected to a thermal treatment at 1200~C, all of the composite briquettes suffered from a sharp decrease in compressive strength during the initial reduction process. This decrease in strength was related to an increase in porosity of the composite briquettes. X-ray diffraction （XRD） and scanning electron microscopy （SEM） analyses showed that the decrease in strength of the composite briquettes could be caused by four factors： decomposition of bonding materials, gasification of coal, transportation of byproduct gases in the composite briquettes, and thermal stress.

Novel mutation in OCRL leading to a severe form of Lowe syndrome

AIM: To investigate the phenotype and genotype of a family with X-linked recessive Lowe syndrome. METHODS: All the members in the Chinese pedigree underwent comprehensive ophthalmologic and systemic examinations. Genomic DNA was isolated from peripheral blood of the pedigree members and 100 unrelated healthy Chinese subjects. Direct sequencing was performed to screen the exons and intron boundaries of OCRL.RESULTS: The ophthalmological and systemic exami nations suggested that the affected individual had Lowe syndrome. The phenotype in the pedigree is severe and consistent among all the affected individuals except for an individual who additionally suffered from congenital heart disease and laryngeal cartilage dysplasia. Directio nal San ger sequenci ng identified a complex mutation c.(2368_2368delG;c.2370A>C) in the Rho-GTPase activating protein domain. This complex mutation causes termination of protein synthesis at amino acid 824 and result in a new peptide with 823 amino acids (p.Ala790ProfsX34). This mutation was not detected in 100 unrelated healthy Chinese subjects.CONCLUSION: Our findings expand the phenotypic and genotypic spectrum of Lowe syndrome.

Dynamic profile of ocular refraction in pediatric cataract patients after lens surgeries

AIM: To study the change in ocular refraction in patients with pediatric cataracts(PCs) after lens extraction. METHODS: A total of 1258 patients who were undergoing cataract extraction with/without intraocular lens(IOL)implantation were recruited during preoperative examinations between Jan 2010 and Oct 2013. Patient ages ranged from 1.5 mo to 14y. Follow-ups were conducted at1 wk, 1, and 3 mo postoperatively and every 3 mo in the first year, then 6 mo thereafter. Ocular refraction [evaluated as spherical equivalent(SE)] and yearly myopic shift(YMS)were recorded and statistically analyzed among patients with age at surgery, baseline ocular refraction, gender,postoperative time and laterality(bilateral vs unilateral). RESULTS: By Dec 31st 2015, 1172 participants had been followed for more than 2y. The median follow-up period was 3y. The critical factors affecting the ocular refraction of PC patients were baseline ocular refraction, postoperative time for both aphakic and pseudophakic eyes. YMS grew most rapidly in young childhood and early adolescence. CONCLUSION: After lens surgeries, ocular refraction in PC patients shows an individual difference of change.Further concerns should be raising to monitor the rapid myopic shift at early adolescence of these patients.

Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable?A propensity matched study

BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

Identification of a novel germline missense mutation of the androgen receptor in African American men with familial prostate cancer

Race, family history and age are the unequivocally accepted risk factors for prostate cancer （PCa）. Androgen receptor （AR）-dependent signaling is an important element in prostate carcinogenesis and its progression to metastatic disease. We examined the possibility of genomic changes in the AR in association with familial PCa in African Americans who have a higher incidence and mortality rate and a clinically more aggressive disease presentation than Caucasians. Genomic DNAs of 60 patients from 30 high-risk African American and Caucasian families participating in the Louisiana State University Health Sciences Center genetic linkage study of PCa were studied. Exon-specific polymerase-chain reaction, bi-directional automated sequencing and restriction enzyme genotyping were used to analyze for mutations in the coding region of the AR gene. We identified a germline AR （A1675T） （T559S） substitution mutation in the DNA-binding domain in three PCa-affected members of an African- American family with a history of early-onset disease. The present study describes the first AR germline mutation in an African-American family with a history of familial PCa. The AR （T559S） mutation may contribute to the disease by altering AR DNA-binding affinity and/or its response to androgens, non-androgenic steroids or anti-androgens. Additional studies will be required to define the frequency and contribution of the AR （A 1675T） allele to early-onset and/or familial PCa in African Americans.

Timing and approaches in congenital cataract surgery:a four-year,two-layer randomized controlled trial

AIM：To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches.METHODS：In this prospective,randomized controlled trial,we recruited congenital cataract patients aged 3 mo or younger before cataract surgery.Sixty-one eligible patients were randomly assigned to two groups according to surgical timing：a 3-month-old group and a 6-month-old group.Each eye underwent one of three randomly assigned surgical procedures,as follows：surgery A,lens aspiration（I/A）;surgery B,lens aspiration with posterior continuous curvilinear capsulorhexis（I/A＋PCCC）;and surgery C,lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy（I/A＋PCCC＋A-Vit）.The long-term best-corrected visual acuity（BCVA） and the incidence of complications in the different groups were compared and analyzed.RESULTS：A total of 57 participants（114 eyes） with a mean follow-up period of 48.7 mo were included in the final analysis.The overall log MAR BCVA in the 6-month-old group was better than that in the 3-month-old group（0.81±0.28 vs 0.96±0.30;P=0.02）.The overall log MAR BCVA scores in the surgery B group were lower than the scores in the A and C groups（A：0.80±0.29,B：1.02±0.28,and C：0.84±0.28;P=0.007）.A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA.CONCLUSION：It might be safer and more beneficial for bilateral total congenital cataract patients to undergosurgery at 6 mo of age than 3 mo.Moreover,with rigorous follow-up and timely intervention,the postoperative complications in these patients are treatable and do not compromise visual outcomes.

Increased prevalence of parent ratings of ADHD symptoms among children with bilateral congenital cataracts

AIM: To investigate the behavioral and psychological disorders and the prevalence of parent ratings of attention deficit hyperactivity disorder(ADHD) symptoms among children with bilateral congenital cataracts(CCs). METHODS: This cross-sectional study investigated children with bilateral CC aged 3-8 y(CC group) using Conners’ Parent Rating Scale-48(CPRS-48) from July to December 2016. The abnormal rates of psychological symptoms in CC children and normal vision(NV) children were compared using the Chi-square test. The scores of CC children were compared with those of NV children and the Chinese urban norm using the independent samples t-test and one-sample t-test, respectively. RESULTS: A total of 262 valid questionnaires were collected. The ratio of CC children to NV children was 119:143. The overall rate of psychological symptoms in CC children was 2.28 times higher than that in NV children(46.22% vs 20.28%, Pearson’s χ2=20.062;P<0.001). CC children showed higher scores for conduct problems, learning problems, impulsiveness/hyperactivity, anxiety, and hyperactivity index than NV children and the Chinese urban norm, particularly between the ages of 3 and 5 y. Furthermore, male children aged between 6 and 8 y showed a higher impulsive/hyperactive score than females of the same age(t=6.083, P<0.001). CONCLUSION: Children with bilateral CCs have a higher rate of ADHD symptoms than children with NV. This study provides clinical evidence that screening for psychological symptoms and particularly for ADHD symptoms in children with bilateral CC are recommended for an early diagnosis and timely treatment.

胃底腺型胃癌临床病理特点的文献回顾分析

背景胃底腺型胃癌(gastric adenocarcinoma of the fundic gland type,GA-FG)是近年来新发现的一种胃癌类型,不同于传统的肠癌和弥漫性胃癌,是一种分化良好的肿瘤.预计GA-FG在所有胃癌中的比例将越来越高,但目前内镜医师及临床病理学家对该病认识不足容易导致误诊.目的本文通过对该病的内镜、临床及病理特点进行系统回顾,旨在增加该疾病的诊断率并减少漏诊及误诊.方法在Pubmed及中国知网收集2007-01/2022-03期间公开发表的中英文文献中报道的胃底腺型胃癌患者临床、病理及内镜资料,并进行回顾分析.结果共收集67篇文献中320例胃底腺型胃癌患者共322处病变相关资料.病变多位于胃上1/3(81.6%),病变平均大小9.66 mm(1 mm-85 mm),约76.88%病变大体形态为隆起型.窄带成像观察病变表面可见微血管扩张及微腺体结构紊乱或增粗.所有病变中主细胞分化型约占74.84%,显著表达MUC6及胃蛋白酶原,预后良好.结论胃底腺型胃癌发病率低,内镜下完整切除及外科手术可到达治愈性切除的目的,预后较好,但易误诊,诊断时应结合其临床病理学特点,从而减少误诊及漏诊率.

A computerized resolution visual acuity test in preschool and school age children

●AIM:To develop a novel approach called the Autoacuity Tester,and to evaluate its validity,especially the sensitivity and specificity for detecting amblyopia.●METHODS:Children aged from 3 to 12 y(n=552)were enrolled in the study.The validity of the Autoacuity Tester was evaluated by comparing it to the Tumbling E Early Treatment Diabetic Retinopathy Study(ETDRS)acuity chart for school age children,and Lea Symbols and Teller acuity card(TAC)for preschool children.The repeatability was assessed by coefficient of repeatability(COR).The sensitivity and specificity for detecting amblyopia were calculated.●RESULTS:The mean difference(95%limits of agreement)between the Autoacuity Tester and the ETDRS tests were-0.03(-0.24,0.19)logMAR for the school age group.In preschool children,the mean difference was 0.04(-0.14,0.21)logMAR between the Autoacuity Tester and the TAC and 0.00(-0.17,0.18)logMAR between the Autoacuity Tester and the Lea Symbols.For the school age group,the COR was 0.20 logMAR for the Autoacuity Tester and 0.18 logMAR for the ETDRS.For the preschool group,the COR was 0.13 logMAR for the Autoacuity Tester and 0.21 logMAR for TAC.The Autoacuity Tester(88%)is more sensitive than TAC(72%)in detecting amblyopia(P=0.04),while had similar specificity(92%vs 90%,P=0.20).●CONCLUSION:The Autoacuity Tester provides a reliable alternative for assessing visual acuity,and offers advantage of higher testability and repeatability for preschool children.

Uphill anomalous transport in a deterministic system with speed-dependent friction coefficient

We investigate the transport of a deterministic Brownian particle theoretically, which moves in simple onedimensional, symmetric periodic potentials under the influence of both a time periodic and a static biasing force. The physical system employed contains a friction coefficient that is speed-dependent. Within the tailored parameter regime, the absolute negative mobility, in which a particle can travel in the direction opposite to a constant applied force, is observed.This behavior is robust and can be maximized at two regimes upon variation of the characteristic factor of friction coefficient. Further analysis reveals that this uphill motion is subdiffusion in terms of localization（diffusion coefficient with the form D（t） -t-（-1） at long times）. We also have observed the non-trivially anomalous subdiffusion which is significantly deviated from the localization; whereas most of the downhill motion evolves chaotically, with the normal diffusion.

Hotspots and frontiers of genetic research on pediatric cataracts from 2013 to 2022:a scientometric analysis

AIM:To explore the hotspots and frontiers of genetic research on pediatric cataracts.METHODS:Global publications from 2013 to 2022 related to genes in pediatric cataracts were extracted from the Web of Science Core Collection,and were analyzed in terms of the publication counts,countries,journals,authors,keywords,cited references,subject categories,and the underlying hotspots and frontiers.RESULTS:Totally 699 publications were included in the final analysis.The predominant actors were identified,with China(n=240)and PLoS One(n=33)being the most productive country and journal respectively.The research hotspots extracted from keywords were crystallin gene mutations,pathogenicity evaluation,phenotypes of ocular and neurodevelopmental abnormalities,genes encoding membrane proteins,and diagnosis of multisystemic disorders.The co-cited articles formed 10 clusters of research topics,including FYCO1(56 items),mutation screening(43 items),gap junction(29 items),the Warburg Micro syndrome(29 items),ephrin-A5(28 items),novel mutation(24 items),eye development and function(22 items),cholestanol(7 items),OCRL(6 items),and pathogenicity prediction(3 items).The research frontiers were FYCO1,ephrin-A5,and cholestanol.Cell biology showed the strongest bridging effects among different disciplines in the field(betweenness centrality=0.44).CONCLUSION:With the progress in next-generation sequencing and multidisciplinary collaboration,genetic research on pediatric cataracts broadens the knowledge scope of the crystalline lens,as well as other organs and systems,shedding light on the molecular mechanisms of systemic diseases.Cell biology may integrate multidisciplinary content to address cutting-edge issues in the field.

Bilateral coronary-pulmonary artery fistula with paroxysmal atrial arrhythmia:a case report

Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However,CPAF can cause a phenomenon of inter-artery steal and hemodynamic disorders,leading to myocardial ischemia,arrhythmia,heart failure,syncope and even cardiac sudden death in severe cases.Here we reported a case of a 53-year-old female who complained of intermittent palpitations and had a history of paroxysmal atrial fibrillation.The coronary angiography revealed bilateral coronary artery fistulae to pulmonary artery.In this case,the multiple fistulas were very rare and significant.Multidisciplinary treatment should be considered,including cardiologists,surgeons,anesthesiologists and nurses,etc.Regular follow-up is essential for long-term disease management after diagnosis or surgery.

Clinical practice guidelines for modified radical mastectomy of breast cancer: Chinese Society of Breast Surgery (CSBrs) practice guidelines 2021

The proportion of patients with early-stage breast cancer undergoing mastectomy exceeds 70%in China/11 among which Auchincloss operation is the major surgical technique for patients with axillary lymph node positive breast cancer.In order to standardize the clinical application of modified radical mastectomy of breast cancer,Chinese Society of Breast Surgery(CSBrS)organized domestic experts to conduct literature retrieval and expert discussion on the theoretical basis and technical details of modified radical mastectomy for breast cancer.With reference to the grading of recommendations assessment,development,and evaluation system。

Three functionally redundant plant-specific paralogs are core subunits of the SAGA histone acetyltransferase complex in Arabidopsis

The SAGA(Spt-Ada-Gcn5 acetyltransferase)complex is an evolutionarily conserved histone acetyltransferase complex that has a critical role in histone acetylation,gene expression,and various developmental processes in eukaryotes.However,little is known about the composition and function of the SAGA complex in plants.In this study,we found that the SAGA complex in Arabidopsis thaliana contains not only conserved subunits but also four plant-specific subunits:three functionally redundant paralogs,SCSI,SCS2A,and SCS2B(SCS1/2A/2B),and a TAF-like subunit,TAFL.Mutations in SCS1/2A/2B lead to defective phenotypes similar to those caused by mutations in the genes encoding conserved SAGA subunits HAG1 and ADA2B,including delayed juvenile-to-adult phase transition,late flowering,and increased trichome density.Furthermore,we demonstrated that SCS1/2A/2B are required for the function of the SAGA complex in histone acetylation,thereby promoting the transcription of development-related genes.These results together suggest that SCS1/2A/2B are core subunits of the SAGA complex in Arabidopsis.Compared with SAGA complexes in other eukaryotes,the SAGA complexes in plants have evolved unique features that are necessary for normal growth and development.

Development and validation of a nomogram for predicting survival of breast cancer patients with ipsilateral supraclavicular lymph node metastasis

Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict the overall survival(OS)of breast cancer patients with ISLNM but without distant metastasis.Methods:Medical records of breast cancer patients who received surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University,Jiyuan People’s Hospital and Huaxian People’s Hospital between December 21,2012 and June 30,2020 were reviewed retrospectively.Overall,345 patients with pathologically confirmed ISLNM and without evidence of distant metastasis were identified.They were further randomized 2:1 and divided into training(n=231)and validation(n=114)cohorts.A nomogram to predict the probability of OS was constructed based on clinicopathologic variables identified by the univariable and multivariable analyses.The predictive accuracy and discriminative ability were measured by calibration plots,concordance index(C-index),and risk group stratification.Results:Univariable analysis showed that estrogen receptor-positive(ER+),progesterone receptor-positive(PR+),human epidermal growth factor receptor 2-positive(HER2+)with Herceptin treatment,and a low axillary lymph node ratio(ALNR)were prognostic factors for better OS.PR+,HER2+with Herceptin treatment,and a low ALNR remained independent prognostic factors for better OS on multivariable analysis.These variables were incorporated into a nomogram to predict the 1-,3-,and 5-year OS of breast cancer patients with ISLNM.The C-indexes of the nomogram were 0.737(95%confidence interval[CI]:0.660–0.813)and 0.759(95%CI:0.636–0.881)for the training and the validation cohorts,respectively.The calibration plots presented excellent agreement between the nomogram prediction and actual observation for 3 and 5 years,but not 1 year,OS in both the cohorts.The nomogram was also able to stratify patients into different risk groups.Conclusions:In this study,we established and validated a novel nomogram for predicting survival of patients with ISLNM.This nomogram may,to some extent,allow clinicians to more accurately estimate prognosis and to make personalized therapeutic decisions for individual patients with ISLNM.

Human U Three Protein 14a Expression is Increased in Hepatocellular Carcinoma and Associated with Poor Prognosis

Background： Human U three protein 14a （hUTP 14a） promotes p53 degradation. Moreover, hUTP 14a expression is upregulated in several types of tumors. However, the expression pattern of hUTP 14a in hepatocellular carcinoma （HCC） remains unknown. The aim of this study was to investigate hUTP 14a expression and its prognostic value in HCC. Methods： The hUTP 14a expression was evaluated using immunohistochemistry （IHC） in HCC tissue specimens. The correlations between hUTP 14a expression and clinicopathological variables were analyzed. The Kaplan-Meier method was used to analyze the association between hUTP14a expression and survival. Independent prognostic factors associated with overall survival （OS） and disease-free survival （DFS） were analyzed using the Cox proportional-hazards regression model. Results： The IHC data revealed that the hUTP 14a positivity rate in HCC tissue specimens was significantly higher than that in nontumorous tissue specimens （89.9% vs. 72.7%, P 〈 0,05）. The hUTP14a expression was detected in both the nucleolus and the cytoplasm. The positivity rate of nucleolar hUTP14a expression in HCC tissue specimens was higher than that in the nontumorous tissue specimens （29.3% vs. 10.1%, P 〈 0.05）. No significant difference was found between HCC and nontumorous tissue specimens of cytoplasmic hUTP 14a expression （60.6% vs. 62.6%, P 〉 0.05）. In addition, no significant correlation was found between nucleolar hUTP 14a expression and other clinicopathological variables. The 5-year OS and DFS rates in patients with positive nucleolar hUTP14a expression were significantly lower than those in patients with negative hUTP 14a expression （P = 0.004 for OS, P = 0.003 for DFS）. Multivariate analysis showed that nucleolar hUTP 14a expression was an independent prognostic factor for OS （P = 0.004） and DFS （P 〈 0.001 ）. Conclusions： The positivity rate of hUTP 14a expression was significantly higher in HCC specimens. Positive expression of nucleolar hUTP 14a might act as a novel prognostic predictor for patients with HCC.