HMGB1基因调控胶质瘤恶性生物学行为研究进展

胶质瘤因其复杂的生物学特性以及胶质瘤干细胞的干细胞特性,标准治疗后易复发。高迁移率族蛋白1(HMGB1)作为癌基因通过多种不同方式参与调控胶质瘤恶性进展。本文对HMGB1基因与胶质瘤预后、肿瘤病理分级、干细胞相关性以及HMGB1基因调控胶质瘤方式如非编码RNA途径、细胞自噬途径、肿瘤微环境等进行综述,为胶质瘤的治疗提供参考。

预测肝细胞癌腹腔镜肝切除术后复发风险的列线图模型

背景与目的肝细胞癌(hepatocellular carcinoma,HCC)患者手术切除术后5年复发率很高(60%)。腹腔镜肝切除术(laparoscopic hepatectomy,LH)不断发展,但鲜有研究对LH与传统手术方法治疗HCC的疗效进行比较。本研究旨在建立一种预测HCC患者LH后复发风险的列线图模型。方法收集432例病理确诊为HCC并首次接受LH治疗且手术切缘>1cm的患者的临床资料。评估了其临床病理特征对无复发生存期(recurrence-free survival,RFS)的影响,在此基础上,使用训练队列(n=324)建立了列线图,并在现有的验证队列(n=108)中进行了内部验证。结果乙型肝炎表面抗原[风险比(hazard ratio,HR),1.838;P=0.044]、肿瘤数目(HR,1.774;P=0.003)、癌栓(HR,2.356;P=0.003)、癌细胞分化程度(HR,0.745;P=0.080)和肿瘤微血管浸润(HR,1.673;P=0.007)是训练队列中RFS的独立预后因素,并用于建立列线图。采用列线图预测RFS的C-index为0.786,高于第8版美国癌症联合会TNM分期系统(C-index,0.698)和巴塞罗那临床肝癌分期系统(C-index,0.632)。校准曲线也证明了列线图预测结果与实际生存一致性较高。受试者工作特征曲线分析表明,与其他系统相比,该列线图对RFS的预测效果更佳,具有更高的阈值概率,这在验证队列中也得到了证实。结论我们建立和验证了可将HCC患者首次接受LH后复发风险量化的列线图,该列线图可应用于临床,辅助医生对患者制订个性化术后监测方案。

Degradation of warm permafrost and talik formation on the Qinghai-Tibet Plateau in 2006-2021

Permafrost is degrading globally,particularly those with low thermal stability on the Qinghai-Tibet Plateau,owing to climate change.However,the inadequacy of direct research on permafrost degradation based on in-situ monitoring limits the prediction of permafrost degradation and engineering practices.This study explored the processes and modes of permafrost degradation into talik by analyzing ground temperature data from five points in the hinterland of the Qinghai-Tibet Plateau from 2006 to 2021.The results showed that the degradation of the warm permafrost layer with a geothermal gradient of zero occurred simultaneously in the top and bottom directions.The rate of permafrost degradation from the top down and bottom up increase during the degradation process,but the increase of the former is more drastic after the formation of thawed interlayer.Additionally,the construction of the Qinghai-Tibet Railway changed the degradation modes of the permafrost in adjacent natural sites through horizontal heat transfer,particularly after through talik formation under the embankment.The findings suggest that taking countermeasures before or immediately after forming thawed interlayer is more effective.When evaluating the thermal impact of projects in warm permafrost regions,special attention should be given to the horizontal heat transfer process that may result from the formation of a through talik.

A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy

Background:Patients with hepatocellular carcinoma(HCC)undergoing surgical resection still have a high 5-year recurrence rate(~60%).With the development of laparoscopic hepatectomy(LH),few studies have compared the efficacy between LH and traditional surgical approach on HCC.The objective of this study was to establish a nomo-gram to evaluate the risk of recurrence in HCC patients who underwent LH.Methods:The clinical data of 432 patients,pathologically diagnosed with HCC,underwent LH as initial treatment and had surgical margin>1 cm were collected.The significance of their clinicopathological features to recurrence-free survival(RFS)was assessed,based on which a nomogram was constructed using a training cohort(n=324)and was internally validated using a temporal validation cohort(n=108).Results:Hepatitis B surface antigen(hazard ratio[HR],1.838;P=0.044),tumor number(HR,1.774;P=0.003),tumor thrombus(HR,2.356;P=0.003),cancer cell differentiation(HR,0.745;P=0.080),and microvascular tumor invasion(HR,1.673;P=0.007)were found to be independent risk factors for RFS in the training cohort,and were used for con-structing the nomogram.The C-index for RFS prediction in the training cohort using the nomogram was 0.786,which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification(C-index,0.698)and the Barcelona Clinic Liver Cancer staging system(C-index,0.632).A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve.An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis,which was also confirmed in the validation cohort compared to other systems.Conclusions:We constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients,which can be clinically implemented in assisting the planification of individual postoperative surveil-lance protocols.

A case of clonal seborrheic keratosis with characteristic dermoscopic features

To the Editor:A 40-year-old woman presented with a gradually enlarging red oval plaque with a rough surface on the lateral aspect of the left leg for 4 years.No ulceration,crust,exudation,or bleeding was seen.Physical examination showed the lesion was a well-defined,red flat plaque,1.5 cm×1.0 cm in diameter,medium hardness,and non-tender[Figure 1A].There were no systematic abnormalities and the patient had no complaints of pain or itching.Dermoscopic examination revealed multiple brown globules,dotted,and globular vessels on the red background.Several follicular keratotic plugs and multiple milia-like cysts could also be seen.The lesion had a demarcated border[Figure 1B and Figure 1C].

Impact of overweightness and critical weight loss on overall survival in patients with hepatocellular carcinoma initially treated with chemoembolization

Background:The effects of overweightness and weight loss on the development and prognosis of hepatocellular carcinoma(HCC)remain unclear.In this study,we aimed to evaluate the impact of overweightness and weight loss on the survival of patients with intermediate/advanced HCC receiving chemoembolization as initial treatment.Methods:We examined 1,170 patients who underwent chemoembolization as initial treatment for Barcelona-Clı´nic Liver Cancer stages B and C HCC at Sun Yat-sen University Cancer Center(Guangzhou,China)between December 2009 and May 2015.A baseline body mass index(BMI)of23 kg/m2 was defined as overweight,and body-weight loss of5.0%from baseline was defined as critical weight loss(CWL).Cox regression analysis was used to determine the association between overweightness or CWL and overall survival(OS).Results:The median survival time was 16.8(95%confidence interval,13.9–19.7)months and 11.1(95%confidence interval,10.0–12.2)months in the overweight and non-overweight groups(log-rank test,P<0.001),respectively.Cox multivariate analysis identified overweightness as an independent protective prognostic factor for OS(P<0.001).Subgroup stratification analysis revealed a significant association between overweightness and survival among patients receiving further treatment(P=0.005),but not in those not receiving further treatment(P=0.683).Multivariate analysis showed that both overweightness and CWL were independent prognostic factors for OS among patients receiving further treatment.Conclusion:Among patients with intermediate-or advanced-stage HCC initially treated with chemoembolization,overweightness was associated with longer OS.Furthermore,CWL was an independent adverse prognostic factor for OS in patients receiving additional treatment.