Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection

BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.AIM To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of ESD.METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after ESD.We compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with ESD.RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN tissues.The disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,respectively.Undifferen-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor prognosis.CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics,which are closely related to the safety and efficacy of ESD.

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

AIM:To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. METHODS: Data were collected from 85 poorly- differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis showed that tumor size (OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found tohave metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION: Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (≤ 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location.

Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection

AIM:To investigate the predictive factors of lymph node metastasis(LNM) in poorly differentiated early gastric cancer(EGC),and enlarge the possibility of using laparoscopic wedge resection(LWR).METHODS:We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010.The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios(OR) with 95%CI were calculated.We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate.RESULTS:In the univariate analysis,tumor size(P = 0.011),depth of invasion(P = 0.007) and lymphatic vessel involvement(P < 0.001) were significantly associated with a higher rate of LNM.In the multivariate model,tumor size(OR = 7.125,95%CI:1.251-38.218,P = 0.041),depth of invasion(OR = 16.624,95%CI:1.571-82.134,P = 0.036) and lymphatic vessel involvement(OR = 39.112,95%CI:1.745-123.671,P = 0.011) were found to be independently risk clinicopathological factors for LNM.Of the 85 patients diagnosed with poorly differentiated EGC,12(14.1%) had LNM.The LNM rates were 5.7%,42.9% and 57.1%,respectively in cases with one,two and three of the risk factors respectively in poorly differentiated EGC.There was no LNM in 29 patients without the three risk clinicopathological factors.CONCLUSION:LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size,and when lymphatic vessel involvement is absent at postoperative histological examination.

Feasibility study on expanded indication for endoscopic submucosal dissection of intramucosal poorly differentiated early gastric cancer

AIM: To identify clinicopathological factors predictive of lymph node metastasis(LNM) in intramucosal poorly differentiated early gastric cancer(EGC), and further to expand the possibility of using endoscopic submucosal dissection(ESD) for the treatment of intramucosal poorly differentiated EGC.METHODS: Data for 81 surgically treated patients with intramucosal poorly differentiated EGC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios(ORs) with 95% confidence intervals(CIs) were calculated. Several clinicopathologic factors were investigated to identify predictive factors for lymph nodes metastasis, including gender, age, family history of gastric cancer, number of tumors, tumor location, ulceration, tumor size, macroscopic type, lymphatic vessel involvement, and signet-ring-cell component.RESULTS: Tumor size(OR = 7.273, 95%CI: 1.246-29.918, P = 0.042), lymphatic vessel involvement(OR = 42.219, 95%CI: 1.923-97.052, P = 0.018) and signet-ring-cell component(OR = 17.513, 95%CI: 1.647-77.469, P = 0.034) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. However, gender, age, family history of gastric cancer, number, location, ulceration and macroscopic type of tumor were found not to be associated with LNM. Of these 81 patients diagnosed with intramucosal poorly differentiated EGC, 7(8.6%) had LNM. The LNM rates were 9.1%, 22.2% and 57.1%, respectively, in cases with one, two and three of the risk factors. There was no LNM in 54 patients without the three risk clinicopathological factors.CONCLUSION: Tumor size, lymphatic vessel involvement and signet-ring-cell component are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used as a simple criterion to expand the possibility of using ESD for the treatment of intramucosal poorly differentiated EGC.

Petrogenesis of 3.15 Ga old Banasandra komatiites from the Dharwar craton, India： Implications for early mantle heterogeneity

Spinifex-textured, magnesian （MgO 〉25 wt.%） komatiites from Mesoarchean Banasandra greenstone belt of the Sargur Group in the Dharwar craton, India were analysed for major and trace elements and 147,146Sm-143,142Nd systematics to constrain age, petrogenesis and to understand the evolution of Archean mantle. Major and trace element ratios such as CaOJAl203, Al2O3JTiO2, GdJYb, LaJNb and NbJY suggest aluminium undepleted to enriched compositional range for these komatiites. The depth of melting is estimated to be varying from 120 to 240 km and trace-element modelling indicates that the mantle source would have undergone multiple episodes of melting prior to the generation of magmas parental to these komatiites. Ten samples of these komatiites together with the published results of four samples from the same belt yield 147Sm-143Nd isochron age of ca. 3.14 Ga with an initial ENd（t） value of ＋3.5. High precision measurements of 142Nd/144Nd ratios were carried out for six komatiite samples along with standards AMES and La Jolla. All results are within uncertainties of the terrestrial samples. The absence of 142Nd/144Nd anomaly indicates that the source of these komatiites formed after the extinction of 146Sm, i.e. 4.3 Ga ago. In order to evolve to the high eNd（t） value of ＋3.5 by 3.14 Ga the time-integrated ratio of 147Sm/144Nd should be 0.2178 at the minimum. This is higher than the ratios estimated, so far, for mantle during that time. These results indicate at least two events of mantle differentiation starting with the chondritic composition of the mantle. The first event occurred very early at ~ 4.53 Ga to create a global early depleted reservoir with superchondritic Sm/Nd ratio, The source of Isua greenstone rocks with positive ~42Nd anomaly was depleted during a second differentiation within the life time of 146Sm, i.e. prior to 4.46 Ga. The source mantle of the Banasandra komatiite was a result of a differentiation event that occurred after the extinction of the 146Sm, i,e. at 4.3 Ga and prior to 3,14 Ga. Banasandra komatiites therefore provide evidence for preservation of heterogeneities generated during mantle differentiation at 4,3 Ga.

Application of intelligence-based computational techniques for classification and early differential diagnosis of COVID-19 disease

Clinical methods are used for diagnosing COVID-19 infected patients,but reports posit that,several people who were initially tested positive of COVID-19,and who had some underlying diseases,turned out having negative results after further tests.Therefore,the performance of clinical methods is not always guaranteed.Moreover,chest X-ray image data of COVID-19 infected patients are mostly used in the computational models for COVID-19 diagnosis,while the use of common symptoms,such as fever,cough,fatigue,muscle aches,headache,etc.in computational models is not yet reported.In this study,we employed seven classification algorithms to empirically test and verify their efficacy when applied to diagnose COVID-19 using the aforementioned symptoms.We experimented with Logistic Regression(LR),Support Vector Machine(SVM),Naïve Byes(NB),Decision Tree(DT),Multilayer Perceptron(MLP),Fuzzy Cognitive Map(FCM)and Deep Neural Network(DNN)algorithms.The techniques were subjected to random undersampling and oversampling.Our results showed that with class imbalance,MLP and DNN outperform others.However,without class imbalance,MLP,FCM and DNN outperform others with the use of random undersampling,but DNN has the best performance by utilizing random oversampling.This study identified MLP,FCM and DNN as better classifiers over LR,NB,DT and SVM,so that healthcare software system developers can adopt them to develop intelligence-based expert systems which both medical personnel and patients can use for differential diagnosis of COVID-19 based on the aforementioned symptoms.However,the test of performance must not be limited to the traditional performance metrics.

Predictive factors of lymph node metastasis in intramucosal poorly differentiated early gastric cancer and their impact on the laparoscopic surgery

Objective The aim of this study was to identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using laparoscopic surgery for the treatment of intramucosal poorly differentiated EGC.

Application of support vector machine algorithm for early differential diagnosis of prostate cancer

Prostate cancer(PCa)symptoms are commonly confused with benign prostate hyperplasia(BPH),particularly in the early stages due to similarities between symptoms,and in some instances,underdiagnoses.Clinical methods have been utilized to diagnose PCa;however,at the full-blown stage,clinical methods usually present high risks of complicated side effects.Therefore,we proposed the use of support vector machine for early differential diagnosis of PCa(SVM-PCa-EDD).SVM was used to classify persons with and without PCa.We used the PCa dataset from the Kaggle Healthcare repository to develop and validate SVM model for classification.The PCa dataset consisted of 250 features and one class of features.Attributes considered in this study were age,body mass index(BMI),race,family history,obesity,trouble urinating,urine stream force,blood in semen,bone pain,and erectile dysfunction.The SVM-PCa-EDD was used for preprocessing the PCa dataset,specifically dealing with class imbalance,and for dimensionality reduction.After eliminating class imbalance,the area under the receiver operating characteristic(ROC)curve(AUC)of the logistic regression(LR)model trained with the downsampled dataset was 58.4%,whereas that of the AUC-ROC of LR trained with the class imbalance dataset was 54.3%.The SVM-PCa-EDD achieved 90%accuracy,80%sensitivity,and 80%specificity.The validation of SVM-PCa-EDD using random forest and LR showed that SVM-PCa-EDD performed better in early differential diagnosis of PCa.The proposed model can assist medical experts in early diagnosis of PCa,particularly in resource-constrained healthcare settings and making further recommendations for PCa testing and treatment.

CTCF acetylation at lysine 20 is required for the early cardiac mesoderm differentiation of embryonic stem cells

The CCCTC-binding factor(CTCF)protein and its modified forms regulate gene expression and genome organization.However,information on CTCF acetylation and its biological function is still lacking.Here,we show that CTCF can be acetylated at lysine 20(CTCF-K20)by CREB-binding protein(CBP)and deacetylated by histone deacetylase 6(HDAC6).CTCF-K20 is required for the CTCF interaction with CBP.A CTCF point mutation at lysine 20 had no effect on self-renewal but blocked the mesoderm differentiation of mouse embryonic stem cells(mESCs).The CTCF-K20 mutation reduced CTCF binding to the promoters and enhancers of genes associated with early cardiac mesoderm differentia-tion,resulting in diminished chromatin accessibility and decreased enhancer-promoter interactions,impairing gene expression.In summary,this study reveals the important roles of CTCF-K20 in regulating CTCF genomic functions and mESC differentiation into mesoderm.