Development and validation of a machine learning-based early prediction model for massive intraoperative bleeding in patients with primary hepatic malignancies

BACKGROUND Surgical resection remains the primary treatment for hepatic malignancies,and intraoperative bleeding is associated with a significantly increased risk of death.Therefore,accurate prediction of intraoperative bleeding risk in patients with hepatic malignancies is essential to preventing bleeding in advance and providing safer and more effective treatment.AIM To develop a predictive model for intraoperative bleeding in primary hepatic malignancy patients for improving surgical planning and outcomes.METHODS The retrospective analysis enrolled patients diagnosed with primary hepatic malignancies who underwent surgery at the Hepatobiliary Surgery Department of the Fourth Hospital of Hebei Medical University between 2010 and 2020.Logistic regression analysis was performed to identify potential risk factors for intraoperative bleeding.A prediction model was developed using Python programming language,and its accuracy was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Among 406 primary liver cancer patients,16.0%(65/406)suffered massive intraoperative bleeding.Logistic regression analysis identified four variables as associated with intraoperative bleeding in these patients:ascites[odds ratio(OR):22.839;P<0.05],history of alcohol consumption(OR:2.950;P<0.015),TNM staging(OR:2.441;P<0.001),and albumin-bilirubin score(OR:2.361;P<0.001).These variables were used to construct the prediction model.The 406 patients were randomly assigned to a training set(70%)and a prediction set(30%).The area under the ROC curve values for the model’s ability to predict intraoperative bleeding were 0.844 in the training set and 0.80 in the prediction set.CONCLUSION The developed and validated model predicts significant intraoperative blood loss in primary hepatic malignancies using four preoperative clinical factors by considering four preoperative clinical factors:ascites,history of alcohol consumption,TNM staging,and albumin-bilirubin score.Consequently,this model holds promise for enhancing individualised surgical planning.

The Role and Mechanism of Unfolded Protein Response Pathway in Tumor Drug Resistance

In the process of tumor proliferation and metastasis,tumor cells encounter hypoxia,low glucose,acidosis,and other stressful environments.These conditions prompt tumor cells to generate endoplasmic reticulum stress(ERS).As a signal mechanism that mitigates ERS in eukaryotic cells,the unfolded protein response(UPR)pathway can activate cells and tissues,regulating pathological activities in various cells,and maintaining ER homeostasis.It forms the most crucial adaptive and defensive mechanism for cells.However,under the continuous influence of chemotherapy drugs,the quantity of unfolded proteins and erroneous proteins produced by tumor cells significantly increases,surpassing the normal regulatory range of UPR.Consequently,ERS fails to function properly,fostering tumor cell proliferation and the development of drug resistance.This review delves into the study of three UPR pathways(PERK,IRE1,and ATF6),elucidating the mechanisms of drug resistance and research progress in the signal transduction pathway of UPR related to cancers.It provides a profound understanding of the role and relationship between UPR and anti-tumor drugs,offering a new direction for effective clinical treatment.

Detection and Clinical Significance of Peripheral Blood CTC, CA125, CA153, and CEA Levels in Patients with Ductal Carcinoma in situ

Objective:To explore the detection and clinical significance of peripheral blood CTC,CA125,CA153,and CEA levels in patients with DCIS.Methods:210 patients who received surgical treatment for breast cancer in our hospital from January 2019 to December 2022 were selected as the research subjects.According to the postoperative pathology,100 cases were divided into breast cancer and 110 benign breast tumor groups.One hundred ten healthy patients undergoing physical examination during the same period were selected as the control group.CA153,CA125,and CEA levels were observed in the three groups.Results:The levels of CA153,CA125,and CEA in the breast cancer group were significantly higher than those in the benign breast tumor group and the control group(P<0.05);the levels of CA153,CA125,and CEA in the benign breast tumor group were all higher than those in the control group,but the differences were not statistically significant;among the three tumor markers,CA153 has the highest sensitivity at 39.00%,CA125 has the second highest sensitivity at 18.00%,and CEA has the lowest sensitivity at 17.00%;The sensitivity of the two joint tests of CA153+CA125,CA153+CEA,and CA125+CEA for the diagnosis of breast cancer were 50.00%,48.00%,and 26.00%respectively;the sensitivity of the three joint tests is the highest,reaching 53.00%,while the specificity of the joint tests was lower than the individual tests.Conclusion:Detection of peripheral blood CTC,CA125,CA153,and CEA levels has specific reference significance for the treatment and prognosis of DCIS patients.

Clinical Value of cfDNA Content in Peripheral Blood of Patients with Triple-Negative Breast Cancer

Objective:To explore the value of circulating free(cfDNA)content in the clinical diagnosis and treatment of triple-negative breast cancer(TNBC).Methods:A total of 39 TNBC patients,45 non-TNBC patients,and 50 healthy individuals admitted to the Baoding First Central Hospital during 2019-2022 were recruited.The clinical data,peripheral blood cfDNA concentration,and clinicopathological indicators of the patients were observed and analyzed.Results:The difference in clinical indicators such as age,age range,tumor size,clinical stage,and lymph node metastasis between patients with TNBC and non-TNBC was insignificant(P>0.05).The cfDNA concentrations(ng/mL)of the TNBC group,non-TNBC group,and healthy group were 24.12±4.98,15.36±4.12,and 3.12±1.02,respectively,and they are statistically different(P<0.05).The difference in cfDNA concentration was insignificant between TNBC patients with tumors≤2 cm and>2 cm(P>0.05)but was significant between TNBC patients with clinical stages I+II and III+IV(P<0.05).The cfDNA concentration in TNBC patients with lymph node metastasis was significantly higher than those without lymph node metastasis(P<0.05).Conclusion:cfDNA has an important application value in the diagnosis and treatment of breast cancer.By detecting the cfDNA level and its gene variation,valuable information about the progress and treatment effects of breast cancer can be obtained.This non-invasive detection method has a wide range of applications and can be used for early screening,auxiliary diagnosis,efficacy evaluation,and recurrence monitoring of breast cancer.

Application Experience of Case-Introduction Teaching in the Pathological Regulation Teaching of the Lymphohematopoietic System

Pathology is the gold standard for clinical diagnosis and an important bridge between clinical work and basic disciplines.Therefore,training qualified clinical pathologists is very important for clinical work.It is challenging to diagnose lymphohematopoietic diseases in practice since they made up a large percentage of resident doctors’standardized training and there are numerous knowledge nodes associated with them.Therefore,this training base adopts the“case-introduction”teaching mode to help resident doctors master the knowledge nodes required by the outline in the study of lymphohematopoietic system pathology.

The Role of Endoplasmic Reticulum Stress Sensor Protein CREB3L2 in the Development of Tissues and Tumors

The endoplasmic reticulum plays an extremely important role in the process of cellular protein secretion.The cyclic AMP-responsive element-binding protein 3(CREB3)transcription factor family is closely associated with the secretion and transport of proteins within the endoplasmic reticulum.As a member of the CREB3 transcription factor family,cyclic AMP-responsive element-binding protein 3-like protein 2(CREB3L2)stands out as a non-classical sensor within the endoplasmic reticulum.CREB3L2 can detect and regulate endoplasmic reticulum pressure,exert control over the processes of protein transport and secretion,participate in the development of tumor cells,and is also closely linked to the development of certain human tissues and organs.This article aims to review the role of CREB3L2 in tissue development and disease,shedding light on the related mechanisms of CREB3L2 in cancer development.The goal is to provide insights and directions for further analysis of CREB3L2.

Natural history of persistent subretinal fluid following the successful repair of rhegmatogenous retinal detachment

AIM:To provide a detailed description of the natural history of persistent subretinal fluid(SRF)after successful repair of rhegmatogenous retinal detachment(RRD)and its association with visual outcome.METHODS:This was a prospective long-term follow-up for eyes undergoing scleral buckling(SB)surgery for maculaoff RRD.Examinations were carried out preoperatively and postoperatively at 1,3,6,9 and 12 mo,until persistent SRF had completely resolved.One month postoperatively,optical coherence tomography(OCT)was used to classify SRF into three patterns:bleb-like loculated(BL),shallow-diffused(SD),and multiple blebs(MB).Serial OCT imaging was used to evaluate morphological changes in SRF until its complete disappearance.Patients were divided into two groups depending on the presence or absence of persistent SRF.RESULTS:A total of 59 patients(59 eyes)were included.There were no statistical differences between two groups at baseline,except for the proportion of patients with high myopia and a younger age.One month after surgery,OCT detected persistent SRF in 49 eyes(83.1%).The 3 morphological patterns of SRF were observed in 27 eyes(55.1%)with BL,13 eyes(26.5%)with SD,and 9 eyes(18.4%)with MB.The mean time for complete absorption differed significantly across the three SRF patterns(F=8.097,P=0.001),which was 8.8±6.1,20.1±12.1,and 16.7±10.2 mo in BL,SD,and MB,respectively.In 9 of the 13 eyes with SD,the pattern transformed into MB type.In cases involving MB,the size and number of blebs decreased gradually until they had been completely absorbed.Eyes with persistent SRF were more likely to demonstrate disruption of the ellipsoid zone(49.0%vs 10%,P=0.034).The final best-corrected visual acuity of two groups was 0.37±0.11(with SRF)vs 0.34±0.12(without SRF)logMAR(P=0.499),respectively.CONCLUSION:High preoperative myopia and younger age are associated with persistent SRF.BL is the most commonly observed pattern with the shortest duration and gradually disappeared.Most cases involving SD SRF transform into MB type during resolution.The size and number of the MBs decrease gradually until they were completely absorbed.The absence of persistent SRF may contribute to slow visual recovery in the short-term but does not influence the final visual outcome.

Effects of aminoguanidine on retinal apoptosis in mice with oxygen-induced retinopathy

AIM:To explore the protective effects of amino-guanidine(AG) on retinal apoptosis in mice with oxygeninduced retinopathy(OIR).·METHODS:A total of 80 C57BL/6J mice,aged 7 days,were randomly divided into four groups:normal,high oxygen,high oxygen saline and high oxygen treated with AG.In the normal group,mice were housed in normoxic conditions from postnatal day P7 to P17.Mice in the other 3 groups were placed under hyperoxic conditions(75 ±2% O2) in an oxygen-regulated chamber for 5 days and subsequently placed in normoxic conditions for 5days.Mice in the AG group were treated once daily,from P12 to P17,with AG hemisulfate(100mg/kg body weight,intraperitoneally) dissolved in physiological saline.An equivalent amount of 0.9% physiological saline was administered,as above,to mice in the high oxygen saline group.Ten mice were randomly selected from each group on P14 and on P17,euthanized and the retinas examined.Apoptotic cells in the retina were detected using the terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL) method.The expression of nitric oxide synthase(iNOS) in the retina was detected by immunohistochemistry and changes in rod cells were observed using electron microscopy.·RESULTS:TUNEL-positive cells and iNOS immunoreactive neurons were present in the inner nuclear and ganglion cell retinal layers of mice in the high oxygen group.The number of TUNEL-positive cells was significantly greater in the high oxygen group compared with the normal group(t =-20.81,P14d【0.05;t =-15.05,P17d【0.05).However,the number of TUNEL-positive cells in the AG treatment group was significantly lower(t =-13.21,P14d【0.05;t =-6.61,P17d【0.05) compared with thehigh oxygen group.The expression of iNOS was significantly higher in the high oxygen group compared with the normal group(t =-21.95,P14d【0.05;t =-17.30,P17d【0.05).However,the expression of iNOS in the AG treatment group was significantly lower(t =-12.17,P14d【0.05;t =-10.30,P17d【0.05) compared with the high oxygen group.The outer segments of the rods were disorganized and short in the high oxygen group.Rod morphology appeared to be slightly improved in the AG group.·CONCLUSION:AG may protect retinal neurons in OIR by inhibiting apoptosis.The mechanism may be related to iNOS.

Overview of the pathogenesis of Henoch-Schonlein purpura in children and the research progress on related mechanism of inflammatory cytokines

Henoch-schonlein purpura (HSP) is a kind of systemic vasculitis that is common in childhood,and its pathogenesis is complicated and considered to have important relationship with lymphocytes, vascular endothelial cells and so on. The causes of this disease are complex and have not been clearly identified, but numerous studies have shown that inflammatory factors such as IL-1, IL-17 and TNF-α play an important role in the development of HSP.

Research Progress of Prostate Stem Cell Antigen in Bladder Cancer Treatment

In order to study the application effect of prostate stem cell antigen in the treatment of bladder cancer,several literatures have been reviewed in this paper,including the predisposition factors of bladder cancer,clinical treatment methods,progress of prostate stem cell antigen,and nanomaterial probe.This paper presents a feasible method of using luminescent nanomaterials(anti-UCNPs)as biological probes.

Multiple well-differentiated retroperitoneal liposarcomas with different patterns of appearance on computed tomography:A case report

BACKGROUND Primary retroperitoneal liposarcoma(PRPLS)is a rare soft tissue tumor with nonspecific clinical symptoms;it has different computed tomography(CT)image features according to pathological types.Some patients with a single tumor have been previously reported in the literature.We present an exceptional case of a PRPLS patient with multiple large tumors exhibiting different patterns of appearance on CT and confirmed as atypical lipomatous tumor/welldifferentiated liposarcoma by postoperative pathology.CASE SUMMARY A 64-year-old man presented with abdominal distension for 1 year.The patient was diagnosed with PRPLS based on physical examination,laparotomy,ultrasonography,CT scan,and surgery.Both of the tumors were completely resected through surgery and confirmed as atypical lipomatous tumor/welldifferentiated liposarcoma by postoperative pathology.The postoperative course was uneventful without recurrence or metastasis,as demonstrated by abdominalpelvic CT during an 18 mo follow-up.CONCLUSION Multiple large Well-differentiated liposarcomas with different patterns of appearance on CT image can occur simultaneously in the same patient,to which more attention should be paid to make an effective differential diagnosis.

Collision carcinoma of the rectum involving neuroendocrine carcinoma and adenocarcinoma:A case report

BACKGROUND Collision carcinoma is a rare histological pattern,and includes two or more different types of tumors coexisting in the same organ as one neoplasm.Different to the combined type,the two adjacent tumors of collision carcinoma are histologically distinct.Collision carcinoma may occur from any origin or organ,including the cecum,liver,cervix,thyroid,stomach,kidney,and esophagus.In the rectum,adenocarcinoma is the most common pathological type,the combined type is rare,and collision tumors are even rarer.To date,only a limited number of collision carcinoma cases originating from the rectum have been reported.Due to the scarcity of rectal collision carcinoma,more cases need to be reported to fully understand the clinico-pathological features and biological behavior of the tumor.CASE SUMMARY Here we report a 40-year-old female who presented with the chief complaints of persistent changes in bowel habits and hematochezia for 10 d.She underwent Miles'operation which revealed a collision carcinoma of the rectum,showing a“side by side”pattern,composed of a high grade neuroendocrine carcinoma,(small cell carcinoma)and moderately differentiated adenocarcinoma,based on its clinico-pathological features and biological behavior.The patient remained disease-free at 12 mo follow-up.We also focused on the related literature and expert opinion.CONCLUSION Collision carcinoma is a rare tumor with ambiguous biological behavior.Greater attention should be paid to its clinico-pathologic diagnosis.Regular and adequate follow-up is essential to help rule out metastasis and assess the prognosis.

Dominant cystoid macular dystrophy associated with mutations in the RP1L1 gene

Dear Editor,We describe in detail a case of dominant cystoid macular dystrophy(DCMD)patient carrying a novel heterozygous RP1 L1 mutation.DCMD is a unique form of macular dystrophy;the appearance of cystic spaces in the macula indicates its onset,while the rest of the retina is essentially normal.

Effect of Liraglutide Combined with Nephritis Rehabilitation Tablets for Type 2 Diabetic Nephropathy

Objective: To explore the effect of liraglutide combined with Nephritis Rehabilitation Tablets in the treatment of type 2 diabetic nephropathy. Methods: Ninety patients with type 2 diabetic nephropathy who had received treatment in the Hospital from January 2018 to March 2019 were enrolled, and then randomly divided into a Liraglutide group, a Nephritis Rehabilitation Tablets group and a combined treatment group, with 30 cases in each group. All patients were given routine treatment. Besides, the Liraglutide group was treated with subcutaneous injection of liraglutide, the Nephritis Rehabilitation Tablets group was treated with oral Nephritis Rehabilitation Tablets, and the combined treatment group was given subcutaneous injection of liraglutide and oral administration of Nephritis Rehabilitation Tablets. The three groups were treated continuously for 12 weeks to compare the changes of glucose metabolism index, renal function and inflammatory factors. Results: After treatment, the levels of FPG, 2hPG and HbALc were decreased in the three groups, and the levels in the combined treatment group were lower than the liraglutide group and the Nephritis Rehabilitation Tablets group, and the liraglutide group lower than the Nephritis Rehabilitation Tablets group. The difference was statistically significant (P<0.05). After treatment, the levels of serum creatinine and urea nitrogen decreased in the three groups, and the levels in the combined treatment group were lower than the liraglutide group and the Nephritis Rehabilitation Tablets group, and the Nephritis Rehabilitation Tablets group lower than the liraglutide group. The difference was statistically significant (P<0.05) After treatment, the levels of IL-6, TNF-α, and hs-CRP decreased in the three groups, and the levels in the combined treatment group were lower than the liraglutide group and the Nephritis Rehabilitation Tablets group. The difference was statistically significant (P<0.05). Conclusions: For patients with type 2 diabetic nephropathy, Liraglutide combined with Nephritis Rehabilitation Tablets can help reduce the blood sugar, relieve renal inflammation and improve their renal function.

Effects of liraglutide on soluble tumor necrosis factor receptor in patients with diabetic nephropathy

Objective:To observe the effects of Liraglutide combined with sequential dialysis on soluble tumor necrosis factor receptor in patients with diabetic nephropathy.Methods: A total of 110 patients with early diabetic nephropathy who had been seeking treatment in the hospital between December 2016 and December 2017 were selected and according to the random number table method, these patients were randomly divided into two groups, with 55 cases in each group. Patients in the control group were given conventional symptomatic treatment such as hypoglycemic therapy, whereas the observation group was treated with Liraglutide based on the conventional symptomatic treatment given to the control group. The renal function, blood glucose metabolism level, serum indexes, vascular endothelial function and adverse drug reactions were compared between the two groups.Results: After treatment, the levels of 24 hUpor, UAER and Scr in the two groups were both shown to be lower than those before treatment, and the levels in the observation group were shown to be lower than those in the control group, with the differences being statistically significant. After treatment, the levels of PBG, FPG, HOMA-IR , HbA1c and FIns in the two groups were both significantly lower than before treatment, and the levels of PBG, FPG, HOMA-IR , HbA1c and FIns in the observation group were shown to be lower than those in the control group, where the differences were statistically significant. After treatment, the levels of TNF-α, sTNFR1 and hs-CRP in the two groups were significantly reduced than before treatment, and the levels in the observation group were shown to be significantly lower than the control group, with statistically significant differences. After treatment, the NO levels in both groups were significantly increased and ET-1 level significantly reduced than before treatment, and the NO level in the observation group was shown to be higher and the ET-1 level lower than the control group, where the difference was statistically significant.Conclusion: Liraglutide is with higher safety for patients with diabetic nephropathy, which can effectively improve their renal function and blood glucose, enhance insulin sensitivity, reduce the levels of inflammatory factors, and improve the endothelial function.

Influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer

Objective: To observe the influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer. Methods:A total of 60 patients with lung cancer were randomly divided into two groups: observation group (30 cases) and control group (30 cases). Observation group: general anesthesia combined with epidural anesthesia;control group: patients were treated only by general anesthesia. Recording and comparing the levels of Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS and immunologic function before and after treatment. Results: (1) Before treatment, there was no statistically significant difference in the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels between the two groups. After treatment, the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels of the two groups were significantly lower than those of the same group before treatment, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. (2) Before treatment, there was no statistically significant difference in CD4+, CD8+, CD4+/CD8+between the two groups. After treatment, the CD4+, CD4+/CD8+ of the two groups were significantly lower than those of the same group before treatment, the CD8+ of the two groups were significantly higher, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. Conclusion:General anesthesia combined with epidural anesthesia for patients with lung cancer can perfect the levels of serum adrenal cortical hormone, stress factors and be beneficial to protect their immunologic function.

Effects of Xintongding and labellol on hemorheology, oxidative stress and inflammatory endothelial factor in patients with gestational hypertension

Objective:To explore the effects of Xintongding and labellol on hemorheology, oxidative stress and inflammatory endothelial factor in patients with gestational hypertension.Methods:104 patients with gestational hypertension admitted to our hospital from March 2016 to January 2018 were selected as the research object. 52 patients in the control group and 52 patients in the observation group were randomly divided into two groups. The control group was treated with Xintongding, while the observation group was treated with Labellol on the basis of the control group. The changes of blood pressure, hemorheology, oxidative stress index and inflammatory endothelial factors were compared and analyzed between the two groups.Results:Before treatment, there were no significant differences in the levels of SBP, DBP, LBV, HBV, PV, FIB, LPO, MDA, SOD, TNF-α, CRP, VEGF and PLGF. After treatment, the levels of SBP, DBP, LBV, HBV, PV, FIB, LPO, MDA, TNF-α and CRP were significantly decreased, while the levels of SOD, VEGF and PLGF were significantly higher than before treatment, and the levels of SBP, DBP, LBV, HBV, PV, FIB, LPO, MDA, TNF-α and CRP in the observation group were significantly lower than those in the control group, and the levels of SOD, VEGF and PLGF were significantly higher than the control group. Conclusions: Xintongding combined with labetalol in the treatment of hypertensive disorder in pregnancy can effectively improve blood pressure, blood rheology and oxidative stress, reduce inflammation and promote angiogenesis, and has clinical significance.

Expression and Clinical Significance of Hypoxia-related Factors HIF-1a,Gli-1 and MMP9 in Breast Cancer

Objective:To investigate the expression and clinical significance of hypoxia inducible factors HIF-1a,Gli-1 and MMP9 in breast cancer.Methods:Eighty patients with invasive ductal carcinoma of the breast and 40 normal tissues adjacent to cancer were selected.Immunohistochemical methods were used to detect the expression of HIF-1a,Gli-1 and MMP9 in breast cancer and normal tissues adjacent to cancer,and their re1ationship with clinicopathological features of breast cancer and prognosis was explored.Results:The positive rates of HIF-1a,Gli-1 and MMP9 in breast cancer tissues were significantly higher than those in normal breast tissues.HIF-1a,Gli-1 and MMP9 expressions are positively corre1ated in breast cancer.Conclusion:HIF-1a,Gli-1 and MMP9 proteins are involved in the pathogenesis of breast cancer.

Current Research Status of Circulating Free DNA in Clinical Application

Circulating free DNA(cfDNA)refers to the free DNA nucleotides in body fluids,but the dynamic response in vivo tumor load and full assessment of genetic heterogeneity in cancer patients provides a non-invasive diagnostic approach.It is one of the effective biomarkers for cancer screening and diagnosis,and also provides for the prognosis for patients with advanced cancer and forecast information.In this paper,the clinical application of cfDNA is reviewed.

Research Progress on Molecular Mechanisms of Tumor Budding in Colorectal Cancer

Tumor buds are usually defined as isolated single cancer cells or clusters of up to four cancer cells located at the front of invasive tumors which play an important role in the clinical pathological study of colorectal cancer.The prognostic value of tumor budding in colorectal cancer has been supported by a large amount of evidence.However,its molecular mechanism remains unclear,and it is also a research hotspot now.This paper reviews the latest research progress on the molecular mechanisms of tumor budding in colorectal cancer.