Objective: To utilize the GEO database for screening DEGs in tissues of esophageal squamous cell carcinoma. It aims to further analyze the correlation with immune cell infiltration and prognosis. Methods: The dataset GSE23400, containing data on esophageal squamous cell carcinoma, was extracted from the GEO database. DEGs analysis was subsequently performed using the Limma package in the R software. The two-platform data of GSE23400 were integrated and the immune cell infiltration in each sample was calculated by ssGSEA algorithm of GSVA package, and the correlation between immune infiltrated cells and DEGs were calculated. The association between DEGs and the overall survival of patients was investigated using the GSE53624 dataset. Furthermore, the correlation analysis between immune infiltrating cells and genes associated with patient survival was evaluated. Also, the expression levels of the survival-related genes in esophageal squamous cell carcinoma were validated using the GSE53622 dataset, and their correlation with patient prognosis was examined. Immunohistochemistry (IHC) was utilized to detect the protein expression levels of DEGs in 38 cases of esophageal squamous cell carcinoma and the corresponding non-tumor tissues. The mRNA and protein expression levels of EHF and CSTB in esophageal squamous cell carcinoma were detected using RT-qPCR and Western blot. Results: Through the analysis of data from 104 patients with esophageal squamous cell carcinoma, a total of 38 DEGs between cancerous and normal tissues were identified. In immune-infiltration analysis, the immune cell infiltration in cancerous and normal tissue was different, the 38 DEGs were related to the abundance of immune cells infiltration. It was exposed that the expressions of EHF and CSTB genes were significantly correlated with survival time of the patients with esophageal cancer through survival analysis (both P<0.05). In GSE53624 dataset, a significant positive correlation was found between EHF gene expression and CD4+T cells, B cells. The correlation coefficients r were 0.69 and 0.67, respectively (both P<0.01). The positively correlation between CSTB gene expression and CD8+T cells, natural killer T cells was significant, with the correlation coefficients r were 0.76 and 0.62, respectively (both P<0.01). The survival time of patients with increased EHF and CSTB genes expression was significantly higher than that of patients with low expression level (median survival 59.1 vs. 24.1; 63.1 vs. 23.9). The expressions of EHF and CSTB genes were decreased in GSE53622 dataset (both P<0.01). Patients with esophageal squamous cell carcinoma who exhibited high expression of EHF and CSTB genes showed a more favorable prognosis compared to those with low expression level (median survival NA vs. 29.7; NA vs. 17.9, both P<0.05). The results from IHC demonstrated a significant decrease in the protein expression levels of EHF and CSTB in esophageal squamous cell carcinoma compared to the corresponding adjacent tissues (both P<0.05). Similarly, the results from RT-qPCR and Western blot analysis indicated a significantly lower expression of EHF and CSTB in esophageal squamous cell carcinoma cells when compared to normal esophageal squamous epithelial cells (both P<0.05). Conclusion: EHF and CSTB genes are likely to play significant roles in tumor immunity and the prognosis of esophageal squamous cell carcinoma. These findings could potentially serve as a theoretical foundation for the development of immunotherapy strategies and prognostic evaluations.
Ferroptosis is a recently discovered form of regulated cell death different from apoptosis, necrosis, pyroptosis and autophagy, which mainly involves three metabolic pathways namely iron metabolism, lipid peroxidation and antioxidant. It plays an important role in the occurrence, progression and drug resistance of digestive tract tumors. Non-coding RNA (ncRNA), including microRNA, lncRNA, and circRNA, regulate the expression of ferroptosis-related genes in digestive tract tumors, thereby influencing the ferroptosis pathway of tumor cells and affecting the initiation and progression of tumors. Therefore, ncRNAs play a crucial role in regulating ferroptosis in digestive tract tumors. This review summarizes the mechanisms of ferroptosis and provides an overview of ncRNA involved in regulating and modulating ferroptosis in digestive tract tumors in recent years, offering theoretical basis for the diagnosis and treatment of digestive tract tumors in the future.
Objective: To explore the characteristics of vestibular evoked myogenic potential (VEMP) in Parkinson's disease (PD) patients and analyze its correlation with postural balance disorders and non-motor symptoms. Methods: A total of 65 patients with primary PD and 60 healthy individuals (HC) matched for gender and age were included in the neurology department of the First Hospital of Hebei Medical University from June 2022 to June 2023, and all underwent VEMP examination. Unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr staging (H-Y) were used to assess patients' motor symptoms and disease severity. Montreal cognitive assessment(MOCA), mini-mental state examination (MMSE), Hamilton depression rating scale-24 (HAMD-24), Hamilton anxiety rating scale-14 (HAMA-14), Pittsburgh sleep quality index (PSQI), rapid eye movement sleep behavior disorder screening questionnaire (RBD-SQ), Parkinson's disease sleep scale (PDSS), scale for outcomes in Parkinson's disease-autonomic(SCOPA-AUT), brief fatigue inventory (BFI), international restless legs scale (IRLS), Kings's Parkinson's disease pain scale (KPPS) and Wexner continence grading score (WCGS) were used to evaluate the non-motor symptoms of patients. Berg balance scale (BBS), activities balance confidence scale (ABC) and Tinetti performance oriented mobility assessment (Tinetti-POMA) were used to assess patients' postural balance disorders. Spearman correlation analysis was used to explore the correlation between VEMP and postural balance disorders and non-motor symptoms. Results: The abnormal rate of VEMP in PD patients was significantly higher than that in HC group [72.31% (47/65) vs. 33.33% (20/60), χ2=19.056, P<0.001], and the abnormal pattern was mainly due to lack of response [58.46% (38/47)]. Spearman correlation analysis between VEMP score and PD patient course, LEDD and various scale scores showed that VEMP score was negatively correlated with BBS score (r=-0.307, P=0.013) and Tinetti-POMA score (r=-0.255, P=0.042), and positively correlated with HAMA-14 score (r=0.323, P=0.009) and RBD-SQ score (r=0.476, P=0.001). Conclusion: The abnormal rate of VEMP in PD patients will significantly increase, and the abnormal pattern was mainly response loss. VEMP abnormalities were significantly correlated with posture balance disorders, anxiety severity, and RBD severity in PD patients. VEMP, as a non-invasive and objective neurophysiological indicator, can provide a basis for diagnosing brainstem dysfunction in PD and lay a theoretical foundation for auxiliary treatments such as vestibular stimulation and vestibular rehabilitation.
Objective: To analyze the correlation between the prevalence of osteoporosis (OP) and osteoarthritis (OA) from the genetic perspective based on Mendelian randomization analysis (MR). Methods: Single nucleotide polymorphism sites (SNPs) were used as instrumental variables to analyze potential causal relationships between exposure factors and outcome factors. The causal relationship between OP and OA in morbidity was analyzed by MR Method. Inverse variance weighting, MR-Egger regression and weighted median method were used to calculate the causal association between OP and OA in terms of morbidity. Results: When bone mineral density (BMD) level was used as exposure dataset and OA as outcome dataset, there was a positive causal effect between BMD level and OA (OR=1.00, 95%CI: 1.00-1.01, P=2.00×10-4<0.01). When OA was used as exposure dataset and BMD level as outcome dataset, there was a negative causal effect between them (OR<1.00, P<0.01). MR analysis results of BMD level and OA in different parts showed: In the positive MR analysis, only when forearm bone density level (FA-BMD) was used as exposure dataset and knee arthritis (KOA) as outcome dataset, there was a negative causal effect between BMD level and OA (OR=1.14, 95%CI: 1.08-1.19, P<0.01); In reverse MR analysis, there was no statistical correlation between OA and OP (OR=1.14, 95%CI: 1.08-1.19, P>0.05); The relationship between OA and OP was affected by the site of disease. Conclusion: Elevated BMD level may increase the risk of OA. There may be a negative correlation between OP and OA in terms of incidence, meaning that OP patients have a lower probability of developing OA.
Objective: The risk factors for collapse in association research circulation osseous (ARCO) stage Ⅱ (non-collapse) nontraumatic osteonecrosis of the femoral head (NONFH) were analyzed, and a nomogram risk prediction model was developed to provide a simple tool and theoretical basis for identifying ARCO stage Ⅱ patients with a high collapse risk. Methods: Patients with ARCO stage Ⅱ and stage ⅢA (early collapse) NONFH diagnosed and treated from July 2017 to February 2024 were retrospectively selected as subjects. The patients were randomly divided into a training group and a verification group at a ratio of 6:4 to screen the independent risk factors of collapse and develop a prediction model and test the model's effectiveness. The optimal characteristic values were screened using LASSO regression analysis of the indexes of the patients in the training group with R statistical software. The risk factors of collapse were screened using a multifactor Logistic regression analysis. A prediction model was developed, and thus, the prediction and differentiation performance of the model for the risk of collapse in ARCO stage Ⅱ patients were compared between the training and verification groups. The evaluation indexes included the C-index and calibration curve. The model was visually quantified by a nomogram and its clinical effectiveness was evaluated by a decision curve. Results: A total of 78 patients (95 hips) with ARCO stage Ⅱ NONFH and 80 patients (102 hips) with ARCO stage ⅢA NONFH who met the criteria were included, totaling 197 hips. Multifactor Logistic regression analysis showed a long pain time (OR=1.176,95%CI:1.090-1.313), the percentage of femoral head involvement (PFHI) >30% (OR=25.257,95%CI:2.771-436.321), bone marrow edema (BME) grade 3 (OR=1.963,95%CI:0.017-22.424), combined preserved angle (CPA) <118.7°(OR=6.814,95%CI:1.658-37.099), high red blood cell volume distribution width (OR=1.097,95%CI:0.611-1.570) and high platelet volume distribution width (OR=1.174,95%CI:0.119-13.149) were independent risk factors for femoral head collapse (P<0.05). The collapse risk prediction model for patients with NONFH in ARCO stage Ⅱ developed in this study showed good differentiation, and its C-indices in the training and verification groups were 0.844 and 0.878, respectively. In the training and verification groups, the calibration curve showed that the predicted results of the nomogram agreed well with the actual observational results. The results of the decision curve analysis showed that the prediction model could provide more net benefits to patients within a more extensive probability threshold range. Conclusion: Long pain duration, PFHI >30%, BME grade 3, CPA <118.7°, high red blood cell volume distribution width and high platelet volume distribution width can be used as predictive factors for the occurrence of femoral head collapse in ARCO stage Ⅱ, which is helpful for clinicians to detect and intervene in the occurrence and development of femoral head collapse in the early stages.
Objective: To investigate the hospitalization expenses and contributing factors for neonate with persistent pulmonary hypertension of the newborn (PPHN) in 37 hospitals in Guangdong Province, providing insights for systematic management, healthcare communication, and policy-making in medical insurance. Methods: Medical records of PPHN neonates from 37 hospitals in Guangdong province (2015-2020) were collected. Hospitalization expense were analysed using descriptive statistics, and influential factors were determined through univariate analysis and recursive partitioning. Results: The average total hospitalization expense for PPHN neonates increased annually from 31 758 (16 715, 46 430) RMB in 2015 to 52 505(30 400, 84 216) RMB in 2020. The total hospitalization cost of deceased children is 26 146 (14 771, 52 505) RMB, and the total hospitalization cost of surviving children is 44 245 (21 274, 74 197) RMB. Factors such as regional economic level (P<0.001), delivery methods (P<0.001), conception methods (P<0.001), gestational age (P<0.001), birth weight (P<0.001), gender (P=0.046), cause of PPHN (P<0.001), treatment with mechanical ventilation (P<0.001), use of pulmonary surfactant (PS) (P<0.001), inhaled nitric oxide (iNO) treatment (P<0.001), and duration of hospitalization (P<0.001) significantly influenced these expense. The recursive system model analysis shows that the influencing factors of hospitalization costs for children with PPHN, in descending order of total effect value, are: length of hospital stay, ventilator-associated ventilation, full-term infants, late preterm infants, use of iNO therapy, use of PS therapy, causative factors of pneumonia, delivery location, combination of two or more causative factors, and female birth gender.Conclusion: From 2015 to 2020, the hospitalization expense for patients with PPHN in Guangdong province increased due to various factors, with hospitalization duration being the predominant factor. Optimizing hospitalization length while ensuring medical quality and safety could effectively reduce PPHN-related hospitalization expense.
Objective: To investigate the correlation between image features,quantitative indices of conventional two-dimensional ultrasound and Virtual Touch Tissue Imaging Quantification (VTIQ) with different molecular subtypes of breast cancer. Then this study further assesses the value of integrating VTIQ quantitative indices with two-dimensional ultrasound imaging types in predicting molecular subtypes of breast cancer. Methods: A total of 110 cases of female breast diseases(112 lesions)who received medical treatment at the department of breast surgery of the Third Affiliated Hospital of Guangzhou Medical University from January 2021 to February 2023 were included. Preoperative two-dimensional ultrasound and VTIQ examinations were performed, recording patient demographics and ultrasound image characteristics. Patients were divided into malignant and benign groups based on postoperative pathology, with molecular markers expression recorded, and subtyped according to immunohistochemical results. Using the benign and malignant breast lesions and molecular subtypes as dependent variables, receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic efficacy of maximum shear wave velocity (SWVmax), minimum shear wave velocity (SWVmin), and mean shear wave velocity (SWVmean) parameters. Results: Statistical significance (P<0.05) was found for tumor margin, shape, hyperechoic halo, calcification, posterior echo, color Doppler flow imaging (CDFI) blood flow grading, VTIQ image type, and SWVmax, SWVmean, SWVmin in distinguishing between benign and malignant breast tumors. Among different molecular subtypes of breast cancer, Luminal A type was less likely to exhibit lymph node metastasis and calcification, with VTIQ images predominantly showing edge type and SWVmax and SWVmean significantly lower than non-Luminal types (P<0.05). Her-2 overexpression type was more prone to calcification compared to Luminal A type, with SWVmax significantly higher and SWVmin significantly lower than Luminal B type (P<0.05). Triple-negative breast cancer often showed increased posterior echo enhancement, with VTIQ images predominantly central type and SWVmin significantly lower than Luminal B type (P<0.05). The diagnostic efficacy of VTIQ quantitative parameters, VTIQ quantitative parameters combined with image types, and VTIQ quantitative parameters combined with image types and two-dimensional ultrasound image characteristics in identifying benign and malignant breast tumors and molecular subtypes of breast cancer progressively improved. Conclusion: Combining VTIQ technology with two-dimensional ultrasound improves diagnostic efficacy for distinguishing benign and malignant breast tumors and identifying molecular subtypes of breast cancer, offering new perspectives for non-invasive preoperative evaluation.
Objective: To explore the diagnostic value of MRI parameters combined with serum AFP and IL-33 in primary hepatocellular carcinoma (HCC). Methods: Patients with HCC, intrahepatic cholangiocarcinoma or benign liver disease admitted to Guangdong Hospital of Traditional Chinese Medicine from January 1, 2020 to April 1, 2024 were included. 106 cases of HCC, 58 cases of intrahepatic cholangiocarcinoma, 179 cases of benign liver disease group (59 cases of hepatic hemangioma, 62 cases of hepatic cyst, 58 cases of and hepatic focal nodular hyperplasia were finally included). All patients were examined by MRI and the levels of AFP and IL-33 were detected. The transport constant (Ktrans), rate constant (Kep), extracellular space volume percentage (Ve), and serum AFP and IL-33 levels were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of the above indexes alone or in combination for HCC. Results: The levels of Ktrans, Kep and Ve in HCC group were significantly higher than those in intrahepatic cholangiocarcinoma and benign liver disease group, and the difference was statistically significant (P<0.001). The levels of serum AFP and IL-33 in HCC group were significantly higher than those in intrahepatic cholangiocarcinoma and benign liver disease group, and the difference was statistically significant (P<0.001). ROC curve analysis showed that the optimal cut-off values of MRI parameters Ktrans, Kep and Ve in the diagnosis of HCC were 0.38 mL/min, 1.32 mL/min and 0.36%. The optimal cut-off values of AFP and IL-33 for HCC diagnosis were 44.52 ng/mL and 100.81 ng/mL. The sensitivity of Ktrans, Kep, Ve, AFP and IL-33 in the diagnosis of HCC were 74.58%, 74.58%, 71.19%, 77.12% and 77.97%, and the specificity was 74.53%, 77.36%, 73.58%, 74.53% and 74.53%. The AUC of Ktrans, Kep, Ve combined with AFP and IL-33 in the diagnosis of HCC was 0.959 (95%CI: 0.936-0.982), and the predictive sensitivity and specificity were 91.53% and 90.57%. Conclusion: The combined detection of Ktrans, Kep, Ve, AFP, and IL-33 show good diagnostic efficacy of HCC, which may provide certain clinical reference value for HCC diagnosis.
Objective: To explore the application effect of Healthcare Failure Mode and Effects Analysis (HFMEA) based on multidisciplinary collaboration in reducing hospital infection rates. Methods: A retrospective analysis was conducted on hospital infection data to the Third Affiliated Hospital of Sun Yat sen University from January to December 2022. The HFMEA model was used for risk assessment, identifying high-risk areas, developing preventive measures and corrective plans for high-risk areas, and implementing improvement measures from January to December 2023. In December 2023, a risk assessment will be conducted to analyze the control effect of hospital infections after the application of multidisciplinary collaboration in HFMEA. Results: Compared with 2022, there were no significant differences in the incidence of hospital infections, MDRO infections, and VAP after the application of multidisciplinary collaboration in HFMEA in 2023 (P values of 0.650, 0.653, and 0.219, respectively). However, there were significant improvements in the rates of antimicrobial pathogen testing, CAUTI, CLABSI, hand hygiene compliance and hand hygiene accuracy (P<0.05). Conclusion: The application of HFMEA based on multidisciplinary collaboration in hospital infection management can significantly improve the rate of antimicrobial pathogen testing, significantly reduce the incidence of CAUTI and CLABSI, and greatly improve hand hygiene compliance and accuracy.
Objective: To investigate the current situation of medication knowledge-attitude-practice (KAP) among self-medicators in Shenzhen, analyze the potential risks and main influencing factors in the process of medication, so as to provide a theoretical basis for the drug regulatory authorities to formulate relevant policies. Methods: A convenient sampling method was used to conduct an online questionnaire survey on the demographic characteristics and medication KAP among self-medicators in Shenzhen through the online questionnaire survey platform(
Objective: Analyze the efficacy of the fully convolutional single-stage breast AI algorithm based on fully digital mammography (FD) and the 3D multi image fusion AI algorithm based on digital breast tomography (DBT) in the diagnosis of breast tumor images. Methods: The FD AI algorithm (AI-FD) and DBT AI algorithm (AI-DBT) were used to calculate the imaging data of 469 cases (515 lesions) with the pathologically confirmed breast diseases in breast surgery department of Changzhou Maternal and Child Health Hospital in 2022. Based on the pathological results, collect and record the positive number and coincidence number of the results of the two algorithms, and compare the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of the two algorithms for breast cancer.With pathological diagnosis as the gold standard,the receiver operating characteristic curve (ROC) and the area under the curve (AUC) of diagnostic methods such as AI algorithm, ultrasound (US), and manual diagnosis of molybdenum target X-ray (manual MG). Results: The positive data of AI-DBT group was 67.81%, higher than the AI-FD group (49.11%), the difference was statistically significant ( χ2=35.01, P<0.05). The coincidence data of AI-DBT group was 44.33%, slightly lower than the AI-FD group (46.90%), there was no statistical difference between groups according to the meaning ( χ2=0.42, P>0.05). Comparing between the two algorithms, AI-DBT has high sensitivity but weak specificity in the diagnosis of breast cancer, while the specificity of AI-FD group was better. In terms of AUC value, manual diagnosis (MG) was the highest, 0.804, followed by the two AI algorithms, which were both slightly higher than ultrasound. Conclusion: The AI algorithm based on three-dimensional tomographic images of breast DBT and two-dimensional images of FD has certain accuracy in the diagnosis of breast tumors, especially breast cancer. However, there is still a certain gap of the diagnostic efficacy between it and manual MG. Therefore, it cannot completely replace manual diagnosis at present.
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