ObjectiveTo explore the immune biomarkers for prognosis of breast cancer and to construct a risk assessment model.MethodsThe gene expression of breast cancer samples was retrieved from The Cancer Genome Map (TCGA) database and immune related genes (IRGs) were retrieved from the ImmPort database. Cox proportional hazards regression and least absolute shrinkage and selection operator (LASSO) regression were used for prognostic analysis. Gene set enrichment analysis ( GSEA) was used to explore biological signaling pathways. ESTIMATE and CIBERSORT algorithms were used to explore the relationship between risk score and tumor immune microenvironment.ResultsNine kinds of immune-related differentially expressed genes independently related to prognosis were identified: adrenoceptor beta 1 (ADRB1), interleukin 12B (IL12B), syndecan 1 (SDC1), thymic stromal lymphopoietin (TSLP), fibroblast growth factor 19 (FGF19), fatty acid binding protein 7 (FABP7), interferon epsilon (IFNE), tumor necrosis factor receptor superfamily member 18 (TNFRSF18) and interleukin 27 (IL27). The risk assessment equation constructed by these nine kinds of genes had powerful predictive ability. The “neurotrophin signaling pathway” and “adipocyte factor signaling pathway” were activated in patients of high-risk group, and “leukocyte transendothelial migration” “WNT signaling pathway” “FcεRI signaling pathway” “valine, leucine and isoleucine biosynthesis” and “protein export pathway” were activated in patients of low-risk group. A variety of tumor-killing immune cells were significantly enriched in the tumor-infiltrating immune cells of patients in the low-risk group. The immunosuppressive immune cells were significantly enriched in tumor infiltrating immune cells of patients in high-risk group.ConclusionIRGs prognostic signatures are an effective potential predictive classifier in breast cancer treatment.
Objective To summarize the research progress of immunotherapy for metastatic breast cancer. Method Literatures about immunotherapy for metastatic breast cancer were reviewed by searching the literatures in domestic and foreign database. Results In recent years, immunotherapy had been initially attempted in patients with metastatic breast cancer and showed its unique value. It provided a new way to improve the therapeutic effect and prolong the survival time of patients with metastatic breast cancer. ConclusionsImmunotherapy is the most effective in triple-negative metastatic breast cancers. The immuno-oncology needs to be developed to improve the clinical benefits of immunotherapy for breast cancer.
ObjectiveTo investigate the influence of misplaced subclavian vein (SCV) catheter into the ipsilateral internal jugular vein (IJV) on transpulmonary thermodilution (TPTD) measurements and explore the possible mechanisms preliminarily.MethodsIn this prospective study, 408 patients in whom an SCV catheterization was indicated for TPTD monitoring were enrolled. A first set of TPTD measurements was collected at baseline in all patients (group 1, SCV catheters were correctly placed; group 2, SCV catheters were misplaced into the ipsilateral IJV). The parameters included mean transit time (MTt), downslope time (DSt), cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). A second set of TPTD measurements was performed only in those with catheter misplacement immediately after the misplaced SCV catheters being corrected (Group 3). The differences in MTt, DSt, GEDVI and EVLWI between group 2 and 3 were recorded as ΔMTt, ΔDSt, ΔGEDVI and ΔEVLWI, respectively.ResultsGEDVI and EVLWI were significantly higher (all P<0.001) in group 2 than those in group 1, while CI was not significantly different (P>0.05) between these two groups. Multivariate logistic regression identified PaO2/FiO2 [adjusted odds ratio (OR) 1.492/10 mm Hg; 95% confidence interval (CI), 1.180 - 1.884; P<0.001], GEDVI (OR=1.307/10 mL/m2, 95% CI 1.131 - 1.511; P<0.001) and EVLWI (OR=3.05; 95%CI 1.593 - 5.840; P<0.001) as the 3 independent factors associated with the misplacement of SCV catheter into the ipsilateral IJV. In group 2, GEDVI [(1041±122)mL/m2 vs. (790±102)mL/m2, P<0.001], EVLWI [(20.3±4.0)mL/kg vs. (10.3±2.3)mL/kg, P<0.001], CI [(3.6±1.2)L·min–1·m–2 vs. (2.9±1.0)L·min–1·m–2, P<0.001], MTt [(38.2±13.3)s vs. (30.8±9.4)s, P<0.001] and DSt [(18.9±7.2)s vs. (13.2±4.9)s, P<0.001)] were significantly higher than those in Group 3. Multiple regression analysis demonstrated that ΔEVLWI (R2=0.86, P<0.001) was negatively correlated with ΔMTt (coefficient±SE, –0.52±0.12; P<0.001) and positively correlated with ΔDSt (coefficient±SE, 1.45±0.17; P<0.001).ConclusionsDuring TPTD measurements, indicator injection through an SCV catheter misplaced into the ipsilateral IJV results in an overestimation of CI, GEDVI and EVLWI. The increase in DSt might be a key factor in explaining the overestimation of EVLWI in patients with misplaced SCV catheters. Given that the accurate measurements of GEDVI and EVLWI are of utmost importance for guiding resuscitation and decision-making regarding fluids administration, immediate repositioning is required if a misplacement is suspected and confirmed by the chest X-ray.
Objective To explore feasibility and clinical value of low dose computed tomography perfusion imaging (CTPI) in quantitative assessing proximal gastric cancer. Methods A total of 34 patients diagnosed with proximal gastric cancer (a proximal gastric cancer group) were enrolled prospectively in this study. The 25 normal parts of gastric fundus of the included patients constituted a control group. All the patients underwent the low dose CTPI before surgery. The total effective radiation dose was recorded, and a specific post-processing software was used to automatically generate the perfusion parameters values, including the time to peak (TTP), blood flow (BF), blood volume (BV), mean transmit time (MTT), and permeability (PMB). The perfusion parameters in the different histopathologic types and stages of the patients were compared. Receiver operating characteristic (ROC) curves were generated to compare their diagnosis performances. Results The histopathologic findings verified that there were 11 patients with T1+T2 stage and 23 patients with T3+T4 stage; 8 patients with signet ring cell carcinoma and 26 patients with adenocarcinoma; and 17 patients with lymphatic metastasis and 17 patients without lymphatic metastasis. ① Compared with the control group, the BF, BV, and PMB values were significantly higher and the MTT and TTP values were significantly lower in the proximal gastric cancer group. The area under the ROC curve (AUC) values of the BF, BV, PMB, MTT, and TTP in the diagnosing proximal gastric cancer was 0.955, 0.807, 0.987, 0.654, and 0.649 respectively. The BF and PMB represented the best diagnostic performances, and the BV was secondary in the ROC curve results. ② The BF value was significantly lower and the PMB value was significantly higher in the patients with signet ring cell carcinoma as compared with the patients with adenocarcinoma. However, the BV, MTT, and TTP values had no significant differences in both them. And the BF (AUC=0.986) had a better ability than the PMB (AUC=0.856) in the discriminating the histopathological type (P=0.047). ③ The PMB value in the patients with pathological stage T3 and T4 was significantly higher than that of the patients with pathological stage T1 and T2 (P=0.004), but the BF, BV, MTT, and TTP values had no differences in both them. The diagnosis value of the PMB in the discriminating the pathological stage was good with an AUC value of 0.814. ④ None of the parameters had significant difference between the patients with and without lymphatic metastasis (P>0.05). ⑤ The total effective radiation dose of each scan was 8.58 mSv, which was lower than that of the standard radiation dose of CTPI. ⑥ The rates of lymphatic metastasis and high T staging were not related to the histopathological type of the proximal gastric cancer (P>0.05). Conclusion Low dose CTPI used in this study could effectively reduce radiation dose, could quantitatively evaluate angiogenesis in proximal gastric cancer, and has a certain clinical value in identifying of histopathological type and evaluating of pathological stage.
Objective To explore the feasibility of mean temporal phase images calculated from perfusion CT datasets by using CT perfusion (CTP) of liver on the third-generation dual-source CT. Methods Twenty-two consecutive patients with suspected hepatocellular carcinoma were enrolled, we retrospectively compared objective and subjective image quality, leson detectability, and radiation dose between mean temporal arterial (mTA) and mean temporal portal venous (mTPV) images which calculated from perfusion CT datasets with conventional enhanced arterial and portal venous datasets. Results ① Image quality: compared with the conventional enhancement image, the standard deviation (SD) values of CTP images on liver (arterial phase), portal vein (arterial phase), and liver (portal vein phase) were lower (P<0.05); the signal-to-noise ratio (SNR) values of CTP images on aorta (arterial phase), portal vein (arterial phase), aorta (portal vein phase), and portal vein (portal vein phase) were all higher (P<0.05), the contrast-to-noise ratio (CNR) value of CTP images on aorta (arterial phase) was higher (P<0.05). ② The subjective image quality: the subjective image quality scores of CTP images (mTA and mTPV images) were higher when compared to responding conventional enhanced arterial and portal venous datasets (P<0.05). ③ The diagnostic efficiency: the CTP images and conventional enhancement images showed all the lesions, but the diagnostic efficiency images of CTP images was better than the conventional enhancement images, both on lesions of blood supply and lack of blood supply (P<0.05). Conclusions The image quality of mTA and mTPV datasets calculated from CTP datasets are non-inferior when compared to conventional enhanced arterial and portal venous acquisitions in patients with suspected hepatic lesions. Thus, CTP could be used as a stand-alone imaging technique without additionally performed conventional arterial and portal venous CT acquisitions.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.