Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pat...Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features ...BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.展开更多
BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer fol...BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common malignant gastrointestinal tumors worldwide,with high incidence and mortality rates.AIM To investigate the expression significance of the chromatin-remodeling...BACKGROUND Colorectal cancer(CRC)is one of the most common malignant gastrointestinal tumors worldwide,with high incidence and mortality rates.AIM To investigate the expression significance of the chromatin-remodeling protein MORC family CW-type zinc finger 4(MORC4)as a biomarker in CRC patients,and to explore its relationship with pathological features and prognosis.METHODS A total of 143 CRC specimens and 57 adjacent tissue specimens,surgically removed from our hospital between January 2020 and January 2021,were collected.MORC4 protein expression was assessed using immunohistochemistry after paraffin embedding.The relationship between MORC4 protein expression and clinicopathological characteristics of patients was analyzed.Kaplan-Meier survival curves were plotted to analyze the relationship between MORC4 protein expression and prognosis in CRC patients.RESULTS Compared with adjacent tissues,the expression rate of MORC4 protein in CRC tissues was significantly higher(P<0.05).No significant difference was observed in the high expression rate of MORC4 protein in CRC tissues among patients of different gender,age,tumor location,tumor diameter,and primary tumor status(P>0.05).However,significant differences were found in the high expression rate of MORC4 protein in patients with different degrees of differentiation,lymph node metastasis,distant metastasis,tumor-lymph node-metastasis stage,and serum carcinoembryonic antigen levels(P<0.05).Compared with patients with low MORC4 expression,patients with high MORC4 expression had a worse prognosis(P<0.05).CONCLUSION The upregulation of MORC4 expression in CRC patients is closely related to disease severity and prognosis,suggesting its potential as an evaluation biomarker,which warrants further investigation.展开更多
This study aims to explore the unconscious motivations underlying migration in Niger, with an emphasis on understanding the phenomenon of pathological travel. Its aim is to identify the unconscious factors of patholog...This study aims to explore the unconscious motivations underlying migration in Niger, with an emphasis on understanding the phenomenon of pathological travel. Its aim is to identify the unconscious factors of pathological travel among migrants. Pathological travel, as discussed in the scientific literature on psychopathology, is characterised by movements initiated under the influence of delusions, hallucinations or other serious psychiatric disorders. The aim of this research is to contribute to our understanding of how these unconscious factors influence migration decisions. Using a retrospective analysis of five cases, this study examines the psychological and psychiatric dimensions of migration, particularly among patients referred to the psychiatry department of the Niamey National Hospital between 2017 and 2018. The five cases analysed, representing 12% of a cohort of 40 migrant patients, suffered from chronic psychotic disorders, including schizophrenia and chronic hallucinatory psychosis. By means of diagnostic interviews and categorical sorting, three main unconscious motivations were identified: the delusional state with themes of filiation and persecution, the hallucinations that dictated the travel behaviour, and the dissociative states manifested by depersonalisation and derealisation. It also emerges from this analysis that pathological travel often involves prolonged journeys on foot and without purpose. Thus, untreated mental illness plays a significant role in shaping and influencing individual and social behaviour. The results of this study have important implications for public health and migration policy. They highlight the need to integrate health assessments into migration management systems, particularly in regions serving as transit hubs for migrants. The research also highlights the need for culturally sensitive psychiatric interventions to address the interaction between pre-existing mental disorders and migration. This study contributes to a better understanding of the psychological dimensions of migration by highlighting the importance of addressing mental health as an integral part of humanitarian action. The knowledge gained paves the way for future research to explore this understudied aspect of migration on a broader scale.展开更多
The study by Luo et al published in the World Journal of Gastrointestinal Oncology presents a thorough and scientific methodology.Pancreatic cancer is the most challenging malignancy in the digestive system,exhibiting...The study by Luo et al published in the World Journal of Gastrointestinal Oncology presents a thorough and scientific methodology.Pancreatic cancer is the most challenging malignancy in the digestive system,exhibiting one of the highest mortality rates associated with cancer globally.The delayed onset of symptoms and diagnosis often results in metastasis or local progression of the cancer,thereby constraining treatment options and outcomes.For these patients,prompt tumour identification and treatment strategising are crucial.The present objective of pancreatic cancer research is to examine the correlation between various pathological types and imaging data to facilitate therapeutic decision-making.This study aims to clarify the correlation between diverse pathological markers and imaging in pancreatic cancer patients,with prospective longitudinal studies potentially providing novel insights into the diagnosis and treatment of pancreatic cancer.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical res...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.展开更多
BACKGROUND Colorectal cancer(CRC)during pregnancy poses significant risks to both maternal and fetal health;however,this topic remains under researched globally.AIM To investigate the impacts of clinical features,path...BACKGROUND Colorectal cancer(CRC)during pregnancy poses significant risks to both maternal and fetal health;however,this topic remains under researched globally.AIM To investigate the impacts of clinical features,pathology type,treatment strategies,and tumor stage on maternal and fetal outcomes in pregnant patients with pregnancy-associated CRC(pCRC).METHODS To address this research gap,we analyzed the clinical and pathological characteristics of pCRC by collecting and evaluating clinicopathological data from 43 patients treated at the National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,between 1999 and 2023 using descriptive statistical methods.RESULTS Treatment for pCRC was initiated with surgery and/or chemotherapy.Among 43 patients,37 underwent surgery,including 21 radical resections(5 prenatal and 16 postpartum resections)and 16 palliative surgeries.Chemotherapy(with regimens such as CapeOx or FOLFOX4)was administered to 37 patients.Six advanced-stage patients received chemotherapy alone.The gestational outcomes among the patients varied.Specifically,5 patients who were diagnosed in early pregnancy chose abortion.Additionally,in mid-pregnancy,3 patients underwent abortion,1 required induced labor,and 2 underwent cesarean delivery with healthy neonates.Among the 3 late-pregnancy diagnoses,1 patient underwent induced abortion,1 delivered via cesarean section with a healthy fetus,and 1 underwent stillbirth management.The 5-year survival rate was 59.8%,with a rate of 100%for stage I/II patients,75%for stage III patients,and 21.1%for stage IV patients.CONCLUSION Patients with poorly differentiated tumors exhibited worse outcomes than those with moderately and highly differentiated tumors.Early-stage diagnosis and timely treatment significantly improved maternal survival and fetal outcomes in pregnant patients with CRC.Advanced tumor stages and delayed diagnosis were observed to be associated with poorer maternal prognoses and may require interventions that compromise fetal survival.Fetal outcomes depend on the pathological stage of the mother’s cancer,the gestational age at diagnosis,and treatment strategies.展开更多
This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limit...This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.展开更多
BACKGROUND Gastric cancer ranks among the leading malignancies worldwide,noted for its high morbidity and mortality,and remains a significant challenge to global public health.AIM To investigate the association betwee...BACKGROUND Gastric cancer ranks among the leading malignancies worldwide,noted for its high morbidity and mortality,and remains a significant challenge to global public health.AIM To investigate the association between the expression of splicing factor 3b subunit 4(SF3B4)and high mobility group box 1(HMGB1)with the clinical characteristics and prognostic outcomes of gastric cancer patients.METHODS A retrospective cohort study was conducted involving 114 individuals diagnosed with gastric cancer and admitted to our institution from January 2020 to December 2021.A comparison group of 90 patients diagnosed with benign gastric disorders during the same period was also included.Expression levels of SF3B4 and HMGB1 were assessed using real-time quantitative polymerase chain reaction.Expression patterns were analyzed in relation to various clinicopathological features.Receiver operating characteristic curves were constructed to evaluate the ability of SF3B4 and HMGB1,alone and in combination,to predict unfavorable one-year outcomes.Multivariate logistic regression was utilized to identify independent predictors of mortality.Kaplan-Meier survival curves were generated to examine survival differences based on SF3B4 and HMGB1 expression levels.RESULTS Both SF3B4 and HMGB1 were markedly upregulated in tumor tissues of gastric cancer patients compared to adjacent normal tissues and to tissues from nonmalignant gastric disease patients(^(a)P<0.05).Higher expression levels of these two genes were significantly associated with aggressive pathological features,including poor differentiation,tumor size>5 cm,deep infiltration(T3-T4),lymph node involvement,and advanced clinical stage(III–IV)(^(a)P<0.05).Receiver operating characteristic analysis revealed that the combined use of SF3B4 and HMGB1 yielded an area under the curve of 0.914,surpassing the predictive performance of either marker alone(SF3B4:0.776;HMGB1:0.757).Multivariate analysis identified SF3B4≥1.45,HMGB1≥0.93,poor differentiation,larger tumor size,deeper invasion,lymph node metastasis,and advanced clinical tumor-node-metastasis staging as independent factors contributing to one-year mortality(^(a)P<0.05).Survival analysis indicated that patients with elevated SF3B4 and HMGB1 levels had a shorter median survival(25.74±5.46 months)compared to those with lower expression levels(33.29±6.71 months,log-rank=10.534,^(a)P<0.05).CONCLUSION Elevated SF3B4 and HMGB1 expression in gastric cancer tissue is significantly associated with tumor aggressiveness,worse prognosis,and reduced survival.These biomarkers may offer clinical value in stratifying patients by risk and in forecasting outcomes.Their combined assessment improves predictive accuracy for poor prognosis and may serve as a more effective tool than individual evaluation.展开更多
BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts ...BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.展开更多
BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly di...BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly differentiated tumor histology,inadequate lymph node sampling(fewer than 12 lymph nodes),and evidence of tumor perforation or obstruction.Tumor-stroma ratio,tumor infiltrating lymphocytes(TIL),Crohn-like reaction(CLR),desmoid reaction,poorly differentiated clusters(PDC)are new pathological markers that are being studied.AIM To examine the relationship between new pathological markers and defined high METHODS We evaluated 155 patients with the diagnosis stage I and II colorectal cancer between the years 2007 and 2021 who were treated at Trakya University Hospital,Department of Medical Oncology.We divided those with and without high-risk factors into two groups.We examined the relationship of new pathological markers with these groups and with pathological markers in risk factors.RESULTS There was no statistically significant correlation between presence of TIL,presence of PDC,presence of tumor budding,presence of CLR,presence of desmoid reaction and low and high-risk groups according to the degree of those with PDC(P=0.82,P=0.51,P=0.77,P=0.37,P=0.83,respectively).In addition,no statistically significant correlation was found between the tumor-stroma ratio and low and high risk groups(P=0.80).We found a statistically significant correlation between the presence of PDC and the presence of PDC grade 3 and T stage(P=0.001,P=0.001,respectively).It was determined that the presence of PDC and the frequency of grade 3 PDC increased with the advanced T stage.CONCLUSION No relationship was found between the presence of new pathological markers and high-low risk groups.When we examined the relationship between new and old pathological markers,only the frequency of detection of PDC and PDC grade 3 was found to be correlated with advanced T stage.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.How...BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.展开更多
Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2...Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.展开更多
Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospi...Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospital from January 2024 to December 2024 were selected.All patients received cervical Pap smear examination,and patients with abnormal examination results underwent colposcopic biopsy and HPV infection test for cervical cancer screening.Results:The results of cervical Pap smear showed that a total of 780 patients among 1200 patients showed cervical abnormalities.The Pap smear combined with colposcopy was used for pathological examination to detect cervical cancer lesions in time,and biopsy and HPV infection examination were arranged for high-risk patients to provide data reference for clinical treatment.Conclusions:Pathological examination has a good screening effect in gynecological physical examination.It can detect lesions early and take timely intervention measures,which is helpful to reduce the incidence and mortality of the disease.展开更多
Pulmonary hypertension(PH)is a pulmonary vascular disease caused by multiple etiologies,characterized by increased pulmonary vascular resistance and elevated pulmonary artery pressure,which can lead to severe cardiova...Pulmonary hypertension(PH)is a pulmonary vascular disease caused by multiple etiologies,characterized by increased pulmonary vascular resistance and elevated pulmonary artery pressure,which can lead to severe cardiovascular complications.The third type of PH,hypoxic pulmonary hypertension(HPH)caused by chronic lung disease and/or hypoxia,has complex and incomplete pathological mechanism.Current clinical treatment for HPH primarily focus on alleviating symptoms,with limited effectiveness in improving pulmonary vascular remodeling(PVR).Recent studies by various scholars have indicated that certain traditional Chinese medicine(TCM)monomers,extracts,and formulations can inhibit multiple signaling pathways,thereby suppressing pulmonary vascular remodeling and demonstrating favorable efficacy against HPH.This article reviews the pathogenesis of HPH,including pulmonary arterial wall thickening,immune inflammation,and thrombogenesis,and discusses the latest research advancements regarding the pharmacodynamic mechanisms of TCM in treating HPH.展开更多
BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumo...BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.展开更多
Retinopathy of prematurity(ROP)is a vision-threatening disorder that leads to pathological growth of the retinal vasculature due to hypoxia.Here,we investigated the potential effects of alamandine,a novel heptapeptide...Retinopathy of prematurity(ROP)is a vision-threatening disorder that leads to pathological growth of the retinal vasculature due to hypoxia.Here,we investigated the potential effects of alamandine,a novel heptapeptide in the renin-angiotensin system(RAS),on hypoxia-induced retinal neovascularization and its underlying mechanisms.In vivo,the C57BL/6J mice with oxygen-induced retinopathy(OIR)were injected intravitreally with alamandine(1.0µmol/kg per eye).In vitro,human retinal microvascular endothelial cells(HRMECs)were utilized to investigate the effects of alamandine(10µg/mL)on proliferation,apoptosis,migration,and tubular formation under vascular endothelial growth factor(VEGF)stimulation.Single-cell RNA sequencing(scRNA-seq)matrix data from the Gene Expression Omnibus(GEO)database and RAS-related genes from the Molecular Signatures Database(MSigDB)were sourced for subsequent analyses.By integrating scRNA-seq data across multiple species,we identified that RAS-associated endothelial cell populations were highly related to retinal neovascularization.The liquid chromatography-tandem mass spectrometry(LC-MS/MS)analysis revealed a significant decrease in alamandine levels in both the serum and retina of OIR mice compared to those in the control group.Next,alamandine ameliorated hypoxia-induced retinal pathological neovascularization and physiologic revascularization in OIR mice.In vitro,alamandine effectively mitigated VEGF-induced proliferation,scratch wound healing,and tube formation of HRMECs primarily by inhibiting the hypoxia-inducible factor-1α(HIF-1α)/VEGF pathway.Further,coincubation with D-Pro7(Mas-related G protein-coupled receptor D(MrgD)antagonist)hindered the beneficial impacts of alamandine on hypoxia-induced pathological angiogenesis both in vivo and in vitro.Our findings suggested that alamandine could mitigate retinal neovascularization by targeting the MrgD-mediated HIF-1α/VEGF pathway,providing a potential therapeutic agent for OIR prevention and treatment.展开更多
Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for d...Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for diagnosing TB,5%-30%of cases remain undiagnosed,emphasizing the urgent need to establish quality control(QC)standards to reduce rates of misdiagnosis and missed diagnoses.To address this,we introduced a novel QC chip for detecting Mycobacterium tuberculosis(MTB).A quantitative pathological QC model was constructed by precisely and uniformly integrating MTB and HeLa cells into a photocurable hydrogel.This model was then sliced into uniform sections to create QC chips.It demonstrated that the QC chips exhibited no significant differences in intra-batch or inter-batch variation(coefficient of variation<5%),and remained stable at−80°C for one year.Furthermore,these chips were found to be 100%effective when tested with 240 clinical samples(200 with special staining and 40 with polymerase chain reaction).In addition to enhancing TB detection rates,this approach offers visualization,quantification,and sustainable production.Overall,this work provides a novel framework for developing QC chips for pathological testing,offering a reliable solution to enhance clinical diagnostic workflows.展开更多
基金supported by the Taishan Scholar Project(No.ts20190991,tsqn202211378)the Key R&D Project of Shandong Province(No.2022CXPT023)the General Program of National Natural Science Foundation of China(No.82371933)。
文摘Objective:This study aims to develop a deep multiscale image learning system(DMILS)to differentiate malignant from benign thyroid follicular neoplasms on multiscale whole-slide images(WSIs)of intraoperative frozen pathological images.Methods:A total of 1,213 patients were divided into training and validation sets,an internal test set,a pooled external test set,and a pooled prospective test set at three centers.DMILS was constructed using a deep learningbased weakly supervised method based on multiscale WSIs at 10×,20×,and 40×magnifications.The performance of the DMILS was compared with that of a single magnification and validated in two pathologist-unidentified subsets.Results:The DMILS yielded good performance,with areas under the receiver operating characteristic curves(AUCs)of 0.848,0.857,0.810,and 0.787 in the training and validation sets,internal test set,pooled external test set,and pooled prospective test set,respectively.The AUC of the DMILS was higher than that of a single magnification,with 0.788 of 10×,0.824 of 20×,and 0.775 of 40×in the internal test set.Moreover,DMILS yielded satisfactory performance on the two pathologist-unidentified subsets.Furthermore,the most indicative region predicted by DMILS is the follicular epithelium.Conclusions:DMILS has good performance in differentiating thyroid follicular neoplasms on multiscale WSIs of intraoperative frozen pathological images.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
文摘BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.
文摘BACKGROUND Esophageal cancer is the sixth most common cancer worldwide,with a high mortality rate.Early prognosis of esophageal abnormalities can improve patient survival rates.The progression of esophageal cancer follows a sequence from esophagitis to non-dysplastic Barrett’s esophagus,dysplastic Barrett’s esophagus,and eventually esophageal adenocarcinoma(EAC).This study explored the application of deep learning technology in the precise diagnosis of pathological classification and staging of EAC to enhance diagnostic accuracy and efficiency.AIM To explore the application of deep learning models,particularly Wave-Vision Transformer(Wave-ViT),in the pathological classification and staging of esophageal cancer to enhance diagnostic accuracy and efficiency.METHODS We applied several deep learning models,including multi-layer perceptron,residual network,transformer,and Wave-ViT,to a dataset of clinically validated esophageal pathology images.The models were trained to identify pathological features and assist in the classification and staging of different stages of esophageal cancer.The models were compared based on accuracy,computational complexity,and efficiency.RESULTS The Wave-ViT model demonstrated the highest accuracy at 88.97%,surpassing the transformer(87.65%),residual network(85.44%),and multi-layer perceptron(81.17%).Additionally,Wave-ViT exhibited low computational complexity with significantly reduced parameter size,making it highly efficient for real-time clinical applications.CONCLUSION Deep learning technology,particularly the Frequency-Domain Transformer model,shows promise in improving the precision of pathological classification and staging of EAC.The application of the Frequency-Domain Transformer model enhances the automation of the diagnostic process and may support early detection and treatment of EAC.Future research may further explore the potential of this model in broader medical image analysis applications,particularly in the field of precision medicine.
基金was approved by the Ethics Committee of Cangzhou Central Hospital,No.29795793.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common malignant gastrointestinal tumors worldwide,with high incidence and mortality rates.AIM To investigate the expression significance of the chromatin-remodeling protein MORC family CW-type zinc finger 4(MORC4)as a biomarker in CRC patients,and to explore its relationship with pathological features and prognosis.METHODS A total of 143 CRC specimens and 57 adjacent tissue specimens,surgically removed from our hospital between January 2020 and January 2021,were collected.MORC4 protein expression was assessed using immunohistochemistry after paraffin embedding.The relationship between MORC4 protein expression and clinicopathological characteristics of patients was analyzed.Kaplan-Meier survival curves were plotted to analyze the relationship between MORC4 protein expression and prognosis in CRC patients.RESULTS Compared with adjacent tissues,the expression rate of MORC4 protein in CRC tissues was significantly higher(P<0.05).No significant difference was observed in the high expression rate of MORC4 protein in CRC tissues among patients of different gender,age,tumor location,tumor diameter,and primary tumor status(P>0.05).However,significant differences were found in the high expression rate of MORC4 protein in patients with different degrees of differentiation,lymph node metastasis,distant metastasis,tumor-lymph node-metastasis stage,and serum carcinoembryonic antigen levels(P<0.05).Compared with patients with low MORC4 expression,patients with high MORC4 expression had a worse prognosis(P<0.05).CONCLUSION The upregulation of MORC4 expression in CRC patients is closely related to disease severity and prognosis,suggesting its potential as an evaluation biomarker,which warrants further investigation.
文摘This study aims to explore the unconscious motivations underlying migration in Niger, with an emphasis on understanding the phenomenon of pathological travel. Its aim is to identify the unconscious factors of pathological travel among migrants. Pathological travel, as discussed in the scientific literature on psychopathology, is characterised by movements initiated under the influence of delusions, hallucinations or other serious psychiatric disorders. The aim of this research is to contribute to our understanding of how these unconscious factors influence migration decisions. Using a retrospective analysis of five cases, this study examines the psychological and psychiatric dimensions of migration, particularly among patients referred to the psychiatry department of the Niamey National Hospital between 2017 and 2018. The five cases analysed, representing 12% of a cohort of 40 migrant patients, suffered from chronic psychotic disorders, including schizophrenia and chronic hallucinatory psychosis. By means of diagnostic interviews and categorical sorting, three main unconscious motivations were identified: the delusional state with themes of filiation and persecution, the hallucinations that dictated the travel behaviour, and the dissociative states manifested by depersonalisation and derealisation. It also emerges from this analysis that pathological travel often involves prolonged journeys on foot and without purpose. Thus, untreated mental illness plays a significant role in shaping and influencing individual and social behaviour. The results of this study have important implications for public health and migration policy. They highlight the need to integrate health assessments into migration management systems, particularly in regions serving as transit hubs for migrants. The research also highlights the need for culturally sensitive psychiatric interventions to address the interaction between pre-existing mental disorders and migration. This study contributes to a better understanding of the psychological dimensions of migration by highlighting the importance of addressing mental health as an integral part of humanitarian action. The knowledge gained paves the way for future research to explore this understudied aspect of migration on a broader scale.
基金Supported by the National Health Commission’s Key Laboratory of Gastrointestinal Tumor Diagnosis and Treatment for The Year 2022,National Health Commission’s Master’s and Doctoral/Postdoctoral Fund Project,No.NHCDP2022001Gansu Provincial People’s Hospital Doctoral Supervisor Training Project,No.22GSSYA-3.
文摘The study by Luo et al published in the World Journal of Gastrointestinal Oncology presents a thorough and scientific methodology.Pancreatic cancer is the most challenging malignancy in the digestive system,exhibiting one of the highest mortality rates associated with cancer globally.The delayed onset of symptoms and diagnosis often results in metastasis or local progression of the cancer,thereby constraining treatment options and outcomes.For these patients,prompt tumour identification and treatment strategising are crucial.The present objective of pancreatic cancer research is to examine the correlation between various pathological types and imaging data to facilitate therapeutic decision-making.This study aims to clarify the correlation between diverse pathological markers and imaging in pancreatic cancer patients,with prospective longitudinal studies potentially providing novel insights into the diagnosis and treatment of pancreatic cancer.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.
基金Supported by the National Natural Science Foundation of China,No.82372989.
文摘BACKGROUND Colorectal cancer(CRC)during pregnancy poses significant risks to both maternal and fetal health;however,this topic remains under researched globally.AIM To investigate the impacts of clinical features,pathology type,treatment strategies,and tumor stage on maternal and fetal outcomes in pregnant patients with pregnancy-associated CRC(pCRC).METHODS To address this research gap,we analyzed the clinical and pathological characteristics of pCRC by collecting and evaluating clinicopathological data from 43 patients treated at the National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,between 1999 and 2023 using descriptive statistical methods.RESULTS Treatment for pCRC was initiated with surgery and/or chemotherapy.Among 43 patients,37 underwent surgery,including 21 radical resections(5 prenatal and 16 postpartum resections)and 16 palliative surgeries.Chemotherapy(with regimens such as CapeOx or FOLFOX4)was administered to 37 patients.Six advanced-stage patients received chemotherapy alone.The gestational outcomes among the patients varied.Specifically,5 patients who were diagnosed in early pregnancy chose abortion.Additionally,in mid-pregnancy,3 patients underwent abortion,1 required induced labor,and 2 underwent cesarean delivery with healthy neonates.Among the 3 late-pregnancy diagnoses,1 patient underwent induced abortion,1 delivered via cesarean section with a healthy fetus,and 1 underwent stillbirth management.The 5-year survival rate was 59.8%,with a rate of 100%for stage I/II patients,75%for stage III patients,and 21.1%for stage IV patients.CONCLUSION Patients with poorly differentiated tumors exhibited worse outcomes than those with moderately and highly differentiated tumors.Early-stage diagnosis and timely treatment significantly improved maternal survival and fetal outcomes in pregnant patients with CRC.Advanced tumor stages and delayed diagnosis were observed to be associated with poorer maternal prognoses and may require interventions that compromise fetal survival.Fetal outcomes depend on the pathological stage of the mother’s cancer,the gestational age at diagnosis,and treatment strategies.
文摘This letter comments on Wei et al's study applying the Wave-Vision Transformer for oesophageal cancer classification.Highlighting its superior accuracy and efficiency,we discuss its potential clinical impact,limitations in dataset diversity,and the need for explainable artificial intelligence to enhance adoption in pathology and personalized treatment.
文摘BACKGROUND Gastric cancer ranks among the leading malignancies worldwide,noted for its high morbidity and mortality,and remains a significant challenge to global public health.AIM To investigate the association between the expression of splicing factor 3b subunit 4(SF3B4)and high mobility group box 1(HMGB1)with the clinical characteristics and prognostic outcomes of gastric cancer patients.METHODS A retrospective cohort study was conducted involving 114 individuals diagnosed with gastric cancer and admitted to our institution from January 2020 to December 2021.A comparison group of 90 patients diagnosed with benign gastric disorders during the same period was also included.Expression levels of SF3B4 and HMGB1 were assessed using real-time quantitative polymerase chain reaction.Expression patterns were analyzed in relation to various clinicopathological features.Receiver operating characteristic curves were constructed to evaluate the ability of SF3B4 and HMGB1,alone and in combination,to predict unfavorable one-year outcomes.Multivariate logistic regression was utilized to identify independent predictors of mortality.Kaplan-Meier survival curves were generated to examine survival differences based on SF3B4 and HMGB1 expression levels.RESULTS Both SF3B4 and HMGB1 were markedly upregulated in tumor tissues of gastric cancer patients compared to adjacent normal tissues and to tissues from nonmalignant gastric disease patients(^(a)P<0.05).Higher expression levels of these two genes were significantly associated with aggressive pathological features,including poor differentiation,tumor size>5 cm,deep infiltration(T3-T4),lymph node involvement,and advanced clinical stage(III–IV)(^(a)P<0.05).Receiver operating characteristic analysis revealed that the combined use of SF3B4 and HMGB1 yielded an area under the curve of 0.914,surpassing the predictive performance of either marker alone(SF3B4:0.776;HMGB1:0.757).Multivariate analysis identified SF3B4≥1.45,HMGB1≥0.93,poor differentiation,larger tumor size,deeper invasion,lymph node metastasis,and advanced clinical tumor-node-metastasis staging as independent factors contributing to one-year mortality(^(a)P<0.05).Survival analysis indicated that patients with elevated SF3B4 and HMGB1 levels had a shorter median survival(25.74±5.46 months)compared to those with lower expression levels(33.29±6.71 months,log-rank=10.534,^(a)P<0.05).CONCLUSION Elevated SF3B4 and HMGB1 expression in gastric cancer tissue is significantly associated with tumor aggressiveness,worse prognosis,and reduced survival.These biomarkers may offer clinical value in stratifying patients by risk and in forecasting outcomes.Their combined assessment improves predictive accuracy for poor prognosis and may serve as a more effective tool than individual evaluation.
文摘BACKGROUND Crohn’s disease(CD)patients with intestinal involvement often require surgical intervention due to resistance to medical therapy.Postoperative recurrence remains a significant challenge,with the Rutgeerts score commonly used to predict endoscopic recurrence.AIM To evaluate the relationship between microscopic and macroscopic pathological findings in resected intestinal specimens and the Rutgeerts score to predict endoscopic recurrence in CD patients.METHODS This retrospective cohort study included 32 patients over 18 years of age with intestinal CD who underwent surgery at General Surgery Clinic of Ankara Bilkent City Hospital between November 2019 and October 2023.Resection specimens were histopathologically re-examined,and postoperative colonoscopy reports were classified according to the Rutgeerts score.The association between pathological findings and endoscopic recurrence was analyzed statistically.RESULTS No significant association was found between macroscopic findings and Rutgeerts scores or endoscopic recurrence(P>0.05).However,the presence and severity of neutrophilic cryptitis(P=0.035)and crypt abscesses(P=0.010)in microscopic findings were significantly associated with higher Rutgeerts scores,indicating a parallel increase with endoscopic recurrence.Other microscopic findings showed no significant correlation with Rutgeerts scores or endoscopic recurrence(P>0.05).CONCLUSION The presence of neutrophilic cryptitis and crypt abscesses in resected intestinal specimens of CD patients increases the likelihood of endoscopic recurrence.Early postoperative medical treatment and close endoscopic follow-up may benefit high-risk patients to prevent recurrence,with treatment decisions made by a weekly multidisciplinary council involving General Surgery,Gastroenterology,and Radiology.
文摘BACKGROUND The decision to administer adjuvant chemotherapy to patients with local stage depends on specific high-risk features that are T4 tumor stage,presence of perineural invasion,lymphovascular invasion,poorly differentiated tumor histology,inadequate lymph node sampling(fewer than 12 lymph nodes),and evidence of tumor perforation or obstruction.Tumor-stroma ratio,tumor infiltrating lymphocytes(TIL),Crohn-like reaction(CLR),desmoid reaction,poorly differentiated clusters(PDC)are new pathological markers that are being studied.AIM To examine the relationship between new pathological markers and defined high METHODS We evaluated 155 patients with the diagnosis stage I and II colorectal cancer between the years 2007 and 2021 who were treated at Trakya University Hospital,Department of Medical Oncology.We divided those with and without high-risk factors into two groups.We examined the relationship of new pathological markers with these groups and with pathological markers in risk factors.RESULTS There was no statistically significant correlation between presence of TIL,presence of PDC,presence of tumor budding,presence of CLR,presence of desmoid reaction and low and high-risk groups according to the degree of those with PDC(P=0.82,P=0.51,P=0.77,P=0.37,P=0.83,respectively).In addition,no statistically significant correlation was found between the tumor-stroma ratio and low and high risk groups(P=0.80).We found a statistically significant correlation between the presence of PDC and the presence of PDC grade 3 and T stage(P=0.001,P=0.001,respectively).It was determined that the presence of PDC and the frequency of grade 3 PDC increased with the advanced T stage.CONCLUSION No relationship was found between the presence of new pathological markers and high-low risk groups.When we examined the relationship between new and old pathological markers,only the frequency of detection of PDC and PDC grade 3 was found to be correlated with advanced T stage.
基金Supported by the Medical Education Research Project from Nanjing Drum Tower Hospital,No.2021-7the Clinical Trials Fund from Nanjing Drum Tower Hospital,No.2022-YXZX-XH-04National Natural Science Foundation of China,No.82203063.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a standardized therapeutic approach for early carcinoma of the digestive tracts.In this regard,the process of histopathological diagnosis requires standardization.However,the uneven development of healthcare in China,especially in eastern and western China,creates challenges for sharing a standardized diagnostic process.AIM To optimize the process of ESD specimen sampling,embedding and slide production,and to provide complete and accurate pathological reports.METHODS We established a practical process of specimen sampling,created standardized reporting templates,and trained pathologists from neighboring hospitals and those in the western region.A training effectiveness survey was conducted,and the collected data were assessed by the corresponding percentages.RESULTS A total of 111 valid feedback forms have been received,among which 58%of the participants obtained photographs during specimen collection,whereas the percentage increased to 79%after training.Only 58%and 62%of the respondents ensured the mucosal tissue strips were flat and their order remained unchanged;after training,these two proportions increased to 95%and 92%,respectively.Approximately half the participants measured the depth of the submucosal infiltration,which significantly increased to 95%after training.The percentage of pathologists who did not evaluate lymphovascular invasion effectively reduced.Only 22%of the participants had fixed clinic-pathological meetings before training,which increased to 49%after training.The number of participants who had a thorough understanding of endoscopic diagnosis also significantly increased.CONCLUSION There have been significant improvements in the process of specimen collection,section quality,and pathology reporting in trained hospitals.Therefore,our study provides valuable insights for others facing similar challenges.
基金supported by the Interdepartmental Research Project of Peking University First Hospital(No.2023IR27 to Liu Y)the Scientific Research Seed Fund of Peking University First Hospital(No.2023SF40 to Qiu J)+3 种基金the High Quality Clinical Research Project of Peking University First Hospital(No.2022CR75 to Gong K)the Beijing Natural Science Foundation(No.QY23068 to Deng R)the National Natural Science Foundation of China(No.82141103,No.82172617,and No.81872081 to Gong K)the Capital’s Funds for Health Improvement and Research(No.2022-2-4074 to Gong K).
文摘Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.
文摘Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospital from January 2024 to December 2024 were selected.All patients received cervical Pap smear examination,and patients with abnormal examination results underwent colposcopic biopsy and HPV infection test for cervical cancer screening.Results:The results of cervical Pap smear showed that a total of 780 patients among 1200 patients showed cervical abnormalities.The Pap smear combined with colposcopy was used for pathological examination to detect cervical cancer lesions in time,and biopsy and HPV infection examination were arranged for high-risk patients to provide data reference for clinical treatment.Conclusions:Pathological examination has a good screening effect in gynecological physical examination.It can detect lesions early and take timely intervention measures,which is helpful to reduce the incidence and mortality of the disease.
基金supported by the Special Funds for the Central Government to Guide Local Science and Technology Development(No.246Z7704G,China)National Natural Science Foundation of China(No.H2024110033,China).
文摘Pulmonary hypertension(PH)is a pulmonary vascular disease caused by multiple etiologies,characterized by increased pulmonary vascular resistance and elevated pulmonary artery pressure,which can lead to severe cardiovascular complications.The third type of PH,hypoxic pulmonary hypertension(HPH)caused by chronic lung disease and/or hypoxia,has complex and incomplete pathological mechanism.Current clinical treatment for HPH primarily focus on alleviating symptoms,with limited effectiveness in improving pulmonary vascular remodeling(PVR).Recent studies by various scholars have indicated that certain traditional Chinese medicine(TCM)monomers,extracts,and formulations can inhibit multiple signaling pathways,thereby suppressing pulmonary vascular remodeling and demonstrating favorable efficacy against HPH.This article reviews the pathogenesis of HPH,including pulmonary arterial wall thickening,immune inflammation,and thrombogenesis,and discusses the latest research advancements regarding the pharmacodynamic mechanisms of TCM in treating HPH.
文摘BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.
基金supported by the National Natural Science Foundation of China(Nos.82200379 and 82300309)the Shanghai Sailing Program(No.22YF1443100)+1 种基金the Academy Talent Special Fund of The First Affiliated Hospital of Nanjing Medical University(Nos.YNRCQN0312 and MXJL202208)the Jiangsu Funding Program for Excellent Postdoctoral Talent(No.2023ZB592),China.
文摘Retinopathy of prematurity(ROP)is a vision-threatening disorder that leads to pathological growth of the retinal vasculature due to hypoxia.Here,we investigated the potential effects of alamandine,a novel heptapeptide in the renin-angiotensin system(RAS),on hypoxia-induced retinal neovascularization and its underlying mechanisms.In vivo,the C57BL/6J mice with oxygen-induced retinopathy(OIR)were injected intravitreally with alamandine(1.0µmol/kg per eye).In vitro,human retinal microvascular endothelial cells(HRMECs)were utilized to investigate the effects of alamandine(10µg/mL)on proliferation,apoptosis,migration,and tubular formation under vascular endothelial growth factor(VEGF)stimulation.Single-cell RNA sequencing(scRNA-seq)matrix data from the Gene Expression Omnibus(GEO)database and RAS-related genes from the Molecular Signatures Database(MSigDB)were sourced for subsequent analyses.By integrating scRNA-seq data across multiple species,we identified that RAS-associated endothelial cell populations were highly related to retinal neovascularization.The liquid chromatography-tandem mass spectrometry(LC-MS/MS)analysis revealed a significant decrease in alamandine levels in both the serum and retina of OIR mice compared to those in the control group.Next,alamandine ameliorated hypoxia-induced retinal pathological neovascularization and physiologic revascularization in OIR mice.In vitro,alamandine effectively mitigated VEGF-induced proliferation,scratch wound healing,and tube formation of HRMECs primarily by inhibiting the hypoxia-inducible factor-1α(HIF-1α)/VEGF pathway.Further,coincubation with D-Pro7(Mas-related G protein-coupled receptor D(MrgD)antagonist)hindered the beneficial impacts of alamandine on hypoxia-induced pathological angiogenesis both in vivo and in vitro.Our findings suggested that alamandine could mitigate retinal neovascularization by targeting the MrgD-mediated HIF-1α/VEGF pathway,providing a potential therapeutic agent for OIR prevention and treatment.
基金supported by the National Natural Science Foundation of China(Nos.52325504 and 52235007)the Basic Public Welfare Research Project of Zhejiang Province(No.LGY23H160089)the Science and Technology Plan Project of Taizhou City(No.24ywa08).
文摘Globally,approximately 10 million new tuberculosis(TB)cases are reported annually.Delayed diagnosis due to low detection rates is the primary cause of mortality.Although pathological examination is commonly used for diagnosing TB,5%-30%of cases remain undiagnosed,emphasizing the urgent need to establish quality control(QC)standards to reduce rates of misdiagnosis and missed diagnoses.To address this,we introduced a novel QC chip for detecting Mycobacterium tuberculosis(MTB).A quantitative pathological QC model was constructed by precisely and uniformly integrating MTB and HeLa cells into a photocurable hydrogel.This model was then sliced into uniform sections to create QC chips.It demonstrated that the QC chips exhibited no significant differences in intra-batch or inter-batch variation(coefficient of variation<5%),and remained stable at−80°C for one year.Furthermore,these chips were found to be 100%effective when tested with 240 clinical samples(200 with special staining and 40 with polymerase chain reaction).In addition to enhancing TB detection rates,this approach offers visualization,quantification,and sustainable production.Overall,this work provides a novel framework for developing QC chips for pathological testing,offering a reliable solution to enhance clinical diagnostic workflows.
