BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors...BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.展开更多
Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary...Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.展开更多
The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagn...The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.展开更多
Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,signifi...Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,significant variability in shape and location,and low contrast with surrounding tissues,achieving high segmentation accuracy remains challenging.To improve segmentation precision,we propose a novel network utilizing EfficientNetV2 and multi-branch structures for automatically segmenting the pancreas fromCT images.Firstly,an EfficientNetV2 encoder is employed to extract complex and multi-level features,enhancing the model’s ability to capture the pancreas’s intricate morphology.Then,a residual multi-branch dilated attention(RMDA)module is designed to suppress irrelevant background noise and highlight useful pancreatic features.And re-parameterization Visual Geometry Group(RepVGG)blocks with amulti-branch structure are introduced in the decoder to effectively integrate deep features and low-level details,improving segmentation accuracy.Furthermore,we apply re-parameterization to the model,reducing computations and parameters while accelerating inference and reducing memory usage.Our approach achieves average dice similarity coefficient(DSC)of 85.59%,intersection over union(IoU)of 75.03%,precision of 85.09%,and recall of 86.57%on the NIH pancreas dataset.Compared with other methods,our model has fewer parameters and faster inference speed,demonstrating its enormous potential in practical applications of pancreatic segmentation.展开更多
BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive ...BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.展开更多
Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biop...Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.展开更多
Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditio...Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.展开更多
Convolutional neural networks(CNNs)-based medical image segmentation technologies have been widely used in medical image segmentation because of their strong representation and generalization abilities.However,due to ...Convolutional neural networks(CNNs)-based medical image segmentation technologies have been widely used in medical image segmentation because of their strong representation and generalization abilities.However,due to the inability to effectively capture global information from images,CNNs can easily lead to loss of contours and textures in segmentation results.Notice that the transformer model can effectively capture the properties of long-range dependencies in the image,and furthermore,combining the CNN and the transformer can effectively extract local details and global contextual features of the image.Motivated by this,we propose a multi-branch and multi-scale attention network(M2ANet)for medical image segmentation,whose architecture consists of three components.Specifically,in the first component,we construct an adaptive multi-branch patch module for parallel extraction of image features to reduce information loss caused by downsampling.In the second component,we apply residual block to the well-known convolutional block attention module to enhance the network’s ability to recognize important features of images and alleviate the phenomenon of gradient vanishing.In the third component,we design a multi-scale feature fusion module,in which we adopt adaptive average pooling and position encoding to enhance contextual features,and then multi-head attention is introduced to further enrich feature representation.Finally,we validate the effectiveness and feasibility of the proposed M2ANet method through comparative experiments on four benchmark medical image segmentation datasets,particularly in the context of preserving contours and textures.展开更多
Based on the finite element-discrete element numerical method,a numerical model of fracture propagation in deflagration fracturing was established by considering the impact of stress wave,quasi-static pressure of expl...Based on the finite element-discrete element numerical method,a numerical model of fracture propagation in deflagration fracturing was established by considering the impact of stress wave,quasi-static pressure of explosive gas,and reflection of stress wave.The model was validated against the results of physical experiments.Taking the shale reservoirs of Silurian Longmaxi Formation in Luzhou area of the Sichuan Basin as an example,the effects of in-situ stress difference,natural fracture parameters,branch wellbore spacing,delay detonation time,and angle between branch wellbore and main wellbore on fracture propagation were identified.The results show that the fracture propagation morphology in deflagration fracturing is less affected by the in-situ stress difference when it is 5-15 MPa,and the tendency of fracture intersection between branch wellbores is significantly weakened when the in-situ stress difference reaches 20 MPa.The increase of natural fracture length promotes the fracture propagation along the natural fracture direction,while the increase of volumetric natural fracture density and angle limits the fracture propagation area and reduces the probability of fracture intersection between branch wells.The larger the branch wellbore spacing,the less probability of the fracture intersection between branch wells,allowing for the fracture propagation in multiple directions.Increasing the delay detonation time decreases the fracture spacing between branch wellbores.When the angle between the branch wellbore and the main wellbore is 45°and 90°,there is a tendency of fracture intersection between branch wellbores.展开更多
Accurately identifying key nodes is essential for evaluating network robustness and controlling information propagation in complex network analysis. However, current research methods face limitations in applicability ...Accurately identifying key nodes is essential for evaluating network robustness and controlling information propagation in complex network analysis. However, current research methods face limitations in applicability and accuracy. To address these challenges, this study introduces the K-GCN model, which integrates neighborhood k-shell distribution analysis with Graph Convolutional Network(GCN) technology to enhance key node identification in complex networks. The K-GCN model first leverages neighborhood k-shell distributions to calculate entropy values for each node, effectively quantifying node importance within the network. These entropy values are then used as key features within the GCN, which subsequently formulates intelligent strategies to maximize network connectivity disruption by removing a minimal set of nodes, thereby impacting the overall network architecture. Through iterative interactions with the environment, the GCN continuously refines its strategies, achieving precise identification of key nodes in the network. Unlike traditional methods, the K-GCN model not only captures local node features but also integrates the network structure and complex interrelations between neighboring nodes, significantly improving the accuracy and efficiency of key node identification.Experimental validation in multiple real-world network scenarios demonstrates that the K-GCN model outperforms existing methods.展开更多
This study examines the development of painting techniques of Chinese ink wash landscape paintings,pays attention to its unique brush and ink language and features of the representation of elements,and deeply analyzes...This study examines the development of painting techniques of Chinese ink wash landscape paintings,pays attention to its unique brush and ink language and features of the representation of elements,and deeply analyzes the artistic characteristics of digital ink wash texture materials.The research focuses on key aspects such as the ink brushstrokes with the combination of emptiness and reality,the profound and serene ink wash space,and the extremely ingenious position layout.It proposes a construction path of digital ink wash texture materials based on the Blender material node system.This method makes use of the flexibility of the Blender material node system to successfully simulate highly realistic digital ink wash textures.It can not only construct static ink wash textures but also realize the dynamic transformation of static ink wash works through animation nodes and procedural control,thereby enhancing the artistic expression of digital ink wash works.The proposal and implementation of this method expand the application scope of the Blender material node system,help deeply explore the potential of digital ink wash art,and open up a brand new research path for constructing digital ink wash textures.展开更多
Identifying key nodes in complex networks is crucial for understanding and controlling their dynamics. Traditional centrality measures often fall short in capturing the multifaceted roles of nodes within these network...Identifying key nodes in complex networks is crucial for understanding and controlling their dynamics. Traditional centrality measures often fall short in capturing the multifaceted roles of nodes within these networks. The Page Rank algorithm, widely recognized for ranking web pages, offers a more nuanced approach by considering the importance of connected nodes. However, existing methods generally overlook the geometric properties of networks, which can provide additional insights into their structure and functionality. In this paper, we propose a novel method named Curv-Page Rank(C-PR), which integrates network curvature and Page Rank to identify influential nodes in complex networks. By leveraging the geometric insights provided by curvature alongside structural properties, C-PR offers a more comprehensive measure of a node's influence. Our approach is particularly effective in networks with community structures, where it excels at pinpointing bridge nodes critical for maintaining connectivity and facilitating information flow. We validate the effectiveness of C-PR through extensive experiments. The results demonstrate that C-PR outperforms traditional centrality-based and Page Rank methods in identifying critical nodes. Our findings offer fresh insights into the structural importance of nodes across diverse network configurations, highlighting the potential of incorporating geometric properties into network analysis.展开更多
本文结合了Node2vec和GCN这两种方法,先利用Node2vec方法得到初步的图嵌入,之后将其作为输入利用GCN进一步更新图嵌入矩阵。本文选择在维基数据集上进行节点分类任务,比较了结合前后方法的表现,验证了其有效性。In this paper, we integ...本文结合了Node2vec和GCN这两种方法,先利用Node2vec方法得到初步的图嵌入,之后将其作为输入利用GCN进一步更新图嵌入矩阵。本文选择在维基数据集上进行节点分类任务,比较了结合前后方法的表现,验证了其有效性。In this paper, we integrate the Node2vec and GCN methods. Initially, the Node2vec method is employed to obtain preliminary graph embeddings, which are then used as input to further update the graph embedding matrix through GCN. The study selects the Wikipedia dataset for node classification tasks, comparing the performance of the methods before and after integration to validate their effectiveness.展开更多
Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation...Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).展开更多
BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic valu...BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.展开更多
Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:W...Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.展开更多
文摘BACKGROUND One of the main characteristics of oral squamous cell carcinoma(OSCC)is that it metastasizes to cervical lymph nodes frequently with a high degree of local invasiveness.A primary feature of malignant tumors is their penetration of neighboring tissues,such as lymphatic and blood arteries,due to the tumor cells'capacity to break down the extracellular matrix(ECM).Matrix metalloproteinases(MMPs)constitute a family of proteolytic enzymes that facilitate tissue remodeling and the degradation of the ECM.MMP-9 and MMP-13 belong to the group of extracellular matrix degrading enzymes and their expression has been studied in OSCC because of their specific functions.MMP-13,a collagenase family member,is thought to play an essential role in the MMP activation cascade by breaking down the fibrillar collagens,whereas MMP-9 is thought to accelerate the growth of tumors.Elevated MMP-13 expression has been associated with tumor behavior and patient prognosis in a number of malignant cases.AIM To assess the immunohistochemical expression of MMP-9 and MMP-13 in OSCC.METHODS A total of 40 cases with histologically confirmed OSCC by incisional biopsy were included in this cross-sectional retrospective study.The protocols for both MMP-9 and MMP-13 immunohistochemical staining were performed according to the manufacturer’s recommendations along with the normal gingival epithelium as a positive control.All the observations were recorded and Pearson’sχ²test with Fisher exact test was used for statistical analysis.RESULTS Our study showed no significant correlation between MMP-9 and MMP-13 staining intensity and tumor size.The majority of the patients were in advanced TNM stages(III and IV),and showed intense expression of MMP-9 and MMP-13.CONCLUSION The present study suggests that both MMP-9 and MMP-13 play an important and independent role in OSCC progression and invasiveness.Intense expression of MMP-9 and MMP-13,irrespective of histological grade of OSCC,correlates well with TNM stage.Consequently,it is evident that MMP-9 and MMP-13 are important for the invasiveness and progression of tumors.The findings may facilitate the development of new approaches for evaluating lymph node metastases and interventional therapy techniques,hence enhancing the prognosis of patients diagnosed with OSCC.
文摘Background: Sentinel lymph node (SLN) biopsy remains a cornerstone in the management of breast cancer, as it provides an accurate staging of the disease while minimizing the morbidity associated with complete axillary lymph node dissection. Advances in SLN detection have been very important in refining surgical techniques and improving patient outcomes. The purpose of the present study is to compare the effectiveness of radiocolloids, blue dyes, and fluorescent tracers in detecting the sentinel lymph node in breast cancer. Materials and Methods: Specifically, we analyzed the detection rate, accuracy, and safety profile of the techniques to outline the most reliable and clinically available. A comprehensive review was conducted, searching key databases, including PubMed, Scopus, and Web of Science, for studies published between 2010 and 2024. The review focused on studies that compared the performance of radiocolloids, blue dyes, and fluorescent tracers in the detection of sentinel lymph nodes in breast cancer patients. A total of 54 studies were included based on specific inclusion criteria. Results: Radiocolloids showed high detection rates in studies. Blue dyes have comparable results, but a small percentage of allergic reactions has been observed. Fluorescent tracers such as indocyanine green have improved visualization and accuracy, but their use requires specialized equipment and expertise. Combining radiocolloids with blue dyes or fluorescent tracers has improved detection rates in several studies. Cost and accessibility challenges have also been pointed out, particularly in low-resource settings. Conclusions: Radiocolloids have attained the status of gold standard in the detection of SLNs in breast cancer for their reliability and accuracy. While combined use with other tracers, like blue dyes or fluorescent agents, enhances overall detection performance, making it more holistic. As expected, further innovation and effort are required to improve accessibility and optimize the technique of sentinel lymph node biopsy worldwide.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81672638 and W2421095)National Natural Science Foundation of Shandong Province(Grant No.ZR2024LMB011)Collaborative Academic Innovation Project of Shandong Cancer Hospital(Grant No.GF003)。
文摘The principal breast cancer treatment approach has long been surgical removal of the primary breast lesions and regional lymph nodes,particularly the axillary lymph nodes.However,the advent of minimally invasive diagnostic techniques,such as sentinel lymph node biopsy(SLNB),has markedly diminished the extent of surgery required for regional lymph nodes.
基金supported by the Science and Technology Innovation Programof Hunan Province(Grant No.2022RC1021)the Hunan Provincial Natural Science Foundation Project(Grant No.2023JJ60124)+1 种基金the Changsha Natural Science Foundation Project(Grant No.kq2202265)the key project of the Hunan Provincial of Education(Grant No.22A0255).
文摘Automatic pancreas segmentation plays a pivotal role in assisting physicians with diagnosing pancreatic diseases,facilitating treatment evaluations,and designing surgical plans.Due to the pancreas’s tiny size,significant variability in shape and location,and low contrast with surrounding tissues,achieving high segmentation accuracy remains challenging.To improve segmentation precision,we propose a novel network utilizing EfficientNetV2 and multi-branch structures for automatically segmenting the pancreas fromCT images.Firstly,an EfficientNetV2 encoder is employed to extract complex and multi-level features,enhancing the model’s ability to capture the pancreas’s intricate morphology.Then,a residual multi-branch dilated attention(RMDA)module is designed to suppress irrelevant background noise and highlight useful pancreatic features.And re-parameterization Visual Geometry Group(RepVGG)blocks with amulti-branch structure are introduced in the decoder to effectively integrate deep features and low-level details,improving segmentation accuracy.Furthermore,we apply re-parameterization to the model,reducing computations and parameters while accelerating inference and reducing memory usage.Our approach achieves average dice similarity coefficient(DSC)of 85.59%,intersection over union(IoU)of 75.03%,precision of 85.09%,and recall of 86.57%on the NIH pancreas dataset.Compared with other methods,our model has fewer parameters and faster inference speed,demonstrating its enormous potential in practical applications of pancreatic segmentation.
基金the Clinical Medical Team Introduction Program of Suzhou,No.SZYJTD201804.
文摘BACKGROUND Lymph node status is a critical prognostic factor in gastric cancer(GC),but stage migration may occur in pathological lymph nodes(pN)staging.To address this,alternative staging systems such as the positive lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)were introduced.AIM To assess the prognostic accuracy and stratification efficacy of three nodal staging systems in GC.METHODS A systematic review identified 12 studies,from which hazard ratios(HRs)for overall survival(OS)were summarized.Sensitivity analyses,subgroup analyses,publication bias assessments,and quality evaluations were conducted.To enhance comparability,data from studies with identical cutoff values for pN,LNR,and LODDS were pooled.Homogeneous stratification was then applied to generate Kaplan-Meier(KM)survival curves,assessing the stratification efficacy of three staging systems.RESULTS The HRs and 95%confidence intervals for pN,LNR,and LODDS were 2.16(1.72-2.73),2.05(1.65-2.55),and 3.15(2.15-4.37),respectively,confirming all three as independent prognostic risk factors for OS.Comparative analysis of HRs demonstrated that LODDS had superior prognostic predictive power over LNR and pN.KM curves for pN(N0,N1,N2,N3a,N3b),LNR(0.1/0.2/0.5),and LODDS(-1.5/-1.0/-0.5/0)revealed significant differences(P<0.001)among all prognostic stratifications.Mean differences and standard deviations in 60-month relative survival were 27.93%±0.29%,41.70%±0.30%,and 26.60%±0.28%for pN,LNR,and LODDS,respectively.CONCLUSION All three staging systems are independent prognostic factors for OS.LODDS demonstrated the highest specificity,making it especially useful for predicting outcomes,while pN was the most effective in homogeneous stratification,offering better patient differentiation.These findings highlight the complementary roles of LODDS and pN in enhancing prognostic accuracy and stratification.
文摘Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors(Fujian Medical University)and Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Metastasis to the infraclavicular and supraclavicular lymph nodes(ISLNs)is an important factor that predicts poor survival in patients with breast cancer;however,pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection.This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy(NAC).Methods:We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions(Fujian cohort and Hebei cohort)from 2010 to 2022.We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs.Results:There were no survival differences among patients with ISLN involvement across different assay method-ologies and patient cohorts.Among 887 patients in the Fujian cohort,238 patients(26.8%)with positive ISLNs had significantly inferior 3-year progression-free survival(PFS,75.9%vs.90.4%,P<0.001)and overall survival(OS,90.6%vs.95.9%,P<0.001).After adjusting for potential confounders,ISLN involvement persisted as an independent predictor of both PFS and OS.We propose a refined axillary classification that combines pathologi-cal axillary staging post-NAC with ISLN involvement,revealing 3-year PFS rates of 95.3%,87.6%,73.4%,and 64.5%for the respective four groups defined by this refined classification combining axillary stage and ISLN status.Conclusions:Involvement of the ISLNs was associated with a worse prognosis,underscoring their prognostic value.This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.
基金supported by the Natural Science Foundation of the Anhui Higher Education Institutions of China(Grant Nos.2023AH040149 and 2024AH051915)the Anhui Provincial Natural Science Foundation(Grant No.2208085MF168)+1 种基金the Science and Technology Innovation Tackle Plan Project of Maanshan(Grant No.2024RGZN001)the Scientific Research Fund Project of Anhui Medical University(Grant No.2023xkj122).
文摘Convolutional neural networks(CNNs)-based medical image segmentation technologies have been widely used in medical image segmentation because of their strong representation and generalization abilities.However,due to the inability to effectively capture global information from images,CNNs can easily lead to loss of contours and textures in segmentation results.Notice that the transformer model can effectively capture the properties of long-range dependencies in the image,and furthermore,combining the CNN and the transformer can effectively extract local details and global contextual features of the image.Motivated by this,we propose a multi-branch and multi-scale attention network(M2ANet)for medical image segmentation,whose architecture consists of three components.Specifically,in the first component,we construct an adaptive multi-branch patch module for parallel extraction of image features to reduce information loss caused by downsampling.In the second component,we apply residual block to the well-known convolutional block attention module to enhance the network’s ability to recognize important features of images and alleviate the phenomenon of gradient vanishing.In the third component,we design a multi-scale feature fusion module,in which we adopt adaptive average pooling and position encoding to enhance contextual features,and then multi-head attention is introduced to further enrich feature representation.Finally,we validate the effectiveness and feasibility of the proposed M2ANet method through comparative experiments on four benchmark medical image segmentation datasets,particularly in the context of preserving contours and textures.
基金Supported by the National Natural Science Foundation of China(52374004)National Key R&D Program of China(2023YFF0614102,2023YFE0110900).
文摘Based on the finite element-discrete element numerical method,a numerical model of fracture propagation in deflagration fracturing was established by considering the impact of stress wave,quasi-static pressure of explosive gas,and reflection of stress wave.The model was validated against the results of physical experiments.Taking the shale reservoirs of Silurian Longmaxi Formation in Luzhou area of the Sichuan Basin as an example,the effects of in-situ stress difference,natural fracture parameters,branch wellbore spacing,delay detonation time,and angle between branch wellbore and main wellbore on fracture propagation were identified.The results show that the fracture propagation morphology in deflagration fracturing is less affected by the in-situ stress difference when it is 5-15 MPa,and the tendency of fracture intersection between branch wellbores is significantly weakened when the in-situ stress difference reaches 20 MPa.The increase of natural fracture length promotes the fracture propagation along the natural fracture direction,while the increase of volumetric natural fracture density and angle limits the fracture propagation area and reduces the probability of fracture intersection between branch wells.The larger the branch wellbore spacing,the less probability of the fracture intersection between branch wells,allowing for the fracture propagation in multiple directions.Increasing the delay detonation time decreases the fracture spacing between branch wellbores.When the angle between the branch wellbore and the main wellbore is 45°and 90°,there is a tendency of fracture intersection between branch wellbores.
基金Supported by the National Natural Science Foundation of China(Grant No.12031002)。
文摘Accurately identifying key nodes is essential for evaluating network robustness and controlling information propagation in complex network analysis. However, current research methods face limitations in applicability and accuracy. To address these challenges, this study introduces the K-GCN model, which integrates neighborhood k-shell distribution analysis with Graph Convolutional Network(GCN) technology to enhance key node identification in complex networks. The K-GCN model first leverages neighborhood k-shell distributions to calculate entropy values for each node, effectively quantifying node importance within the network. These entropy values are then used as key features within the GCN, which subsequently formulates intelligent strategies to maximize network connectivity disruption by removing a minimal set of nodes, thereby impacting the overall network architecture. Through iterative interactions with the environment, the GCN continuously refines its strategies, achieving precise identification of key nodes in the network. Unlike traditional methods, the K-GCN model not only captures local node features but also integrates the network structure and complex interrelations between neighboring nodes, significantly improving the accuracy and efficiency of key node identification.Experimental validation in multiple real-world network scenarios demonstrates that the K-GCN model outperforms existing methods.
基金Research results of the General Scientific Research Project of Zhejiang Education Department in 2024,“Research on the Digitalization of Song Yun Ink Painting-Taking the Ten Scenes of West Lake as an Example”(Project No.:Y202455200).
文摘This study examines the development of painting techniques of Chinese ink wash landscape paintings,pays attention to its unique brush and ink language and features of the representation of elements,and deeply analyzes the artistic characteristics of digital ink wash texture materials.The research focuses on key aspects such as the ink brushstrokes with the combination of emptiness and reality,the profound and serene ink wash space,and the extremely ingenious position layout.It proposes a construction path of digital ink wash texture materials based on the Blender material node system.This method makes use of the flexibility of the Blender material node system to successfully simulate highly realistic digital ink wash textures.It can not only construct static ink wash textures but also realize the dynamic transformation of static ink wash works through animation nodes and procedural control,thereby enhancing the artistic expression of digital ink wash works.The proposal and implementation of this method expand the application scope of the Blender material node system,help deeply explore the potential of digital ink wash art,and open up a brand new research path for constructing digital ink wash textures.
基金Project partially supported by the National Natural Science Foundation of China (Grant Nos. 61672298 and 62373197)the Major Project of Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province,China (Grant No. 2018SJZDI142)the Postgraduate Research & Practice Innovation Program of Jiangsu Province,China (Grant No. KYCX23 1045)。
文摘Identifying key nodes in complex networks is crucial for understanding and controlling their dynamics. Traditional centrality measures often fall short in capturing the multifaceted roles of nodes within these networks. The Page Rank algorithm, widely recognized for ranking web pages, offers a more nuanced approach by considering the importance of connected nodes. However, existing methods generally overlook the geometric properties of networks, which can provide additional insights into their structure and functionality. In this paper, we propose a novel method named Curv-Page Rank(C-PR), which integrates network curvature and Page Rank to identify influential nodes in complex networks. By leveraging the geometric insights provided by curvature alongside structural properties, C-PR offers a more comprehensive measure of a node's influence. Our approach is particularly effective in networks with community structures, where it excels at pinpointing bridge nodes critical for maintaining connectivity and facilitating information flow. We validate the effectiveness of C-PR through extensive experiments. The results demonstrate that C-PR outperforms traditional centrality-based and Page Rank methods in identifying critical nodes. Our findings offer fresh insights into the structural importance of nodes across diverse network configurations, highlighting the potential of incorporating geometric properties into network analysis.
文摘本文结合了Node2vec和GCN这两种方法,先利用Node2vec方法得到初步的图嵌入,之后将其作为输入利用GCN进一步更新图嵌入矩阵。本文选择在维基数据集上进行节点分类任务,比较了结合前后方法的表现,验证了其有效性。In this paper, we integrate the Node2vec and GCN methods. Initially, the Node2vec method is employed to obtain preliminary graph embeddings, which are then used as input to further update the graph embedding matrix through GCN. The study selects the Wikipedia dataset for node classification tasks, comparing the performance of the methods before and after integration to validate their effectiveness.
文摘Introduction The accuracy of sentinel lymph node biopsy(SLNB)after neoadjuvant therapy(NAT)has been confirmed in clinical nodal stage 1(c N1)patients,and more patients could benefit from axillary surgery de-escalation after NAT(1,2).
基金Supported by The Shandong Provincial Medical and Health Science and Technology Youth Project,China,No.202304081355The Weifang Youth Medical Talent Lift Project,Chinaand The Science and Technology Development Project of Affiliated Hospital of Shandong Second Medical University,China,No.2023FYQ004.
文摘BACKGROUND Gastric cancer(GC)is frequently diagnosed at advanced stages,often with lymph node metastasis(LNM),which complicates prognosis.Swollen LNM(SLNM)in GC has been linked to poor outcomes,yet its prognostic value requires validation.AIM To evaluate the prognostic significance of SLNM in GC patients undergoing curative-intent gastrectomy.METHODS A retrospective analysis included 507 GC patients with LNM,categorized by SLNM status into positive(SLNM present)and negative(SLNM absent)groups.Survival outcomes were compared between groups,including propensity score matching and multivariate analysis to assess the role of SLNM as an independent prognostic factor.RESULTS One hundred and thirty-nine(27.4%)patients exhibited SLNM,associated with significantly lower 5-year overall survival(OS)compared to non-SLNM patients(13.6%vs 35.8%,P<0.001).After matching,SLNM-positive patients maintained worse OS rates(13.4%vs 21.2%,P=0.006).Multivariate analysis confirmed SLNM as an independent prognostic factor(hazard ratio=1.318,P=0.031).Additionally,T4 stage,N3 stage,and neoadjuvant chemotherapy independently influenced survival outcomes for SLNM-positive patients.Those who received neoadjuvant chemotherapy demonstrated better prognosis.CONCLUSION SLNM is an independent predictor of poor prognosis in GC.Neoadjuvant chemotherapy followed by D2 gastrectomy and adjuvant chemotherapy may offer survival benefits for patients with SLNM.
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
文摘Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.
