Sun Yat-sen University Research Articles

Treatment of pediatric refractory or relapsed Epstein-Barr virus-associated hemophagocytic syndrome with PD-1 inhibitors.

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is a type of pediatric HLH that occurs frequently in Asia. Although immunochemotherapy based on etoposide and hormone has improved survival rates, there are still about 30% of HLH patients that do not respond. The objective of the article is to examine the efficacy and safety of programmed cell death protein 1 (PD-1) inhibitors for children with relapsed/refractory (r/r) EBV-HLH. A retrospective case note review of four pediatric patients with r/r EBV-HLH who were treated with PD-1 inhibitors at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. All four patients responded to PD-1 inhibitors and achieved partial response after their first infusion. Plasma EBV DNA copy number and HLH-related monitoring indicators decreased in all of these patients. All patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and two were still alive at the last follow-up on December 30, 2022. Two patients died because of transplantation-related complications. Serious side effects included increased liver enzymes and edema in two patients. PD-1 inhibitors are an effective salvage therapy and can provide a bridge to allo-HSCT for pediatric patients with r/r EBV-HLH. However, side effects should be monitered.

Research landscape of radiotherapy for nasopharyngeal carcinoma from 1959 to 2022: A bibliometric analysis

BackgroundRadiotherapy, as the main treatment method for nasopharyngeal carcinoma (NPC), has evolved over time, but there has been no bibliometric study on NPC radiotherapy to date. In our study, the scientific achievements of NPC radiotherapy around the world were evaluated by bibliometric analyses, and the previous research hotspots and future trends are described. MethodsOriginal articles related to NPC radiotherapy were obtained from the Web of Science Core Collection. To identify research hotspots and future trends, countries/regions, institutions, journals, references, authors, and keywords were evaluated and visualized by Excel, VOSviewer, and CiteSpace. ResultsFrom 1959 to 2022, 7139 original articles were collected. The annual publications showed an increasing trend, especially after 2011. China had the most publications (n = 3719, 52.09 %). Sun Yat-sen University has the most publications and citations among institutions. Jun Ma is most productive and SR Baker has the highest co-cited centrality. International Journal of Radiation Oncology-Biology-Physics is the core journal, with most publications, citations and co-citations. Analysis of keywords showed intensity-modulated radiotherapy and chemoradiotherapy were the main keywords, and multicenter showed the strongest burst. ConclusionNPC radiotherapy has attracted increasing attention, and precision and artificial intelligence may be the future trends in this field.

Estimation of Fractal Dimension and Segmentation of Body Regions for Deep Learning-Based Gender Recognition

There are few studies utilizing only IR cameras for long-distance gender recognition, and they have shown low recognition performance due to their lack of color and texture information in IR images with a complex background. Therefore, a rough body segmentation-based gender recognition network (RBSG-Net) is proposed, with enhanced gender recognition performance achieved by emphasizing the silhouette of a person through a body segmentation network. Anthropometric loss for the segmentation network and an adaptive body attention module are also proposed, which effectively integrate the segmentation and classification networks. To enhance the analytic capabilities of the proposed framework, fractal dimension estimation was introduced into the system to gain insights into the complexity and irregularity of the body region, thereby predicting the accuracy of body segmentation. For experiments, near-infrared images from the Sun Yat-sen University multiple modality re-identification version 1 (SYSU-MM01) dataset and thermal images from the Dongguk body-based gender version 2 (DBGender-DB2) database were used. The equal error rates of gender recognition by the proposed model were 4.320% and 8.303% for these two databases, respectively, surpassing state-of-the-art methods.

Study on the restoration of glass slides dating back to the 1940s

The Museum of Sun Yat-sen University houses a collection of antique glass slides dating back to the 1940s. These historical artifacts not only serve as a record of the past but also bring history to life. During extended storage, the emulsion layer on glass slides may harden and become brittle, leading to cracking and buckling. This study suggests a method to enhance the physical property of the emulsion layer by using a combination of nonionic surfactant isomeric alcohol ethoxylates eight (TO-8) and waterborne epoxy resin (WER). We investigated the microscopic action mechanism of the two on the emulsion layer of glass slides using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), water contact angles, and other techniques. Our study revealed that TO-8 can significantly eliminate the spherulitic crystal structure of the emulsion layer, as well as improve its softness and hydrophilicity. The addition of the WER ensures that the cracking and warping of the emulsion layer film is fully corrected, resulting in a flat surface. Additionally, the size of the emulsion layer film remains stable even after wetting. The WER has minimal impact on the image information of glass slides. The emulsion layer of the glass slides, restored using the softening protection solutions developed in this study, showed almost full recovery of image information. This research holds significant theoretical and practical value for repairing cracked and warped emulsion layers on glass slides.

Systematic bibliometric and visualized analysis of research hotspots and trends on the application of artificial intelligence in glaucoma from 2013 to 2022.

To conduct a bibliometric analysis of research on artificial intelligence (AI) in the field of glaucoma to gain a comprehensive understanding of the current state of research and identify potential new directions for future studies. Relevant articles on the application of AI in the field of glaucoma from the Web of Science Core Collection were retrieved, covering the period from January 1, 2013, to December 31, 2022. In order to assess the contributions and co-occurrence relationships among different countries/regions, institutions, authors, and journals, CiteSpace and VOSviewer software were employed and the research hotspots and future trends within the field were identified. A total of 750 English articles published between 2013 and 2022 were collected, and the number of publications exhibited an overall increasing trend. The majority of the articles were from China, followed by the United States and India. National University of Singapore, Chinese Academy of Sciences, and Sun Yat-sen University made significant contributions to the published works. Weinreb RN and Fu HZ ranked first among authors and cited authors. American Journal of Ophthalmology is the most impactful academic journal in the field of AI application in glaucoma. The disciplinary scope of this field includes ophthalmology, computer science, mathematics, molecular biology, genetics, and other related disciplines. The clustering and identification of keyword nodes in the co-occurrence network reveal the evolving landscape of AI application in the field of glaucoma. Initially, the hot topics in this field were primarily "segmentation", "classification" and "diagnosis". However, in recent years, the focus has shifted to "deep learning", "convolutional neural network" and "artificial intelligence". With the rapid development of AI technology, scholars have shown increasing interest in its application in the field of glaucoma. Moreover, the application of AI in assisting treatment and predicting prognosis in glaucoma may become a future research hotspot. However, the reliability and interpretability of AI data remain pressing issues that require resolution.

Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial.

Performing obstetric ultrasound scans is challenging for inexperienced operators; therefore, the prenatal screening artificial intelligence system (PSAIS) software was developed to provide real-time feedback and guidance for trainees during their scanning procedures. The aim of this study was to investigate the potential benefits of utilizing such an artificial intelligence system to enhance the efficiency of obstetric ultrasound training in acquiring and interpreting standard basic views. A prospective, single-center randomized controlled study was conducted at The First Affiliated Hospital of Sun Yat-sen University. From September 2022 to April 2023, residents with no prior obstetric ultrasound experience were recruited and assigned randomly to either a PSAIS-assisted training group or a conventional training group. Each trainee underwent a four-cycle practical scan training program, performing 20 scans in each cycle on pregnant volunteers at 18-32 gestational weeks, focusing on acquiring and interpreting standard basic views. At the end of each cycle, a test scan evaluated trainees' ability to obtain standard ultrasound views without PSAIS assistance, and image quality was rated by both the trainees themselves and an expert (in a blinded manner). The primary outcome was the number of training cycles required for each trainee to meet a certain standard of proficiency (i.e. end-of-cycle test scored by the expert at ≥ 80%). Secondary outcomes included the expert ratings of the image quality in each trainee's end-of-cycle test and the discordance between ratings by trainees and the expert. In total, 32 residents and 1809 pregnant women (2720 scans) were recruited for the study. The PSAIS-assisted trainee group required significantly fewer training cycles compared with the non-PSAIS-assisted group to meet quality requirements (P = 0.037). Based on the expert ratings of image quality, the PSAIS-assisted training group exhibited superior ability in acquiring standard imaging views compared with the conventional training group in the third (P = 0.012) and fourth (P < 0.001) cycles. In both groups, the discordance between trainees' ratings of the quality of their own images and the expert's ratings decreased with increasing training time. A statistically significant difference in overall trainee-expert rating discordance between the two groups emerged at the end of the first training cycle and remained at every cycle thereafter (P < 0.013). By assisting inexperienced trainees in obtaining and interpreting standard basic obstetric scanning views, the use of artificial intelligence-assisted systems has the potential to improve training effectiveness. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

A lightweight detection algorithm for tooth cracks in optical images

ObjectivesCracked tooth syndrome (CTS) is one of the major causes of tooth loss, presents the problem of early microcrack symptoms that are difficult to distinguish. This paper aims to investigate the practicality and feasibility of an improved object detection algorithm for automatically detecting cracks in dental optical images. MethodsA total of 286 teeth were obtained from Sun Yat-sen University and Guangdong University of Technology, and simulated cracks were generated using thermal expansion and contraction. Over 3000 images of cracked teeth were collected, including 360 real clinical images. To make the model more lightweight and better suited for deployment on embedded devices, this paper improves the YOLOv8 model for detecting tooth cracks through model pruning and backbone replacement. Additionally, the impact of image enhancement modules and coordinate attention modules on optimizing our model was analyzed. ResultsThrough experimental validation, we conclude that that model pruning reduction maintains performance better than replacing a lightweight backbone network on a tooth crack detection task. This approach achieved a reduction in parameters and GFLOPs by 16.8 % and 24.3 %, respectively, with minimal impact on performance. These results affirm the effectiveness of the proposed method in identifying and labeling tooth fractures. In addition, this paper demonstrated that the impact of image enhancement modules and coordinate attention mechanisms on YOLOv8's performance in the task of tooth crack detection was minimal. ConclusionsAn improved object detection algorithm has been proposed to reduce model parameters. This lightweight model is easier to deploy and holds potential for assisting dentists in identifying cracks on tooth surfaces.

Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma.

Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma (ESCC). The use of corticosteroids as pretreatment might reduce immunotherapy efficacy. To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy (nIC) outcomes in locally advanced ESCC patients. Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included. Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment. Antiallergic efficacy and safety were evaluated, as well as its impact on short-term efficacy [complete pathological response (pCR), major pathological response (MPR)] and long-term efficacy [overall survival (OS), progression-free survival (PFS)] of nIC. From September 2019 to September 2023, 142 patients were analyzed. No severe treatment-related adverse events or deaths were observed. Allergy occurrence was greater in the antihistamine group (P = 0.014). Short-term efficacy was not significantly different: The pCR rates were 29.9% and 40.0%, and the MPR rates were 57.9% and 65.7% in the dexamethasone and antihistamine groups, respectively. The long-term efficacy was not significantly different: The 2 years OS rates were 95.2% and 93.5%, and the 2 years PFS rates were 90.3% and 87.8%. Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the < 20 mg dexamethasone group, but PFS was significantly greater in the 20 mg dexamethasone group (93.9% vs 56.4%, P = 0.001). Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short- or long-term efficacy. Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.

Electron spins from a molecular perspective: an interview with Song Gao.

Spin chemistry has emerged as an interdisciplinary field that focuses on electron spins in molecules and related applications in physics, chemistry, biology, materials science and information science. It will play a crucial role in technological innovations. The chemistry of spins is deeply related to the essence of chemical bonds, chemical catalysis, enzyme catalysis, optical and electromagnetic properties, quantum computation and quantum precision measurements. The related research is intersectional, cutting-edge and has a wide range of application prospects. National Science Review (NSR) recently interviewed Prof. Song Gao to discuss spin chemistry. Prof. Gao is a renowned inorganic chemist and an academician of Chinese Academy of Sciences. He is the president of Sun Yat-sen University and the founder of the Spin-X Institute of South China University of Technology. He is recognized as a leader in coordination chemistry and molecular magnetism, and has strong academic influence. Since 2008, he has served on the International Advisory Committee of International Conference on Molecule-Based Magnets, and organized and chaired its 2010 conference. Prof. Gao's primary research topics include molecular nanomagnets; the relationship between geometric structures, electronic structures and magnetism of molecules; and the spin states and reactivity of molecules.

Retrospective clinical and microbiologic analysis of metagenomic next-generation sequencing in the microbiological diagnosis of cutaneous infectious granulomas

BackgroundCutaneous infectious granulomas (CIG) are localized and chronic skin infection caused by a variety of pathogens such as protozoans, bacteria, worms, viruses and fungi. The diagnosis of CIG is difficult because microbiological examination shows low sensitivity and the histomorphological findings of CIG caused by different pathogens are commonly difficult to be distinguished.ObjectiveThe objective of this study is to explore the application of mNGS in tissue sample testing for CIG cases, and to compare mNGS with traditional microbiological methods by evaluating sensitivity and specificity.MethodsWe conducted a retrospective study at the Department of Dermatology of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 1st, 2020, to May 31st, 2024. Specimens from CIG patients with a clinical presentation of cutaneous infection that was supported by histological examination were retrospectively enrolled. Specimens were delivered to be tested for microbiological examinations and mNGS.ResultsOur data show that mNGS detected Non-tuberculosis mycobacteria, Mycobacterium tuberculosis, fungi and bacteria in CIG. Compared to culture, mNGS showed a higher positive rate (80.77% vs. 57.7%) with high sensitivity rate (100%) and negative predictive value (100%). In addition, mNGS can detect more pathogens in one sample and can be used to detect variable samples including the samples of paraffin-embedded tissue with shorter detective time. Of the 21 patients who showed clinical improvement within a 30-day follow-up, eighteen had their treatments adjusted, including fifteen who continued treatment based on the results of mNGS.ConclusionsmNGS could provide a potentially rapid and effective alternative detection method for diagnosis of cutaneous infectious granulomas and mNGS results may affect the clinical prognosis resulting from enabling the patients to initiate timely treatment.

Design of a mixed material moderator in a beam-shaping assembly for proton accelerator-based boron neutron capture therapy

Boron Neutron Capture Therapy is being promoted with the development of accelerator neutron sources, and many new accelerator-based BNCT facilities are being built. In Particle Accelerator Facility project of Sun Yat-sen University, we plan to build a terminal for BNCT research based on an 8 MeV, CW 3 mA proton accelerator. In this paper, we present a beam-shaping assembly for this proton accelerator with such low 24 kW beam power, using composite moderator materials composed of five elements: Mg, Al, F, O, and Li. The calculation result of FLUKA with ENDF/B and JENDL libraries shows that the epithermal neutron beam flux is 1.57×109n/cm2/s with the CW 3 mA proton beam. The fast neutron component and the gamma ray component under free-air condition are 1.49×10−13Gy∙cm2 and 8.12×10−14Gy∙cm2 respectively, in line with IAEA-TECDOC-1223 design recommendations. The thermal analysis shows that the maximum temperature of beryllium target is 706.5 K, and the structure materials of BSA do not melt.

Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial

ObjectiveTo assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease.DesignNon-inferiority randomised controlled trial.SettingRecruitment was from clinics and community and the trial took place at Zhongshan...

Analysis of factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma

Objective: To investigate the factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma (POAG), and to clarify whether the factors vary in patients with different degrees of myopia. Method: An ambispective cohort study was conducted among patients diagnosed with myopia and POAG from the glaucoma outpatient department at the Zhongshan Ophthalmic Center of Sun Yat-sen University between January 2006 and January 2024. Based on the criteria of functional visual field progression, patients were divided into the progression group and non-progression group, and further divided into the low to moderate myopia subgroup and high myopia subgroup according to the degree of myopia. The patient age, gender, type of glaucoma (high tension glaucoma and normal tension glaucoma), spherical equivalent refraction, best corrected visual acuity (BCVA, recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), central corneal thickness, baseline visual field, history of ophthalmic surgery (corneal refractive surgery and glaucoma surgery), and number of anti-glaucoma medications were summarized. The generalized estimation equation was used for comparison between groups, and the Cox proportional hazards model was used to analyze the factors affecting the progression of visual field defects. Results: A total of 182 eyes from 106 patients were included in this study. There were 57 eyes in the progression group and 125 eyes in the non-progression group. Compared with the non-progression group, the progression group had the older age [43 (29, 53) years old], worse BCVA [0.05 (0.00, 0.17)], greater IOP fluctuation [1.8 (1.3, 2.9)mmHg(1 mmHg=0.133 kPa)], more common baseline central defects [52.6%(30/57)], higher visual field pattern standard deviations [8.92 (5.32, 12.00)dB], lower visual field index [77% (67%, 88%)], and more anti-glaucoma medications [35.1% (20/57) patients used three medications] (all P<0.05). The Cox proportional hazards models showed that the baseline moderate visual field defects [hazard ratio (HR)=2.33, 95% confidence interval (CI): 1.25 to 4.36, P=0.008], baseline central defects (HR=2.09, 95%CI: 1.11 to 3.93, P=0.022), older age (Model A, HR=1.03, 95%CI: 1.00 to 1.05, P=0.017; Model B, HR=1.02, 95%CI: 1.00 to 1.05, P=0.019), and greater IOP fluctuation (Model A, HR=1.54, 95%CI: 1.32 to 1.81, P<0.001; Model B, HR=1.49, 95%CI: 1.26 to 1.75, P<0.001) were risk factors for visual field progression. In the low to moderate myopia subgroup, the increased risk of progression was associated with baseline central defects (HR=5.74, 95%CI: 1.72 to 19.20, P=0.005), worse BCVA (Model A, HR=15.80, 95%CI: 2.07 to 121.00, P=0.008; Model B, HR=12.50, 95%CI: 2.65 to 58.70, P=0.001), and older age (Model A, HR=1.05, 95%CI: 1.02 to 1.08, P=0.002; Model B, HR=1.07, 95%CI: 1.03 to 1.11, P<0.001). In the high myopia subgroup, the increased risk of progression was associated with baseline moderate visual field defects (HR=2.35, 95%CI: 1.12 to 4.92, P=0.024) and greater IOP fluctuation (Model A, HR=1.50, 95%CI: 1.24 to 1.82, P<0.001; Model B, HR=1.52, 95%CI: 1.26 to 1.83, P<0.001). Conclusions: Age, IOP fluctuation, baseline moderate visual field defects, and baseline central defects were the factors affecting the progression of visual field defects in patients with myopia and POAG. There were differences in the influencing factors of visual field progression in patients with different degrees of myopia.

Results of mother-to-child transmission in hepatitis B-positive mothers who underwent amniocentesis

PurposeThis study aims to analyze whether undergoing amniocentesis during pregnancy in women diagnosed with hepatitis B virus (HBV) infection leads to HBV transmission to newborns.MethodsRetrospective data collection was conducted from June 2019 to November 2022 on expectant mothers positive for hepatitis B surface antigen (HBsAg) who underwent amniocentesis at The Third Affiliated Hospital of Sun Yat-sen University, along with data on their newborns. The study summarized the HBV infection status of newborns born to mothers with different expressions of hepatitis B e antigen (HBeAg), antiviral treatment versus no treatment, and different HBV DNA viral loads before delivery.ResultsIn this study, 346 expectant mothers tested positive for HBsAg, along with 351 newborns (including 5 sets of twins, with 8 infants (2.28%) testing HBsAg-positive at birth. All newborns received dual immunotherapy and were followed up. At 7–12 months, retesting for HBsAg positivity and HBV DNA positivity among infants revealed that out of the infants born with HBsAg positivity, 7 cases had seroconverted to negative, while the remaining infant, who was positive for both HBsAg and HBeAg at birth, tested positive for both HBsAg and HBV DNA at 7–12 months. Thus, one case of vertical transmission of hepatitis B from mother to child occurred in this study. The proportion of infants born with HBsAg + among newborns born to HBeAg-positive mothers (4 cases, 6.06%) was significantly higher than that among newborns born to HBeAg-negative mothers (4 cases, 1.41%) (P < 0.05). The proportion of infants born with HBsAg + showed no significant difference between newborns born to mothers receiving antiviral therapy (2 cases, 2.90%) and those born to mothers not receiving antiviral therapy (6 cases, 2.13%) (P > 0.05). Among expectant mothers with viral load ≥ 6 log 10 IU/mL before delivery, 3 newborns (30.00%) were manifesting HBsAg positivity at birth, significantly higher than the group with viral load < 6 log 10 IU/mL before delivery (5 cases, 1.47%) (P < 0.05).ConclusionAmong HBsAg-positive expectant mothers, only a small number of infants are infected with the hepatitis B virus at birth, the proportion of which is relatively low. Infants born to mothers who are HBeAg-positive or have a viral load ≥ 6 log10 IU/mL have a higher risk of being born positive.

Serum amyloid A for predicting prognosis in patients with newly diagnosed Crohn’s disease

ObjectiveSerum amyloid A (SAA) was found to be positively correlated with the activity of Crohn’s disease (CD); however, its prognostic value remains uncertain. Here, we examined its predictive ability in...

Postoperative pulmonary complications after major abdominal surgery in elderly patients and its association with patient-controlled analgesia

ObjectivesThis study aims to identify the risk factors for postoperative pulmonary complications (PPCs) in elderly patients undergoing major abdominal surgery and to investigate the relationship between patient-controlled analgesia (PCA) and PPCs.DesignA retrospective study.MethodClinical data and demographic information of elderly patients (aged ≥ 60 years) who underwent upper abdominal surgery at the First Affiliated Hospital of Sun Yat-sen University from 2017 to 2019 were retrospectively collected. Patients with PPCs were identified using the Melbourne Group Scale Version 2 scoring system. A directed acyclic graph was used to identify the potential confounders, and multivariable logistic regression analyses were conducted to identify independent risk factors for PPCs. Propensity score matching was utilized to compare PPC rates between patients with and without PCA, as well as between intravenous PCA (PCIA) and epidural PCA (PCEA) groups.ResultsA total of 1,467 patients were included, with a PPC rate of 8.7%. Multivariable analysis revealed that PCA was an independent protective factor for PPCs in elderly patients undergoing major abdominal surgery (odds ratio = 0.208, 95% confidence interval = 0.121 to 0.358; P < 0.001). After matching, patients receiving PCA demonstrated a significantly lower overall incidence of PPCs (8.6% vs. 26.3%, P < 0.001), unplanned transfer to the intensive care unit (1.1% vs. 8.4%, P = 0.001), and in-hospital mortality (0.7% vs. 5.3%, P = 0.021) compared to those not receiving PCA. No significant difference in outcomes was observed between patients receiving PCIA or PCEA after matching.ConclusionPatient-controlled analgesia, whether administered intravenously or epidurally, is associated with a reduced risk of PPCs in elderly patients undergoing major upper abdominal surgery.

Chromosomal instability is associated with prognosis and efficacy of bevacizumab after resection of colorectal cancer liver metastasis

Introduction Individualized treatment of colorectal cancer liver metastases (CRLM) remains challenging due to differences in the severity of metastatic disease and tumour biology. Exploring specific prognostic risk subgroups is urgently needed. The current study aimed to investigate the prognostic value of chromosomal instability (CIN) in patients with initially resectable CRLM and the predictive value of CIN for the efficacy of bevacizumab. Methods Ninety-one consecutive patients with initially resectable CRLM who underwent curative liver resection from 2006 to 2018 at Sun Yat-sen University Cancer Center were selected for analysis. CIN was evaluated by automated digital imaging systems. Immunohistochemistry (IHC) was performed to detect interleukin-6 (IL-6), vascular endothelial growth factor A (VEGFA) and CD31 expression in paraffin-embedded specimens. Recurrence-free survival (RFS) and overall survival (OS) were analysed using the Kaplan–Meier method and Cox regression models. Results Patients with high chromosomal instability (CIN-H) had a worse 3-year RFS rate (HR, 1.953; 95% CI, 1.001–3.810; p = 0.049) and a worse 3-year OS rate (HR, 2.449; 95% CI, 1.150–5.213; p = 0.016) than those with low chromosomal instability (CIN-L). CIN-H was identified as an independent prognostic factor for RFS (HR, 2.569; 95% CI, 1.078–6.121; p = 0.033) and OS (HR, 3.852; 95% CI, 1.173–12.645; p = 0.026) in the multivariate analysis. The protein levels of IL-6, VEGFA and CD31 were upregulated in patients in the CIN-H group compared to those in the CIN-L group in both primary tumour and liver metastases tissues. Among them, 22 patients with recurrent tumours were treated with first-line bevacizumab treatment and based on the clinical response assessment, disease control rates were adversely associated with chromosomal instability (p = 0.043). Conclusions Our study showed that high chromosomal instability is a negative prognostic factor for patients with initially resectable CRLM after liver resection. CIN may have positive correlations with angiogenesis through expression of IL-6–VEGFA axis and be used as a potential predictor of efficacy of bevacizumab.

A log odds of positive lymph nodes-based predictive model effectively forecasts prognosis and guides postoperative adjuvant chemotherapy duration in stage III colon cancer: a multi-center retrospective cohort study

BackgroundThe log odds of positive lymph nodes (LODDS) was considered a superior staging system to N stage in colon cancer, yet its value in determining the optimal duration of adjuvant chemotherapy for stage III colon cancer patients has not been evaluated. This study aims to assess the prognostic value of a model that combines LODDS with clinicopathological information for stage III colon cancer patients and aims to stratify these patients using the model, identifying individuals who could benefit from varying durations of adjuvant chemotherapy.MethodA total of 663 consecutive patients diagnosed with stage III colon cancer, who underwent colon tumor resection between November 2007 and June 2020 at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University, were enrolled in this study. Survival outcomes were analyzed using Kaplan–Meier, Cox regression. Nomograms were developed to forecast patient DFS, with the Area Under the Curve (AUC) values of time-dependent Receiver Operating Characteristic (timeROC) and calibration plots utilized to assess the accuracy and reliability of the nomograms.ResultsMultivariate analysis revealed that perineural invasion (HR = 1.776, 95% CI: 1.052–3.003, P = 0.032), poor tumor differentiation (HR = 1.638, 95% CI: 1.084–2.475, P = 0.019), and LODDS groupings of 2 and 1 (HR = 1.920, 95% CI: 1.297–2.842, P = 0.001) were independent predictors of disease-free survival (DFS) in the training cohort. Nomograms constructed from LODDS, perineural invasion, and poor tumor differentiation demonstrated robust predictive performance for 3-year and 5-year DFS in both training (3-year AUC = 0.706, 5-year AUC = 0.678) and validation cohorts (3-year AUC = 0.744, 5-year AUC = 0.762). Stratification according to this model showed that patients in the high-risk group derived significant benefit from completing 8 cycles of chemotherapy (training cohort, 82.97% vs 67.17%, P = 0.013; validation cohort, 89.49% vs 63.97%, P = 0.030).ConclusionThe prognostic model, integrating LODDS, pathological differentiation, and neural invasion, demonstrates strong predictive accuracy for stage III colon cancer prognosis. Moreover, stratification via this model offers valuable insights into optimal durations of postoperative adjuvant chemotherapy.

Neoadjuvant radiation target volume definition in esophageal squamous cell cancer: a multicenter recommendations from Chinese experts

BackgroundThis study aimed to establish a consensus on the delineation of target volumes for neoadjuvant radiation therapy (nRT) in esophageal squamous cell carcinoma (ESCC) within China.MethodsFrom February 2020 to June 2021, nine ESCC patients who received nRT were retrospectively selected from Sun Yat-sen University Cancer Center and Shandong Cancer Hospital. A panel from eight cancer radiotherapy centers performed two rounds of nRT target volume delineation for these patients: the first round for cases 1–6 and the second for cases 7–9. Online meetings were held after each delineation round to discuss findings. The consistency of delineations across centers was compared using mean undirected Hausdorff distances (Hmean), dice similarity coefficients (DSC), and total volumes, analyzed with the Mann-Whitney U test.ResultsThe second round of delineations showed improved consistency across centers (total clinical target volume (CTVtotal): mean DSC = 0.76–0.81; mean Hmean = 2.11–3.14 cm) compared to the first round (CTVtotal: mean DSC = 0.63–0.64; mean Hmean = 5.66–7.34 cm; DSC and Hmean: P < 0.050 between rounds), leading to the formation of a consensus and an atlas for ESCC nRT target volume delineation. A proposal was reached through evaluating target volume delineations, analyzing questionnaire survey outcomes, and reviewing pertinent literature.ConclusionsWe have developed guidelines and an atlas for target volume delineation in nRT therapy for ESCC in China. These resources are designed to facilitate more consistent delineation of target volumes in both clinical practice and clinical trials.

NAT10 Overexpression Promotes Tumorigenesis and Epithelial-Mesenchymal Transition Through AKT Pathway in Gastric Cancer.

N-acetyltransferase 10 (NAT10), the only RNA cytosine acetyltransferase known in humans, contributes to cancer tumorigenesis and progression. This study aims to investigate the effect of NAT10 on the malignant biological properties of gastric cancer (GC) and its underlying mechanism. The expression and prognostic significance of NAT10 in GC were analyzed using The Cancer Genome Atlas (TCGA) and Sun Yat-sen University (SYSU) cohorts. The influence of NAT10 on the malignant biological behaviors of GC was detected by Cell Counting Kit-8 (CCK-8) assay, plate colony formation assay, 5-ethynyl-2'-deoxyuridine (EdU), Transwell migration and invasion assays, scratch wound assay, flow cytometric analysis, and animal studies. The overall level of N4 acetylcytidine (ac4C) in GC was detected by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The downstream signal pathways of NAT10 were analyzed by Gene Set Enrichment Analysis (GSEA) and verified by Western blot (WB) and immunofluorescence (IF). The significant upregulation of NAT10 expression in GC was associated with a poor prognosis. The knockdown of NAT10 markedly suppressed GC cell proliferation, migration, invasion, and cell cycle progression. Downregulating NAT10 reduced ac4C levels and inhibited AKT phosphorylation and epithelial-mesenchymal transition (EMT) in GC. NAT10 functions as an oncogene and may provide a new therapeutic target in GC.