ObjectiveTo detect the expression of Krüppel like factor 8 (KLF8) in breast cancer tissues and cells and to explore the clinical significance of KLF8.Methods① The Oncomine database was used to analyze the differential expression of KLF8 mRNA in the breast cancer tissues. The Kaplan-Meier Plotter database was used to analyze the relationship between KLF8 mRNA expression and prognosis (relapse free survival, overall survival, post-progression survival, and distant metastasis-free survival) of patients with breast cancer. ② The quantitative real-time PCR (qRT-PCR) and Western blot were used to detect the KLF8 expression levels in the 16 clinical patients with breast cancer and 7 breast cancer cell lines (MDA-MB-231, MCF-12A, Hs-578T, MCF-7, BT-474, MDA-MB-453, ZR-75-30) and normal breast epithelial cell lines MCF-10A, and the immunofluorescence was used to further detect the localization of KLF8 expression in the 2 breast cancer cell lines with higher KLF8 expression level. ③ The immunohistochemistry was used to detect the expression of KLF8 protein in 135 cases of breast cancer tissue microarrays, and the relationships between KLF8 protein expression and clinicopathologic characteristics or overall survival were analyzed.Results① The Oncomine database showed that KLF8 mRNA expression in the breast cancer tissues was higher than that in the normal breast tissues (P<0.001). The median KLF8 mRNA expression level was taken as the cut-off point for high or low KLF8 expression. The results of Kaplan-Meier Plotter data analysis showed that the prognosis (relapse free survival, overall survival, postprogression survival, and distant metastasis-free survival) of patients with low KLF8 mRNA expression were better than those of patients with high KLF8 mRNA expression (P<0.05). ② The results of qRT-PCR and Western blot all showed that the KLF8 mRNA and protein expression levels in the breast cancer tissues were higher than those in the adjacent normal tissues (P=0.002, P<0.001). In addition, the Western blot results showed that the expression of KLF8 protein in the 7 breast cancer cell lines was higher than that in the normal breast epithelial cell lines MCF-10A respectively, and KLF8 protein mainly expressed in the cytoplasm of breast cancer cells and highly expressed in the nuclear of a few cells. ③ There were 63 cases of high KLF8 expression and 72 cases of low KLF8 expression by the immunohistochemical analysis of 135 patients with breast cancer tissue microarray (the H-score of the immunohistochemical test results was 75 as the cut-off point, H-score >75 was the high KLF8 expression and H-score ≤75 was the low KLF8 expression), the differences of statuses of estrogen receptor (ER) and progesterone receptor (PR) between the patient with high KLF8 expression and low KLF8 expression were significant (P<0.05). The Kaplan-Meier survival curve analysis showed that the prognosis of patients with high KLF8 expression was worse than that of patients with low KLF8 expression (P=0.002). The univariate analysis showed that the TNM stage, statuses of ER and PR, and KLF8 expression were related to the prognosis of patients with breast cancer (P<0.05), further multivariate Cox proportional hazards regression analysis indicated that the later stage of TNM and high KLF8 expression were the independent risk factors (P<0.05).ConclusionsThe results of this study suggest that KLF8 highly expresses in both breast cancer tissues and breast cancer cells, which is related to the statuses of ER and PR and prognosis of patients with breast cancer. KLF8 might be involved in the progression of breast cancer as an oncogenic gene, or it might provide a new direction for prognosis judgment and molecular targeted therapy of breast cancer.
The use of echocardiography ventricle segmentation can obtain ventricular volume parameters, and it is helpful to evaluate cardiac function. However, the ultrasound images have the characteristics of high noise and difficulty in segmentation, bringing huge workload to segment the object region manually. Meanwhile, the automatic segmentation technology cannot guarantee the segmentation accuracy. In order to solve this problem, a novel algorithm framework is proposed to segment the ventricle. Firstly, faster region-based convolutional neural network is used to locate the object to get the region of interest. Secondly, K-means is used to pre-segment the image; then a mean shift with adaptive bandwidth of kernel function is proposed to segment the region of interest. Finally, the region growing algorithm is used to get the object region. By this framework, ventricle is obtained automatically without manual localization. Experiments prove that this framework can segment the object accurately, and the algorithm of adaptive mean shift is more stable and accurate than the mean shift with fixed bandwidth on quantitative evaluation. These results show that the method in this paper is helpful for automatic segmentation of left ventricle in echocardiography.
Objective To explore the anatomical parameters of the cervical uncinate process “inflection point” through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. Methods A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C3-C7 were constructed, and the following measurements were obtained from the superior view: uncinate process “inflection point” to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process “inflection point” to “inflection point” distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process “inflection point” to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process “inflection point” to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C3-C7 were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. Results The measurement parameters from C3 to C7 in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment (P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C3 and C6 and UID at C3, C6, and C7 (P<0.05). The MRI measured DSW showed a general increasing trend from C3 to C7, and the DSW at C6 was greater in females than in males, with a significant difference (P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C6. There was no significant difference between males and females or between the left and right sides within the same segment (P>0.05). The UID was greater than the DSW at C3-C7, and the differences were significant (P<0.05). ConclusionThe uncinate process “inflection point” is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.
【Abstract】ObjectiveTo evaluate the localized biopsy of nonpalpable breast lesions (NPBLs) and its role in the early diagnosis and treatment of breast cancer. MethodsOne hundred and fifty-eight NPBLs from a series of 141 women detected by mammography were resected with wire localization technique. ResultsForty-two lesions (26.6%, 42/158) in 42 patients were diagnosed with malignant result, including 12(28.6%) patients with stage 0 breast cancer, 24(57.1%) with stageⅠ, 2(4.8%) with stage Ⅱ and 4(9.5%) with stage Ⅲ disease according to American Joint Committee on Cancer (AJCC) staging system（the 6th edition）. The contralateral axillary lymph nodes metastasis were found in only one (2.4%) patient with stage Ⅲ disease and the other fortyone patients remained free of recurrent disease at a median follow-up of 31 months.ConclusionThe results showed that the most nonpalpable breast cancers detected by mammography were earlystage breast cancers and had good prognosis. The NPBLs should get a localized biopsy in order to facilitate the early diagnosis and treatment of nonpalpable breast cancers.
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.
With the wide utilization of high-resolution computed tomography (HRCT) in the lung cancer screening, patients detected with pulmonary ground-glass nodules (GGNs) have increased over time and account for a large proportion of all thoracic diseases. Because of its less invasiveness and fast recovery, video-assisted thoracoscopic surgery (VATS) is currently the first choice of surgical approach to lung nodule resection. However, GGNs are usually difficult to recognize during VATS, and failure of nodule localization would result in conversion to thoracotomy or extended lung resection. In order to cope with this problem, a series of approaches for pulmonary nodule localization have developed in the last few years. This article aims to summarize the reported methods of lung nodule localization and analyze its corresponding pros and cons, in order to help thoracic surgeons to choose appropriate localization method in different clinical conditions.
ObjectiveTo summarize the current common clinical laparoscopic gastrointestinal tumor surgical localization methods, and to provide reference for clinicians to choose reasonable localization methods. MethodThe domestic and foreign literatures related to laparoscopic gastrointestinal tumor surgical localization methods were searched and reviewed. ResultsThe common localization methods for laparoscopic gastrointestinal tumor surgery were imaging localization, preoperative endoscopic localization, intraoperative endoscopic localization and intraoperative fluorescence localization, among which abdominal enhanced CT and endoscopic-related localization methods were the most commonly used localization methods in clinical practice at present. ConclusionA variety of methods are available for surgeons to choose from, and the precise localization of tumors is better facilitated by combining multiple methods.
ObjectiveTo study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application.MethodsClinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years.ResultsAll 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning.ConclusionPreoperative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.
ObjectiveTo compare the effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules.MethodsThe literature published from the inception to January 2021 about the comparison between electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules in the PubMed, The Cochrane Library, Web of Science, EMbase, Chinese Wanfang database and CNKI database was searched. RevMan (version 5.4) software was used for meta-analysis. Nonrandomized controlled trials were evaluated using methodological index for nonrandomized studies (MINORS).ResultsA total of six retrospective studies (567 patients) were included in this meta-analysis. MINORS scores of all studies were all 17 points and above. There were 317 patients in the CT-guided percutaneous localization group and 250 patients in the electromagnetic navigation-guided localization group. The complication rate of the CT-guided percutaneous localization group was significantly higher than that in the electromagnetic navigation-guided localization group (OR=11.08, 95%CI 3.35 to 36.65, P<0.001). There was no significant difference in the success rate of localization (OR=0.48, 95%CI 0.16 to 1.48, P=0.20), localization time (MD=0.30, 95%CI –6.16 to 6.77, P=0.93) or nodule diameter (MD=–0.07, 95%CI –0.19 to 0.06, P=0.29) between the two groups.ConclusionElectromagnetic navigation can be used as an effective preoperative positioning method for pulmonary nodules, which has the advantage of lower complication rate compared with the traditional CT positioning method.
ObjectiveTo analyze the independent risk factors affecting complications of preoperative CT-guided Hookwire localization of pulmonary nodules, and establish and validate a nomogram risk prediction model. MethodsClinical data of patients who underwent thoracoscopic lung surgery with preoperative CT-guided Hookwire localization at the Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University from January 2023 to October 2023 were collected. Patients were divided into a complication group and a non-complication group according to whether they had complications. The clinical data of the two groups were compared by univariate analysis and multivariate binary logistic regression analysis to determine the independent risk factors causing complications during localization, and a nomogram prediction model was established. The discrimination of the model was evaluated by receiver operating characteristic (ROC) curve, and the consistency between predicted events and actual results was evaluated by calibration curve. ResultsA total of 300 patients were included, including 143 males and 157 females, aged 24-68 (46.00±22.81) years. Univariate analysis showed that there were statistically significant differences in age, number and location of nodules, preoperative anxiety score, history of chronic obstructive pulmonary disease (COPD), number of needle adjustments, pain score, and distance between the tip of the localization needle and the visceral pleura between the two groups (P<0.05). Multivariate binary logistic regression analysis suggested that pain score [OR=1.253, 95%CI (1.094, 1.434), P=0.001], age [OR=1.020, 95%CI (1.000, 1.042), P=0.049], history of COPD [OR=3.281, 95%CI (1.751, 6.146), P<0.001], number of nodules [OR=1.667, 95%CI (1.221, 2.274), P=0.001], preoperative anxiety score [OR=1.061, 95%CI (1.031, 1.092), P<0.001], number of needle adjustments [OR=1.832, 95%CI (1.263, 2.658), P=0.001], and distance between the needle tip and the visceral pleura [OR=1.759, 95%CI (1.373, 2.254), P<0.001] were associated with localization complications. The area under the ROC curve for the modeling group was 0.825, and that for the validation group was 0.845. Hosmer-Lemeshow test showed that there was no statistically significant difference between the ideal curve of the model fitting curve and that of the modeling group and internal validation group, indicating good goodness of fit (χ2=6.488, P=0.593). ConclusionAdvanced age, multiple nodules, preoperative anxiety, history of COPD, multiple needle adjustments, severe pain during localization, and long distance between the tip of the localization needle and the visceral pleura are independent risk factors for complications of lung nodule localization, and the prediction model based on these factors has good predictive performance.