Construction of a pancreatic cancer nerve invasion system using brain and pancreatic cancer organoids

Pancreatic cancer (PC) is a fatal malignancy in the human abdominal cavity that prefers to invade the surrounding nerve/nerve plexus and even the spine, causing devastating and unbearable pain. The limitation of available in vitro models restricts revealing the molecular mechanism of pain and screening pain-relieving strategies to improve the quality of life of end-stage PC patients. Here, we report a PC nerve invasion model that merged human brain organoids (hBrO) with mouse PC organoids (mPCO). After merging hBrOs with mPCOs, we monitored the structural crosstalk, growth patterns, and mutual interaction dynamics of hBrO with mPCOs for 7 days. After 7 days, we also analyzed the pathophysiological statuses, including proliferation, apoptosis and inflammation. The results showed that mPCOs tend to approximate and intrude into the hBrOs, merge entirely into the hBrOs, and induce the retraction/shrinking of neuronal projections that protrude from the margin of the hBrOs. The approximating of mPCOs to hBrOs accelerated the proliferation of neuronal progenitor cells, intensified the apoptosis of neurons in the hBrOs, and increased the expression of inflammatory molecules in hBrOs, including NLRP3, IL-8, and IL-1β. Our system pathophysiologically replicated the nerve invasions in mouse GEMM (genetically engineered mouse model) primary and human PCs and might have the potential to be applied to reveal the molecular mechanism of nerve invasion and screen therapeutic strategies in PCs.

Prognostic Predicting Model of Pancreatic Body Tail Carcinoma Using Clinical and CT Radiomic Data

Objective: To collect the clinical, pathological, and computed tomography (CT) data of 143 accepted surgical cases of pancreatic body tail cancer (PBTC) and to model and predict its prognosis. Methods: The clinical, pathological, and CT data of 143 PBTC patients who underwent surgical resection or endoscopic ultrasound biopsy and were pathologically diagnosed in Xiangyang No.1 People's Hospital Hospital from December 2012 to December 2022 were retrospectively analyzed. The Kaplan-Meier method was adopted to make survival curves based on the 1 to 5 years' follow-up data, and then the log-rank was employed to analyze the survival. According to the median survival of 6 months, the PBTC patients were divided into a group with a good prognosis (survival time ≥ 6 months) and a group with a poor prognosis (survival time < 6 months), and further the training set and test set were set at a ratio of 7/3. Then logistic regression was conducted to find independent risk factors, establish predictive models, and further the models were validated. Results: The Kaplan-Meier analysis showed that age, diabetes, tumor, node, and metastasis stage, CT enhancement mode, peripancreatic lymph node swelling, nerve invasion, surgery in a top hospital, tumor size, carbohydrate antigen 19-9, carcinoembryonic antigen, Radscore 1/2/3 were the influencing factors of PBTC recurrence. The overall average survival was 7.4 months in this study. The multivariate logistic analysis confirmed that nerve invasion, surgery in top hospital, dilation of the main pancreatic duct, and Radscore 2 were independent factors affecting the mortality of PBTC (P < .05). In the test set, the combined model achieved the best predictive performance [AUC 0.944, 95% CI (0.826-0.991)], significantly superior to the clinicopathological model [AUC 0.770, 95% CI (0.615-0.886), P = .0145], and the CT radiomics model [AUC 0.883, 95% CI (0.746-0.961), P = .1311], with a good clinical net benefit confirmed by decision curve. The same results were subsequently validated on the test set. Conclusion: The diagnosis and treatment of PBTC are challenging, and survival is poor. Nevertheless, the combined model benefits the clinical management and prognosis of PBTC.

Microscopic Invasion of Nerve Is Associated With Aggressive Behaviors in Pancreatic Neuroendocrine Tumors

Objectives

The role of neural invasion has been reported in cancers. Few studies also showed that neural invasion was related to survival rate in patients with pancreatic neuroendocrine tumor (PNET). The aim of this study is to explore the association between neural invasion and aggressive behaviors in PNET.

Methods

After excluding those patients with biopsy and with missing histological data, a total 197 patients with PNET who underwent surgery were retrospectively analyzed. The demographic data and histological data were obtained. Aggressive behavior was defined based on extra-pancreatic extension including vascular invasion, organ invasion and lymph node metastases. Logistic regression analyses were used to identify risk factor for aggressive behavior. Receiver operating characteristic (ROC) curves were performed to show the performance of nomograms in evaluating aggressive behavior of PNET.

Results

The prevalence of neural invasion in the cohort was 10.1% (n = 20). The prevalence of lymph node metastasis, organ invasion, and vascular invasion in PNET patients with neural invasion was higher than those in patients without neural invasion (p < 0.05). Neural invasion was more common in grade 3 (G3) tumors than G1/G2 (p < 0.01). Tumor size, tumor grade, and neural invasion were independent associated factors of aggressive behavior (p < 0.05) after adjusting for possible cofounders in total tumors and G1/G2 tumors. Two nomograms were developed to predict the aggressive behavior. The area under the ROC curve was 0.84 (95% confidence interval (CI): 0.77–0.90) for total population and was 0.84 (95% CI: 0.78–0.89) for patients with G1/G2 PNET respectively.

Conclusions

Neural invasion is associated with aggressive behavior in PNET. Nomograms based on tumor size, grade and neural invasion show acceptable performances in predicting aggressive behavior in PNET.

Neurological Manifestations of COVID-19: Causality or Coincidence?

The COVID-19 pandemic that swept the world at the beginning of 2020 is still raging. It is well established that in addition to respiratory symptoms, COVID-19 can also have neurological manifestations that may result from direct or indirect neurological damage. But are these neurological manifestations coincidental or causal? From a neurological perspective, these symptoms could be the result of neurological damage following SARS-CoV-2 infection, or they could be coincidental, from causes such as secondary systemic complications or side effects of drug treatment. The aim of this review is to raise clinician's awareness to the development of neurological impairment in SARS-CoV-2 infected patients in the current normative prevention and control.

Correlation between Claudin-18 expression and clinicopathological features and prognosis in patients with gastric cancer

BACKGROUND

To investigate the correlation between Claudin-18 expression and the clinicopathological features and prognosis of gastric cancer.

METHODS

A total of 63 patients who underwent gastric cancer surgery from December 2012 to June 2013 were recruited as the research participants. The clinicopathological data and prognostic information of the participants were collected, and expression levels of Claudin-18 in gastric cancer and adjacent tissues were detected by immunohistochemical (IHC) staining. The correlation between Claudin-18 expression and clinicopathological features of gastric cancer patients was analyzed. The Cox regression model was used to analyze the risk factors associated with the prognosis of gastric cancer patients.

RESULTS

The expression of Claudin-18 was positive in 35 (55.6%) of the participants' gastric cancer tissues, which was significantly lower than that in the adjacent tissues (51 tissues/81.0%), and the difference was statistically significant (P=0.002). In addition, the IHC staining score of Claudin-18 expression in gastric cancer tissues (1.49±1.69), was significantly lower than that in the adjacent tissues (4.61±1.81), and the difference was statistically significant (P=0.016), The incidence of nerve invasion in patients with low expression of Claudin-18 was significantly higher than that in patients with high expression of Claudin-18 (P=0.038). In addition, univariate Cox regression analysis showed that nerve invasion, Claudin-18 staining score, tumor size, and positive count of lymph nodes were risk factors associated with the survival of gastric cancer patients. Multivariate Cox regression analysis showed that Claudin-18 staining score and tumor size were independent risk factors associated with the survival of gastric cancer patients. The overall survival (OS) of patients with low Claudin-18 staining score or larger tumor size was significantly reduced.

CONCLUSIONS

The low expression of Claudin-18 was closely related to nerve invasion in gastric cancer, which indicated the poor clinical prognosis of gastric cancer patients.

The significance of diffusion tensor magnetic resonance imaging for patients with nasopharyngeal carcinoma and trigeminal nerve invasion

To investigate the significance of diffusion tensor imaging (DTI) for patients with nasopharyngeal carcinoma (NPC) and trigeminal nerve invasion.Fifty-two patients with NPC and unilateral infringement and 30 healthy controls were recruited for our study. Routine magnetic resonance imaging (MRI) and DTI were performed for all participants. Within-group and between-group comparisons of DTI metrics, including fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the third (V3) branch of the bilateral trigeminal nerves of all participants, were carried out.The FA and ADC values on the affected sides of patients revealed a significant decrease and increase, respectively, when compared with those on the unaffected sides of patients and the healthy controls (P = 0.000 for all), whereas there were no significant differences in DTI metrics between both sides of healthy controls or between the unaffected sides of patients and the healthy controls (P = 0.930, 0.580, 0.095, and 0.360, respectively). The decreasing FA rate on the affected sides of patients correlated negatively with the increasing ADC rate (r = -0.675, P = 0.000).DTI can quantitatively evaluate microstructural abnormalities of the V3 branch of the trigeminal nerve in patients with NPC, which is important for the early detection of trigeminal nerve invasion to achieve a precise T classification, assess prognosis, and guide treatment.