Journal of Healthcare Engineering

Deep Learning for Intelligent Recognition and Prediction of Endometrial Cancer

The aim of the study was to investigate the intelligent recognition of radiomics based on the convolutional neural network (CNN) in predicting endometrial cancer (EC). In this study, 158 patients with EC in hospital were selected as the research objects and divided into a training group and a test group. All the patients underwent magnetic resonance imaging (MRI) before surgery. Based on the CNN, the imaging model of EC prediction was constructed according to the characteristics. Besides, the comprehensive prediction model was established through the clinical information and imaging parameters. The results showed that the area under the working characteristic curve (AUC) of the radiomics model and comprehensive prediction model was 0.897 and 0.913 in the training group, respectively. In addition, the AUC of the radiomics model was 0.889 in the test group and that of the comprehensive prediction model was 0.897. The comprehensive prediction model was established through specific imaging parameters and clinical pathological information, and its prediction performance was good, indicating that radiomics parameters could be applied as noninvasive markers to predict EC.

Effect of CMB Carrying PTX and CRISPR/Cas9 on Endometrial Cancer Naked Mouse Model

Endometrial cancer, one of the most common gynecological cancers in women. Patients with advanced or recurrent disease have poor long-term outcomes. The current experiment explore the roles of cationic microbubbles (CMBs) carrying paclitaxel (PTX) and CRISPR/Cas9 plasmids on the xenotransplantation model of mice with endometrial cancer. The tumor histology, tumor cell viability, cell cycle, and invasion ability were investigated. Meanwhile, the P27, P21, GSK-3, Bcl-2 associated death promoter (Bad), mammalian target of rapamycin (mTOR), and C-erbB-2 expressions were evaluated by qRT-PCR and western blotting, respectively. CMB-PTX-CRISPR/Cas9 had an inhibitory action on the tumor growth, tumor cell viability, cell cycle, and invasion ability of the mouse xenograft model of endometrial cancer. The CMB-PTX-CRISPR/Cas9 increased the GSK-3, P21, P27, and Bad expression levels, while reduced the C-erbB-2 and mTOR expressions. CMBs loaded with both PTX and CRISPR/Cas9 plasmids may be a new combination treatment with much potential. CMB-PTX-CRISPR/Cas9 may regulate the tumor cell viability, invasion, and metastasis of endometrial cancer naked mouse model by upregulating expressions of GSK-3, P21, P27, and Bad.

Construction of an Immune-Autophagy Prognostic Model Based on ssGSEA Immune Scoring Algorithm Analysis and Prognostic Value Exploration of the Immune-Autophagy Gene in Endometrial Carcinoma (EC) Based on Bioinformatics

Background. Endometrial carcinoma (EC) is a malignant cancer spreading worldwide and in the fourth position among all other types of cancer in women. The purpose of this paper is to explore the prognostic value of the immune-autophagy gene in endometrial carcinoma (EC) based on bioinformatics, construct an immune-autophagy prognostic model of endometrial carcinoma, search for independent prognostic markers, and finally predict the potential therapeutic drugs of TCGA subgroup. Methods. The Cancer Genome Atlas (TCGA) database was used to extract transcriptome sequencing data of patients suffering from EC; 28 kinds of immune cells were scored by ssGSEA, and the immune subtypes were grouped by consistency cluster analysis. The accuracy and effectiveness of the grouping were verified by the analysis of differential gene expression and survival rate of immune checkpoints in the two groups to provide the premise and basis for the establishment of independent prognostic factors. The expression of different genes in high and low immune groups was analyzed. The analysis of various genes’ expression in immune groups (high and low) has been performed. Go function annotation and KEGG pathway enrichment analysis were used to evaluate the difference of immune infiltration between high and low immune groups. The immune and autophagy genes were crossed, the key (hub) genes were selected, the risk was scored, the prognosis model was constructed, and the independent prognostic markers were established. CAMP and CTRP 2.0 were used to test the drug sensitivity. Results. According to the level of immune cell enrichment, the results have been subcategorized into two immune subtypes: high immunity group_ H and low immunity group_ L. Two immune subtypes, CD274, PDCD1, and CTLA4, were detected in the immune system_ H and immunity_L. A significant difference was detected between these two groups in the expression and survival rate. Few more differences were also detected between the two groups through the evaluation of immune infiltration, which proved the grouping’s accuracy and effectiveness. Differential gene expression analysis showed that there were 721 DEGs and 3 hub genes. DEGs are mainly involved in lymphocyte activation, proliferation, differentiation, leukocyte proliferation, and other biological processes, mediate chemokines’ activities, chemokine receptor binding, and other molecular functions, and are enriched in the outer plasma membrane, endoplasmic reticulum, and T cell receptor complex. The enriched pathways are allograft, complex, inflammatory, interferon-alpha, interferon-gamma, E2F, G2M, mitotic, etc. Conclusion. Through bioinformatics analysis, we successfully constructed the immuno-autophagy prognosis model of endometrial cancer and identified three high-risk immunoautophagy genes, including VEGFA, CCL2, and Ifng. Four potential therapeutic drugs were predicted as sildenafil, sunitinib, TPCA-1, and etoposide.

Effects of BMI1 Gene on Regulating Apoptosis, Invasion, and Migration of HEC-1B Cells Induced by Ionizing Radiation

The aim of this study was to examine the role of B lymphoma Moloney murine leukemia virus insertion region 1 (BMI1) gene in regulating the apoptosis, invasion, and migration of human endometrial adenocarcinoma cell line (HEC-1B) cells induced by ionizing radiation. The expression of BMI1 mRNA was detected by quantitative real-time polymerase chain reaction (qRT-PCR), and the positive expression of BMI1 was detected by immunohistochemistry (IHC) staining. HEC-1 B cells were randomly divided into three groups: control group, BMI1 overexpression group, and BMI1 inhibitor group. Cell proliferation was detected by cell counting kit-8 (CCK-8); cell migration and invasion were detected by Transwell test; cell apoptosis was detected by flow cytometry; and the expression of MMP2, MMP7, MMP9, Rock1, RhoA, P53, P21, and Bax protein was detected by the western blot. The results suggested that the expression of BMI1 mRNA and tissue positive in endometrial cancer tissues was increased significantly. After ionizing radiation, compared with the control group, the proliferation, cell migration, and invasion of HEC-1B cells were increased significantly in the BMI1 overexpression group, while the proliferation, cell migration, and invasion of HEC-1B cells were decreased significantly in BMI1 inhibitor group. The apoptosis rate of BMI1 overexpression group was decreased significantly, while the BMI1 inhibitor group was increased significantly. The levels of MMP2, MMP7, MMP9, Rock1, RhoA and p53, p21, Bax protein in BMI1 overexpression group were significantly increased, while the levels of MMP2, MMP7, MMP9, Rock1, RhoA and p53, p21, Bax protein in BMI1 inhibitor group were significantly decreased. BMI1 is highly expressed in endometrial cancer tissues, and inhibiting BMI1 expression can reduce the proliferation, migration, and invasion of HEC-1B cells after ionizing radiation and promote apoptosis, which offers new insights into the clinical radiotherapy of tumors.

Identification of ZEB2 as an Immune-Associated Gene in Endometrial Carcinoma and Associated with Macrophage Infiltration by Bioinformatic Analysis

Endometrial cancer (EC) is the most common gynecological tumor arising from the endometrium. In this study, we use a published single-cell transcriptome profile of endometrial carcinoma (EC) to reveal the composition of immune cells and found an immunosuppressive environment since the presence of macrophage subtype M2 and exhausted CD8+ T cell markers. We focused on ZEB2 (Zinc finger E-box binding homeobox 2), a well-known player in epithelial to mesenchymal transition process, and we showed that ZEB2 is exclusively expressed in immune cells in single-cell transcriptome and, at the same time, downregulated in TCGA-UCEC (The Cancer Genome Atlas—Uterine Corpus Endometrial Carcinoma) bulk RNA-seq data and negatively associated with tumor purity. Loss of ZEB2 protein in EC in normal endometrium and EC samples was validated in samples using immunohistochemistry (IHC) from HPA (Human Protein Atlas) database. Furthermore, we found ZEB2 was associated with immune infiltrations especially for macrophage using TIMER 2.0. Interestingly, ZEB2 prognostic significance differed under various macrophage and Th2 helper cell content using Kaplan–Meier Plotter analysis. More importantly, we showed that over 11% EC patients have somatic mutations of ZEB2 in EC samples collected from cBioportal and they have a lower body weight, earlier diagnosis age, and better overall survival and disease-free survival status compared with the unaltered group. Analysis in TIMER2.0 suggested that ZEB2 mutation would possibly change the composition of tumor-infiltrating lymphocytes. Taken together, by combining the results from single-cell data, bulk TCGA RNA-seq, and other online bioinformatic tools, we provided evidence that ZEB2 might have a unique role in the immune environment of EC. These results would provide a better insight into the pathogenetic process and ZEB2 might further be used an immunotherapeutic target of EC.

Functional New Transcription Factors (TFs) Associated with Cervical Cancer

The goal of this research was to find noval transcription factors (TFs) that are involved in cervical carcinogenesis. The Gene Expression Omnibus (GEO) database was utilized to analyze ten cervical cancer datasets using the Robust Rank Aggregation (RRA) technique. Survival and differential expression were validated using GEPIA (Gene Expression Profiling Interactive Analysis). The transcriptional regulatory network and putative targets were built using Cytoscape. A real-time PCR (quantitative real-time polymerase chain reaction) experiment was used to confirm the mRNA expression. Using public cervical cancer single-cell RNA-sequencing (scRNA-seq), bulk TCGA-CESC RNA-seq, and microarray datasets, coexpression correlations between putative targets and TFs were confirmed. After combining the results of 10 datasets, 8 TFs, including EMX2 (Empty Spiracles Homeobox 2), were chosen among 385 robust DEGs. In the normal female reproductive tract, EMX2 is extensively expressed, but it is reduced in cervical cancer. Overexpression EMX2 suppresses the proliferation of HeLa cells. 12 potential targets of EMX2 were selected. Our research has revealed evidence that EMX2 acted as a tumor suppressor in cervical cancer and PDZRN3 might be possible target of EMX2 in cervical cancer. It might be a therapeutic target in the future.

Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement

This study aims at exploring the effect of continuous catheterization on reducing postoperative urinary tract infection in cervical cancer patients with double J tube placement. To be specific, a retrospective analysis was performed on 120 cases of cervical cancer patients who underwent laparoscopic or open radical hysterectomy in Shengjing Hospital of China Medical University from January to December 2019. They were divided into a persistent group (n = 70) and a short-term group (n = 50) according to indwelling catheter time. The incidence of postoperative complications and the positive rate of bacterial culture in bladder urine and double J tube bacterial culture were compared between the two groups. As a result, it was found that the incidence of postoperative fever and urinary tract infection in the short-term group was significantly higher than that in the persistent group ( P < 0.05 ). There was no significant difference in the incidence of postoperative hematuria, bladder stimulation, and urinary system injury between the two groups. The positive rate of double J tube bacterial culture in both groups was also proved to be higher than that in bladder culture, and the difference was statistically significant ( P < 0.05 ). And in the short-term group ( P < 0.05 ), the difference in the positive rate of bladder culture between the two groups was not statistically significant. To conclude, we found that continuous catheterization can reduce the incidence of postoperative urinary tract infection in cervical cancer patients with double J tube placement, which might be helpful for the treatment of cervical cancer.

Analysis of Multiple Human Tumor Cases Reveals the Carcinogenic Effects of PKP3

Plakophilins (PKPs) act as a key regulator of different signaling programs and control a variety of cellular processes ranging from transcription, protein synthesis, growth, proliferation, and tumor development. The function and possible mechanism of PKP3 in ovarian cancer (OC) remain unknown. It is extremely important to investigate the expression and prognostic values of PKP3, as well as their possible mechanisms, and immune infiltration in OC. Therefore, in this paper we explored the potential oncogenic role of PKP3 in 33 tumors based on The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets. The result outcomes showed that PKP3 is highly expressed in most cancers, and the expression level and prognosis of PKP3 showed little significance in cancer patients. Moreover, oncologists have found that members of the plakophilin family have different degrees of abnormality in ovarian cancer. PKP3 played a key part in carcinogenesis and aggressiveness of OC as well as malignant biological activity and can be used as a biomarker for early diagnosis and prognosis evaluation in OC.

Application of Laparoscopy in Comprehensive Staging Operation of Ovarian Cancer Based on Electronic Medical Blockchain Technology

Ovarian cancer has always entangled most women. Studies have shown that the prevalence of ovarian cancer ranks third in female reproductive malignancies, and the mortality rate has always been the highest. The reason is mainly because the diagnosis and treatment of preovarian cancer has always been a big problem. However, the emergence of laparoscopy can well solve this problem, especially laparoscopy assisted by blockchain technology, which plays a huge role in the overall staging of ovarian cancer. This article proposes the application research of laparoscopy in the comprehensive staging of ovarian cancer based on electronic medical blockchain technology. First of all, this article uses the literature method to study the clinical characteristics and surgical classification of ovarian cancer, as well as the application status of blockchain technology and laparoscopic technology. Secondly, it designed an application experiment based on electronic medical blockchain technology to assist laparoscopy in the comprehensive staging of ovarian cancer and analyzed the comparison of the laparoscopic group and the control group in the comprehensive staging of ovarian cancer. The results of the study showed that the amount of bleeding in the laparoscopic group was 103.5 ml, while the amount of bleeding in the control group was 141.1 ml; the proportion of tertiary pain in the laparoscopic group was 11.37%, and the proportion of tertiary pain in the control group was 31.82%. From this, it can be seen that, in the comprehensive staging operation for ovarian cancer, the laparoscopic group has less intraoperative blood loss than the control group and lower pain, and the treatment effect is better.

The Correlation between Targeted Contrast-Enhanced Ultrasound Imaging and Tumor Neovascularization of Ovarian Cancer Xenografts in Nude Mice

In order to explore the correlation between targeted contrast-enhanced ultrasound imaging and tumor neovascularization of ovarian cancer xenografts in nude mice, a total of 49 nude mice were selected and randomly divided into 1-week group, 2-week group, 3-week group, 4-week group, 5-week group, 6-week group, and 7-week group according to their ovarian cancer xenografts’ growth time, with 7 ovarian cancer xenografts in each group. After preparing antibody-carrying targeted contrast agent, each group of xenografts performed normal and targeted contrast ultrasound examinations to obtain peak intensity, time to peak, and other imaging parameters; then, those ovarian cancer xenografts were sacrificed for pathological analysis: the neovascular density and antibody expression of the cancer xenografts at different stages were observed and counted, and the correlation between targeted contrast-enhanced ultrasound parameters and tumor neovascular densities of the ovarian cancer xenografts was analyzed. The results show that the peak intensities of targeted contrast ultrasound imaging are greater than that of ordinary ultrasound imaging in the 2-, 3-, 4-, and 5-week groups with statistically significant differences ( P < 0.05 ); the time to peak of targeted contrast ultrasound imaging is shorter than that of ordinary ultrasound imaging in the 2-, 3-, 4-, and 5-week groups with statistically significant differences ( P < 0.05 ); there is a positive correlation between the peak intensities of targeted contrast ultrasound imaging and tumor neovascular densities of the ovarian cancer xenografts in the 2-, 3-, and 4-week group (r2 = 0.645, r3 = 0.668, and r4 = 0.693, P < 0.05 ); there is a negative correlation between the time to peak of targeted contrast ultrasound imaging and tumor neovascular densities of the ovarian cancer xenografts in the 2-, 3-, and 4-week groups (r2 = −0.669, r3 = −0.692, and r4 = −0.704, P < 0.05 ). Therefore, the targeted contrast-enhanced ultrasound imaging parameters have a certain correlation with tumor neovascular density of ovarian cancer xenografts in nude mice and this correlation is more significant in the early stage of ovarian cancer; hence, targeted contrast-enhanced ultrasound imaging may provide a new method, new idea, and new basis for the diagnosis of early ovarian cancer.

A Research Study to Measure the Efficacy of Terminating Cervical Cancer via Customized Optimum Pathway

Background. To develop a precise prognostic model of overall survival in patients with terminating cervical cancer based on surveillance, epidemiology, and end results (SEER) program. Methods. The patients were retrieved from SEER data who are diagnosed with terminating cervical cancer from 2004 to 2016. The data were performed using univariate and multivariate analyses and constructed nomograms for predicting survival. Use C-index to validate the model accuracy. Results. Totally 15839 patients diagnosed with cervical cancer were independently allocated into the training set (n = 11088) and validation set (n = 4751). The multivariate analysis results indicated that age, race, stage_T, stage_M, and stage_N were confirmed as independent risk predictors, and those factors are applied to construct this clinical model. The C-index of overall survival in the training set was 0.6816 (95% confidence intervene (CI), 0.694–0.763) and that in the validation set was 0.6931(95% CI, 0.613–0.779). All calibration curves of various factors were consistent with predicted and actual survival. Conclusion. The nomogram provides a novel method for predicting the survival of patients with terminating cervical cancer, assisting in accurate therapeutic methods for patients with primary terminating cervical cancer.

Clinical Efficacy of Yiqi Yangyin Decoction Combined with Docetaxel on Advanced Ovarian Cancer and the Effect on the Levels of Serum Markers VEGF, HE4, and CA125

Objective. The study is designed to investigate the therapeutic effect of Yiqi Yangyin Decoction combined with docetaxel on advanced ovarian cancer (OC) patients and the effects on serum markers VEGF, HE4, and CA125. Methods. 92 patients with advanced OC were grouped into the study group and control group. The control group was given the treatment of basic chemotherapy combined with docetaxel. The study group was added the treatment of Yiqi Yangyin Decoction on the basis of the control group. The short-term efficacy, adverse reactions, tumor markers, quality of life, 3-year survival, and T cell subsets of the two groups were observed. Results. Compared to the control group, the study group’s incidence of adverse reactions was lower. VEGF, HE4, and CA125 in the study group were decreased more obviously. The levels of CD3+, CD4+, and CD4+/CD8+ were sharply higher in the study group, while CD8+ was notably reduced. After treatment, the scores of physical health, social function, and mental health in the study group were notably higher than those in the control group. Compared with the control group, the 3-year survival rate of the study group was notably higher, and the therapeutic effect of the study group was obviously better. Conclusion. The combination of Yiqi Yangyin Decoction and docetaxel can improve the body immunity and the therapeutic effect of advanced OC, decrease the incidence of adverse reactions, and prolong the survival time, with good safety and effectiveness.

Anti-NMDA Receptor Encephalitis: Retrospective Analysis of 15 Cases, Literature Review, and Implications for Gynecologists

Background. Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare form of autoimmune encephalitis caused by anti-NMDA receptor antibodies. This disease mainly affects women of childbearing age and is commonly associated with ovarian teratoma. However, the relationship between anti-NMDA receptor encephalitis and ovarian teratoma and the role of anti-NMDA receptor antibody in the relationship remain unclear. Objectives. This study aimed to describe 15 cases of anti-NMDA receptor encephalitis (5 with ovarian teratoma), review literature, and reinforce the gynecologist's knowledge of this disorder. Methods. Clinical data of 15 patients from January 2015 to December 2020 admitted to The Second Hospital of Hebei Medical University were collected and analyzed. The diagnosis of anti-NMDA receptor encephalitis was based on the presence of anti-NMDA receptor antibodies in cerebrospinal fluid (CSF) and/or serum. Laparoscopic teratoma removal was performed in patients with ovarian teratoma. All patients had received immunotherapy. In addition, a review of the literature was performed to reinforce the gynecologist's knowledge of this disorder. Results. A total of 15 patients with anti-NMDA receptor encephalitis were screened, of whom 5 patients were confirmed with ovarian teratoma by pathology. The most common symptoms of anti-NMDAR encephalitis with teratoma are fever (5/5, 100%), seizure (5/5, 100%), mental and behavioral disorders (4/5, 80%), and decreased consciousness (4/5, 80%). Conversely, the most common symptoms of patients without teratoma were neuropsychiatric symptoms, including headache (6/10, 60%) and mental and behavioral disorders (7/10, 70%). All patients underwent immunotherapy, including steroids, intravenous immunoglobulin (IVIG), plasma exchange, and cyclophosphamide, and 4 out of 5 patients with ovarian teratomas underwent surgical treatment. All patients had a good outcome after systemic, surgical, and immunotherapy treatment. No patient who underwent surgical treatment developed a recurrence. Conversely, 2 of 10 patients without teratoma developed an anti-NMDA receptor encephalitis recurrence. Conclusions. Patients with anti-NMDA encephalitis show severe mental and neurological symptoms. Resection of teratoma is beneficial to the relief or disappearance of symptoms and has a good prognosis. This disorder should be fully recognized by gynecologists, who play an important role in diagnosis and treatment.

LINC-DUBR Suppresses Malignant Progression of Ovarian Cancer by Downregulating miR-107 to Induce SMAC Expression

Background. LINC-DUBR may be a potential therapeutic target in ovarian cancer (OC). The purpose of this research was to explore the impact of miR-107 on the tumorigenicity of OC and its underlying molecular mechanisms. Methods. RT-qPCR was adopted to measure the expression of LINC-DUBR and miR-107 in ovarian cancer tissues and cells. CCK-8 assays and transwell chamber assays were conducted to evaluate the impacts of LINC-DUBR and miR-107 on the proliferation and invasion of human ovarian cancer cells (SKOV3). In addition, we determined the relationship between LINC-DUBR, miR-107, and SMAC using TargetScan and luciferase reporter assay. The protein expression of SMAC was determined by western blot. Results. Compared with normal tissues and cells, LINC-DUBR was downregulated and miR-107 was highly expressed in ovarian cancer tissues and cell lines. Overexpression of LINC-DUBR inhibited the cell proliferation and invasive ability in OC cells SKOV3. The luciferase reporter assay proved overexpression of LINC-DUBR repressed cells proliferation and invasion via binding to miR-107 in ovarian cancer. In addition, we found that SMAC was downregulated directly by miR-107 in ovarian cancer. miR-107 mimic significantly increased cell proliferation and invasiveness of SKOV3, while overexpressed SMAC eliminated this effect. Furthermore, miR-107 could regulate the XIAP/caspase-3 signaling pathway in ovarian cancer by targeting SMAC. Conclusion. LINC-DUBR suppressed malignant progression of ovarian cancer by downregulating miR-107 to induce SMAC expression and involving in the XIAP/caspase-3 signaling pathway.

Ultrasound Elastography under Deep Learning Algorithm to Analyze the Therapeutic Effect of Clustered Regularly Interspaced Short Palindromic Repeats Short Hairpin Ribonucleic Acid Nanoparticles on Cervical Cancer

This study aimed to analyze the effect of the deep learning algorithm on ultrasound elastography on the treatment of cervical cancer with clustered regularly interspaced short palindromic repeats (CRISPR) short hairpin ribonucleic acid (shRNA) nanoparticles, aiming to provide a reference for the clinical application of deep learning to analyze the therapeutic effect of the disease. In this study, CRISPR and shRNA plasmid nanoparticle drugs were used to treat 55 patients with cervical cancer in the experimental group, and normal saline was injected to another 53 patients in the control group, so compare the effect of nanoparticles in the treatment of cervical cancer. Professional doctors and the recurrent neural network (RNN) intelligent algorithm were used to score cervical cancer based on the ultrasound elastograph images by taking blue, green, and red (BGR) as diagnosis criteria. As a result, the experimental group had a total of 217 points before drug administration and a total of 224 points after drug administration. Each patient had an average increase of 0.13 points. The control group had a total of 200 points before drug administration and a total of 223 points after drug administration, and each patient had an average increase of 0.43 points. The experimental group was obviously different from the control group ( P < 0.05 ). Each tissue image output by the RNN was clearer than the original image, and the score given by intelligent calculation was faster than that of professional doctors. The monitoring effect of the deep learning RNN intelligent algorithm on the therapeutic effect of nanomedicine was analyzed. It was found that the average accuracy of the experimental group and the control group was 98.95% and 90.34%, respectively; and the experimental group was greatly different from the control group ( P < 0.05 ). In short, nano-CRISPR and shRNA drugs had remarkable effects on the treatment of cervical cancer, and the scores given by the deep learning intelligent algorithm were faster and more accurate, which provided theoretical guidance for the clinical application of deep learning algorithms to analyze the treatment effects of diseases.

Dose Prediction Models Based on Geometric and Plan Optimization Parameter for Adjuvant Radiotherapy Planning Design in Cervical Cancer Radiotherapy

The prediction of an additional space for the dose sparing of organs at risk (OAR) in radiotherapy is still difficult. In this pursuit, the present study was envisaged to find out the factors affecting the bladder and rectum dosimetry of cervical cancer. Additionally, the relationship between the dose-volume histogram (DVH) parameters and the geometry and plan dose-volume optimization parameters of the bladder/rectum was established to develop the dose prediction models and guide the planning design for lower OARs dose coverage directly. Thirty volume modulated radiation therapy (VMAT) plans from cervical cancer patients were randomly chosen to build the dose prediction models. The target dose coverage was evaluated. Dose prediction models were established by univariate and multiple linear regression among the dosimetric parameters of the bladder/rectum, the geometry parameters (planning target volume (PTV), volume of bladder/rectum, overlap volume of bladder/rectum (OV), and overlapped volume as a percentage of bladder/rectum volume (OP)), and corresponding plan dose-volume optimization parameters of the nonoverlapping structures (the structure of bladder/rectum outside the PTV (NOS)). Finally, the accuracy of the prediction models was evaluated by tracking d = (predicted dose-actual dose)/actual in additional ten VMAT plans. V30, V35, and V40 of the bladder and rectum were found to be multiple linearly correlated with the relevant OP and corresponding dose-volume optimization parameters of NOS (regression R2 > 0.99, P < 0.001 ). The variations of these models were less than 0.5% for bladder and rectum. Percentage of bladder and rectum within the PTV and the dose-volume optimization parameters of NOS could be used to predict the dose quantitatively. The parameters of NOS as a limited condition could be used in the plan optimization instead of limiting the dose and volume of the entire OAR traditionally, which made the plan optimization more unified and convenient and strengthened the plan quality and consistency.

Analysis of Clinicopathological Factors Associated with Radiation-Induced Cystitis in Patients with Cervical Cancer

Objective. To analyze the clinicopathological characteristics associated with radiation-induced cystitis (RIC) in patients with cervical cancer treated with chemoradiotherapy (CRT) alone or postoperational (post-op) CRT. Methods. 107 patients with cervical cancer were retrospectively recruited into the study. The surgical status, FIGO staging, total and fractionated doses of radiotherapy (RT), and multiparameters including the dose, volume irradiated to the total bladder, and bladder wall were evaluated for RIC. The criteria on RIC were referred to CTCAE v5.0. Results. Surgical operation and post-op CRT were delivered in 65 patients and CRT or RT alone in 42 patients. Among those with post-op CRT, 33/34 (97.06%), 22/43 (51.16%), and 10/30 (33.33%) patients were classified as FIGO stage I, II, and III/IV, respectively. The incidence of RIC was 30.84% for the whole group with 87.87% occurred in stage I and II patients. The incidence of CTCAE grade 2 and beyond was significantly higher in patients treated with post-op CRT than those with CRT alone (13.85% vs 2.38%, p  = 0.043). Further analyses showed that the CTCAE level of RIC in the post-op CRT group was related to the relatively smaller average bladder volume ( p  = 0.029), whereas the difference in volume of bladder and bladder wall irradiated to 35.0 Gy or 40.0 Gy was not statistically significant between patients with or without RIC. Conclusion. The combination of surgery and post-op CRT may increase the incidence and severity of radiation-induced cystitis when compared to CRT alone, suggesting that bladder dysfunction associated with surgical procedure might increase the frequency and severity radiation related bladder toxicity. Further study is merited.

Application Value of Real-Time Ultrasonic Elastograph with Serum Human Epididymis Protein 4, Interleukin-33, and Carbohydrate Antigen 153 in Diagnosis of Early Cervical Cancer

Objective. To explore the application value of real-time ultrasonic elastograph (USE) with serum human epididymis protein 4 HE4, interleukin-33 (IL-33), and carbohydrate antigen 153 (CA153) in the diagnosis of early cervical cancer. Methods. A total of 120 cervical cancer patients treated in our hospital (06, 2019–06, 2021) and meeting the study criteria were screened and divided into the benign group (BG, n = 70) and malignant group (MG, n = 50) according to their final diagnostic results, and healthy females who received physical examination in our hospital in the same period were selected as the control group (CG, n = 60). Patients in the three groups received real-time USE and detection of serum HE4, IL-33, and CA153 so as to analyze the diagnostic value of single examination and combined examination in diagnosing early cervical cancer. Results. The patients’ real-time USE score, Emax, Emean, and elastic fibers were significantly higher in the MG than those in the BG ( P < 0.05 ), and the patients’ real-time USE Emin, stroma ratio and collagen fibers were significantly lower in the MG than those in the BG ( P < 0.05 ); the HE4, IL-33, and CA153 levels were obviously higher in the MG than those in the BG ( P < 0.05 ) and were significantly higher in the BG than those in the CG ( P < 0.05 ); the positive detection rate of combining real-time USE with serum HE4, IL-33, and CA153 was higher than that of single examination, and the diagnostic accuracy rate, sensitivity, specificity, positive predictive value, and negative predictive value of the combined examination were significantly higher than those of single examination ( P < 0.05 ); according to the diagnostic efficacy of single examination and combined examination in diagnosing early cervical cancer by ROC curve, it was combined diagnosis > real-time USE > HE4 > CA153 > IL-33. Conclusion. Combined examination of real-time USE and serum HE4, IL-33, and CA153 has higher diagnostic value in diagnosing early cervical cancer, which can obviously improve the diagnostic accuracy rate of cervical cancer.

Expression of Dickkopf-1 and Twist2 in Cervical Squamous Cell Carcinoma and Their Correlation with Vasculogenic Mimicry

Wnt/β-catenin signaling, epithelial-mesenchymal transition (EMT), and vasculogenic mimicry (VM) all exert important effects in tumors. Dickkopf-1 (DKK1) is an antagonist of the Wnt/β-catenin, Twist homolog 2 (Twist2) is a key EMT transcription factor involved in cancer cell migration and invasion, and VM participates in the progression and metastasis of a variety of cancers. However, the correlation of DKK1, Twist2, and VM in cervical squamous cell carcinoma(CSC) is still unclear. This study focuses on correlations among these factors as well as their correlation with clinicopathologic data and survival in CSC. DKK1, Twist2, and VM expressions were immunohistochemically examined in 116 CSC tissues and 37 normal cervical tissues. Furthermore, clinical data were processed. The expression levels of these three factors differed between CSC and normal tissues. VM was observed in CSC, but not in normal cervical tissues. Twist2 expression was high in CSC but low in normal cervical tissues, whereas DKK1 expression had the opposite pattern. Tumor cells with VM had a high expression of Twist2 and low expression of DKK1. In addition, DKK1 expression was negatively correlated with Twist2 expression. Analyzing the relationships of DKK1, Twist2, and VM with the data of patients with CSC revealed that DKK1 expression was negatively correlated with the clinical stage, degree of differentiation, depth of infiltration, and lymph node metastasis of tumors. VM and Twist2 expression were positively correlated with the degree of differentiation, the depth of infiltration, and lymph node metastasis. The positive rate of VM was greater in stage II than in stage I. The patients who expressed VM and Twist2 had a reduced overall survival (OS) when compared with patients not expressing these proteins. However, the patients who expressed DKK1 had an increased OS when compared with patients who did not show any DKK1 expression. Multivariate analysis indicated that the expressions of DKK1, Twist2, and VM were prognostic factors for CSC. VM and the expression of DKK1 and Twist2 can be the potential prognostic biomarkers and therapeutic targets for CSC.

Analysis of Distributions of HPV Infection in Females with Cervical Lesions in the Western District of Beijing Chaoyang Hospital

Objective. To analyze the distribution of human papilloma virus (HPV) infection in women with cervical lesions of different grades and analyze the relationship of high-risk HPV and cervical lesions in order to facilitate targeted prevention. Methods. The infection status of HPV subtype was statistically analyzed in patients who underwent colposcopy examination from April 2017 to June 2019. Results. The infection rate of HPV was 81.4% in chronic cervicitis, 82.9% in 1ow-grade squamous intraepithelial lesion (LSIL), 63.7% in HSIL (high-grade squamous intraepithelial lesion), and 50% in cervical squamous cell carcinoma (CSCC). Among the 16 high-risk HPV types, the top six HPV types with the comprehensive infection rates were HPV16 > HPV52 > HPV58 > HPV18 > HPV51 > HPV53 in turn, and the infection rates were 23.3%, 14.8%, 13.3%, 9.8%, 9.2%, and 8.8%, respectively. The infection rates of HPV16 in chronic cervicitis group, LSIL group, and HSIL group were significantly different. There was no significant difference in the injection rates of HPV52, HPV58, and HPV18 among the three groups. HPV infection rates were highest in the 31–40 years old group, followed by the 41–50 years old group. Conclusion. The distribution of different types of HPV varies in different tissue types, which can be used to develop relevant vaccines to achieve better prevention and treatment of cervical cancer.

LncRNA ABHD11-AS1 Participates in the Progression of Cervical Carcinoma by Targeting miR-1254 and Is the Key to the Diagnosis and Treatment of Cervical Carcinoma in the Future

Cervical carcinoma is the most common gynecologic tumor in the clinic. The incidence of cervical carcinoma has been increasing in recent years, and the age of the affected population is showing a younger trend. Long-chain noncoding RNA (LncRNA) acts in the cell cycle. In cervical carcinoma, many studies have also confirmed the important role of LncRNA. LncRNA ABHD11-AS1 is one of the genes abnormally expressed in cervical carcinoma, but the specific situation has not been fully explained. This study intended to confirm whether LncRNA ABHD11-AS1 can be applied for the treatment of cervical carcinoma in the future. From January 2015 to January 2017, 72 cases of cervical carcinoma patients and 78 cases of healthy people during the same period in our hospital were selected for prospective analysis. ABHD11-AS1 and miR-1254 in serum and carcinoma tissues of cervical carcinoma patients were detected. In addition, human cervical carcinoma cells HeLa and CaSki were obtained to analyze the effects of interference with ABHD11-AS1 and miR-1254 on the biological behavior of cervical carcinoma cells. Finally, the correlation of ABHD11-AS1 with miR-1254 was verified by double fluorescein reporter enzyme and immunocoprecipitation. ABHD11-AS1 was upregulated, and miR-1254 was reduced in serum and carcinoma tissues of cervical carcinoma patients ( P < 0.05 ). The expression levels of the two were negatively correlated ( P < 0.001 ). ABHD11-AS1 decreased and miR-1254 increased in serum of cervical carcinoma patients after treatment ( P < 0.05 ). High ABHD11-AS1 and low miR-1254 had a close correlation with the poor prognosis of cervical carcinoma patients ( P < 0.05 ). Silencing LncRNA ABHD11-AS1 could inhibit the activity of cervical carcinoma cells ( P < 0.05 ), while inhibiting miR-1254 could promote the activity of cervical carcinoma cells ( P < 0.05 ). ENCORI online website found that LncRNA ABHD11-AS1 and miR-1254 had binding sites. Bifluorescein reporter enzyme experiment found that ABHD11-AS1-WT fluorescence activity was inhibited by transfected miR-1254-mimics ( P < 0.05 ). LncRNA ABHD11-AS1 accelerates proliferation, invasion, and migration of cervical carcinoma cells through targeted regulation of miR-1254, which may become the key to the treatment of cervical carcinoma.

Clinical Effect of Laparoscopic Radical Surgery Combined with Neoadjuvant Chemotherapy in Treating Cervical Cancer and Its Influence on Postoperative Complications and Adverse Reaction Rates

Background. Cervical cancer, the only gynecological malignancy for which a clear pathogeny has been established, has an incidence rate only second to breast cancer. Objective. In our study, we aim to investigate the clinical effect of laparoscopic radical surgery combined with neoadjuvant chemotherapy in treating cervical cancer and its influence on postoperative complications and adverse reaction rates. Methods. Cervical cancer patients admitted to our hospital from August 2018 to May 2020 were retrospectively analyzed as the research object and divided into the control group and the experimental group by the draw method, with 50 cases in each group. The laparoscopic radical surgery was performed on the control group, and the laparoscopic radical surgery combined with neoadjuvant chemotherapy was performed on the experimental group to compare their effective rates, adverse reaction rates, postoperative complication rates, expression levels of serum tumor necrosis factor-α (TNF-α) and soluble interleukin-2 receptor (SIL-2R) inside the body before surgery and at one week after surgery, quality of life (QLI) scores, and Mental Status Scale in Nonpsychiatric Settings (MSSNS) scores. Results. Compared with the control group, the experimental group obtained significantly higher effective rate and QLI scores ( P  < 0.05) and significantly lower adverse reaction rates, postoperative complication rates, expression levels of serum TNF-α and SIL-2R inside the body at one week after surgery, and MSSNS scores ( P  < 0.05), with statistical differences; before surgery, the TNF-α and SIL-2R expression levels of the two groups were not significantly different ( P  > 0.05), but the levels at one week after surgery were significantly lower than those before, indicating statistical significance ( P  < 0.05). Conclusion. The clinical effect of laparoscopic radical surgery combined with neoadjuvant chemotherapy can obviously improve the effective rate of cervical cancer patients and lower the incidence rates of postoperative complications and adverse reactions.

Multispectral Image under Tissue Classification Algorithm in Screening of Cervical Cancer

The objectives of this study were to improve the efficiency and accuracy of early clinical diagnosis of cervical cancer and to explore the application of tissue classification algorithm combined with multispectral imaging in screening of cervical cancer. 50 patients with suspected cervical cancer were selected. Firstly, the multispectral imaging technology was used to collect the multispectral images of the cervical tissues of 50 patients under the conventional white light waveband, the narrowband green light waveband, and the narrowband blue light waveband. Secondly, the collected multispectral images were fused, and then the tissue classification algorithm was used to segment the diseased area according to the difference between the cervical tissues without lesions and the cervical tissues with lesions. The difference in the contrast and other characteristics of the multiband spectrum fusion image would segment the diseased area, which was compared with the results of the disease examination. The average gradient, standard deviation (SD), and image entropy were adopted to evaluate the image quality, and the sensitivity and specificity were selected to evaluate the clinical application value of discussed method. The fused spectral image was compared with the image without lesions, it was found that there was a clear difference, and the fused multispectral image showed a contrast of 0.7549, which was also higher than that before fusion (0.4716), showing statistical difference ( P < 0.05 ). The average gradient, SD, and image entropy of the multispectral image assisted by the tissue classification algorithm were 2.0765, 65.2579, and 4.974, respectively, showing statistical difference ( P < 0.05 ). Compared with the three reported indicators, the values of the algorithm in this study were higher. The sensitivity and specificity of the multispectral image with the tissue classification algorithm were 85.3% and 70.8%, respectively, which were both greater than those of the image without the algorithm. It showed that the multispectral image assisted by tissue classification algorithm can effectively screen the cervical cancer and can quickly, efficiently, and safely segment the cervical tissue from the lesion area and the nonlesion area. The segmentation result was the same as that of the doctor's disease examination, indicating that it showed high clinical application value. This provided an effective reference for the clinical application of multispectral imaging technology assisted by tissue classification algorithm in the early screening and diagnosis of cervical cancer.