RESUMO
Background: Gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) is a rare heterogeneous tumor. Liver metastasis seriously affects the prognosis of GEP-NEN. However, few tools are existed to predict GEP-NEN complicated with synchronous liver metastasis. Aims: To analyze the risk factors of synchronous liver metastasis in patients with GEP-NEN and establish a nomogram to predict synchronous liver metastasis in patients with GEP-NEN. Methods: A total of 10 973 pathologically confirmed patients with GEP-NEN from Jan. 2010 to Dec. 2017 were collected from SEER database and divided randomly into training set (n=7 511) and test set (n=3 462). Both groups were divided into liver metastasis group and non-liver metastasis group according to the occurrence of liver metastasis. Multifactorical logistic regression analysis was used to identify the risk factors of liver metastasis in patients with GEP-NEN. R software was used to establish and verify the nomogram of liver metastasis in GEP-NEN patients. Results: Liver metastasis was associated with gender, age, race, primary tumor site, degree of differentiation, tumor diameter, T3/4 stage, and lymph node metastasis in patients with GEP-NEN. The results of multivariate logistic regression analysis showed that primary tumor site (small intestine and pancreas), differentiation degree (poorly differentiated and undifferentiated), diameter of tumor ≥ 5 cm, T3/4 stage and lymph node metastasis were independent risk factors affecting liver metastasis in patients with GEP-NEN (P< 0.001). The concordance index of internal validation for nomogram was 0.838 (95% CI: 0.826-0.849), and the concordance index of external validation was 0.847 (95% CI: 0.829-0.864). Conclusions: GEP-NEN patients with primary tumor site in small intestine or pancreas, poor differentiation and undifferentiation, diameter of tumor ≥5 cm, T3/4 stage and lymph node metastasis are more likely to develop liver metastasis which suggested that such patients need to be alert for the occurrence of liver metastasis and need more aggressive treatment. The calibration curves fits are good for both the training and test sets, and can help clinicians to make individualized prediction for whether the GEP-NEN patient has synchronous liver metastasis at the initial diagnosis.
RESUMO
The thalamostriatal pathway is implicated in Parkinson's disease (PD); however, PD-related changes in the relationship between oscillatory activity in the centromedian-parafascicular complex (CM/Pf, or the Pf in rodents) and the dorsal striatum (DS) remain unclear. Therefore, we simultaneously recorded local field potentials (LFPs) in both the Pf and DS of hemiparkinsonian and control rats during epochs of rest or treadmill walking. The dopamine-lesioned rats showed increased LFP power in the beta band (12 Hz-35 Hz) in the Pf and DS during both epochs, but decreased LFP power in the delta (0.5 Hz-3 Hz) band in the Pf during rest epochs and in the DS during both epochs, compared to control rats. In addition, exaggerated low gamma (35 Hz-70 Hz) oscillations after dopamine loss were restricted to the Pf regardless of the behavioral state. Furthermore, enhanced synchronization of LFP oscillations was found between the Pf and DS after the dopamine lesion. Significant increases occurred in the mean coherence in both theta (3 Hz-7 Hz) and beta bands, and a significant increase was also noted in the phase coherence in the beta band between the Pf and DS during rest epochs. During the treadmill walking epochs, significant increases were found in both the alpha (7 Hz-12 Hz) and beta bands for two coherence measures. Collectively, dramatic changes in the relative LFP power and coherence in the thalamostriatal pathway may underlie the dysfunction of the basal ganglia-thalamocortical network circuits in PD, contributing to some of the motor and non-motor symptoms of the disease.