Immune-related gene based prognostic signature for the risk stratification analysis of breast cancer

Background: Breast cancer has plagued women for many years and caused many deaths around the world. Method: In this study, based on the weighted correlation network analysis, univariate Cox regression analysis and least absolute shrinkage and selection operator, 12 immune-related genes were selected to construct the risk score for breast cancer patients. The multivariable Cox regression analysis, gene set enrichment analysis and nomogram were also conducted in this study. Results: Good results were obtained in the survival analysis, enrichment analysis, multivariable Cox regression analysis and immune-related feature analysis. When the risk score model was applied in 22 breast cancer cohorts, the univariate Cox regression analysis demonstrated that the risk score model was significantly associated with overall survival in most of the breast cancer cohorts. Conclusion: Based on these results, we could conclude that the proposed risk score model may be a promising method, and may improve the treatment stratification of breast cancer patients in the future work.

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Identification of an independent immune-genes prognostic index for breast cancer

10.21203/rs.3.rs-41670/v1 ◽

2020 ◽

Author(s):

Lin Chen ◽

Yuxiang Dong ◽

Yitong Pan ◽

Chen Chen ◽

Junyi Wang ◽

...

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

Risk Score ◽

Cox Regression ◽

R Package ◽

Breast Cancer Patients ◽

Cox Regression Analysis ◽

Immune Genes ◽

Score Model ◽

Survival Risk

Abstract Objective Increasing evidence has indicated an association between immune micro-environment in breast cancer and clinical outcomes. The aim of this research is to comprehensively investigate the effect of tumor immune genes on the prognosis of breast cancer patients. Methods 2498 immune genes were downloaded from ImmPort database. Additionally, we identified and downloaded the transcriptome data of patients with breast cancer from the TCGA database through the R package, as well as relevant clinical information. Survival R package was applied in survival analyses for hub-genes. Cox regression analysis was used to analyze the effect of immune genes on the prognosis of breast cancer. Immune risk scoring model was constructed based on the statistical correlation between hub immune genes and survival. Meanwhile, multivariate cox regression analysis was utilized to investigate whether the immune genes risk score model was an independent factor for predicting the prognosis of breast cancer. Nomogram was constructed to comprehensively predict the survival rate of breast cancer. P < 0.05 was considered to be statistically significant. Results The results of the difference analysis showed that 556 immune genes exhibited differential expression between normal and breast cancer tissues (p < 0. 05). Univariate cox regression analysis revealed 66 immune genes statistically correlated with breast cancer related survival risk, of which 30 were associated with overall survival (P < 0.05). In addition, a 15-genes based immune genes risk scoring model was constructed through lasso COX regression analysis. KM curve indicated that patients in high-risk were associated with poor outcomes (p < 0.001). ROC curve indicated that the immune risk score model was reliable in predicting survival risk (5-year OS, AUC = 0.752). Our model showed satisfying AUC and survival correlation in the validation dataset (3-year over survival (OS) AUC = 0.685, 5-year OS AUC = 0.717, P = 0.00048). Furthermore, multivariate cox regression analysis confirmed that the immune risk score model was an independent factor for predicting the prognosis of breast cancer. A nomogram was established to comprehensively predict the survival of breast cancer patients with the results of multivariate cox regression analysis. Finally, we found that 15 immune genes and risk scores were significantly associated with clinical factors and prognosis, and were involved in multiple oncogenic pathways. Conclusion Collectively, tumor immune genes played an essential role in the prognosis of breast cancer. Furthermore, immune risk score was an independent predictive factor of breast cancer, indicating a poor survival.

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Treatment outcomes and its associated factors among breast cancer patients at Kitui Referral Hospital

SAGE Open Medicine ◽

10.1177/20503121211067857 ◽

2022 ◽

Vol 10 ◽

pp. 205031212110678

Author(s):

Mwendwa Dickson Wambua ◽

Amsalu Degu ◽

Gobezie T Tegegne

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

Confidence Interval ◽

Treatment Outcomes ◽

Cancer Patients ◽

Medical Records ◽

Cox Regression ◽

Breast Cancer Patients ◽

Cox Regression Analysis ◽

Study Setting

Objectives: Despite breast cancer treatment outcomes being relatively poor or heterogeneous among breast cancer patients, there was a paucity of data in the African settings, especially in Kenya. Hence, this study aimed to determine treatment outcomes among breast cancer patients at Kitui Referral Hospital. Methods: A hospital-based retrospective cohort study design was conducted among adult patients with breast cancer. All eligible breast cancer patients undergoing treatment from January 2015 to June 2020 in the study setting were included. Hence, a total of 116 breast cancer patients’ medical records were involved in the study. Patients’ medical records were retrospectively reviewed using a predesigned data abstraction tool. The data were entered, cleaned, and analyzed using SPSS (Statistical Package for Social Sciences) version 26 software. Descriptive analysis—such as percentage, frequency, mean, and figures—was used to present the data. Kaplan–Meier survival analysis was used to estimate the mean survival estimate across different variables. A Cox regression analysis was employed to determine factors associated with mortality. Results: The study showed that the overall survival and mortality rate was 62.9% (73) and 37.1% (43), respectively. The regression analysis showed that patients who had an advanced stage of disease had a 3.82 times risk of dying (crude hazard ratio= 3.82, 95% confidence interval = 1.5–9.8) than an early stage of the disease. Besides, patients with distant metastasis had 4.4 times more hazards of dying than (crude hazard ratio = 4.4, 95% confidence interval = 2.1–9.4) their counterparts. Conclusion: The treatment outcome of breast cancer patients was poor, and its overall mortality among breast cancer patients was higher in the study setting. In the multivariate Cox regression analysis, the tumor size was the only statistically significant predictor of mortality among breast cancer patients. Stakeholders at each stage should, therefore, prepare a relevant strategy to improve treatment outcomes.

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A Signature of Autophagy-Related Long Non-coding RNA to Predict the Prognosis of Breast Cancer

Frontiers in Genetics ◽

10.3389/fgene.2021.569318 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaoping Li ◽

Jishang Chen ◽

Qihe Yu ◽

Hui Huang ◽

Zhuangsheng Liu ◽

...

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

High Risk ◽

Cox Regression ◽

Enrichment Analysis ◽

Low Risk ◽

Gene Set Enrichment Analysis ◽

Lasso Regression ◽

Cox Regression Analysis ◽

Risk Scoring

Background: A surge in newly diagnosed breast cancer has overwhelmed the public health system worldwide. Joint effort had beed made to discover the genetic mechanism of these disease globally. Accumulated research has revealed autophagy may act as a vital part in the pathogenesis of breast cancer.Objective: Aim to construct a prognostic model based on autophagy-related lncRNAs and investigate their potential mechanisms in breast cancer.Methods: The transcriptome data and clinical information of patients with breast cancer were obtained from The Cancer Genome Atlas (TCGA) database. Autophagy-related genes were obtained from the Human Autophagy Database (HADb). Long non-coding RNAs (lncRNAs) related to autophagy were acquired through the Pearson correlation analysis. Univariate Cox regression analysis as well as the least absolute shrinkage and selection operator (LASSO) regression analysis were used to identify autophagy-related lncRNAs with prognostic value. We constructed a risk scoring model to assess the prognostic significance of the autophagy-related lncRNAs signatures. The nomogram was then established based on the risk score and clinical indicators. Through the calibration curve, the concordance index (C-index) and receiver operating characteristic (ROC) curve analysis were evaluated to obtain the model's predictive performance. Subgroup analysis was performed to evaluate the differential ability of the model. Subsequently, gene set enrichment analysis was conducted to investigate the potential functions of these lncRNAs.Results: We attained 1,164 breast cancer samples from the TCGA database and 231 autophagy-related genes from the HAD database. Through correlation analysis, 179 autophagy-related lncRNAs were finally identified. Univariate Cox regression analysis and LASSO regression analysis further screened 18 prognosis-associated lncRNAs. The risk scoring model was constructed to divide patients into high-risk and low-risk groups. It was found that the low-risk group had better overall survival (OS) than those of the high-risk group. Then, the nomogram model including age, tumor stage, TNM stage and risk score was established. The evaluation index (C-index: 0.78, 3-year OS AUC: 0.813 and 5-year OS AUC: 0.785) showed that the nomogram had excellent predictive power. Subgroup analysis showed there were difference in OS between high-risk and low-risk patients in different subgroups (stage I-II, ER positive, Her-2 negative and non-TNBC subgroups; all P < 0.05). According to the results of gene set enrichment analysis, these lncRNAs were involved in the regulation of multicellular organismal macromolecule metabolic process in multicellular organisms, nucleotide excision repair, oxidative phosphorylation, and TGF-β signaling pathway.Conclusions: We identified 18 autophagy-related lncRNAs with prognostic value in breast cancer, which may regulate tumor growth and progression in multiple ways.

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Identification of Prognosis-related RNA Binding Proteins to Reveal the Role of RNA Binding Proteins in the Progression and Prognosis of Colon Cancer

10.21203/rs.3.rs-54019/v1 ◽

2020 ◽

Author(s):

Qi Zou ◽

Yue Ding ◽

Yuxiang Dong ◽

Dejun Wu ◽

Junyi Wang ◽

...

Keyword(s):

Breast Cancer ◽

Colon Cancer ◽

Regression Analysis ◽

Risk Score ◽

Binding Proteins ◽

Cox Regression ◽

Cox Regression Analysis ◽

Immune Genes ◽

Score Model ◽

Survival Risk

Abstract Background: RNA binding proteins (RBPs) are now under discussion as novel promising bio-markers for patients with colon cancer. The purpose of our study is to identify several RBPs related to the progression and prognosis of colon cancer, and to further investigate the mechanism of their influence on tumor progression. Methods: The transcriptome data of colon cancer as well as clinical characteristics used in this study were downloaded from the The Cancer Genome Atlas (TCGA) database. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and Gene set enrichment analysis (GSEA) were performed to elucidate the gene functions and relative pathways. Cox and lasso regression analysis were used to analyze the effect of immune genes on the prognosis of breast cancer. Immune risk scoring model was constructed based on the statistical correlation between hub immune genes and survival. Meanwhile, multivariate cox regression analysis was utilized to investigate whether the immune genes risk score model was an independent factor for predicting the prognosis of breast cancer. Nomogram was constructed to comprehensively predict the survival rate of breast cancer. P< 0.05 was considered to be statistically significant. Results: The results of the difference analysis showed that 473 RBPs exhibited differential expression between normal and colon cancer tissues (p<0. 05). Univariate cox regression analysis revealed 25 RBPs statistically correlated with colon cancer related survival risk (P<0.05). In addition, a 10-RBPs based risk scoring model was constructed through multivariate cox regression analysis. KM curve indicated that patients in high-risk were associated with poor outcomes (p<0.001). ROC curve indicated that the immune risk score model was reliable in predicting survival risk (5-year OS, AUC=0.782). Our model showed satisfying AUC and survival correlation in the validation dataset (5-year OS AUC=0.744). Furthermore, multivariate cox regression analysis confirmed that the immune risk score model was an independent factor for predicting the prognosis of colon cancer. A nomogram was established to comprehensively predict the survival of colon cancer patients with the results of multivariate cox regression analysis. Finally, we found that 10 RBPs and risk scores were significantly associated with clinical factors and prognosis, and were involved in multiple oncogenic pathways. Conclusion: Collectively, RBPs played an essential role in the progression and prognosis of colon cancer by regulating multiple biological pathways. Furthermore, RBPs risk score was an independent predictive factor of colon cancer, indicating a poor survival.

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Comprehensive Analysis of m6A RNA Methylation Regulators in the Prognosis and Immune Microenvironment of Multiple Myeloma

Frontiers in Oncology ◽

10.3389/fonc.2021.731957 ◽

2021 ◽

Vol 11 ◽

Author(s):

Rui Liu ◽

Ying Shen ◽

Jinsong Hu ◽

Xiaman Wang ◽

Dong Wu ◽

...

Keyword(s):

Multiple Myeloma ◽

Regression Analysis ◽

Risk Score ◽

Cox Regression ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Cox Regression Analysis ◽

Rna Methylation ◽

Immune Infiltration ◽

M6a Rna Methylation

BackgroundN6-methyladenosine is the most abundant RNA modification, which plays a prominent role in various biology processes, including tumorigenesis and immune regulation. Multiple myeloma (MM) is the second most frequent hematological malignancy.Materials and MethodsTwenty-two m6A RNA methylation regulators were analyzed between MM patients and normal samples. Kaplan–Meier survival analysis and least absolute shrinkage and selection operator (LASSO) Cox regression analysis were employed to construct the risk signature model. Receiver operation characteristic (ROC) curves were used to verify the prognostic and diagnostic efficiency. Immune infiltration level was evaluated by ESTIMATE algorithm and immune-related single-sample gene set enrichment analysis (ssGSEA).ResultsHigh expression of HNRNPC, HNRNPA2B1, and YTHDF2 and low expression of ZC3H13 were associated with poor survival. Based on these four genes, a prognostic risk signature model was established. Multivariate Cox regression analysis demonstrated that the risk score was an independent prognostic factor of MM. Enrichment analysis showed that cell cycle, immune response, MYC, proteasome, and unfold protein reaction were enriched in high-risk MM patients. Furthermore, patients with higher risk score exhibited lower immune scores and lower immune infiltration level.ConclusionThe m6A-based prognostic risk score accurately and robustly predicts the survival of MM patients and is associated with the immune infiltration level, which complements current prediction models and enhances our cognition of immune infiltration.

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Assessing the prognostic value of stemness-related genes in breast cancer patients

Scientific Reports ◽

10.1038/s41598-020-73164-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Wen-Jie Wang ◽

Han Wang ◽

Meng-sen Wang ◽

Yue-Qing Huang ◽

Yu-Yuan Ma ◽

...

Keyword(s):

Breast Cancer ◽

Stem Cells ◽

Regression Analysis ◽

Cancer Stem Cells ◽

Risk Score ◽

Prognostic Model ◽

Cox Regression ◽

Treatment Resistance ◽

Breast Cancer Patients ◽

Cox Regression Analysis

Abstract Breast cancer (BC) is currently one of the deadliest tumors worldwide. Cancer stem cells (CSCs) are a small group of tumor cells with self-renewal and differentiation abilities and high treatment resistance. One of the reasons for treatment failures is the inability to completely eliminate tumor stem cells. By using the edgeR package, we identified stemness-related differentially expressed genes in GSE69280. Via Lasso-penalized Cox regression analysis and univariate Cox regression analysis, survival genes were screened out to construct a prognostic model. Via nomograms and ROC curves, we verified the accuracy of the prognostic model. We selected 4 genes (PSMB9, CXCL13, NPR3, and CDKN2C) to establish a prognostic model from TCGA data and a validation model from GSE24450 data. We found that the low-risk score group had better OS than the high-risk score group, whether using TCGA or GSE24450 data. A prognostic model including four stemness-related genes was constructed in our study to determine targets of breast cancer stem cells (BCSCs) and improve the treatment effect.

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Identification and development of an independent immune-related genes prognostic model for breast cancer

BMC Cancer ◽

10.1186/s12885-021-08041-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lin Chen ◽

Yuxiang Dong ◽

Yitong Pan ◽

Yuhan Zhang ◽

Ping Liu ◽

...

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

Cox Regression ◽

Gene Set Enrichment Analysis ◽

Risk Scores ◽

Validation Dataset ◽

Immune Gene ◽

Cox Regression Analysis ◽

Immune Genes ◽

Immune Related Genes

Abstract Background Breast cancer is one of the main malignant tumors that threaten the lives of women, which has received more and more clinical attention worldwide. There are increasing evidences showing that the immune micro-environment of breast cancer (BC) seriously affects the clinical outcome. This study aims to explore the role of tumor immune genes in the prognosis of BC patients and construct an immune-related genes prognostic index. Methods The list of 2498 immune genes was obtained from ImmPort database. In addition, gene expression data and clinical characteristics data of BC patients were also obtained from the TCGA database. The prognostic correlation of the differential genes was analyzed through Survival package. Cox regression analysis was performed to analyze the prognostic effect of immune genes. According to the regression coefficients of prognostic immune genes in regression analysis, an immune risk scores model was established. Gene set enrichment analysis (GSEA) was performed to probe the biological correlation of immune gene scores. P < 0.05 was considered to be statistically significant. Results In total, 556 immune genes were differentially expressed between normal tissues and BC tissues (p < 0. 05). According to the univariate cox regression analysis, a total of 66 immune genes were statistically significant for survival risk, of which 30 were associated with overall survival (P < 0.05). Finally, a 15 immune genes risk scores model was established. All patients were divided into high- and low-groups. KM survival analysis revealed that high immune risk scores represented worse survival (p < 0.001). ROC curve indicated that the immune genes risk scores model had a good reliability in predicting prognosis (5-year OS, AUC = 0.752). The established risk model showed splendid AUC value in the validation dataset (3-year over survival (OS) AUC = 0.685, 5-year OS AUC = 0.717, P = 0.00048). Moreover, the immune risk signature was proved to be an independent prognostic factor for BC patients. Finally, it was found that 15 immune genes and risk scores had significant clinical correlations, and were involved in a variety of carcinogenic pathways. Conclusion In conclusion, our study provides a new perspective for the expression of immune genes in BC. The constructed model has potential value for the prognostic prediction of BC patients and may provide some references for the clinical precision immunotherapy of patients.

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Development of prognosis model for colon cancer based on autophagy-related genes

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02061-w ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Xu Wang ◽

Yuanmin Xu ◽

Ting Li ◽

Bo Chen ◽

Wenqi Yang

Keyword(s):

Colon Cancer ◽

Regression Analysis ◽

High Risk ◽

Cancer Patients ◽

Risk Score ◽

Cox Regression ◽

Patient Survival ◽

Expression Profiles ◽

Cox Regression Analysis ◽

Risk Patients

Abstract Background Autophagy is an orderly catabolic process for degrading and removing unnecessary or dysfunctional cellular components such as proteins and organelles. Although autophagy is known to play an important role in various types of cancer, the effects of autophagy-related genes (ARGs) on colon cancer have not been well studied. Methods Expression profiles from ARGs in 457 colon cancer patients were retrieved from the TCGA database (https://portal.gdc.cancer.gov). Differentially expressed ARGs and ARGs related to overall patient survival were identified. Cox proportional-hazard models were used to investigate the association between ARG expression profiles and patient prognosis. Results Twenty ARGs were significantly associated with the overall survival of colon cancer patients. Five of these ARGs had a mutation rate ≥ 3%. Patients were divided into high-risk and low-risk groups based on Cox regression analysis of 8 ARGs. Low-risk patients had a significantly longer survival time than high-risk patients (p < 0.001). Univariate and multivariate Cox regression analysis showed that the resulting risk score, which was associated with infiltration depth and metastasis, could be an independent predictor of patient survival. A nomogram was established to predict 1-, 3-, and 5-year survival of colon cancer patients based on 5 independent prognosis factors, including the risk score. The prognostic nomogram with online webserver was more effective and convenient to provide information for researchers and clinicians. Conclusion The 8 ARGs can be used to predict the prognosis of patients and provide information for their individualized treatment.

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Prognostic Significance of SQSTM1 in Breast Cancer: A Comprehensive Analysis

10.21203/rs.3.rs-64416/v1 ◽

2020 ◽

Author(s):

Yang Liu ◽

Qian Du ◽

Dan Sun ◽

Ruiying Han ◽

Mengmeng Teng ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Somatic Mutation ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Functional Enrichment ◽

Regulation Mechanism ◽

Breast Cancer Patients ◽

Gene Set ◽

Multiple Datasets

Abstract Background: SQSTM1 (Sequestosome 1, p62) is degraded by activated autophagy and involved in the progression of in various types of cancers. However, the prognostic role and underlying regulation mechanism of SQSTM1 in the progression and development of breast cancer remain unclear.Methods: In this study, 1336 samples with available mRNA data from Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) database and 27 formalin fixation and paraffin embedding (FFPE) tissue samples from the First Affiliated Hospital of Xi’an Jiaotong University were collected to evaluate SQSTM1 expression in mRNA and protein levels. Kaplan–Meier and Cox regression were used for revealing prognostic value in three independent breast cancer independent datasets. Tumor Immune Estimation Resource (TIMER) database and Gene Set Variation Analysis (GSVA) was used to explore the relationship of SQSTM1 mRNA expression and immune infiltration level in breast cancer. Dysregulation mechanisms of SQSTM1 were also explored including copy number variation (CNV), somatic mutation, epigenetic alterations and other transcription and post-transcription level using multiple datasets. Finally, Gene Set Enrichment Analysis (GSEA) was constructed to elucidate functional regulating performance of SQSTM1 in breast cancer.Results: The results showed that mRNA and protein level of SQSTM1 were significantly elevated in breast cancer and receiver operating characteristic (ROC) curve showed that p62 may act as diagnostic biomarker. Lower expression of SQSTM1 predicted better outcome through multiple datasets. It was also found that SQSTM1 correlated with immune infiltrates in breast cancer. Moreover, CNV and methylation of SQSTM1 DNA was correlated with SQSTM1 dysregulation and act as prognostic factors for breast cancer patients. Yet, somatic mutation status of SQSTM1 didn’t show any prognostic relevance. We also identified diverse transcription factors that directly bound to SQSTM1 DNA and the miRNAs which may regulate SQSTM1 mRNA. Finally, functional enrichment analysis revealed that SQSTM1 is related to cell signal transduction, oxidative stress and autophagy in breast cancer.Conclusion: Our findings revealed that SQSTM1 plays a key role in the progression of breast cancer and might be a promising biomarker for the diagnosis and personalized treatment of breast cancer patients.

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Identification and Validation of Immune-Related LncRNA Prognostic Signature for Lung Adenocarcinoma

Frontiers in Genetics ◽

10.3389/fgene.2021.681277 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guomin Wu ◽

Qihao Wang ◽

Ting Zhu ◽

Linhai Fu ◽

Zhupeng Li ◽

...

Keyword(s):

Regression Analysis ◽

Lung Adenocarcinoma ◽

Clinical Features ◽

Cox Regression ◽

Differential Expression Analysis ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Prognostic Signature ◽

Cox Regression Analysis ◽

Immune Infiltration

This study aimed to establish a prognostic risk model for lung adenocarcinoma (LUAD). We firstly divided 535 LUAD samples in TCGA-LUAD into high-, medium-, and low-immune infiltration groups by consensus clustering analysis according to immunological competence assessment by single-sample gene set enrichment analysis (ssGSEA). Profile of long non-coding RNAs (lncRNAs) in normal samples and LUAD samples in TCGA was used for a differential expression analysis in the high- and low-immune infiltration groups. A total of 1,570 immune-related differential lncRNAs in LUAD were obtained by intersecting the above results. Afterward, univariate COX regression analysis and multivariate stepwise COX regression analysis were conducted to screen prognosis-related lncRNAs, and an eight-immune-related-lncRNA prognostic signature was finally acquired (AL365181.2, AC012213.4, DRAIC, MRGPRG-AS1, AP002478.1, AC092168.2, FAM30A, and LINC02412). Kaplan–Meier analysis and ROC analysis indicated that the eight-lncRNA-based model was accurate to predict the prognosis of LUAD patients. Simultaneously, univariate COX regression analysis and multivariate COX regression analysis were undertaken on clinical features and risk scores. It was illustrated that the risk score was a prognostic factor independent from clinical features. Moreover, immune data of LUAD in the TIMER database were analyzed. The eight-immune-related-lncRNA prognostic signature was related to the infiltration of B cells, CD4+ T cells, and dendritic cells. GSEA enrichment analysis revealed significant differences in high- and low-risk groups in pathways like pentose phosphate pathway, ubiquitin mediated proteolysis, and P53 signaling pathway. This study helps to treat LUAD patients and explore molecules related to LUAD immune infiltration to deeply understand the specific mechanism.

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