Prediction of deep learning-based radiomic features for neoadjuvant radiochemotherapy response in locally advanced rectal cancer / 中华放射肿瘤学杂志

Objective:To evaluate the effectiveness of deep learning (DL)-based radiomic features extracted from pre-treatment diffusion-weighted magnetic resonance images (DWI) for predicting neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC).Methods:Forty-three patients receiving nCRT from 2016 to 2017 were included. All patients received DWI before nCRT and total mesorectal excision surgery 6-12 weeks after completion of nCRT. The patient-cohort was split into the responder group ( n=22) and the non-responder group ( n=21) based on the post-nCRT response assessed by postoperative pathology, MRI or colonoscopy. DL-based radiomic features were extracted from the apparent diffusion coefficient map of the DWI using a pre-trained convolution neural network, respectively. Least absolute shrinkage and selection operator-Logistic regression models were constructed using extracted radiomic features for predicting treatment response. The model performance was evaluated with repeated 20 times stratified 4-fold cross-validation using receiver operating characteristic (ROC) curves. Results:The model established with DL-based radiomic features achieved the mean area under the ROC curve of 0.73(SE, 0.58-0.80).Conclusion:DL-based radiomic features extracted from pre-treatment DWI achieve high accuracy for predicting nCRT response in patients with LARC.

Study on the sensitivity of multi-slice spiral CT in diagnosis of lymph node metastasis in different lymph node stations of gastric cancer / 中华胃肠外科杂志

Objective@#To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer.@*Methods@#A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ2 test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station.@*Results@#A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ2=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ2=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ2=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ2=9.673, P=0.002).@*Conclusion@#The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.

Progress in adjuvant therapy decision-making after endoscopic resection of early esophageal cancer / 中华放射肿瘤学杂志

Both endoscopic resection and surgery are the common treatment modes for early esophageal cancer. Compared with radical surgery, endoscopic resection has the advantages of less trauma, quicker recovery, lower cost, less complications, the preservation of the normal anatomy, the physiological function of the esophagus, and higher postoperative quality of life. For patients with a high risk of lymph node metastasis, endoscopic resection alone can lead to inadequate treatment, which need adjuvant therapies. Currently, the common adjuvant therapies consist of adjuvant radiochemotherapy and adjuvant radiochemotherapy combined with surgery. How to combine endoscopic resection with adjuvant therapy to bring maximal benefits to patients has become the hot topic in the field of clinical researches. In this article, the current research status, progress and challenges in the combination of endoscopic resection and adjuvant therapy for the treatment of high-risk patients were reviewed.

The level of exhaled nitric oxide and its clinical significance in children with Mycoplasma pneumoniae pneumonia / 中国基层医药

Objective To investigate the changes of levels of exhaled nitric oxide and the clinical signifi -cance in children with Mycoplasma pneumoniae pneumonia ( MPP).Methods From June 2014 to March 2017,95 children with MPP and 64 children with bronchial pneumonia in Jinshan Branch of The Sixth People ＇s Hospital of Shanghai were collected,32 healthy children were enrolled as controls.According to the imaging examination,patients with MPP were further grouped into lobar pneumonia group,bronchopneumonia group and interstitial pneumonia group.FeNO and lung function were measured in all children.Results The level of FeNO in the MPP group was (7.25 ±3.41) ppb,which was lower than that in the non -MPP group and control group [(11.24 ±3.52) ppb,(10.51 ±4.23)ppb](t＝5.82,5.77,all P＜0.01).The level of FeNO between the non -MPP group and control group had no statistically significant difference (P＞0.05).The FEV1,FEV1/FVC%,FEF25%-75% of the MPP group[(66.23 ±13.21),(84.62 ±6.73),(58.65.±19.43)]were lower than those of the control group and non -MPP group[(91.81 ±11.36),(93.80 ±8.91),(86.80 ±20.71);(85.43 ±10.32),(90.18 ±11.35),(74.73 ± 17.91)](t＝4.35,3.62,4.78;4.56,7.12,5.06,all P＜0.01).The FEV1,FEV1/FVC%,FEF25%-75% of the non-MPP group[(85.43 ±10.32),(90.18 ±11.35),(74.73 ±17.91)]were lower than those of the control group [(91.81 ±11.36),(93.80 ±8.91),(86.80 ±20.71)] ( t＝2.12,3.05,2.53,all P＜0.05).The level of FeNO among the lobar pneumonia group,bronchopneumonia group and interstitial pneumonia group had no statistically significant difference ( all P ＞0.05 ).In the MPP group,the FEV1,FEV1/FVC%,FEF25% -75% were not associated with FeNO level(r＝-0.15,P＞0.05;r＝-0.06,P＞0.05;r＝0.07,P＞0.05).Conclusion The level of FeNO in children with MPP is lower,and the level of FeNO is not significantly correlated with the parameters of lung function,and FeNO can be used as an inflammatory marker to evaluate the correlation between MP infection and airway inflammation.

A dose-effect analysis of organs at risk during preoperative chemoradiotherapy for gastric cancer / 中华放射肿瘤学杂志

Objective To investigate the clinical and dose-volume factors for damages to organs at risk(OARs)during preoperative chemoradiotherapy for gastric cancer, and to provide a reference for optimization of radiotherapy plans to avoid or reduce damages to OARs.Methods A total of 58 patients with locally advanced gastric adenocarcinoma undergoing neoadjuvant treatment were enrolled as subjects.In those patients,30 received preoperative chemoradiotherapy combined with surgery and adjuvant chemotherapy, while others received preoperative chemotherapy combined with surgery and adjuvant chemotherapy. The preoperative chemotherapy group received 2-3 cycles of xeloxregimen(capecitabine+oxaliplatin)before surgery and 3-4 cycles of xeloxregimen after surgery(a total of 6 cycles). The preoperative chemoradiotherapy group received preoperative radiotherapy(45 Gy in 25 fractions)combined with 2 cycles of concurrent xeloxchemotherapy at 14-21 days after the first cycle of xeloxregimen, as well as 3 cycles of xeloxchemotherapy after surgery. The analyses of clinical and dose-volume factors for damages to OARs were performed based on laboratory indices and clinical symptoms during the treatment. Results In all the patients,the incidence rates of liver injury(LI), renal injury(RI), and duodenum injury(DI)before surgery were 22%,48%,and 33%,respectively;the incidence rates of LI and RI after treatment were 35%and 49%, respectively. After appropriate treatment, neither LI nor DI affected the treatment of gastric cancer. RI healed without any special treatment. Compared with preoperative chemotherapy, preoperative chemoradiotherapy caused higher incidence of LI(P=0.00,0.03).RI was only associated with glomerular filtration rate before radiotherapy(P=0.08,0.13). A V3.5of ≤98.96% for the liver reduced LI, while a D2ccof ≤48 Gy for the duodenum reduced DI. Conclusions Preoperative chemoradiotherapy is safe for treating gastric cancer. Compared with preoperative chemotherapy, preoperative chemoradiotherapy does not increase the risk of RI. However,preoperative chemoradiotherapy tends to increase LI.Further studies are needed to improve the treatment method.

Salvage treatment outcome and prognosis of patients with locoregionally recurrent early-stage extranodal NK/T cell lymphoma,nasal type / 中华放射肿瘤学杂志

Objective To retrospectively analyze the prognostic factors for locoregionally recurrent early?stage extranodal nasal?type natural killer/T?cell lymphoma ( NKTCL) . Methods A total of 56 patients with early?stage extranodal nasal?type NKTCL, who had locoregional recurrence after initial treatment and then received salvage treatment from 1995 to 2014, were enrolled as subjects. The effects of salvage treatment on the overall survival ( OS) rate were analyzed after initial treatment and recurrence. Univariate and multivariate prognostic analyses were performed on the OS rate after recurrence. Results The median follow?up time was 35. 9 months after initial treatment and 14. 8 months after recurrence. The 3?year OS rate was 73% after initial treatment and 58% after recurrence. Compared with chemotherapy alone, radiotherapy?containing salvage treatment significantly improved the OS rates after initial treatment and recurrence ( P=0. 040, 0. 009 ) , and re?irradiation also significantly improved the OS rates after initial treatment and recurrence (P=0. 018, 0. 019). Most (84%) of the acute and late adverse reactions after re?irradiation were grade 1?2 ones. The univariate and multivariate analyses showed that the Karnofsky Performance Status score, radiotherapy in initial treatment, and radiotherapy in salvage treatment were influencing factors for the OS rate after recurrence. Conclusions Radiotherapy achieves improved survival and tolerable toxicities, making it indispensable in the treatment of locoregionally recurrent extranodal nasal?type NKTCL.

Early primary pulmonary mucosa-associated lymphoid tissue lymphoma:a prognostic analysis and literature review / 中华放射肿瘤学杂志

Objective To analyze the clinical features,treatment methods,and prognostic factors for early primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma.Methods A retrospective analysis was performed on the clinical data,treatment outcomes,and survival of 32 patients with early pulmonary MALT lymphoma from March 2001 to September 2013.The median age of those patients was 56 years.Twenty-three patients had stage ⅠE disease and nine had stage Ⅱ E disease.According to the marginal zone B-cell lymphoma prognostic index (MZLPI),twenty-three patients were scored as 0 and nine as 1.Nine patients received radiotherapy,eight patients underwent surgery alone,three patients underwent surgery plus chemotherapy,and twelve patients received chemotherapy alone.The Kaplan-Meier method was adapted for calculating the OS,PFS and the log-rank test was used for survival difference analysis and univariate prognostic analysis.Results The 5-year sample size was 22.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 84.5％ and 73.2％,respectively.Radiotherapy yielded an overall response rate of 100％,including a complete response rate of 66.7％ and a partial response rate of 33.3％.The univariate analysis showed that non-radiotherapy treatment was a prognostic factor for poor PFS.The patients treated with radiotherapy had significantly higher 5-year PFS rates than those treated without radiotherapy (100％ vs.63.0％,P=0.029),while there was no significant difference in 5-year OS rate between these two groups (100％ vs.78.8％,P=0.129).Age older than 60 years,an ECOG score of 2,and an MZLPI score of 1 were prognostic factors for poor PFS (P=0.041,0.018,and 0.044) and OS (P=0.001,0.001,and 0.003).Conclusions The prognostic factors for early pulmonary MALT lymphoma include age,ECOG score,and MZLPI score.Low-dose involved-field radiotherapy (24-30 Gy) can improve local control and survival.

Clinical analysis of children with refractory Mycoplasma pneumoniae pneumonia / 中国基层医药

Objective To study clinical manifestations,laboratory variables,imaging features and therapies of refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods The retrospective analysis of clinical data was conducted in 45 children with RMPP and 74 children with Mycoplasma pneumoniae pneumonia (MPP)admitted to department of pediatrics.The general data,clinical manifestations,laboratory variables,imaging features and therapies were compared between two groups.Results As compared to MPP,the age(6.14 ±3.35)y,febrile days(9.49 ± 5.28)d,the hospitalized days(11.45 ±3.42)d were significantly higher than that of MPP group (P <0.001);RMPP had higher rations of unilateral pulmonary infiltration[41(91.11%)],large consolidation shadows[35(77.78%)], pulmonary[21(46.67%)]and extrapulmonary complications[24(51.33%)](P <0.05);CRP,ESR,LDH and IgM were increased,the difference was statistically significant (P <0.01);Thirty -seven cases(82%)of RMPP had to add ceftriaxone sodium,thirty -two cases(71.7%)of RMPP had to add glucocorticoid,,Bronchofiberoscope lavages were used in six cases of RMPP.Only one case of RMPP occured sequela.Conclusion The older children,the per-sistent high fever,large consolidation shadows of pulmonary,pulmonary and extrapulmonary complications,high level of serum CRP,ESR,LDH and IgM are the clinical related factors of RMPP.The combination of cephalosporins and (or)glucocorticoid might consider for the cases who have no effect with macrolides.The effect is sure for RMPP with Bronchofiberoscope lavages.

Risk factors of atherosclerosis in elderly senile obstructive sleep apnea hypopnea syndrome patients with hypertension and type 2 diabetes / 中华全科医师杂志

Objective To explore the related factors of atherosclerosis in senile obstructive sleep apnea hypopnea syndrome (OSAHS) patients.Methods From May 2012 to January 2014,129 elderly hypertension and type 2 diabetes patients were recruited.According to the presence or absence of OSAHS,they were divided into OSAHS (n =60) and non-OSAHS (n =69) groups.And 30 physical examination subjects were selected as control group.The parameters of age,gender,height,weight,high sensitivity C-reactive protein (Hs-CRP),homocysteine (Hcy),triglyceride (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C) and intimate-media thickness of carotid artery (CIMT) were measured with ultrasonography.And their levels were compared among OSAHS,non-OSAHS and normal control groups.And the correlations were analyzed between CIMT and Hs-CRP,Hcy,TG,TC,HDL-C,LDL-C,age and body mass index (BMI).Results The levels of Hs-CRP[(3.40 ± 0.91) mg/L,(2.57 ± 1.01) mg/L],Hcy [(16.50 ± 2.89) μmol/L,(11.20 ± 2.32) μmol/L],CIMT[(1.06 ±0.14) mm,(0.93 ±0.13) mm],TG[(2.52 ± 1.40) mmol/L,(2.51 ±2.02) mmol/L],TC[(5.74 ± 1.16) mmol/L,(5.49 ± 1.09) mmol/L] and LDL-C[(3.15 ±0.47) mmol/L,(3.05 ±0.70) mmol/L] in both OSAHS and non-OSAHS groups were higher than those in normal control group [Hs-CRP:(2.06 ± 1.22) mg/L,Hcy:(6.04 ± 1.85) μmol/L,CIMT:(0.65 ± 0.07) mm,TG:(0.99±0.24) mmol/L,TC:(3.63 ±0.71) mmol/L and LDL-C:(2.47 ±0.27) mmol/L] (OSHAS group vs.control group,t =5.88,18.15,15.62,5.91,9.17,7.47,non-OSAHS group vs.control group,t=2.20,10.73,11.51,4.09,8.56,4.45,all P＜0.05).The levels of Hs-CRP,Hcy,CIMT and plaque score were higher in OSAHS group than those in non-OSAHS group [(1.92 ± 1.03) vs.(1.35 ± 0.97) points] (OSHAS group vs.non-OSAHS group,t =4.84,11.72,5.54,3.91,all P ＜0.05).CIMT or carotid artery plaque were related with age,BMI,TG,TC,LDL-C,Hs-CRP and Hcy in OSAHS group.Conclusions OSAHS may elevate the level of inflammatory factors and cause atherosclerosis.And the changes of CIMT,Hs-CRP and Hcy are parallel.Hcy also has important clinical significance in the progression of atherosclerosis.

Preliminary results of a phase Ⅱ prospective clinical study of early-stage nasal NK/T-cell lymphoma with extended involved-field intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective To investigate the feasibility of the scheme of target volume delineation with extended involved?field intensity?modulated radiotherapy (IMRT) for patients with early?stage nasal NK/ T?cell lymphoma (NC?NKTL). Methods Twenty?one patients with stage IE?IIE NC?NKTL were treated with short?course chemotherapy combined with radiotherapy from 2011 to 2013. The majority of patients received the GELOX regimen. All patients received extended involved?field IMRT with a dose of 54?? 6 Gy in 26 fractions for gross tumor volume, 50?? 7 Gy in 26 fractions for high?risk clinical target volume (CTV), and 45?? 5 Gy in 26 fractions for low?risk CTV. The dose distribution, short?term treatment outcomes, and adverse reactions were analyzed. Results The 2?year sample size was 12. The 2?year follow?up rate was 100%. The 2?year local control rate ( LRC) was 100%. The 2?year overall and progression?free survival rates were 90?? 5% and 90?? 5%, respectively. The median coverage rates of planning target volumes with 90% of the prescribed doses of 54?? 6 Gy, 50?? 7 Gy, and 45?? 5 Gy were 99?? 8%, 99?? 6%, and 99?? 7%, respectively. No grade 3 or 4 adverse reactions were observed in patients. Conclusions The scheme of target volume delineation and dose configuration in our study not only achieves excellent target volume coverage, but also reduces adverse reactions in patients, which achieves a 2?year LRC ideal for patients with early?stage NC?NKTL.

Content Determination of Amino Acids in Folium Isatidis by RP-HPLC Precolumn Derivatization Method / 中国药房

OBJECTIVE:To establish a RP-HPLC precolumn derivatization method for the content determination of argi-nine(Arg)and proline(Pro)in Folium Isatidis.METHOD:2,4-dinitro-fluorobenzene was undergone precolumn derivatization and the amino acids was determined directly under alkaline condition with Kromasil C 18 as chromatographic column,the mobile phase was composed of sodium acetate buffer solution(pH=6.4)-acetonitrile(850∶150)with detection wavelength at360nm,the content was calculated by external reference method.RESULTS:The linear ranges for Arg and Pro were0.627?g～5.016?g(r=0.9996)and0.874?g～7.000?g(r=0.9995),respectively.The average recovery was98.2%with RSD at2.3%and2.2%,respectively.CONCLUSION:The method is simple,accurate and reliable,and suitable for the assaying of amino acids in Folium Isatidis.

Determination of anthraquinone aglycones of Radix et Rhizome Rhei in Ganning Granule by HPLC / 中成药

AIM:To determine Radix et Rhizoma Rhici in Ganning Granula(Radix et Rhizoma Rhei,Rhizoma Chuanxiong). METHODS: In order to determine five anthraquinone aglycones of Radix et Rhizoma Rhei,the HPLC system consisted of Nucleosil ODS column,methand-0.1% phosphoric acid(85∶15) mixture as mobile phase,with detection wavelength at 430 nm. RESULTS: HPLC showed that the linearity ranges were as follows: aloe-emodin concentration was at the range of 0.041 6-0.291 2 ?g,the rhein concentration was at the range of 0.037 1-0.259 8 ?g,the emodin concentration was at the range of 0.045 8-0.320 3 ?g,the chrysophanol concentration was at the range of 0.049 60.347 2 ?g,the physcion concentration was at the range of 0.020 6-0.144 5 ?g.The average recoveries of five anthraquinone aglycones were between 96.6%-98.4%.CONCLUSION: The method is simple,accurate,sensible and with good repeatability and can be used for quality control of Ganning Granule.