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Objective:To analyze the survival efficacy, prognostic factors and failure patterns of patients with esophageal squamous cell carcinoma (ESCC) underwent postoperative radiotherapy (PORT) using modified clinical target volume (CTV) based on postoperative high-frequency recurrence regions, so as to provide reference for the further optimization of CTV of PORT.Methods:The patients with ESCC underwent radical operation in Comprehensive Cancer Center of Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from April 28, 2014 to November 29, 2018 were retrospectively analyzed. Patients with stage pT 3-4aN 0 or N +, who underwent PORT with modified CTV based on postoperative high-frequency recurrence regions, were included in the study. Kaplan-Meier method was used to calculate overall survival (OS) and locoregional recurrence free survival (LRFS) , adverse events of patients were evaluated, Cox proportional hazards model was used for univariate and multivariate survival analysis, and the failure patterns of patients after PORT were analyzed. Results:A total of 85 patients were included in this study, and the median follow-up time was 52.6 months. The median OS of the whole group was 74.1 months. The 1-year, 2-year and 3-year OS rates were 97.6%, 84.7% and 71.7% respectively. The median LRFS was not reached, and the 1-year, 2-year and 3-year LRFS rates were 92.9%, 78.6% and 71.5% respectively. The incidence of grade 3-4 adverse events was 17.6% (15/85) , mainly including lymphopenia, bone marrow suppression, gastrointestinal reaction and skin reaction. Univariate analysis of OS after PORT showed that the degree of differentiation (set G1+G1-2+G2 group as the control group, G2-3+G3 group HR=4.19, 95% CI: 1.91-9.17, P<0.001; NA+basal-like group HR=4.16, 95% CI: 1.29-13.44, P=0.017) and postoperative stage ( HR=2.19, 95% CI: 1.09-4.39, P=0.030) were the influencing factors of OS. Cox multivariate analysis showed that the degree of differentiation was an independent prognostic factor for OS after PORT (set G1+G1-2+G2 group as the control group, G2-3+G3 group HR=5.24, 95% CI: 2.30-11.93, P<0.001; NA+basal-like group HR=4.83, 95% CI: 1.33-17.62, P=0.017) . The first failure patterns analysis showed that 39 cases (45.9%) had recurrence, among which, 22 cases (25.9%) had locoregional recurrence with the median onset time of 15.2 months after operation, 19 cases (22.4%) had distant metastasis with the median onset time was 14.1 months after operation, and 2 cases (2.4%) were mixed failure mode. Among the locoregional recurrence, 16 cases (72.7%) recurred in the radiation field. Among all the local recurrence sites, the lymph node drainage regions in the supraclavicular, upper middle mediastinum and upper abdominal perigastric/celiac artery trunk areas were the most common sites. Among the distant metastatic organs, lung, bone and liver metastases were the most common. Conclusion:Patients of ESCC with high risk of recurrence after radical esophagectomy have long survival time and high safety after PORT with modified CTV according to the high-frequency recurrence regions. It is worthy of further confirmation by multicenter, large sample and prospective clinical trials.
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Objective:To evaluate the safety and clinical efficacy of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis (ICAS).Methods:A total of 36 patients with severe ICAS receiving Neuroform EZ stent angioplasty were retrospectively analyzed at Beijing Anzhen Hospital from July 2018 to January 2020. Digital subtraction angiography (DSA) before endovascular intervention confirmed the diagnosis. Follow-up information was reviewed by neurologists at 30 days and 6 months after the procedure. The primary endpoints were transient ischemic attack (TIA), ischemic or hemorrhagic stroke and death caused by any reason within 30 days.Results:The overall technical success rate was 100%. The median stenosis rate was reduced from 93.6%±4.5% to 18.8%±11.2% ( t=37.36, P<0.001).Primary endpoint event was not reported. During follow-up, one patient developed TIA and no death or ischemic stroke was observed. No in-stent restenosis at six months occurred. Conclusion:Neuroform EZ stent is safe and effective in patients with severe ICAS. However, perspective studies need to be operated for further validation via long-term follow-up.
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Objective:To investigate the effect of curcumin on the nucleotide-binding oligomerization domain-like receptor protein (NLRP3) inflammasome in cardiomyocytes of rats with early sepsis and its mechanism.Methods:Twenty-four male SD rats were randomly divided into three groups: the sham-operated group (sham group, n=8), the sepsis group ( n=8), and the curcumin intervention group (Cur group, n=8). A rat model of sepsis was prepared by cecal ligation and perforation (CLP). After modeling, 100 mg/kg of curcumin was intraperitoneally injected and repeated 24 h later. Rats in the sepsis group were injected with normal saline. The levels of myocardial injury-specific troponin T (cTnT) in rat plasma were detected by ELISA at 6, 24, and 48 h. Hematoxylin-eosin (HE) staining was used to observe the pathological injury of the myocardium in the myocardial tissue of rat at 48 h. The apoptosis of cardiomyocytes was detected by TUNEL assay. The expression levels of Cleaved caspase-1, NLRP3 and IL-1β protein were detected by Western blot, and the ultrastructural changes of the cardiomyocytes were observed under a transmission electron microscope. Results:The levels of cTnT in rat plasma at 6, 24, and 48 h in the Cur group were significantly lower than those in the sepsis group ( P<0.05). HE staining showed infiltration, cell edema and necrosis of myocardial inflammatory cells in the sepsis group, while only partial cell edema and necrosis were observed in the Cur group. TUNEL assay showed that the apoptosis of cardiomyocytes in the Cur group was significantly lower than that in the sepsis group [(28.4±2.3)% vs. (43.6±3.8)%, P<0.05]. The expression levels of Cleaved caspase-1, NLRP3 and IL-1β in the Cur group were lower than those in the sepsis group and higher than those in the sham-operated group ( P<0.05). Under transmission electron microscopy, the nuclei in the sham-operated group had intact membranes and uniform chromatin distribution; in the sepsis group chromatin margination, pyknosis, mitochondrial cristae breakage, cavitation, and partial breakage of sarcomere were observed; while in the Cur group partial chromatin margination, slightly edema and dilation of mitochondria, with basically complete morphology were observed. Conclusions:Curcumin inhibits NLRP3-mediated acute myocardial injury in septic rats, and its mechanism may be related to pyroptosis induced by the down-regulation of the expression of Cleaved caspase-1 and IL-1β protein.
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Objective:To investigate the feasibility and safety of submaximal balloon dilation and to perform small-diameter stent for symptomatic carotid artery severely stenosis before coronary artery bypass grafting(CABG).Methods:From January 2016 to December 2019, 30 patients of the Department of Neurointervention in Beijing Anzhen Hospital with symptomatic carotid artery stenosis(≥70%) and the left main trunk or triple-vessel of coronary artery disease were analyzed retrospectively. General information, clinical characteristics, and imaging data of all cases were collected. All patients underwent submaximal balloon dilation and small-diameter stent implantation. Preoperative comorbidities or risk factors included hypertension 23 cases(76.7%), diabetes 10 cases(33.3%), hyperglycemia 14 cases(46.7%), moking 13 cases(43.3%). Left main trunk disease 6 cases(20.0%), three-vessels disease 24 cases(80.0%), mitral regurgitation 1 case(3.3%), stable angina 25 cases(83.3%), myocardial infarction 8 cases(26.7%), cerebral infarction 24 cases(80.0%) and transient ischemia attack(TIA) 6 cases(20.0%) caused by ipsilateral carotid artery stenosis. The median National Institutes of Health Stroke Scale(NIHSS) score was 2(0-3), and the median modified Rankin Scale(mRS) score was 1(0-1) before the operation. The mean interval between carotid artery intervention and CABG was(23.4±8.2)days.Results:29 cases(96.7%, 29/30) underwent CAS-CABG operation successfully. In one case of carotid artery extreme tortuosity, the emboli protective device could not place the distal carotid artery. In the operative procedure, 27 cases(90.0%, 27/30) underwent with 3mm diameter balloon, only 3 cases(10.0%) with 3 mm balloon after pre-dilatation with 2 mm diameter balloon because of severely high-grade stenosis(99%). 25 cases(83.3%) with 7mm diameter stents and 5 cases(16.7%) with 6 mm diameter stents, including 22 cases(73.3%) with a closed-cell stent and 8 cases(26.7%) with an open-cell stent. In the perioperative period, the heart rate of two patients was lower than 50 BPM during operation and returned to normal after using atropine immediately. Another patient presented with chest tightness during interventional therapy. TNI elevation was examined urgently. After oxygen inhalation and intravenous infusion of Nitroglycerin, the patient's symptoms improved rapidly. No cardiac and cerebrovascular complications occurred during the perioperative period of CABG, no cardiac-related complications occurred within 30 days of follow-up, one case of TIA and 1 case of cerebral infarction. After intensive anti-platelet aggregation and lipid-lowering treatment, two patient's symptoms improved. There were no death cases in all patients during carotid artery interventional therapy, perioperative CABG and 30-day follow-up. Thirty days later, we performed a clinical follow-up of 23 cases, median 4.5(3.0-7.9) months, mRS Score Median 1(0-1). One patient presented with TIA, any patient had no symptoms of the cardiac or nervous system. Image follow-up of 17 cases, median 3.5(2.8-4.5) months, carotid artery ultrasound showed in-stent restenosis(stenosis rate>50%) in 1 case, the patient was asymptomatic restenosis, continue treatment of aggressive anti-platelet and lipid-lowering drugs.Conclusion:Submaximal balloon dilation and performing small-diameter stent for symptomatic carotid artery severely stenosis before CABG is safe and feasible, which could not only reduce the incidence of vagus reflex resulted in acute coronary syndrome during carotid artery stenosis intervention but also morbidity of acute ischemic stroke events during CABG.
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Objective:To explore the diagnostic value of transrectal ultrasound(TRUS)/multiparametric magnetic resonance imaging(mpMRI) fusion targeted biopsy(FTB) for clinically significant prostate cancer(PCa) detection by using both biopsy histopathology and radical prostatectomy histopathology as reference standards.Methods:A total of 303 consecutive patients with suspicious lesions detected by mpMBI and underwent prostate biopsy at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between November 2017 to January 2020 were retrospectively analyzed. All the suspicious lesions were sampled by TRUS/mpMRI FTB in addition with standard 12-core systematic biopsy(SB). The clinically significant PCa detection rates by TRUS/mpMRI FTB and SB were compared by using both biopsy histopathology and radical prostatectomy histopathology as reference standards.Results:The diagnosis of PCa was histologically confirmed in 189 of 303 patients, including 178 patients with clinically significant PCa and 11 patients with clinically insignificant PCa. With biopsy histopathology as reference standard, the clinically significant PCa detection rate of TRUS/mpMRI FTB was statistically higher than SB (57.1% vs 45.9%, P<0.001). Among 189 patients with biopsy proven PCa, 80 patients underwent radical prostatectomy, and the radical prostatectomy histopathology confirmed 79 patients with clinically significant PCa.With radical prostatectomy as reference standard, the clinically significant PCa detection rate of TRUS/mpMRI FTB was statistically higher than SB (91.1% vs 74.7%, P<0.001). Conclusions:Compared with SB, MRI/US FTB can offer more accurate sampling of suspicious lesions on mpMRI, and consequently improve the clinically significant PCa detection rate.
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Objective:To assess the utility of contrast-enhanced ultrasound (CEUS) targeted biopsy (TB) for clinically significant prostate cancer (PCa) detection.Methods:A total of 983 consecutive patients scheduled for prostate biopsy from October 2015 to March 2019 in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine were enrolled in this retrospective study. All patients had suspicious lesions on CEUS, defined as increased focal contrast enhancement, rapid contrast enhancement and low enhancement lesions with ill-defined borders. Suspicious lesions on CEUS were sampled in addition with standard 12-core systematic biopsy(SB). Clinically significant PCa was defined using Epstein criteria. The clinically significant PCa detection rate by CEUS-TB and combined biopsy was evaluated in comparison with SB.Results:In 502 of the 983 patients, the diagnosis of PCa was histologically confirmed, including 445 patients with clinically significant PCa and 57 patients with clinically insignificant PCa. The clinically significant PCa by CEUS-TB and combined biopsy were 41.9% (412/983) and 45.3% (445/983) respectively, which was significantly higher than SB (36.8%, 362/983)(all P<0.001). CEUS-TB resulted in additional 83 cases of clinically significant PCa, including 61 patients missed by SB and 22 patients under-graded by SB. Conclusions:CEUS is helpful in the detection of PCa lesions. Combined CEUS-TB and SB can improve the clinically significant PCa detection rate.
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The treatment options for liver cancer and liver cirrhosis are limited. Cell therapy (immune cells, stem cells) can significantly improve the therapeutic effect by actively regulating body's immunity. In addition, when choosing different methods of cell therapy, clinicians should also fully consider the adverse reactions associated with cell therapy. This article reviews the progress of cells therapy in clinical trials of liver cancer and liver cirrhosis, including therapeutic mechanism, advantages, disadvantages and limitations.
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Objective@#To investigate the clinical value of quantitative detection of DNA aneuploidy in the diagnosis and treatment of cervical lesions in middle-aged and senile women.@*Methods@#A total of 1 404 middle-aged and elderly women who underwent screening for early cervical lesions were retrospectively studied.Patients were divided into the two groups: the 40-49 years old group(n=897)and the 50-78 years old group(n=507). Cervical lesions were screened by DNA ploidy analysis and the results were compared with those screened by liquid-based cytology, colposcopy and high-risk human papillomavirus(HPV).@*Results@#The positive detection rate of HPV by DNA ploidy analysis was 54.4%(764/1 404). Of 1 404 patients, HPV16/18 infection accounted for 21.3%(299/1 404). The detection rate of heteroploid cells was 50.92%(715/1 404). There was a significant positive correlation between HPV infection type and cervical epithelial cell ploidy changes(r=870, P=0.001). The detection rate of HPV by liquid-based cytology was 45.08%, which was lower than that by DNA aneuploidy(χ2=9.594, P=0.002). The differences in the incidences of low-grade squamous intraepithelial lesion(LSIL)and high-grade squamous intraepithelial lesion(HSIL)and above categories of lesions were statistically significant(χ2=289.598, P=0.000)between patients with and without DNA aneuploidy.The statistically significant differences were found between the 40-49 years old group and 50-78 years old group(P<0.05)in the occurrence of abnormal DNA ploidy cells, HPV infection rate, the proportion of LSIL, HSIL and above categories of lesions.@*Conclusions@#Compared with the conventional cytology, DNA aneuploidy quantitative detection has higher sensitivity and better specificity, and has no significant difference from the high-risk HPV detection.It can be used as one of methods for screening cervical lesions in middle-aged and elderly women, especially those with high-risk HPV infection.
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Chemoradiation has been the standard treatment of stage Ⅲ unresectable non-small cell lung cancer (NSCLC) for a long period of time. However, the clinical efficacy of chemoradiation has not been significantly improved in recent two decades. In the past 2-3 years, the role of immune-checkpoint inhibitors in metastatic NSCLC has been persistently strengthened. Moreover, the synergistic effect between radiotherapy and immune-checkpoint blockade has been conformed in pre-clinical and clinical studies. Recent clinical trials have demonstrated that the combination of radiotherapy and immune-checkpoint blockade has been proven to be more effective in the treatment of stage Ⅲ unresectable NSCLC. In this article, the latest clinical studies since 2017 regarding the application value of this combined treatment of stage Ⅲ unresectable NSCLC were summarized.
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Objective@#To understand the in vitro growth characteristics of Cryptococcus gattii VGⅠ and VGⅡ isolated in China and the diversity in their virulence to Galleria mellonella.@*Methods@#Based on the results of multilocus sequence typing for eight strains of Cryptococcus gattii isolated in China, the strains were cultured in vitro to draw growth curves, observe the melanin production and measure the capsule thickness. The median lethal time (LT50) and median lethal dose (LC50) at 48 h of Cryptococcus gattii were calculated using Galleria mellonella infection test. Fourteen strains of Cryptococcus neoformans were studied for comparison.@*Results@#The eight Cryptococcus gattii strains were six VGⅠ and two VGⅡ. The growth curves of Cryptococcus gattii VGⅠ and VGⅡ were similar to that of Cryptococcus neoformans when culture at 30℃. The total number for each of them could reach 108 CFU/ml at 96 h under 30℃. However, the total number at any time point at 37℃ was less than that at 30℃. There was no significant difference in the amount of melanin produced by Cryptococcus neoformans under 30℃ and 37℃, but both VGⅠand VGⅡ types of Cryptococcus gattii could produce more amount of melanin under 37℃ than under 30℃. The ratio of capsule/cell wall diameter of Cryptococcus gattii VGⅠwas greater at 37℃ than that at 30℃ with statistical significance (P<0.001). Cryptococcus neoformans showed the longest LT50, followed by VGⅠand VGⅡ types of Cryptococcus gattii. The LT50 of Cryptococcus gattii VGⅡ at the concentration of 1×106 CFU/ml was 72 h, and its LC50 at 48 h was 1×108 CFU/ml.@*Conclusions@#Like Cryptococcus neoformans, Cryptococcus gattii VGⅠ and VGⅡ grew faster under 30℃ than under 37℃, but more melanin was produced and thicker capsule was formed under 37℃ than under 30℃. Among Cryptococcus neoformans and VGⅠ and VGⅡ types of Cryptococcus gattii, Cryptococcus gattii VGⅡ showed the shortest LT50 and the strongest virulence to Galleria mellonella.
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Objective To understand the in vitro growth characteristics of Cryptococcus gattii VGⅠ and VGⅡ isolated in China and the diversity in their virulence to Galleria mellonella. Methods Based on the results of multilocus sequence typing for eight strains of Cryptococcus gattii isolated in China, the strains were cultured in vitro to draw growth curves, observe the melanin production and measure the capsule thickness. The median lethal time (LT50 ) and median lethal dose (LC50 ) at 48 h of Cryptococcus gattii were calculated using Galleria mellonella infection test. Fourteen strains of Cryptococcus neoformans were studied for comparison. Results The eight Cryptococcus gattii strains were six VGⅠ and two VGⅡ. The growth curves of Cryptococcus gattii VGⅠ and VGⅡ were similar to that of Cryptococcus neoformans when culture at 30℃ . The total number for each of them could reach 108 CFU/ ml at 96 h under 30℃ . However, the total number at any time point at 37℃ was less than that at 30℃ . There was no significant difference in the amount of melanin produced by Cryptococcus neoformans under 30℃ and 37℃ , but both VGⅠand VGⅡtypes of Cryptococcus gattii could produce more amount of melanin under 37℃ than under 30℃ . The ratio of capsule/ cell wall diameter of Cryptococcus gattii VGⅠwas greater at 37℃ than that at 30℃ with statistical significance (P<0. 001). Cryptococcus neoformans showed the longest LT50 , followed by VGⅠand VGⅡtypes of Cryptococcus gattii. The LT50 of Cryptococcus gattii VGⅡ at the concentration of 1×106 CFU/ ml was 72 h, and its LC50 at 48 h was 1×108 CFU/ ml. Conclusions Like Cryptococcus neoformans, Cryptococcus gattii VGⅠ and VGⅡ grew faster under 30℃ than under 37℃ , but more melanin was produced and thicker capsule was formed under 37℃ than under 30℃ . Among Cryptococcus neoformans and VGⅠ and VGⅡtypes of Cryptococcus gattii, Cryptococcus gattii VGⅡ showed the shortest LT50 and the strongest virulence to Galleria mellonella.
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Objective To retrospectively investigate the value of contrast enhanced ultrasound ( CEUS) in breast cancer biopsy . Methods A total of 49 consecutive patients with biopsy confirmed breast cancer were retrospectively analyzed . All patients underwent CEUS and biopsies were thus performed targeting both the high perfusion and low/non‐perfusion regions on CEUS . T he diagnostic performance and core cancer involvement of the biopsy cores taken from the high perfusion regions were compared with those from the low/non‐perfusion . Results A total of 53 breast cancer lesions were biopsy confirmed in 49 patients .CEUS revealed homogeneous enhancement in 8 lesions ( 15 .1% ) ,and heterogeneous enhancement in 45 lesions ( 84 .9% ) . T he diagnostic accuracy rate for biopsy cores taken from the high perfusion regions was significantly higher than that from the low/non‐perfusion regions ( 98 .5% vs 72 .9% , P ＜0 .01) . T he core cancer involvement was also higher in high perfusion lesions ( 55% vs 30% , P ＜0 .01) . Conclusions CEUS can differentiate the active area and necrotic fibrosis area of breast tumors by displaying the microvessels ,thus contributing to the selection of biopsy sites .
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Objective To investigate the clinical value of quantitative detection of DNA aneuploidy in the diagnosis and treatment of cervical lesions in middle-aged and senile women.Methods A total of 1 404 middle-aged and elderly women who underwent screening for early cervical lesions were retrospectively studied.Patients were divided into the two groups:the 40-49 years old group(n=897)and the 50-78 years old group(n=507).Cervical lesions were screened by DNA ploidy analysis and the results were compared with those screened by liquid-based cytology,colposcopy and high-risk human papillomavirus(HPV).Results The positive detection rate of HPV by DNA ploidy analysis was 54.4 ％ (764/1 404).Of 1 404 patients,HPV16/18 infection accounted for 21.3％ (299/1 404).The detection rate of heteroploid cells was 50.92 ％ (715/1 404).There was a significant positive correlation between HPV infection type and cervical epithelial cell ploidy changes(r=870,P=0.001).The detection rate of HPV by liquid-based cytology was 45.08 ％,which was lower than that by DNA aneuploidy(x2=9.594,P=0.002).The differences in the incidences of low-grade squamous intraepithelial lesion(LSIL)and high-grade squamous intraepithelial lesion(HSIL)and above categories of lesions were statistically significant (x 2 =289.598,P =0.000) between patients with and without DNA aneuploidy.The statistically significant differences were found between the 40-49 years old group and 50-78 years old group(P＜0.05)in the occurrence of abnormal DNA ploidy cells,HPV infection rate,the proportion of LSIL,HSIL and above categories of lesions.Conclusions Compared with the conventional cytology,DNA aneuploidy quantitative detection has higher sensitivity and better specificity,and has no significant difference from the high-risk HPV detection.It can be used as one of methods for screening cervical lesions in middle-aged and elderly women,especially those with highrisk HPV infection.
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Objective@#To retrospectively investigate the value of contrast enhanced ultrasound (CEUS) in breast cancer biopsy.@*Methods@#A total of 49 consecutive patients with biopsy confirmed breast cancer were retrospectively analyzed. All patients underwent CEUS and biopsies were thus performed targeting both the high perfusion and low/non-perfusion regions on CEUS. The diagnostic performance and core cancer involvement of the biopsy cores taken from the high perfusion regions were compared with those from the low/non-perfusion.@*Results@#A total of 53 breast cancer lesions were biopsy confirmed in 49 patients.CEUS revealed homogeneous enhancement in 8 lesions (15.1%), and heterogeneous enhancement in 45 lesions (84.9%). The diagnostic accuracy rate for biopsy cores taken from the high perfusion regions was significantly higher than that from the low/non-perfusion regions (98.5% vs 72.9%, P<0.01). The core cancer involvement was also higher in high perfusion lesions (55% vs 30%, P<0.01).@*Conclusions@#CEUS can differentiate the active area and necrotic fibrosis area of breast tumors by displaying the microvessels, thus contributing to the selection of biopsy sites.
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Objective To investigate the relationship between trait mindfulness( TM) and rumina-tion,as well as the mediating effects of experiential avoidance(EA) and thought suppression(TS) in under-graduates. Methods A sample of 1 219 undergraduates was recruited to complete Mindful Attention Aware-ness Scale,Acceptance and Action Questionnaire-Ⅱ,the White Bear Suppression Inventory and Rumination Response Style Questionnaire. Results (1) The significant positive correlations of each two different fac-tors were found among experiential avoidance (18. 020±7. 446),thought suppression (47. 769±10. 011) and rumination (47. 668±10. 497),and the correlation coefficients were 0. 466,0. 546 and 0. 525 respectively, all P<0. 01. TM (64. 977± 9. 623) was found to be significantly related with EA ( r=-0. 450),TS ( r=-0. 424) and rumination (r=-0. 527),all P<0. 01. (2) Partially mediating effect of EA ( effect value=-0. 132) and TS (effect value=-0. 073) were both found in TM and rumination,and the proportion of these two effects were 25. 0% and 13. 9%,respectively. The chain mediating effect of EA and TS (effect value=-0. 042 ) was also found between TM and rumination, whose indirect effect size was 8. 0%. Conclusion The relationship between TM and rumination in undergraduates can be mediated by EA and TS respectively,as well as their chain effect.
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Objective To explore the function of soluble apoptosis inhibitive factor Fas (sFas) in pathogenesis of Graves ophthalmopathy (GO). Methods The subjects were enrolled in the Second Affiliated Hospital of Harbin Medical University from January 2014 to January 2017, and they were divided into three groups: GO accompanied with Graves disease (GD) group, GO without GD group and normal control group, with 30 patients in each group. Serum levels of sFas in three groups were investigated with enzyme-linked immunosorbent assay, and serum levels of freeing triiodothyronine (FT3), serum free thyroxine (FT4), thyrotrophin (TSH), thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb) were measured by chemoluminescent technique, and compared. Results The serum level of sFas in GO accompanied with GD group was (0.76 ± 0.13)μg/L, which was higher than that in GO without GD group [(0.63 ± 0.08)μg/L] and normal control group [(0.52 ± 0.05)μg/L], and there was significant difference (P＜0.01). The serum level of sFas in GO without GD group and normal control group had significant difference (P＜0.05). The serum levels of FT3, FT4, TGAb, TPOAb in GO without GD group were lower than those in GO accompanied with GD group (P＜0.01).The serum level of TSH in GO without GD group was higher than that in GO accompanied with GD group (P＜0.01). The concentration of sFas were negatively correlated with FT3, FT4, TSH, TGAb and TPOAb (P > 0.05). Conclusions Abnormal serum concentration of sFas can be observed in patients with GD and GO which proves that sFas may play a role in the pathogenesis of GD and GO.
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Objective To explore whether CT perfusion imaging (CTPI)parameters can early predict the curative effect of anlotinib hydrochloride and their predictive accuracy for the treatment in lung cancer patients.Methods 2 6 patients with advanced nonGsmall cell lung cancer (NSCLC)were treated with anlotinib hydrochloride and underwent CTPI scanning before chemotherapy,after the first and second treatment cycle respectively.The average values of perfusion value (PV),peak enhancement image (PEI),time to peak (TTP),blood volume (BV)and the change rate of these parameters after one treatment cycle every time were measured and recorded. According to the response evaluation criteria in solid tumors 1.1 (RECIST1.1),the maximum diameter of the target tumor was measured and the tumor regression rate after two treatment cycles was calculated.Then a correlation analysis was conducted between the change rate of perfusion parameters (PV%,PEI%,TTP%,BV%)after one treatment cycle and the tumor regression rate (D%)after two treatment cycles. The ROC curve was performed to evaluate the accuracy of those parameters.Results PV after one treatment cycle was significantly lower than that before treatment,and PV% showed a statistical difference (P＝0.00).The PV% after one treatment cycle was positively correlated with D% after two treatment cycles (r＝0.56).In addition,the AUC of PV% and BV% were 0.99 and 0.88 respectively, and specificity were both 100%,with sensitivity respectively 75.7% and 82.6%.Conclusion CTPI can early reflect the curative effect of anlotinib hydrochloride for advanced NSCLC and provide more options for clinical evaluation.
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Objective To analyze the therapeutic effects of adjuvant therapy with the human epidermal growth factor receptor 2 (HER2) double-blocker Trastuzumab and Lapatinib on the differential expression of different molecular subtypes of breast cancer,especially for the HER2 overexpression.Methods A prospective study was conducted to select 227 patients with early-stage HER2-positive breast cancer who were not treated in the Yulin First Hospital from January 2014 to March 2017.The average age was 55 years old,rang from 22 to 67 years old.All patients received a double blocker treatment for consecutive 18 weeks [oral Lapatinib 1 000 mg/(time · d) and injection Trastuzumab (first 8 mg/kg,later 6 mg/kg,Intravenous drip,once every 3 weeks)].Among them,postmenopausal patients took Letrozole 2.5 mg/d,and premenopausal patients took Tamoxifen 20 mg/d.If a serious adverse reaction occurs during the administration,the amount of Lapatinib was reduced to 750 mg/(time · d).The test can continue after the adverse reaction had dropped to level 1 and below,up to 14 days.Safety tests were performed on the first day of each cycle,and biopsy was performed on the 14th day for the detection of initial gene expression changes,and the effect of the reaction was initially judged by ultrasound at 6th week.According to the Response Evaluation Criteria in Solid Tumors 1.1 of the solid tumor,if the tumor volume becomes large,it was determined that the treatment was ineffective.Ineffective patients were given an intravenous infusion of 80 mg/m2 Paclitaxel per week.The dose of lapatinib was reduced to 750 mg/(time · d) and the remaining 12 courses were continued.Normal patients underwent surgery within 1 to 3 weeks of the completion of the last course of treatment.Ineffective patients underwent surgery within 2 to 3 weeks after the end of the procedure,and the last safety examination was followed up 30 days after surgery.Clinical variables,complete response rates,and adverse events were observed in patients with different molecular subtypes.Measurement data were expressed as median (interquartile range) [M(P25,P75)],Wilcoxon rank sum test was used for comparison between groups;Chi-square test was used for compare the count data between groups.Results Of the 227 patients,207 (91.19％) completed the entire treatment process.After treatment,compared with the initial molecular subtypes,63 (41.72％) of the 151 patients with HER2 overexpression had complete remission,while only 10 of the 76 other subtypes (13.16％) were completely relapsed.Remission,the difference between the two groups was statistically significant (x2 =17.62,P ＜ 0.001);after 14 days of treatment,most of the tumor types were converted to normal breast-like type,and the patients who became normal breast-like type were completely,the response rate was 50.00％ (56/112),which was much higher than the complete response rate of other patients [14.78％ (17/115),x2 =30.66,P ＜ 0.001].Of the initial 151 HER2 overexpressing patients,115 (76.16％) patients switched to other subtypes,of which 84 (73.04％) converted to normal breast-like and 51 (60.71％) for complete remission.Most of the adverse reactions were concentrated in grades 1 to 2.Among them,liver function abnormalities,diarrhea,skin rashes,and hand-foot syndrome were the main factors.Conclusion In HER2-positive early breast cancer,adjuvant therapy with the HER2 double-blocker Trastuzumab and Lapatinib is more effective in patients with HER2 overexpression and can be used to determine the intrinsic molecular subtype of breast cancer,with its potential utilization value.
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Objective To investigate the expression of programmed death ligand 1 (PD-L1) in lung adenocarcinoma tissues and its correlation with clinicopathological features of patients. Methods A total of 141 paraffin-embedded specimens of patients with newly diagnosed lung adenocarcinoma by pathology from January to August 2018 in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School were collected. The expression of PD-L1 in the tumor cells (TC) and tumor-infiltrating immune cells (IC) were detected by immunohistochemistry EnVision staining. Based on the percentage of expression, PD-L1 in TC and IC were divided into TC3 (≥50％), TC2 (≥5％ and <50％), TC1 (≥1％ and <5％), and TC0 (<1％); IC3 (≥10％), IC2 (≥5％ and <10％), IC1 (≥1％ and <5％), and IC0 (<1％). Results PD-L1 expression was positive in 90 cases, and the positive rate was 63.8％ (90/141) at a TC1 or IC1 threshold. When a TC3 or IC3 threshold was applied, PD-L1 expression was positive in 17 cases, and the positive rate was 12.1％ (17/141). In the TC1 or IC1 threshold group, PD-L1 expressions were different in patients with different sex, nerve invasion and pleural invasion, and the differences were statistically significant (all P < 0.05). While in the TC3 or IC3 threshold group, PD-L1 expressions were different in patients with different cell differentiation, clinical stage, lymphocyte infiltration, vascular invasion and nerve invasion, and the differences were statistically significant (all P < 0.05). In both TC1 or IC1 threshold group and TC3 or IC3 threshold group, PD-L1 expression was associated with nerve invasion (both P < 0.05). Conclusions PD-L1 expression is associated with nerve invasion. PD-L1 inhibitors expect to be used as a potential treatment strategy for recurrent and progressive lung adenocarcinoma patients with high level expression of PD-L1.
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Objective@#To investigate the predictive value of transient elastography (FibroScan), aspartate aminotransferase-to-platelet ratio index (APRI) in the detection of esophagogastric varices in patients with liver cirrhosis. @*Methods@#236 patients with liver cirrhosis who met the criteria were selected. All patients underwent gastroscopy. According to the degree of esophagogastric varices, patients were divided into four groups: none, mild, moderate, and severe. The patient's liver stiffness (LSM) and aspartate aminotransferase- to-platelet ratio index (APRI) were measured within 3 days of gastroscopy. One-way analysis of variance was used to compare multi-group data. The ROC curves of LSM, APRI, LSM+APRI in patients with liver cirrhosis with esophageal varices were plotted and their area under the ROC curve (AUC) were compared. @*Results@#The area under the ROC curve of LSM, APRI, LSM + APRI in patients with mild esophagogastric varices were 0.856, 0.900, and 0.906, respectively; moderate esophagogastric varices were 0.857, 0.924, and 0.923 respectively; and severe esophagogastric varices were 0.801, 0.903, and 0.901, respectively. @*Conclusion@#APRI and LSM+APRI have better predictive value for patients with cirrhosis who have esophagogastric varices.