Prognostic value of immunotherapy in advanced non-small cell lung cancer based on baseline and dynamic changes in hemoglobin, albumin, and platelets.

Immune checkpoint inhibitors enhance the tumor-killing ability of T-cells in non-small cell lung cancer (NSCLC), thereby boosting overall survival (OS) and transforming treatment for advanced stages. However, challenges persist, including low response rates and the absence of effective markers for candidate selection. This study evaluated the impact of hemoglobin, albumin, and platelet (HALP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) on immunotherapy efficacy and survival in advanced NSCLC. Furthermore, the study aimed to develop a nomogram based on these parameters. Clinical and hematological data from patients diagnosed with NSCLC who received immunotherapy were analyzed. Efficacy was assessed using the immune Response Evaluation Criteria in Solid Tumors (iRECIST), and progression-free survival (PFS) and OS were analyzed. Prediction models were based on baseline and post-treatment HALP, NLR, and PLR. The 203 included patients had a median follow-up of 16 months, a median PFS (mPFS) of 7 months (6.0 - 8.0), while the median OS (mOS) was not available (24.0 - not available). The PLR before treatment (PLR0) was linked to a higher disease control rate (DCR) (odds ratio [OR] = 0.258), while initial immunotherapy and NLR after four cycles of treatment (NLR4C) significantly boosted the objective response rate (ORR). Cox regression showed that HALP before treatment (HALP0), HALP after four cycles of treatment (HALP4C), and NLR before treatment (NLR0) significantly influenced PFS. Additionally, HALP0, NLR0, and PLR after four cycles of treatment (PLR4C) were associated with OS. The C-indices for PFS and OS were 0.823 and 0.878, respectively, indicating good prediction accuracy. HALP, NLR, and PLR at various time points effectively predicted immunotherapy response in advanced NSCLC patients. Low HALP with high NLR and PLR indicated a poor prognosis. The findings can provide the basis for stratified randomized controlled trials (RCTs) in the future.

Effects of the cage height and positioning on clinical and radiographic outcome of lateral lumbar interbody fusion: a retrospective study.

BACKGROUND: The proper cage positioning and height in lateral lumbar interbody fusion (LLIF). This study evaluated their effects on clinical and radiographic outcome measures in patients undergoing LLIF. METHODS: This single-center retrospective study analyzed the characteristics and perioperative data of patients who underwent LLIF between January 2019 and December 2020. Radiographic (lumbar lordosis [LL], foraminal height, disc height [DH], segmental angle [SA], cross-sectional area [CSA] of thecal sac) and clinical (Oswestry Disability Index and Visual Analog Scale) outcomes were assessed preoperatively, postoperatively, and at the last follow-up. The effects of cage height and positioning on these parameters were also investigated. RESULTS: With a mean follow-up of 12.8 months, 47 patients with 70 operated level were analyzed. Data demonstrated that postsurgical clinical and radiographic outcome measures were significantly better than before surgery(P < 0.05). Cage height and positioning showed no significant difference with regarding to clinical outcome(P > 0.05). Subgroup analysis of the cage positioning showed that DH and SA were better restored by the final follow-up in patients with anteriorly placed cages than those with posteriorly placed cages (P < 0.05). Cages of posterior position showed significantly upgrading cage subsidence (P = 0.047). Cage height subgroup analysis showed that the preoperative forminal height, DH, and SA in the 11-mm cage group were significantly lower than in the 13-mm cage group; however, these parameters were comparable in the two groups postoperatively and at the final follow-up (P > 0.05). Furthermore, the postoperative and final follow-up degrees of DH, SA, and LL have improved in the 11-mm cage group more than the 13-mm cage group. The preoperative, postoperative, and final follow-up LL values in the 11-mm cage group were lower than in the 13-mm cage group(P < 0.01). CONCLUSIONS: Cage height and positioning did not affect the clinical outcomes in the present study. Cages in anterior position showed better restoration in DH, SA and decreased the incidence of cage subsidence. A comparable radiographic outcome can be achieved by inserting an appropriate cage height based on preoperative radiography.

A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety.

BACKGROUND AND STUDY AIM: Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. PATIENTS AND METHODS: Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. RESULTS: There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). CONCLUSION: Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

Comparison of the Biomechanical Changes After Percutaneous Full-Endoscopic Anterior Cervical Discectomy versus Posterior Cervical Foraminotomy at C5-C6: A Finite Element-Based Study.

OBJECTIVE: Percutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) have been reported as effective treatments for the cervical spondylosis radiculopathy (CSR), but the biomechanical effects on the discs and facet joints of PEACD and PCF remain largely unclear. The purpose of this paper is to investigate and compare the biomechanical changes on cervical spine after PECAD and PCF procedures, thus providing evidences for surgeons to select a more appropriate approach. METHODS: An intact cervical C5-C6 digital model was constructed and then modified to obtain the PCF and PEACD models using finite element method. All the models were subjected to a 73.6N preload accompanied by a 1.8 Nm moment during flexion, extension, axial rotation, lateral bending. The range of motion (ROM), intervertebral disc pressure (IDP), facet joint contact area, and contact pressure were calculated under different loading conditions. RESULTS: The ROM of the PCF model changed slightly (0.28%), whereas that of the PEACD model increased significantly (20.49%) compared with intact model. The trend of IDP changes in these 2 surgical models were similar to ROM in the corresponding motion state. The contact pressure on the facet joint of the PEACD model increased by 20.53%, 33.38%, and 17.46% during extension, lateral bending, and axial bending, respectively, compared with the intact model, and the PCF increased by 33.53% and 16.16% during extension and lateral bending, respectively, whereas it decreased 0.97% in axial rotation. The facet joint contact area of the PCF model increased by 85.71%, 1.54%, and 2.17% during extension, lateral bending, and axial rotation, respectively, and the area of the PEACD model increased by 157.14% and 36.96% during extension and axial rotation, whereas it decreased by 13.85% during lateral bending. CONCLUSIONS: This is the first biomechanical finite element study comparing PEACD with PCF for the treatment of CSR. Our results showed that PEACD led to hypermobility with high IDP within the cervical segment undergone surgery, whereas the ROM and IDP changed slightly after PCF. The variations of the contact stress indicated that both procedures changed the transmission path of the force on the facet joint and may accelerate the degeneration of the facet joint. PCF may be a better choice for the treatment of CSR compared with PEACD.

Overexpression of microRNA-190 inhibits migration, invasion, epithelial-mesenchymal transition, and angiogenesis through suppression of protein kinase B-extracellular signal-regulated kinase signaling pathway via binding to stanniocalicin 2 in breast cancer.

Breast cancer (BC) is known as the most deadly cancer among females, worldwide. Despite the research advances in this regard, effective diagnosis and treatment still have a long way to go. In this study, our stance was to investigate the regulatory mechanism of miR-190 on epithelial-mesenchymal transition (EMT) and angiogenesis via mediation of protein kinase B (AKT)-extracellular signal-regulated kinase (ERK) signaling pathway by targeting stanniocalicin 2 (STC2) in BC. The BC gene chip was retrieved with differentially expressed genes (DEGs) obtained. MDA-MB-231 and T47D cell lines were selected and separately introduced with miR-190 inhibitors, activators, and small interfering RNAs with the intent of exploring the regulatory functions that miR-190 has shown while governing STC2 in BC. The regulatory effect of miR-190 on cell proliferation, migration, invasion, and angiogenesis was evaluated, followed by determination of AKT-ERK signaling pathway-related factors, EMT-related factors, and angiogenesis-related factors. The xenograft tumor of nude mice was also implemented for determining the change of tumor after transfection. The GSE26910 gene chip was obtained with STC2 being selected as the potential DEG. STC2 was the target gene of miR-190. The results showed that cells introduced with the miR-190 activators along with small interfering RNA-STC2 inhibited proliferation, invasion, migration, angiogenesis, as well as EMT. Moreover, the in vivo experiment also went on to confirm that the tumor volume had significantly increased in the nude mice along with an elevated expression of miR-190. Collectively, the findings suggested that overexpression of miR-190 inhibited EMT and angiogenesis by inactivating AKT-ERK signaling pathway via STC2 in BC.

Significance of stem cell marker Nanog gene in the diagnosis and prognosis of lung cancer.

The aim of the present study was to analyze the stem cell marker, Nanog gene, for the diagnosis and prognosis of lung cancer cases, and to study its application in the diagnosis of lung cancer. In total, 100 patients diagnosed with lung cancer between April, 2013 and May, 2015 were included in the present study. The patients were randomly divided into group A (lung cancer) and group B (squamous cell lung carcinoma). RT-PCR was used to detect the cancer and adjacent tissues, and Nanog gene expression was detected in groups A and B in cells. The results showed that, analysis of Nanog gene expression in the two groups of patients varied to different degrees. There was no significant difference between the two groups with regard to age, gender, disease stage and lymph node metastasis. Nanog gene expression in patients with carcinoma were significantly higher than that in the adjacent tissues (p<0.05). By contrast, differentiated and well-differentiated carcinoma tissue showed a significantly higher Nanog gene expression than poorly differentiated and undifferentiated carcinoma (p<0.05). The expression of Nanog in normal cells was significantly higher than that in normal lung tissues and benign lesions in lung cancer stem cells. Nanog was highly expressed in CD44+ cells, and Nanog expression in lung cancer stem cells was significantly higher (p<0.05). In conclusion, for groups A (lung cancer) and B (squamous cell lung carcinoma) the Nanog gene expression was significantly higher. The data of the present study show that the patients with stage III and IV lung cancer had a higher Nanog gene expression. In addition, there was a higher expression of Nanog in lung cancer patients. By contrast, a lower degree of cell differentiation was associated with strong Nanog gene expression in lung cancer.

Transcatheter arterial chemoembolization combined with microwave coagulation therapy and the perioperative care for patients with hepatocellural carcinoma.

PURPOSE: To explore the value of artificial hydrothorax microwave coagulation combined with transcatheter arterial chemoembolization (TACE) therapy in the treatment of ultrasound-invisible malignant tumors in the hepatic dome (mainly hepatocellular carcinoma/HCC) and the perioperative care for the patients. METHODS: Sixty-eight patients with malignant liver tumors in the hepatic dome were treated with a combination therapy of TACE and microwave coagulation via an artificially induced hydrothorax. Their perioperative condition was under close observation and the nursing care was intensified. Paracentesis of the chest was successfully carried out via the positioning of ultrasound and guidance of microwave to the tumor site, so that the tumor could be treated with cold cycle microwave coagulation therapy. RESULTS: After treatment, 3/68 patients (4.4%) achieved complete tumor ablation, while 59/68 (86.8%) achieved tumor ablation >50% or tumor shrinkage >30%. Another 6/68 patients (8.8%) achieved tumor ablation <50% or tumor shrinkage <30%. Of 45 patients, 42 (93.3%) obtained a reduction of AFP level >50% post-therapy, 28/37 patients (75.7%) achieved a reduction of CEA level >50%, 23/29 patients (79.3%) achieved a reduction of CA19-9 level> 50%; 3/68 patients (4.4%) survived for 4 to 6 months, 31/68 (45.6%) survived >6 months and 34/68 (50%) survived >12 months. No bleeding, liver failure, infection or needle tract seeding occurred after the operation, and no treatment-related deaths occurred. CONCLUSION: Microwave coagulation combined with TACE for HCC in the hepatic dome is safe and effective. Perioperative observation and nursing care can not only reduce the complications but also improve the therapeutic effect and the patient quality of life.

Expression of interleukin-17A in lung tissues of irradiated mice and the influence of dexamethasone.

PURPOSE: To investigate the expressions of IL-17A in different phases of radiation-induced lung injury and the effect of dexamethasone. METHODS: The thorax of C57BL/6 mice was irradiated with 15 Gy rays. Mice from dexamethasone-treated group were injected intraperitoneally with dexamethasone (0.42 mg/kg/day) every day for the first month after irradiation. IL-17A in lung tissues was detected by immunohistochemistry. IL-17A, TGF-ß1, and IL-6 in bronchoalveolar lavage fluid were detected by ELISA. Lung inflammation and collagen deposition were observed by H&E and Masson methods. The degree of alveolitis and fibrosis was judged according to scoring. RESULTS: IL-17A expression was appreciable at 1 week, peaked at 4 weeks, and subsequently declined at 8 weeks after irradiation. IL-17A was reduced after dexamethasone application at all the observation periods. Dexamethasone also inhibited expressions of TGF-ß, IL-6, and TNF-α in bronchoalveolar lavage fluid. Moreover, dexamethasone attenuated the severity of lung injury by reducing the infiltration of inflammatory cells and collagen deposition. Terms of survival and the time of death in mice of treatment group were postponed and survival rate was improved. CONCLUSIONS: IL-17A plays an important role in the process of radiation-induced lung injury. And dexamethasone may provide a protective role in lung injury induced by radiation.

HPV infection in esophageal squamous cell carcinoma and its relationship to the prognosis of patients in northern China.

PURPOSE: Human papillomavirus (HPV) as a risk factor for esophageal squamous cell carcinoma (ESCC) has previously been studied, but importance of HPV status in ESCC for prognosis is less clear. METHODS: A total of 105 specimens with ESCC were tested by in situ hybridization for HPV 16/18 and immunohistochemistry for p16 expression. The 5-year overall survival (OS) and progression-free survival were calculated in relation to these markers and the Cox proportional hazards model was used to determine the hazard ratio (HR) of variables in univariate and multivariate analysis. RESULTS: HPV was detected in 27.6% (29) of the 105 patients with ESCC, and all positive cases were HPV-16. Twenty-five (86.2%) of the 29 HPV-positive tumors were stained positive for p16. HPV infected patients had better 5-year rates of OS (65.9% versus 43.4% among patients with HPV-negative tumors; P = 0.002 by the log-rank test) and had a 63% reduction in the risk of death (adjusted HR = 0.37, 95% CI = 0.16 to 0.82, and P = 0.01). CONCLUSIONS: HPV infection may be one of many factors contributing to the development of ESCC and tumor HPV status is an independent prognostic factor for survival among patients with ESCC.