Objective To evaluate the safety and feasibility of three-dimensional conformal radiation therapy combined with tegafur in treating locally recurrent rectal cancer. Methods A total of 32 patients with locally recurrent rectal cancer were treated with chemoradiotherapy ( CRT) . Radiotherapy was delivered to a total of 45 Gy in 25 fractions followed by a boost of 18 Gy in 10 fractions using three dimensional radiotherapy planning. Tegafur was given orally[80 mg·(m2)-1·d-1] on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, and 43-47 during radiotherapy. Results Most of the adverse effects were mild. Grade 3-4 toxic effects occurred in 12. 5% of patients. Thirty-one patients completed full course of CRT, while one patient discontinued chemotherapy due to Grade 4 thrombocytopenia. There were 3 cases (9. 4%) with complete response, 21 cases (65. 6%) with partial response, and the overall response rate was 75. 0%. Overall pain response (complete and partial pain relief) was achieved in 96. 9% of patients. The 1- and 2-year overall survival rate was 71. 0% and 56. 5%, respectively. Conclusion 3D-CRT combined with tegafur for locally recurrent rectal cancer is feasible with high patient compliance and tolerable toxicities.

Objective To evaluate the diagnostic efficiency of double-balloon enteroscopy in small bowel Crohn’s disease. Methods In sixty five patients with suspected small bowel Crohn's disease double-balloon enteroscopy were performed, and some of them received enteroscopy and enteroclysis, capsule endoscopy as well.Results The first enteroscopy was performed via mouth in 20 of 65 cases, and the lesions were detected in 11 cases (55%), 5 of 9 cases(55.6%) had lesions detected in enteroscopy via anus while nothing was found in mouth route. Among 45 cases examed by enteroscopy firstly via anus, 34 cases had lesions detected (75.6%), 8 of 11 cases(72.7%) had lesions found in following exam via mouth. Totally 58of 65 had lesions detected through enterosocpy examination, the overall diagnostic yield was 89.2%. Twenty four of 46 cases had positive findings with enteroclysis. The diagnosis of Crohn's disease was comfirmed in 14 of 22 patients(63.6%) underwent capsule endoscoy. The diagnosis was finally confirmed by enteroscopy only in 11 patients(78.6%).Conclusion The entire small intestine could be examined by enteroscopy with combination of mouth and anus route. Double-balloon enteroscopy was an ideal diagnostic modality for small bowel Crohn's diseases, which was also valuable in assessment on extent and severity of the disease. Small bowel enteroclysis was a useful screening alternative for selecting procedure route in DBE.

Brain Neoplasms ; Germinoma ; Humans ; Pineal Gland

OBJECTIVETo investigate the apoptosis of NK cells induced by the erythroleukemia cell line K562 in vitro.

METHODSPrimary NK cells isolated from the peripheral blood of healthy donors by magnetic-activated cell sorting were cultured with stem cell medium containing recombinant human interleukin-2 (rhIL-2). The NK cells and K562 cells were mixed and co-cultured at different E:T ratios for different time lengths. The apoptosis of NK cells and K562 cells were detected using PE-AnnexinV/7-AAD labeling and flow cytometry.

RESULTSThe purity of isolated NK cells reached (93.99∓4.22)%. At the same E: T ratio, the apoptotic rate of NK cells induced by K562 cells increased significantly with time. As the E:T ratio reduced, the apoptotic rate of the NK cells increased and their cytotoxic activity against K562 cells was attenuated.

CONCLUSIONK562 cells can induce the apoptosis of activated NK cells, which is one of the probable mechanisms of immune escape of tumors.

Apoptosis ; Cytotoxicity, Immunologic ; Humans ; K562 Cells ; Killer Cells, Natural ; cytology ; immunology ; Tumor Escape

Objective To explore the effect of neutrophil to lymphocyte ratio(NLR)and other related in-dicators on the prognosis of advanced non-small cell lung cancer patients treated with programmed death 1(PD-1)inhibitor and construct a nomogram prediction model.Methods A total of 198 patients with advanced non-small cell lung cancer who received PD-1 inhibitor treatment in the hospital from February 2020 to April 2022 were selected and followed up to August 2022.According to the clinical outcome,they were divided into the death group(46 cases)and the survival group(152 cases).The clinical data of the death group and the survival group were recorded,and the prognostic factors of advanced non-small cell lung cancer patients trea-ted with PD-1 inhibitor were analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR,platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)for the prognosis of patients.Multivariate Logistic regression model was used to analyze the independent risk factors affecting the prognosis of patients.A prediction nomogram model for the prognosis of patients was construc-ted using R software 4.0"rms"package,and the calibration curve was used to internally validate the nomo-gram prediction model.Results Compared with the survival group,the proportion of smoking,TNM stageⅣ,ECOG score 2,and NLR,PLR,LMR were higher(P<0.05).The area under the curve of NLR,PLR and LMR were 0.707,0.793 and 0.819,respectively,and the optimal cut-off value were 4.72%,179.21%and 3.44%,respectively.Smoking,TNM stage,ECOG score,NLR,PLR,and LMR were independent risk factors for the prognosis of advanced non-small cell lung cancer patients treated with PD-1 inhibitor(P<0.05).The internal validation results show that the nomogram inhibitor treatment of PD-1 model prediction the prognosis of patients with advanced non-small cell lung cancer C-index was 0.847(95%CI 0.769-0.902),the calibra-tion curve tends to be the ideal curve.The threshold value of the nomogram model for predicting the prognosis of patients with advanced non-small cell lung cancer treated with PD-1 inhibitor was>0.22.The nomogram prediction model provided a net clinical benefit,and the net clinical benefit was higher than that of smoking,TNM stage,ECOG score,NLR,PLR and LMR.Conclusion Based on smoking,TNM stage,ECOG score,NLR,PLR,and LMR,a nomogram prediction model for the prognosis of advanced non-small cell lung cancer patients treated with PD-1 inhibitor is constructed,which has important clinical application value.

[摘 要] 目的：探讨程序性死亡受体-1（PD-1）单抗联合顺铂或吉西他滨在KRAS基因突变非小细胞肺癌（NSCLC）A549细胞移植瘤小鼠模型治疗中的作用。方法：构建免疫系统-肿瘤双人源化A549细胞小鼠移植瘤模型，将60只小鼠按随机数字表法分成6组（10只/组），分别为对照组（200 μL/kg PBS）、PD-1单抗组（20 mg/kg PD-1单抗）、顺铂组（3 mg/kg顺铂）、PD-1单抗+顺铂组（20 mg/kg PD-1单抗+3 mg/kg顺铂）、吉西他滨组（30 mg/kg吉西他滨）和PD-1单抗+吉西他滨组（20 mg/kg PD-1单抗+30 mg/kg吉西他滨）。TUNEL和DAPI双染色法检测移植瘤组织中细胞凋亡水平，测量移植瘤体积和质量并计算肿瘤生长抑制率，免疫组化法检测移植瘤微血管密度（MVD）。结果：成功构建免疫系统-肿瘤双人源化NSCLC A549细胞小鼠移植瘤模型，PD-1单抗+顺铂组移植瘤的细胞凋亡率、肿瘤生长抑制率均最高，移植瘤体积、质量和MVD均最小，与其他5组小鼠比较差异均有统计学意义（均P<0.05）。结论：顺铂与PD-1单抗具有协同活性，而吉西他滨拮抗PD-1单抗的治疗作用。提示PD-1单抗联合顺铂对KRAS突变NSCLC A549细胞移植瘤小鼠的疗效更好。

BACKGROUND: The patients with advanced lung adenocarcinoma should select targeted drugs based on the type of tumor epidermal growth factor receptor (EGFR) gene mutation. However, it is difficult to collect tumor tissue of advanced lung adenocarcinoma, and some experts agree that peripheral blood can be used as a substitute for tumor tissue as a test specimen. This paper aimed to investigate the clinical value of ddPCR and super-amplification refractory mutation system (ARMS) in detecting EGFR gene mutation in peripheral blood of patients with advanced lung adenocarcinoma. METHODS: A total of 119 patients diagnosed in Beijing Chest Hospital Affiliated to Capital Medical University from February 2016 to February 2019 were collected, and the sensitivity and specificity of plasma ctDNA EGFR gene mutation detected by ddPCR and super-arms were compared. Some patients with positive EGFR gene mutations received oral treatment with first-line EGFR tyrosine kinase inhibitors (EGFR-TKI). The patients were divided into subgroups according to the test results. In group 1, both ddPCR and super-arms showed positive EGFR gene mutation results, with 21 cases. In group 2, ddPCR and super-arms detection of EGFR gene mutation were all negative, with 16 cases. In group 3, the ddPCR test was positive and the super-arms test was negative, with 5 cases. In group 4, the ddPCR test result was negative while the super-arms test result was positive. Since the number of patients in group 4 was 0, no statistics were included. Objective response rate (ORR) and disease control rate (DCR) were used to evaluate the short-term outcome, and progression-free survival (PFS) was compared with survival analysis to evaluate the long-term outcome. RESULTS: EGFR mutations were detected in 58 (48.7%) of 119 patients with advanced lung adenocarcinoma. The coincidence rate between ddPCR and EGFR gene mutation in tumor tissues was 82.4% (Kappa=0.647, P<0.001), the sensitivity was 74.1%, and the specificity was 90.2%. However, the coincidence degree of super-arms test and tissue test was 71.4%, the sensitivity was only 58.6%, and the specificity was 83.6%. The ORR and DCR values in group 3 were lower than those in group 1 and 2, but there was no significant difference in ORR between groups (P>0.05). Survival analysis showed that the PFS of the three groups was compared. The difference was not statistically significant (χ²=2.221, P=0.329). CONCLUSIONS ddPCR, as a high sensitivity and specificity liquid gene detection method, can be used as a reliable method to detect the mutation of plasma ctDNA EGFR gene in patients with advanced lung adenocarcinoma. The results of plasma genetic testing can also be used as the basis for predicting the efficacy of EGFR-TKIs in patients.