CMTM家族作为一个新的基因家族，在免疫、生殖等系统以及多种肿瘤的发病机制中起到重要作用。CMTM家族中， CMTM1可影响细胞增殖，导致肿瘤发生；与非小细胞肺癌（NSCLC）患者的化疗耐药和预后有关。CMTM2通过AP-1、CREB通 路一定程度上影响HIV-1转录，同时在男性生殖系统中起重要作用。CMTM3等位基因失活或甲基化使其丧失对细胞增殖的负 性调控能力，是胃癌独立的预后指标。CMTM4调控细胞周期影响肿瘤细胞增殖，通过对PD-L1的协同保护参与免疫逃逸。 CMTM5在许多肿瘤中沉默表达，参与肿瘤发生发展相关的信号通路。CMTM6协同PD-L1参与免疫逃逸，是潜在的免疫治疗靶 点。CMTM7在NSCLC中通过Rab5控制EGFR-AKT信号影响肿瘤发展，且与胃癌发展相关。CMTM8通过MARVEL区域影响 EGFR和相关信号通路，调控细胞增殖、分化和凋亡等。上述重要发现，为研究肿瘤的发生发展及肿瘤基因治疗提供了新思路。

Objective:To establish a stable primary culture method of human gingival epithelial cells, with a higher successful rate and shorter culture time.Methods:Nine patients who received “crown-lengthening surgery”with relatively healthy periodontal conditions were selected (n =9).Gingival sam-ples were collected from the 9 donors during gingivectomy.Gingival epithelial cells were isolated and cul-tured by both an advanced enzyme digestion method and a tissue explant method.In the advanced enzyme digestion culture process,2.5 g/L DispaseⅡwas used to separate the epithelial tissue part from the con-nective tissue part,which lasted for one night.Then the epithelial tissues were digested by 0.025% tryp-sin without EDTA for 10 minutes,and centrifuged by keeping the digested epithelial tissues that re-mained.This advanced method not only decreased the concentration and digesting time of the two above-mentioned enzymes,but also simplified the centrifugel process.The tissue explant method was not changed too much compared with the original method.Growing processes of the primary cells cultured by the two methods were observed and recorded respectively,and indirect immunocytochemical staining was used to identify the type of cultured cells.At the same time,successful rates and cell culture time were also compared between the two methods.Results:Human gingival epithelial cells with typical morpholo-gy could be cultured within a shorter period by the advanced enzyme digestion method with a successful rate of 88.9%,and proliferated rapidly as sheets.After 10 -14 d cells could be passaged,gradually turned to be like fibroblasts when passaged to the third generation,and eventually went to apoptosis.The primary culture time was longer by using the tissue explant method,and approximately after 17 -22 d cells could be passaged,although the successful rate was the same as the enzyme digestion method.Cy-tokeratin staining was both positive by indirect immunocytochemical staining of cells.Conclusion:Pri-mary human gingival epithelial cells cultured by the advanced enzyme digestion method could grow faster and be passaged to the second generation successfully,which could supply a stable origin for cellular ex-periments.

Objective To evaluate the effect of active cycle of breathing techniques(ACBT) on promoting lung recruitment in post-thoracic surgery patients with lung cancer. Methods Totally 100 cases of patients with lung cancer were collected and randomly divided into two groups(the control group and the observation group) with 50 cases in each group. The additional ACBT was applied≥3 times per day in the control group compared with the observation group. The main observation indexes(pulmonary function and arterial blood gas, etc) and the secondary indexes(vital signs and pain score, etc) of the patients were collected at different time period. Results The main observation index and the secondary index of the patients in the control group gained an advantage over those in the observation group(P＜0.05). No obvious adverse events occurred. Conclusion ACBT applied in the post-thoracic surgery patients with lung cancer is safe and effective. It can improve the cleaning efficiency of respiratory secretion, promote lung recruitment and fastly recover the pulmonary function and save medical costs.

Simulation-based medical education can ensure medical safety, reduce medical errors and improve students' clinical skills. At present, the main problems in medical teaching are the conflict between doctors and patients, the contradiction between medical teaching and ethics, the shortage of teaching resources and the lack of a universal assessment standard. The advantages of simulation-based medical education are its safety, repeatability, standardization, controllability, relative authenticity, and the cultivation of humanistic spirit and teamwork for students. Simulation-based medical education has two major limits. First, its teaching effect relies on the function and quality of each model. Second, simulation cannot replace clinical practice. This article proposes the following ways and means for promoting the simulation-based medical education: training of faculty is the core, establishment of courses is the focus, cooperation and communication is an important way to promote development, and phased and refined development is the future direction.

Objective To observe the pathological response in the tumor tissue and the changes of serum level of vascular endothelial growth factor ( VEGF) in esophageal cancer patients receiving concurrent chemoradiotherapy, in order to study the impacts of these two factors on the prognosis of patients. Methods One hundred pathologically confirmed esophageal cancer patients were treated with radiotherapy including 72 patients with concurrent chemoradiotherapy. After 4 weeks, gastroscopy was performed to collect tumor biopsies for examination of pathological changes. The responses to radiotherapy were classified into three degrees: mild, moderate and intensive. Moreover, serum samples were collected from the patients prior to, at the fourth week during radiotherapy, and one week after radiotherapy, and serum VEGF level was determined. The changes of serum VEGF were classified as increased, unchanged and decreased. Serum samples from 30 healthy subjects were collected and represented as VEGF healthy control. Results Among the eighty?nine patients evaluable, the 1? and 3?year overall survival ( OS) rates were 70.8% and 33.3%, respectively;1?year and 3?year progression?free survival ( PFS) rates were 61.8% and 28.2%, respectively;and 1?year and 3?year local control ( LC) rates were 76.9% and 50.0%, respectively. The 1?year OS rates in the patients with mild, moderate and intensive pathological responses were 50. 0%, 76. 9% and 78. 0%, respectively. The 1?year OS rate in the mild response group was significantly lower than that in the intensive response group ( P<0.05) . The 1?year and 3?year PFS rates in the three groups were 36.4%, 73.1%, 68.3%, and 0. 0%, 40.0% and 38. 9%, respectively, showing that the rate in the mild response group was significantly lower than that in the moderate and intensive response groups ( P<0.05 for both) . The PFS rate in the mild response group was significantly lower than that in the moderate and intensive response groups ( P<0.05 for both) . Moreover, the 1?year local control ( LC) rates in the three groups were 52.9%, 83.3%and 83.8%, and the three?year LC rates were 0. 0%, 64. 3% and 64. 0%, respectively, showing that the lowest LC rates in the mild response group were significantly lower than that in the moderate and intensive response groups (P<0.05 for both). The average serum VEGF levels in the patients prior to, during and after radiotherapy were (109.6±33.7) ng/L, (101.2±24.3) ng/L and (99.5±22.9) ng/L, respectively, all significantly higher than that in the healthy subjects [(79.6±39.2) ng/L, P<0.05 for both]. The level of serum VEGF was decreased during and after radiotherapy compared with that before radiotherapy ( F=6.124, P=0.004). The 1?year OS rates in the VEGF?increased, unchanged and decreased groups were 50.0%, 67.4% and 86.7%, respectively, and the 3?year OS rates in these three groups were 15. 4%, 27. 0% and 50.0%, respectively. The OS rates in the increased group were significantly lower than that in the VEGF?decreased group (P<0.05). Moreover, the 3?year PFS rates in the three groups were 7.7%, 21.6% and 46.4%, respectively, and the rate in the VEGF?increased group was significantly lower than that in the VEGF?decreased group ( P<0.05) . The multi?variate analysis showed that TNM stage, pathological response and serum VEGF were independent factors affecting the survival in the non?surgical patients with esophageal cancer (P<0.05 for all). Conclusions Tumor tissue pathological response and variation of serum VEGF level in response to chemoradiotherapy can be used to predict the efficacy of chemoradiotherapy in non?surgical patients with esophageal cancer. Hence, monitoring the pathological response and VEGF changes during the course of therapy is of utmost importance to evaluate and perform an individualized therapy in clinical practice.

Objective To observe the pathological response in the tumor tissue and the changes of serum level of vascular endothelial growth factor ( VEGF) in esophageal cancer patients receiving concurrent chemoradiotherapy, in order to study the impacts of these two factors on the prognosis of patients. Methods One hundred pathologically confirmed esophageal cancer patients were treated with radiotherapy including 72 patients with concurrent chemoradiotherapy. After 4 weeks, gastroscopy was performed to collect tumor biopsies for examination of pathological changes. The responses to radiotherapy were classified into three degrees: mild, moderate and intensive. Moreover, serum samples were collected from the patients prior to, at the fourth week during radiotherapy, and one week after radiotherapy, and serum VEGF level was determined. The changes of serum VEGF were classified as increased, unchanged and decreased. Serum samples from 30 healthy subjects were collected and represented as VEGF healthy control. Results Among the eighty?nine patients evaluable, the 1? and 3?year overall survival ( OS) rates were 70.8% and 33.3%, respectively;1?year and 3?year progression?free survival ( PFS) rates were 61.8% and 28.2%, respectively;and 1?year and 3?year local control ( LC) rates were 76.9% and 50.0%, respectively. The 1?year OS rates in the patients with mild, moderate and intensive pathological responses were 50. 0%, 76. 9% and 78. 0%, respectively. The 1?year OS rate in the mild response group was significantly lower than that in the intensive response group ( P<0.05) . The 1?year and 3?year PFS rates in the three groups were 36.4%, 73.1%, 68.3%, and 0. 0%, 40.0% and 38. 9%, respectively, showing that the rate in the mild response group was significantly lower than that in the moderate and intensive response groups ( P<0.05 for both) . The PFS rate in the mild response group was significantly lower than that in the moderate and intensive response groups ( P<0.05 for both) . Moreover, the 1?year local control ( LC) rates in the three groups were 52.9%, 83.3%and 83.8%, and the three?year LC rates were 0. 0%, 64. 3% and 64. 0%, respectively, showing that the lowest LC rates in the mild response group were significantly lower than that in the moderate and intensive response groups (P<0.05 for both). The average serum VEGF levels in the patients prior to, during and after radiotherapy were (109.6±33.7) ng/L, (101.2±24.3) ng/L and (99.5±22.9) ng/L, respectively, all significantly higher than that in the healthy subjects [(79.6±39.2) ng/L, P<0.05 for both]. The level of serum VEGF was decreased during and after radiotherapy compared with that before radiotherapy ( F=6.124, P=0.004). The 1?year OS rates in the VEGF?increased, unchanged and decreased groups were 50.0%, 67.4% and 86.7%, respectively, and the 3?year OS rates in these three groups were 15. 4%, 27. 0% and 50.0%, respectively. The OS rates in the increased group were significantly lower than that in the VEGF?decreased group (P<0.05). Moreover, the 3?year PFS rates in the three groups were 7.7%, 21.6% and 46.4%, respectively, and the rate in the VEGF?increased group was significantly lower than that in the VEGF?decreased group ( P<0.05) . The multi?variate analysis showed that TNM stage, pathological response and serum VEGF were independent factors affecting the survival in the non?surgical patients with esophageal cancer (P<0.05 for all). Conclusions Tumor tissue pathological response and variation of serum VEGF level in response to chemoradiotherapy can be used to predict the efficacy of chemoradiotherapy in non?surgical patients with esophageal cancer. Hence, monitoring the pathological response and VEGF changes during the course of therapy is of utmost importance to evaluate and perform an individualized therapy in clinical practice.

Objective: To evaluate the expression of CKLF-like MARVEL transmembrane domain containing member 6 (CMTM6) in lung adenocarcinoma tissues, and to explore its correlation with the clinicopathologic features and prognosis of patients. Methods: Eighty-six pairs of cancer tissues and para-cancer tissues from patients that pathologically confirmed with lung adenocarcinoma were collected during September 2004 and June 2009 at the Third Affiliated Hospital of Soochow University. The expression levels of CMTM6 in above mentioned tissues were detected by immunohistochemistry. Serum of 52 patients with confirmed lung adenocarcinoma was collected before and after surgery, and serum of 32 healthy subjects was also collected. The levels of CMTM6 and PD-L1 in peripheral blood before and after surgery were measured and analyzed by ELISA. Chi-square test was used to analyze the relationship between CMTM6 expression and clinicopathological features; Kaplan-Meier method and Log-Rank test were used to analyze the survival data of patients. Results: CMTM6 was widely expressed in lung adenocarcinoma tissues; 30% of the tumor tissues showed an up-regulation as compared with para-cancer tissues, and 70% showed no difference. CMTM6 expression was associated with clinical stage and distant metastasis (all P<0.05), but not significantly associated with age, gender, tumor size, and T stage (P>0.05). Kaplan-Meier survival analysis showed the survival rate of patients with high CMTM6 expression was significantly lower than those with stable expression (P=0.014), and among patients at stage Ⅲ, the survival rate of patients with high CMTM6 expression was significantly lower than those with stable CMTM6 expression (P=0.001). Cox regression model analysis of multiple factors showed CMTM6 expression was an independent risk factor for the prognosis of patients with lung adenocarcinoma. CMTM6 expression in pre-surgery serum, post-surgery serum and healthy donors’serum showed statistically significant differences (P<0.05), which was significantly correlated with tumor size and age of the patients. Spearman correlation analysis showed a significant correlation between serum CMTM6 and PD-L1 expression level (r=0.623, P<0.01). Conclusion: CMTM6 is an independent risk factor for the prognosis of lung adenocarcinoma patients. It plays an important role in the occurrence and development of lung adenocarcinoma and it is a potential tumor suppressor gene.

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic Jejunostomy (PEJ) are common channels for enteral nutrition input. In the past five years, there are no relevant nursing guidelines and reviews in China. In August 2018, Wound, Ostomy and Continence Nurses Society (WOCN) issued the Clinical Practice Guidelines for Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy in Adults, including preoperative preparation, surgical procedure and postoperative monitoring of gastrostomy and Jejunostomy. The management of enteral nutrition tube, the use of enteral nutrition and drugs, the prevention of medication errors, the treatment of early and late complications, the education of patients and their caregivers, and the replacement of catheters are all recommended. This article interpreted the guideline in order to provide reference for clinical nursing of gastrostomy and Jejunostomy.

Objective     To summarize the progress and trend on clinical drug trials of esophageal squamous cell carcinoma in China. Methods     Based on the clinical drug trial registration and information disclosure platform and the drug data query system of the National Medical Products Administration, the characteristics of clinical trials, investigational drugs and listed drugs of esophageal squamous cell carcinoma in China from 2012 to 2021 were analyzed. Results     From 2012 to 2021, a total of 49 clinical drug trials of esophageal squamous cell carcinoma were registered in China, accounting for 1.6% of all clinical trials of anticancer drugs. Among them, there were 39 (79.6%) trials initiated by domestic pharmaceutical enterprises, 6 (12.2%) for adjuvant and neoadjuvant treatment, and 9 (18.4%) for local treatment. There were differences in the treatment line distribution between global and domestic enterprise-initiated trials (P=0.032). The above trials covered 29 investigational drugs, including 23 (79.3%) targeted drugs, most of which targeted programmed death-1, programmed death-ligand 1 and epidermal growth factor receptor. From 2012 to 2021, there were 2 drugs for esophageal squamous cell carcinoma listed in China, both of which were approved for the first-line and second-line treatment. Conclusion     Great achievements have been made in the clinical development of esophageal squamous cell carcinoma drugs in China. It is suggested that domestic enterprises increase the investment of esophageal squamous cell carcinoma, pay attention to adjuvant and local treatment, explore novel targets and drug categories, and focus on the details of pivotal trials.

Machine Learning ; Image Processing, Computer-Assisted/methods*