Objective To study the analysis of non-small cell lung cancer patients with multiple brain metastases with erlotinib combined with whole brain radiation therapy clinical observation and effect of C on vascular endothelial growth factor level. Methods 40 cases of non - small cell lung cancer patients with multiple brain metastases treated in Taizhou tumor hospital from January 2015 to April 2016 were selected and randomly divided into the control group and the experimental group, with 20 patients in each group. The control group and the experimental group patients were given clinical treatment of whole brain radiotherapy, the control group was given routine treatment, the experimental group received erlotinib. The clinical effects of the 2 groups were compared and analyzed. Results After the corresponding treatment, the experimental group of 20 patients, 8 cases of complete remission, 7 cases of partial remission, the number of effective treatment for 15 cases, the treatment rate was 75.0％. Of the patients in the control group, 6patients had complete remission, and 4 patients had partial remission. The effective rate was 50％. Available, the effective rate of the treatment group (75.0％) was significantly higher than that of the control group (50.0％), with statistical difference (P<0.05). The survival rate of the experimental group after one year (80.0％) was significantly higher than that of the control group (60.0％), with statistical difference (P<0.05). The level of vascular endothelial growth factor (C) in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion Non small cell lung cancer patients with multiple brain metastases with erlotinib combined with radiotherapy in the clinical treatment effect of whole brain is better, can improve the survival rate in a large extent, improve the endothelial growth factor C levels, with the further promotion of the clinical significance.

Objective To analyze and discuss the clinical effect of sequential radiotherapy and chemotherapy in 40 patients with advanced gastric cancer after operation.Methods 80 postoperative gastric cancer patients who received sequential radiotherapy and chemotherapy in our hospital were prospectively analyzed.According to the order of admission,80 patients were divided into two groups,40 cases of the control group(chemotherapy)and 40 cases of the observation group(sequential chemotherapy).The clinical effects of the two groups were compared.Results In the observation group,1 year survival rate and 2-year survival rate(77.50%,47.50%)were higher than those in the control group(50.00%,25.00%),there were statistically significant differences between the two groups(x2=19.20,32.65,all P<0.05).The incidence rate of adverse reactions of the control group was 12.50%,which was lower than 30.00% of the observation group,there was statistically significant difference between the two groups(x2=9.15,P<0.05).The mortality rate of the observation group was 32.50%,which was lower than 45.00% of the control group,the difference was statistically significant(x2=5.29,P<0.05).Conclusion Compared with the simple chemotherapy after the operation of gastric cancer,sequential radiotherapy and chemotherapy can effectively improve the clinical efficacy,significantly reduce the rate of postoperative metastasis and recurrence of gastric cancer,and it is worthy of promoting.

Objective To study the effect of gemcitabine combined with cisplatin in the treatment of non-small cell lung cancer.Methods 100 cases of non-small cell lung cancer patients who were treated in our hospital from March 2015 to August 2016 were selected as the subjects in this study.They were randomly divided into the control group and the experimental group, with 50 cases in each group.The control group were treated with gemcitabine combined with cisplatin, and routine nursing care was used.The experimental group were given psychological intervention on the basis of gemcitabine combined with cisplatin treatment, pay attention to the psychological status of patients, medical staff should strengthen communication, inform the relevant knowledge of disease, eliminate the negative emotions, improve the treatment compliance.Anxiety scores and satisfaction between the experimental group and the control group were compared.Results After the corresponding nursing, the treatment satisfaction of the control group was 72.0%, which was lower than that of the experimental group, and the satisfaction rate was 92.0%, the difference was statistically significant (P<0.05).After the intervention, the anxiety score of the experimental group(36.83±4.23)was significantly lower than that of the control group(42.12±3.41), and the difference was statistically significant (P<0.05).There was no significant difference in survival rate between the two groups after a follow-up of 1 years.Conclusion Gemcitabine Combined with cisplatin in the treatment of non-small cell lung cancer, the application of psychological intervention nursing can help patients to eliminate anxiety in a large extent, improve patient satisfaction, with further clinical promotion and application significance.

Objective To evaluate the efficacy of superficial temporal artery(STA)pressure-guided selective cerebral perfusion(SCP)during deep hypothermic circulatory arrest(DHCA)in patients undergoing aortic arch surgery.Methods Ninety-six patients of both sexes,aged 35-64 yr,with body mass index of 19-23kg/m2,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,undergoing aortic arch surgery,were divided into STA pressure group(group A)and clinical experience group(group B)using a random number table,with 48 patients in each group.In group A,STA catheterization was performed after tracheal intubation,and arterial pressure was monitored.SCP flow was adjusted to maintain the target value of STA pressure between 30 and 40mmHg during DHCA in group A.SCP flow rate was set at 5-10ml·kg-1·min-1 according to clinical experience in group B.The volume of fluid perfused during SCP,emergence time,extubation time and duration of intensive care unit stay were recorded.Neurological function was evaluated during length of hospitalization after surgery,and the development of permanent and transient neurological dysfunction and mortality in hospital were recorded.Results Compared with group B,the volume of fluid perfused during SCP was significantly decreased,the emergence time,extubation time and duration of intensive care unit stay were shortened,the incidence of permanent and transient neurological dysfunction(2% and 4%,respectively)was decreased(P < 0.05),and no significant change was found in the mortality rate in hospital in group A(P>0.05).Conclusion Maintaining STA pressure at 30-40mmHg is a reliable method for guiding SCP during DHCA in patients undergoing aortic arch surgery.

Objective To investigate the effect of mitochondrial unfolded protein response(UPRmt)on lipid metabolism in human kidney 2(HK-2)cells.Methods Lipid accumulation was induced by palmitic acid(PA)in HK-2 cells.The cells were pretreated with siRNA or CDDO respectively.The intracellular lipid accumulation was observed by oil red staining;mitochondrial membrane potential(MMP)was measured by JC-1.The contents of reactive oxygen species(ROS)in mitochondria were measured by Mito-SOX,and the expressions of HSP60,LONP1,CLPP,ACOX1,PPARα,PGC1α and CPT1α were detected by Western blotting.Results PA induced lipid aggregation,MMP decrease,ROS generation in mitochondria and the decreased expression of UPRmt proteins(e.g.,HSP60 and LONP1)in HK-2 cells.Pretreatment of HK-2 cells with siRNA could aggravate lipid aggregation,MMP decrease and ROS generation induced by PA,and further decrease the expression of HSP 60and LONP1.Pretreatment of HK-2 cells with CDDO alleviated lipid aggregation,MMP decrease,ROS generation and decreased HSP60 and LONP1 expressions induced by PA.Conclusion Lipid aggregation in HK-2 cells induced by PA may be related to mitochondrial dysfunction and UPRmt has a protective effect on HK-2 cells in the process.

Objective·To further clarify the mechanism of podocyte damage by studying the expression of cartilage oligomeric matrix protein(COMP)in glomerular podocytes and its relationship with podocyte autophagy under high glucose environment.Methods·The gene expression dataset GSE104948 was downloaded from the GENE EXPRESSION OMNIBUS(GEO)database,and differentially expressed genes(DEGs)were obtained via GEO2R.The molecular functions and signaling pathways related to differential genes were summarized.The most correlated key genes(hub genes)were acquired by Weighted Gene Co-Expression Network Analysis(WGCNA)and the protein-protein interaction network(PPI)of DEGs was constructed with STRING database.The enrichment analysis was performed again.Conditionally immortalized mouse podocyte cells were cultured in vitro.After being fully differentiated,they were stimulated with high glucose,and the expressions of COMP,mammalian target of rapamycin(mTOR),microtubule-associated protein 1 light chain3(LC3)and other proteins in podocytes were detected by Western blotting.The shRNA constructed by lentiviral vector was further used to infect podocytes to inhibit the expression of COMP,and the stable cell strains were screened by puromycin.The expression of COMP,mTOR,and LC3 of stable strains were detected by Western blotting,in order to observe the effect of COMP on autophagy.Results·A total of 362 DEGs were filtered for subsequent analysis.Among these DEGs,284 genes were up-regulated and 78 genes were down-regulated.The results of Gene Onotology(GO)term analysis showed that DEGs in diabetic nephropathy(DN)were mainly enriched in cell surface receptor signaling pathway,receptor binding,etc.The main enriched Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways included phosphatidylinositol 3-kinase(PI3K)/protein kinase B(PKB/AKT)signaling pathway,extracellular matrix(ECM)-receptor interaction,etc.Sixty-four hub genes were refined through the intersection of WGCNA and PPI hub genes,and the hub genes with significantly increased or decreased expression were sifted.The hub genes were annotated with KEGG again,and it was found that most of the hub genes were enriched in"ECM-receptor interaction"and"PI3K/AKT signaling pathway".The PI3K/AKT/mTOR signaling pathway is a classic autophagy pathway,and COMP was absolutely overexpressed(logFC>2)in the 64 hub genes,suggesting that it may affect autophagy through this pathway.Western blotting showed that compared with the mannitol control group and the low glucose group,the expression of COMP in podocytes was significantly increased under high glucose stimulation.Compared with the control group,the expression of LC3-Ⅱ in the high glucose group was significantly decreased,indicating that the autophagy initiation of podocytes was inhibited under the high glucose environment.Compared with the negative control,the expression of LC3-Ⅱ in renal podocytes of mice with knockdown of COMP was significantly increased,and the mTOR decreased with the decrease of the expression of COMP,indicating that inhibiting COMP contributed to the recovery of autophagy in podocytes.Conclusion·COMP is highly expressed in DN patients and highly enriched in ECM receptor and PI3K/AKT signaling pathway.Autophagy in mouse renal podocytes is inhibited under high glucose conditions,and the high expression of COMP induced by high glucose may be a key factor in autophagy inhibition.Inhibiting COMP helps to restore autophagy in mouse renal podocytes.

Objective:To evaluate the diagnostic performance of radiomics model based on contrast-enhanced ultrasound(CEUS) in predicting pathological complete response(pCR) after neoadjuvant chemoradiotherapy(nCRT) in patients with locally advanced rectal cancer(LARC).Methods:One hundred and six patients with LARC who underwent total mesorectal excision after nCRT between April 2018 and April 2023 in the First Affiliated Hospital of Guangxi Medical University were retrospectively included, the patients were randomly divided into a training set of 63(14 pCR patients) and a validation set of 43(12 pCR patients) in a 6∶4 ratios. Radiomics features were extracted from the tumors′ region of interest of CEUS images based on PyRadiomics. Intra-class correlation coefficient(ICC), Mann-Whitney U test, and least absolute shrinkage and selection operator(LASSO) algorithms were used to reduce features dimension. Finally, 7 radiomics features relevanted to pCR were selected to construct an ultrasomics model using elastic network regression, based on the R language. A combined model was constructed by jointing clinical feature. The performance of the models was assessed with the area under the ROC curve(AUC). Results:The AUC of the ultrasomics model and the combined model was 0.695(95% CI=0.532-0.859) and 0.726(95% CI=0.584-0.868) respectively in the training set. The AUC of the ultrasomics model and the combined model was 0.763(95% CI=0.625-0.902) and 0.790(95% CI=0.653-0.928) respectively in the validation set. Both univariate and multivariate Logistic regression analyses showed that CA199( P<0.05) and ultrasomics score( P<0.001) could be an independent predictor of pCR after nCRT in patients with LARC. Conclusions:The CEUS-based radiomics scores has certain predictive value for whether LARC patients achieve pCR after nCRT, and may provide a non-invasive imaging biomarker for predicting LARC patients achieve pCR after nCRT.

Background::Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. Methods::Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. Results::The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) ( χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exact P = 1.000) to and slightly lower specificity (87% [77/89]) ( χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) ( P = 0.734). Sputum LFD had similar specificity (91% [81/89]) ( χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) ( χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) ( χ2 = 6.95, P = 0.008), BDG ( χ2 = 10.43, P = 0.001), and fungal culture ( χ2 = 12.70, P < 0.001). Conclusions::Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.