OBJECTIVE: To construct and validate a nomogram for predicting the risk of secondary peripheral neuropathy in patients with advanced lung cancer. METHODS: The sociodemographic and clinical data of 335 patients with advanced lung cancer admitted to Department of Respiratory, the First Affiliated Hospital of Zhejiang University School of Medicine from May 2020 to May 2021 were retrospectively collected. Pearson correlation analysis, univariate and multivariate logistic regression analyses were used to identify the risk factors of secondary peripheral neuropathy in patients with advanced lung cancer. A nomogram was constructed according to the contribution of each risk factor to secondary peripheral neuropathy, and the receiver operating characteristic (ROC) curve, Calibration curve and clinical decision curve were used to evaluate differentiation, calibration, and the clinical utility of the model. The nomogram was further validated with data from 64 patients with advanced lung cancer admitted between June 2021 and August 2021. RESULTS: The incidences of secondary peripheral neuropathy in two series of patients were 34.93% (117/335) and 40.63% (26/64), respectively. The results showed that drinking history ( OR=3.650, 95% CI: 1.523-8.746), comorbid diabetes ( OR=3.753, 95% CI: 1.396-10.086), chemotherapy ( OR=2.887, 95% CI: 1.046-7.970), targeted therapy ( OR=8.671, 95% CI: 4.107-18.306), immunotherapy ( OR=2.603, 95% CI: 1.337-5.065) and abnormal liver and kidney function ( OR=12.409, 95% CI: 4.739-32.489) were independent risk factors for secondary peripheral neuropathy (all P<0.05). A nomogram was constructed based on the above risk factors. The area under the ROC curve (AUC) of the nomogram for predicting the secondary peripheral neuropathy was 0.913 (95% CI: 0.882-0.944); and sensitivity, specificity, positive and negative predictive values were 85.47%, 81.65%, 71.43% and 91.28%, respectively. The Calibration curve and clinical decision curve showed good calibration and clinical utility. External validation results showed that the AUC was 0.764 (95% CI: 0.638-0.869); and sensitivity, specificity, positive and negative predictive values were 79.28%, 85.79%, 73.25% and 85.82%, respectively. CONCLUSIONS Advanced lung cancer patients have a high risk of secondary peripheral neuropathy after anticancer therapy. Drinking history, comorbid diabetes, chemotherapy, targeted therapy, immunotherapy, abnormal liver and kidney function are independent risk factors. The nomogram prediction model constructed in the study is effective and may be used for the risk assessment of secondary peripheral neuropathy in patients with advanced lung cancer.
Humans ; Nomograms ; Retrospective Studies ; Peripheral Nervous System Diseases/etiology* ; Risk Factors ; Lung Neoplasms/complications*

Objective To investigate the expression of osteopontin in colorectal cancer and hepatic metastatic cancer and its clinical significance.Methods The expression of osteopontin in 76 cases of colorectal cancer tissues,30 para carcinoma normal mucosa,liver metastatic tumor tissues in 16 patients was examined by immunohistochemical SP staining method.Results The expression rates of osteopontin in normal mucosa,colorectal cancer tissues and liver metastatic cancer tissues were 6.7％ (2/30),69.7％ (53/76),75.0％ (12/16) respectively.The expression rates of osteopontinin colorectal cancer and liver metastatic cancer was significantly higher than those in the normal mucosa (respectively x2 =34.273,23.014,all P ＜ 0.001).The expression of osteopontin was related to infiltration depth,lymph node metastasis,and distant metastasis (respectively x2 =14.347,6.577,7.278,5.537,all P ＜ 0.05).There was no significant difference in the sex and age.Kaplan-Meier survival analysis showed that patients with osteopontin positive had poor prognosis compared with osteopontin negative patients (P ＜ 0.001).Conclusions The expression of osteopontin is closely related to the invasion and metastasis of colorectal carcinoma,a hopeful indicator for the prognosis of colorectal cancer.

A method based on in situ formed ionic liquids microextraction-ultra performance liquid chromatography(ISFILM-UPLC) was established for the determination of vancomycin in human serum.The samples were pretreated by vortex and centrifugation.[C6MIM] [Br] and NaPF6 were applied as the extracting agent,and Metronidazole as the internal standard.Methanol was applied to redissolve the precipitate.The separation was carried out on a BEH C18 column,and the mobile phase consisted of methanol and 0.05 mol/L monopotassium phosphate solution.The flow rate was 0.2 mL/min,the injection volume was 5 μL,and the column temperature was 18 ℃.The key parameters of this method such as the specificity,accuracy and precision were validated.This method showed good correlation with the immunoassay.It shows great potential for the application in clinical practice.

Objective To explore the effect of ultrasound in the diagnosis and treatment of rheumatoid arthritis .Methods though early diagnose of RA by ultrasound ,DAS28 and MRI′s result to measure the accuracy of ultrasound test .then though the ul‐trasound index at different time point in the treatment of RA patients ,we knew the changes of the joint ,and provide treatment plan and prognosis .Results ultrasound had high accuracy rate in the diagnoses of RA(P< 0 .05) ,and there were correlation among ul‐trasound diagnoses accuracy and DAS28 and MRI score(r= 0 .859 ,P< 0 .05) ;at the same time ,it provided accurate changes of the joint during the treatment ,and provided basis for treatment .Conclusion Ultrasound has manifest advantageous in diagnose RA .It could be used as a method in early diagnose RA and evaluate the effect on RA′s treatment .

Objective To develop a simple high-resolution melting ( HRM) analysis method for differentiation of Pc and P2 variants in class 1 integron.Methods DNA fragments containing Pc and P2 variants were amplified from plasmids pACW ( PcW ) and pACWP2 ( PcW-P2 ) respectively , then these purified PCR products and P 2 promoters were analyed full-length amplicon by HRM .Eight DNA fragments containing different Pc promoters were amplified and site-specific mutated from plasmids pACS ( PcS ) , pACH2 ( PcH2 ) , pACH1 ( PcH1 ) , pACW ( PcW ) , genomic DNA of Klebsiellar pneumonia HS07-68 (PcWTGN-10)and HS05-1792(PcH2TGN-10)respectively.The purified PCR products and eight Pc variants were characterized by HRM analyses of an unlabeled probe and full-length amplicon.This assay was applied to the differentiate Pc and P2 variants in 109 class 1 integrons from 95 urine clinical Escherichia coli isolates in Huashan Hospital during 2004 -2007.The differentiation results were compared with that determined by direct sequencing .Results P2 promoter with a significant higher melting temperature ( Tm ) can be identified by HRM analysis clearly .P2 promoters were identified in 2 class 1 integrons and consistent with direct sequencing results .Eight Pc variants were classified into three groups: PcS, PcSTGN-10 , PcW, PcWTGN-10, PcH1, PcH1TGN-10.Using direct HRM analysis.PcH2, PcH2TGN-10 were classified into four groups:PcS, PcH1, PcH2, PcW, PcSTGN-10 , PcH1TGN-10 , PcH2TGN-10 , PcWTGN-10 according to the melting curves of the unlabeled probe .Combined the HRM analyses of the whole amplicon and unlabeled probe , the eight Pc variants can be differentiated from each other .Five different Pc variants, PcS, PcW, PcH1, PcH2TGN-10 and PcWTGN-10 , were identified and consistent with direct sequencing results .Conclusions This developed a simple Pc and P 2 variants differentiation method via simultaneous HRM analyses of an unlabeled probe and full-length amplicon .This method is cost-effective and accurate , could be used in differentiation of Pc and P2 variants of class 1 integrons in clinical isolates .

Objective To investigate the protective effects of ambroxol on lung during perioperation in elderly patients with myasthenia gravis.Methods 58 elderly patients diagnosed as myasthenia gravis combined with thymic disease were divided into treatment group and control group randomly.During the perioperation,the treatment group was treated with ambroxol,while the control group was not.Comparative analysis of pulmonary complications,pulmonary ventilation indexes,blood gas indexes,and serum concentration of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),interleukin 1β (IL-1β) and IL-10 was performed.Results The incidence rate of postoperative pulmonary complications (pulmonary atelectasis,pneumonia and bronchitis) was significantly lower in the treatment group in the control group (9.4％ vs 15.6％,P＜0.05).Peak inspiratory pressure (PIP) and resistance of air way (RAW) were lower in treatment group than in control group [(22.32±3.43) cmH2O vs (26.54±4.81) cmH2O,(29.17±5.74) cmH2O· L-1s-1vs (34.47±7.94) cmH2O · L-1 · s-1 both P＜0.05],while compliance of lung (CL) washigher in treatment group than in control group [(106.04±-14.73)ml/cmH2O vs (95.11±9.50) ml/cmH2O,P＜0.05].Two days after operation,PaO2,SaO2 and PaO2/FiO2 were significantly higher in treatment group than in control group [(89.66 ±13.23) mmHg vs (70.94±12.75) mmHg,(96.95±2.65)％ vs (89.44±2.78)％,(219.47±54.05)mmHg vs (187.38±37.72) mmHg,respectively,all P＜0.05].Serum concentration of CRP,TNF-α,IL-1β were lower and serum level of IL-10 was higher in treatment group than in control group [(29.37 ± 14.87)mg/L vs (43.94 ±21.42) mg/L,(35.55±4.74)μg/L vs.(52.80±6.63) μg/L,(17.06±6.85)μg/L vs.(28.62±7.72) μg/L],[(132.84± 12.91)μg/L vs.(87.18± 16.37)μg/L,respectively,all P＜0.05].Conclusions Ambroxol hydrochloride can effectively reduce the incidence rate of postoperative pulmonary complications after thymectomy,improve the pulmonary ventilation function,and inhibit the inflammatory reaction in elderly patients with myasthenia gravis,which is worthy of wide application in the perioperation.

Objective To investigate the evaluation of plasma osteoprotegerin (OPG) measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients met the inclusion criteria of suspicious chest pain or confirmed coronary artery disease (CHD),and intermediate stenosis lesions (20 ％ ～ 70 ％) in 3 main coronary arteries served as target vessels for qualitative comparative analysis (QCA).Plasma OPG level was detected by protein array method,and the concentration of hypersensitive C-reactive protein (hs-CRP)was determined by enzyme-linked immunosorbent assay(ELISA).Clinical endpoints were followed up.Results A total of 890 patients with intermediate coronary stenosis were enrolled in this study,and were divided into＜60 years of age group(n＝370)and ≥ 60 years of age group(n＝520).There were statistical differences in age,smoking history,hypertension history,triglycerides (TG),high-density lipoprotein cholesterol(HDL-C),white blood cell count,OPG,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI)between the two groups.The morphological indices in coronary lesions assessed by QCA had no differences between the two groups.During a median of 24 months of follow-up,58 patients(l1.2％)had clinical endpoints events.Age,smoking history,hypertension history,TC,TG,HDL-C,white blood cell count,levels of OPG above-median,hs-CRP,SBP,DBP,and BMI were used as the independent variables,and the clinical end events as the dependent variable.Forward stepwise logistic regression analysis showed that HDL-C,levels of OPG above-median,hs-CRP were the independent risk factors in elderly patients.The risk of cardiovascular events in patients with levels of OPG above-median was 2.510 fold higher than those with levels of OPG below-median.Conclusions The high levels of OPG and hs-CRP are the independent risk factors for the occurrence of coronary heart disease in the elderly with intermediate coronary lesions.

Objective To investigate the relationship between blood vessel invasion (BVI) and clinicopathologic features and prognosis in patients with gastric cancer,and analyze related factors affecting the prognosis of patients.Methods The clinicopathological data of 206 patients with gastric cancer who were admitted to the Nanjing Hospital Affiliated to Nanjing Medical University from January 2007 to December 2010 were retrospectively analyzed.The BVI of surgical tumor specimens in all patients was detected by immunohistochemical staininng.All the patients were followed up via outpatient examination and telephone interview up to March 2014.The count data were analyzed using the chi-square test.The survival curve was drawn by Kaplan-Meier method.The survival analysis and univariate analysis were done using the Log-rank test,and multivariate analysis was done using the COX regression model.Results The BVI rate of 206 patients was 27.67％ (57/206).The BVI rate of tumor tissues,tumor differentiation,perineural invasion,T stage,N stage and TNM stage in all patients with gastric cancer were compared,showing significant differences (x2=14.396,9.569,15.579,43.453,30.732,P ＜ 0.05).After operation,188 patients were followed up for 6.0-60.0 months (median,34.0 months),with the follow-up rate of 91.26％ (188/206).Among 188 patients with follow-up,the median survival time and 5-year cumulative survival rate in patients with BVI and with negative BVI were 32.4 months and 19.6％,40.7 months and 42.0％,respectively,with a significant difference in the survival of patients (x2 =9.364,P ＜ 0.05).The results of univariate analysis showed that the diameter of tumor,tumor differentiation,perineural invasion,BVI,T stage,N stage and TNM stage were factors affecting the prognosis of patients with gastric cancer (x2=9.241,17.486,11.243,9.364,27.666,216.745,49.887,P ＜ 0.05).The results of multivariate analysis showed that the diameter of tumormore than 5 cm,BVI,stage T4,stage N3 and stage Ⅲ were independent risk factors affecting the prognosis of patients with gastric cancer (HR =0.502,0.456,0.052,0.001,0.735; 95％ confidence interval:0.334-0.754,0.289-0.720,0.004-0.664,0.000-0.006,0.159-3.398,P ＜ 0.05).Conclusions BVI in patients with gastric cancer is associated with the progression of tumors.The diameter of tumor more than 5cm,BVI,stage T4,stage N3 and stage Ⅲ are independent risk factors affecting the prognosis of patients with gastric cancer,and BVI may be a predictor of poor prognosis of patients with gastric cancer.

Objective To investigate the relationship between personal disposable income and female depression,and to examine the moderating roles of personality in this link.Methods The demographic questionnaire,self-rating depression scale (SDS) and eysenck's personality questionnaire short scale (EPQ-RSC) were used to survey 139 cases of married female patients with depression.Results Personal disposable income could be used to significantly and negatively predict female depression(β=-0.669,P＜0.01).The interaction between personal disposable income and introversion-extroversion,personal disposable income and neuroticism was significant (β=0.142,P＜0.05.β=-0.232,P＜0.01).In the groups of higher and lower scores on the introversion-extroversion dimension,personal disposable income could be used to significantly predict female depression(β=-0.397,P ＜0.05.β=-0.452,P＜0.05).In the group of higher scores on the neuroticism dimension,personal disposable income could be used to significantly predict female depression(β=-0.553,P＜0.01),but not in the group of lower scores(β=-0.349,P＞0.05).Conclusion Personal disposable income has significantly negative prediction effect on female depression,and introversion-extroversion and neuroticism have significant moderating effects on the relationship between personal disposable income and female depression.

Objective To evaluate the effect of remifentanil on Toll-like receptor 2 (TLR2) mRNA expression during renal ischemia-reperfusion (Ⅰ/R) in rats.Methods Fifty-four male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 3 groups (n=18 each) using a random number table:sham operation group (group S),Ⅰ/R group and remifentanil group (group R).Renal Ⅰ/R injury was produced by clamping the bilateral renal arteries for 45 min followed by reperfusion in Ⅰ/R and R groups.Bilateral renal arteries were only exposed but not clamped in group S.Remifentanil 1.0 μg · kg-1 · min-1 was infused via the tail vein starting from 15 min before ischemia until 30 min of reperfusion in group R,while the equal volume of normal saline was given instead in S and Ⅰ/R groups.The animals were sacrificed at 15 min before ischemia and 6 and 24 h of reperfusion,and the renal specimens were obtained for examination of the pathological changes (with light microscope) and for determination of the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) (by ELISA) and expression of TLR2 mRNA (by RT-PCR) and cell apoptosis (by double staining and flow eytometry).The apoptotic rate was calculated.Results Compared with group S,TLR2 mRNA expression was significantly up-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were increased at 6 and 24 h of reperfusion in Ⅰ/R and R groups.Compared with group Ⅰ/R,TLR2 mRNA expression was significantly down-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were decreased at 6 and 24 h of reperfusion in group R.The pathological changes were significantly attenuated in group R as compared with group Ⅰ/R.Conclusion The mechanism by which remifentanil reduces renal Ⅰ/R injury is related to down-regulation of TLR2 expression and decrease in TLR2 activity and inhibition of inflammatory responses in renal tissues and cell apoptosis in rats.