Objective To develop a CT-based weighted radiomic model that predicts tumor response to programmed death-1(PD-1)/PD-ligand 1(PD-L1)immunotherapy in patients with non-small cell lung cancer.Methods The patients with non-small cell lung cancer treated by PD-1/PD-L1 immune checkpoint inhibitors in the Peking Union Medical College Hospital from June 2015 to February 2022 were retrospectively studied and classified as responders(partial or complete response)and non-responders(stable or progressive disease).Original radiomic features were extracted from multiple intrapulmonary lesions in the contrast-enhanced CT scans of the arterial phase,and then weighted and summed by an attention-based multiple instances learning algorithm.Logistic regression was employed to build a weighted radiomic scoring model and the radiomic score was then calculated.The area under the receiver operating characteristic curve(AUC)was used to compare the weighted radiomic scoring model,PD-L1 model,clinical model,weighted radiomic scoring + PD-L1 model,and comprehensive prediction model.Results A total of 237 patients were included in the study and randomized into a training set(n=165)and a test set(n=72),with the mean ages of(64±9)and(62±8)years,respectively.The AUC of the weighted radiomic scoring model reached 0.85 and 0.80 in the training set and test set,respectively,which was higher than that of the PD-L1-1 model(Z=37.30,P<0.001 and Z=5.69,P=0.017),PD-L1-50 model(Z=38.36,P<0.001 and Z=17.99,P<0.001),and clinical model(Z=11.40,P<0.001 and Z=5.76,P=0.016).The AUC of the weighted scoring model was not different from that of the weighted radiomic scoring + PD-L1 model and the comprehensive prediction model(both P>0.05).Conclusion The weighted radiomic scores based on pre-treatment enhanced CT images can predict tumor responses to immunotherapy in patients with non-small cell lung cancer.
Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms/drug therapy* ; B7-H1 Antigen/therapeutic use* ; Retrospective Studies ; Programmed Cell Death 1 Receptor ; Tomography, X-Ray Computed ; Immunotherapy

Aim To investigate the mechanism of Pi- ezol in the phenotypic changes of rat coronary arterial smooth muscle cells ( CASMCs) induced by high hydrostatic pressure.Methods CASMCs were isolated from Wistar rats and stimulated for 24 h at 0, 120 and 180 mmHg, respectively.The expressions of Piezol , contractile phenotvpe-related proteins including Cavl.2 ,SM-MHC ,cx-SMA and synthetic phenotvpe-re- lated proteins including OPN , MMP-2, Coll al were detected by Western blot.The effect of calcium influx mediated by Piezol was detected by Laser confocal mi- j j croscopy.CASMCs were treated with Piezol agonist Yodal , inhibitor GsMTx4 and Piezol-siHNA , respectively and the expressions of contractile phenotvpe and synthetic phenotvpe-related proteins were detected by Western blot.Results Compared with control ( 0 mmHg) , the expressions of Piezol , OPN, MMP-2 and Collal increased, but the expressions of Cavl.2,SM- MHC and cx-SMA decreased in 120 mmHg as well as 180 mmHg group.After stimulated by 180 mmHg high pressure, Piezol-mediated calcium influx was stronger than that in 0 mmHg group, hut decreased after Piezol knockdown.Treated with Yodal at 0 mmHg, the expression of contractile phenotvpe-related protein decreased while the expression of synthetic phenotvpe-re- lated protein increased compared with DMSO group..\Jfter using GsMTx4 to inhibit or siRNA to knockdown Piezol at 180 mmHg,the expression of contractile phe- notvpe-related protein increased and the expression of synthetic phenotype-related protein decreased compared with the control group.Conclusion Piezol promotes the transition from contractile phenotvpe to syn-thetic phenotvpe of CASMCs induced by high hydrostatic pressure.

Aim To investigate the role of calcium-independent phospholipase A2(iPLA2)in calcium regu-lation of intrarenal artery smooth muscle contraction.Methods The method of measuring the tension of isolated arterioles was used to explore the effect of bromoenol lactone(BEL), a specific inhibitor of iPLA2, on the tension of the intrarenal arteries in mice induced by different calcium channels, and the laser confocal calcium measurement technology was used to investigate the effect of BEL on the intracellular calcium influx mediated by arachidonic acid-mediated calcium channels.Results The intrarenal artery concentration dependent contractile response induced by the vasoconstrictors phenylephrine and 5-hydroxy tryptamine was inhibited by BEL(P<0.01).The contraction curve induced by CaCl2 was also inhibited by BEL(P<0.05).In the calcium-free K-H solution incubated with nifedipine, the intrarenal artery vasoconstriction caused by the release of sarcoplasmic reticulum calcium and the calcium influx of the SOC channel induced by CaCl2 was inhibited by BEL(P<0.05).BEL significantly inhibited the external calcium influx mediated by the ARC channel of human aortic smooth muscle cell lines incubated with nifedipine(P<0.01).Conclusions iPLA2 mediates the contractile response of intrarenal arteries by regulating the functions of L-type calcium channels, sarcoplasmic reticulum calcium release, SOC channels and ARC channels.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective:To discussed the clinical efficacy of addition and subtraction therapy of Shenling Baizhu San to antibiotic-associated diarrhea (AAD) with spleen-stomach deficiency and cold syndrome, and to investigate its effects on immune function and intestinal flora. Method:One hundred and fifteen patients were randomly divided into control group (57 cases) and observation group (58 cases) by random number table. Patients in control group got Shuangqi Ganjun Sanlian Huojun San, 2 bags/time, 2 times/days. Mengtuoshi San, 1 bag/time, 3 times/days, and they also got measures to prevent disturbance of water, electrolyte, acid-base balance and nutritional support. Based on the treatment in control group, patients in observation group also got addition and subtraction therapy of Shenling Baizhu San, 1 dose/day. The course of treatment was 7 days in both groups. Before and after treatment, scores of symptoms, intestinal secretory immunoglobulin (SIgA) levels, peripheral blood immunoglobulin A (IgA), G (IgG), M (IgM) and T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺and CD4⁺/CD8⁺). Detection of bacillus faccalis in feces before and after treatment and the bacteria were cultured to identify and count bifidobacterium, lactobacillus and enterococcus. In addition, diamine oxidase (DAO) and D-lactic acid levels were detected before and after treatment. Result:In rank sum test, clinical efficacy in observation group was better than that in control group (Z=2.268, P<0.01). Scores of main symptoms, secondary symptoms, spleen-stomach deficiency and cold syndrome were lower than those in control group(P<0.01). Levels of SIgA, IgA and IgG were significantly higher than those in the control group (P<0.01). Levels of CD3⁺, CD4⁺and CD4⁺/CD8⁺were higher than those in control group (P<0.05), while level of CD8⁺was lower than that in control group (P<0.05). Bacillus in faeces was significantly lower than that in control group(P<0.01). Count of enterococcus was lower than that in control group (P<0.05), while counts of bifidobacterium and lactobacillus were higher than those in control group (P<0.05). In addition, levels of DAO and D-lactic acid were significantly lower than those in control group (P<0.01). Conclusion:Based on conventional treatment, addition and subtraction therapy of Shenling Baizhu San can alleviate symptoms, improve clinical efficacy, improve immune function, regulate intestinal flora and promote the repair of intestinal mucosal barrier in the treatment of antibiotic-associated diarrhea (AAD) with spleen-stomach deficiency and cold syndrome.

OBJECTIVE: Todevelop a rapid and sensitive UHPLC-Q-orbitrap method for the identification of chemical constituents in Nelumbinis Folium. METHODS: Thermo Scientific Hypersil GOLD aQ(2.1 mm×100 mm,1.9 μm) was used with 0.1% formic acid-acetonitrile solution and 0.1% formic acid-water solution as the mobile phase in gradient elution. The extract was detected by Q-orbitrapmass spectrometry equipped with an ESI ion source in both positiveand negative mode. RESULTS: Based on the accurate mass-to-charge measurements, retention time, mass fragmentation patterns, compound discoverer software which can link to local compound database of Traditional Chinese Medicine from Thermo Scientific and online compound database from mzCloud, using Mass Frontier software to explain the fragmentations, a total of 53 compounds were screened and characterized, including 21 flavonoids,5 terpenes,13 alkaloids, 3 coumarins, 3 amino acids, 2 lignans and 6 other compounds. CONCLUSION: These results are helpful for the comprehensive quality control, better comprehension of the metabolism, and further study of the pharmacodynamic substances from Nelumbinis Folium.

As a standard method for early stage prostate cancer, 125Ⅰ seed implantations are used widely in America. Although there are guidelines from American Brachytherapy Society and American Association of Physicists in Medicine, some hospitals still cannot implant the seeds properly according to the guidelines. Complications were observed inevitably. The medical events about seeds implantation in America from 2002 were investigated and the reasons were analyzed in this paper. Additionally, some solutions were given to avoid the medical events, so that the practitioners in China can learn from it and make sure the 125Ⅰ seeds implantation can be developed healthily and smoothly.

The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy (CSP) was evaluated.The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 were collected and analyzed retrospectively,including the patients' age,gestational age,the size of gestational sac or uneven mass,the uterine scar thickness,β human chorionic gonadotropin (hCG) levels and so on.Of these 104 cases,30 cases were subjected to laparotomy,29 cases to laparoscopy,27 cases to hysteroscopy,16 cases to ultrasound-guided uterine curettage,and 2 cases to conservative treatment.The transvaginal ultrasound showed that uterine scar thickness and gestational sac or uneven mass size had significant difference (P＜0.05) among different surgical methods by comparatively analyzing the patients' data.It was suggested that transvaginal ultrasound may provide the valuable reference for choosing clinical surgical procedures for CSP.

Objective To investigate the surrounding and central dosimetric distribution difference of the same activity, same number of 125I seeds. Methods 3D treatment planning system (3D-TPS) was used to separately sketch out 7 cubes with side length of 2 cm, 2.5 cm, 3 cm, 3.5 cm, 4 cm, 4.5 cm and 5 cm;simulations of different tumor sizes were established, into which 125I seeds with activity of 0.5 mCi were respectively loaded. All seeds were distributed at the periphery of the tumor (peripheral group) with the prescribed dose of 145 Gy. The dose volume histogram (DVH) was printed and the 90% of target volume absorbed dose (D90), 90% of prescription dose coverage target volume percentage (V90), the maximum dose and mean dose were determined. Then the seeds in every cube were distributed into the center (central group) and the above parameters were calculated by using the same method. Results The mean D90 of the peripheral and central group was (147.29 ±0.58) Gy and (106.08 ±9.40) Gy respectively, the difference between the two groups was statistically significant (t=-4.292, P=0.005). The mean V90 of the peripheral and central group was (95.46±0.44)% and (79.07±4.19)% respectively, the difference between the two groups was statistically significant (t=-3.831, P=0.009). The mean maximum dose of the peripheral and central group was (1 224.65 ±12.7) Gy and (1 532.48 ±48.54) Gy respectively, the difference between the two groups was statistically significant (t=6.823, P=0.000). The mean value of average dose of the peripheral and central group was (192.14 ±2.89) Gy and (179.81 ±5.40) Gy respectively, the difference between the two groups was statistically significant (t=-2.847, P=0.029). Conclusion The dose distribution is directly influenced by the distribution pattern of the 125I seeds. When the number and activity of the 125I seeds are the same, the peripheral seeds implantation has a better dose distribution.

Objective To discuss the feasibility, efficacy and complications of CT-guided 125I seed implantation for the treatment of lymph node metastasis nearby the iliac vessels.Methods The clinical data of twelve patients with para-iliac vessel lymph node metastasis, who had been treated with CT-guided 125I seed implantation, were retrospectively analyzed. A total of 12 lesions were detected; the diameter ≤6 cm was seen in seven lesions, and the diameter >6 cm was seen in five lesions. Using computer treatment planning system, the source distribution was calculated. Under CT guidance 125I seeds with the activity of 0.4-0.7 mci were implanted into the metastatic lymph nodes with a seed interval of 0.5-1.0 cm. CT scan was performed immediately after implantation to check the distribution of seeds as well as the possible complications. After the treatment, D90 (90%prescription dose received by target volume) was ≥75 Gy in 6 patients and <75 Gy in other 6 patients. Two months after the treatment CT reexamination was employed, and imaging evaluation was conducted according to WHO Response Evaluation Criteria in Solid Tumors. Results CT-guided 125I seed implantation was successfully accomplished in all 12 patients. Two months after the treatment, the evaluation of the therapeutic effect showed that complete remission (CR) was obtained in 0 patient, partial remission (PR) in 8 patients, stable disease in 3 patients and progress disease in one patient;and the total effect rate(CR+PR) was 66.7%. The local control rate was 91.7%. In eight patients the pain that was caused by metastatic lymph nodes was significantly relieved within 1-14 days after 125I implantation treatment. Before the treatment three patients had lower limb edema, and in two of them the lower limb edema was obviously relieved within 1-14 days after the treatment. All patients were followed up for 3-39 months, and the median follow-up time was 11 months. One-year survival rate was 41.7%. No severe complications such as massive hemorrhage, infection, myelosuppression or seed displacement occurred. Conclusion For the treatment of para-iliac vessel lymph node metastasis, CT-guided 125I seed implantation is safe and feasible. Better curative effect may be achieved when the diameter of the metastatic lymph node is<6 cm and the peripheral radiation dose is>75 Gy.