Objective To explore the effectiveness and safety of hypofractionated radiotherapy(HFRT)combined with transcatheter arterial chemoembolization(TACE)for metachronous hepatic oligometastasis from nasopharyngeal carcinoma(NPC).Methods The clinical data of patients with metachronous hepatic oligometastasis from NPC,who received HFRT combined with TACE treatment at the Sichuan Provincial Cancer Hospital of China from January 2012 to October 2022,were retrospectively analyzed.The 3-year and 5-year overall survival(OS),progression-free survival(PFS),local recurrence-free survival(LRFS),no extrahepatic distant metastasis survival(EMFS),and treatment-related adverse reactions were analyzed.Results A total of 55 patients were enrolled in this study,including 36 males and 19 females,the median age at the time of occurring metachronous hepatic oligometastasis was 44(27-75)years.The 3-year and 5-year OS,PFS,LRFS,EMFS were 67.8％and 40.0％,55.8％and 30.0％,72.7％and 56.5％,63.6％and 56.5％,respectively.The subgroup analysis indicated that the treatment course of TACE ≥3 cycles could significantly improve the PFS of patients with oligometastasis.HFRT combined with TACE treatment was well tolerated by all patients,and the incidence of Grade Ⅲ-Ⅳadverse reactions was quite low.Conclusion For the treatment of metachronous hepatic oligometastasis from NPC,HFRT combined with TACE is clinically effective,besides,the patients can well tolerate the therapeutic scheme.

[Purpose]To analyze and evaluate the application effect of quantitative fecal immuno-chemical test(FIT)in the opportunistic screening of colorectal cancer(CRC)in health examination population.[Methods]10 025 healthy individuals who completed quantitative FIT at the Health Management Cancer of Sichuan Cancer Hospital from January 1,2021 to December 31,2023 were included.Participants with positive FIT results were recommended for diagnostic colonoscopy.Quantitative FIT positivity rate,colonoscopy screening compliance rate,and colorectal lesion de-tection rate in the queue population were analyzed,the detection rate of colorectal lesions and colonoscopy resource load between quantitative FIT positive and negative colonoscopy screening groups at all levels were compared and the diagnostic efficacy of quantitative FIT for non progres-sive lesions and progressive lesions were explored.[Results]The positive rate of quantitative FIT was 6.24％(95％CI:5.77％～6.71％).The compliance rate of colonoscopy screening was 20.93％(95％CI:17.74％～24.12％).Among 284 colonoscopy patients,7 cases were detected with CRC,21 cases with advanced adenomas,52 cases with non advanced adenomas,40 cases with non adenomatous polyps,51 cases with other benign lesions,and 113 cases without abnormalities.The detection rates of non advanced adenomas,advanced adenomas,colorectal cancer,non pro-gressive lesions and progressive lesions in the quantitative FIT positive group were significantly higher than those in the quantitative FIT negative group.The detection rates of those without obvi-ous abnormalities were significantly lower than those in the quantitative FIT negative group,and the differences were statistically significant(all P＜0.05).The resource burden of colonoscopy in the quantitative FIT positive and negative groups was 5.46(95％CI:1.56～9.34)and 38.25(95％CI:30.55～45.95),respectively.The level of FIT measurement gradually increases with the severity of the lesion,and the difference between groups is statistically significant(H=48.308,P＜0.001).Quan-titative FIT has high sensitivity and negative predictive value for non progressive lesions and pro-gressive lesions,with values of 71.15％,85.71％and 90.20％,97.39％,respectively.The AUC values for quantitative FIT screening of non progressive lesions and progressive lesions were 0.653(95％CI:0.572～0.734,P=0.001)and 0.720(95％CI:0.631～0.808,P＜0.001),respectively.[Conclusion]Quantitative FIT,as a suitable technique for CRC opportunistic screening in health check-up population,has good diagnostic efficacy for non progressive lesions and progressive le-sions.Performing colonoscopy on FIT positive individuals can improve lesion detection rates while reducing colonoscopy resource consumption,aligning with China's healthcare resource landscape.

Lymphomas represent a group of highly heterogeneous malignant tumors.The tumor microenvironment(TME)surrounding these tumors plays a crucial role in disease progression and the efficacy of therapeutic interventions.Traditional two-dimensional cell cul-ture models fail to accurately recapitulate the inherent complexity of three-dimensional(3D)in vivo architecture.Organoid technology provides a novel tool for lymphoma research,utilizing 3D culture systems to reconstruct tumor tissue organization and functionality.Despite the potential of this technology,the development of lymphoma organoid models remains a significant challenge.Developing lymphoma or-ganoid models faces numerous hurdles,including replicating the unique biological characteristics of lymphoma and itscomplexmicroenvir-onment.This study provides a systematic summary of challenges associated with lymphoma organoid construction and describes recent ad-vances in relevant methodologies.Moreover,the study further reviews recent advances in co-culture techniques combining lymphoma or-ganoids and immune cells,including protocols for culturing patient-derived primary central nervous system lymphoma organoids and patient-derived lymphoma organoids.These advances have significantly facilitated the clinical translation of lymphoma research,transitioning it from fundamental mechanistic studies toward personalized and precision therapeutic approaches.

Objective:To investigate the incidence of port-site metastasis (PSM) after laparoscopic surgery in patients with epithelial ovarian cancer and prognostic factors influencing outcomes in those with abdominal wall PSM.Methods:Clinicopathological and follow-up data of 22 ovarian epithelial cancer patients diagnosed with abdominal wall PSM after laparoscopic surgery, who were treated in the Sichuan Cancer Hospital between May 2014 and July 2023, were retrospectively collected. A retrospective analysis of PSM characteristics and prognostic factors influencing outcomes, was conducted in these patients.Results:(1) Between May 2014 and July 2023, a total of 369 ovarian cancer patients with a history of laparoscopic surgery performed at other hospitals were admitted. Among them, 24 cases (6.5%, 24/369) were diagnosed with tumor lesions at the abdominal wall port sites via postoperative pathological examination, with a median interval time of 25.5 days (interquartile range: 19.5, 32.0 days) after laparoscopic surgery. Of these, 22 cases with complete clinicopathological and follow-up data were included in this study. (2) The age of the 22 PSM patients was (53.0±8.6) years, and the median follow-up time was 37.6 months (24.7, 63.4 months). Surgical-pathological staging revealed stage Ⅰ-Ⅱ disease in 4 cases and stage Ⅲ-Ⅳ disease in 18 cases. Histopathological differentiation included 5 cases of well-to-moderately differentiated tumors and 17 cases of poorly differentiated tumors. Pathological subtypes comprised 11 cases of high-grade serous adenocarcinoma, 5 cases of low-grade serous adenocarcinoma, and 6 cases of clear cell carcinoma or cystadenocarcinoma. Lymph node status was as follows: negative for lymph node metastasis ( n=16), positive ( n=5), and no lymphadenectomy performed ( n=1). Postoperative residual disease was categorized as no macroscopic residual disease ( n=13), residual disease ≤1 cm ( n=7), and residual disease >1 cm ( n=2). (3) Following secondary cytoreductive surgery combined with postoperative adjuvant therapy, the median progression-free survival and overall survival (OS) time of the patients were 8.8 months (4.6, 14.3 months) and 27.7 months (15.5, 38.4 months), respectively. Univariate Cox regression analysis demonstrated that surgical-pathological stage, histopathological differentiation grade, and lymph node metastasis status were significantly associated with OS time in patients with abdominal wall PSM (all P<0.05). In contrast, age, Eastern Cooperative Oncology Group performance status score, histopathological subtype, preoperative serum cancer antigen 125 level, presence of residual lesions after surgery and poly adenosine diphosphate ribose polymerase inhibitor usage showed no significant correlation with OS time (all P>0.05). Multivariate Cox regression analysis identified surgical-pathological stage ( HR=4.579，95% CI：1.111-18.866； P=0.035) and histopathological differentiation grade ( HR=5.307，95% CI：1.042-27.031； P=0.045) as independent risk factors for OS time in PSM patients. Conclusion:Abdominal wall PSM following laparoscopic surgery for epithelial ovarian cancer maybe adversely affect patient prognosis, particularly in cases with advanced stage and poorly differentiated tumors, which warrants significant clinical attention.

Objective:To explore the feasibility of automatic target volume tracing in the Elekta Unity magnetic resonance imaging (MRI)-guided radiotherapy system and to further enhance the real-time target volume tracing performance of MRI-guided radiotherapy by introducing the deep learning technology based on a large Transformer model.Methods:A total of 4 661 frames of cine MRI binary images from 75 patients with malignant tumors in the chest/abdomen who were treated with MRI-guided radiotherapy were retrospectively collected as a training set. Another 500 frames of cine MRI binary images from 10 patients were collected as an independent test set. A module for medical image format conversion was developed to convert binary images into medical meta-images. The outer contours of tumor target volumes in the cine MRI images of the test set were manually delineated as actual control labels. With the first frame of the cine MRI images of each patient as the reference image and the other frames as motion images, a Transformer-based deep learning model was constructed to describe the deformable vector field (DVF) of motion images relative to the reference image. The Dice similarity coefficient (DSC), the 95% Hausdorff distance (HD 95), the negative Jacobian determinant (NegJ), and the average processing time per frame of cine MRI images were calculated. These values were compared to those of the conventional B-Spline scheme to quantitatively assess the target volume tracing accuracy, DVF physical plausibility, and execution efficiency of the Transformer-based deep learning model. Results:The Transformer-based deep learning model constructed in this study delivered superior target volume tracing performance, with improved DSC [(0.84 ± 0.05) vs. (0.74 ± 0.16), t = 11.44, P < 0.05] and HD 95 [(9.25 ± 2.98) vs. (14.70 ± 8.55) mm, t = -11.83, P < 0.05]. Furthermore, this model reduced the average image processing time from 1.95 s to 30.99 ms, enhancing the efficiency by two orders of magnitude. Besides, this model yielded NegJ similar to that of the B-Spline scheme. This suggests that the DVF extracted using this model had comparable physical plausibility with that obtained using the B-Spline scheme. Conclusions:The Transformer-based deep learning model for automatic target volume tracing fills the functional gap of the Elekta Unity MRI-guided radiotherapy system, facilitating relatively accurate, efficient automatic tracing of moving tumor targets in the chest and abdomen.

Objective:To compare the dose-response effects of single-fraction ultra-high dose rate (FLASH) and conventional dose rate (CONV) whole abdominal irradiation (WAI) with X-rays on acute radiation-induced intestinal injury in mice, in order to identify optimal dose parameters and potential mechanisms.Methods:A total of 186 male C57BL/6J mice were randomly assigned to a non-irradiation group ( n=6), FLASH irradiation groups ( n=90), and CONV irradiation groups ( n=90). Acute radiation-induced intestinal injury models were established using single-fraction WAI with 11, 12, 13, 14, and 15 Gy X-rays (200 Gy/s for FLASH and 4 Gy/min for CONV). Changes in body weight, stool characteristics, and disease activity index (DAI) scores were assessed at 9 d post-irradiation. At 7 d post-irradiation at 11, 12, and 13 Gy, the intestines were collected for macroscopic examination and length measurement. The small intestine was selected for HE staining and quantitative analysis of intestinal crypt number and mucosal epithelial thickness. The survival of mice was assessed at 15 d post-WAI across all dose groups. Results:After single-fraction WAI at 11, 12, and 13 Gy, the body weight was higher in the FLASH group than that in the CONV group ( t=10.17, 12.65, 10.16, P<0.05). The DAI scores for the FLASH group were 1.00±1.10, 3.17±0.75, and 2.83±1.17, respectively, which were lower than those of the CONV group (4.33±0.52, 7.00±0.00, 8.60±0.55; t=8.70, 11.71, 14.99, P<0.05). However, after WAI at 14 Gy and 15 Gy, there were no significant differences in body weight and DAI between the FLASH group and the CONV group ( P>0.05). At 7 d after single-fraction WAI at 11, 12, and 13 Gy, mice in the FLASH group exhibited less intestinal congestion, edema, and shortening compared with the CONV group. The difference between the FLASH and CONV groups were statistically significant in small intestine length at 11 and 13 Gy ( t=4.42, 3.78, P<0.05), and in colorectal length at 11 and 12 Gy ( t=3.97, 3.12, P<0.05). Small intestine HE staining revealed superior preservation of intestinal architecture in the FLASH group compared with the CONV group, characterized by longer villi, increased crypt numbers, thicker mucosal epithelium, and enhanced structural integrity. The differences in crypt number and mucosal epithelial thickness were statistically significant ( tcrypt=13.10, 23.80, 11.90; tmucosal=5.75, 2.64, 7.74; P<0.05). At 15 d post-irradiation, the survival rate in the 15 Gy FLASH group was higher than that in the CONV group (50% vs. 10%, χ2=5.39, P<0.05), with a median survival extension of 6 d ( HR=0.340, 95% CI: 0.115 4-0.999 9). No significant survival differences were observed between the FLASH group and the CONV group at 11, 12, 13, and 14 Gy ( P>0.05). Conclusions:FLASH irradiation significantly alleviated acute radiation-induced intestinal injury from medium single-fraction WAI with 11, 12, and 13 Gy X-rays compared with CONV irradiation, and showed potential to improve mouse survival after single-fraction WAI at 15 Gy. This effect is likely associated with the preservation of intestinal crypts and exhibits a dose-dependent relationship.

Research based auditing is a new requirement for auditing work in the new era,which has important guiding signifi-cance for internal auditing of public hospitals.It reviews the existing literature on research-based auditing,summarizes the back-ground and requirements of research-based auditing,and analyzes the necessity and current situation of conducting research-based in-ternal auditing.Based on the characteristics of internal auditing in public hospitals,it explores the construction of a research-based in-ternal auditing system in public hospitals from both theoretical and practical perspectives,in order to provide reference ideas for pub-lic hospitals to regularly use research-based auditing models to carry out internal auditing work.

Purpose To quantitatively evaluate myocardial three-dimensional strains using cardiac magnetic resonance feature tracking,investigate whether ferroptosis contributes to myocardial injury in experimental autoimmune myocarditis(EAM),and explore the relationship between strains and ferroptosis biomarkers.Materials and Methods EAM was induced in Lewis rats via subcutaneous injections with porcine cardiac myosin emulsified in same amount of complete Freund's adjuvant.Both EAM(n=15)and control(n=15)rats underwent 7T cardiac magnetic resonance and were euthanatized at day 21.Cardiac magnetic resonance assessments included left ventricular function and strains.The cardiac damage and ferroptosis-related markers were measured with histopathology,serology,Western blot and polymerase chain reaction.Results The left ventricular ejection fraction declined in the rats post-immunization with porcine cardiac myosin at day 21(t=7.86,P<0.001).Global,basal,middle and apical strains encompassing radial strain,circumferential strain and longitudinal strain were significantly lower in the EAM group compared to the control group(t=2.61-10.45,P<0.05).Cardiac and inflammatory biomarkers,including lactate dehydrogenase,cardiac troponin I and interferon γ indicated myocardial injury in EAM group compared to the control group(t=16.54,21.20,16.06,all P<0.001).Prussian blue staining revealed iron overload in EAM group.Compared to the control group,malondialdehyde and reactive oxygen significantly increased in EAM group(t=15.75,3.47,both P<0.01),and superoxide dismutase were significantly decreased(t=14.21,P<0.001).Western blot and histopathology showed that the protein expression of ferritin heavy chain was significantly higher in the EAM group compared to the control group(t=5.15,P<0.01).The solute carrier family 7 member 11/glutathione/glutathione peroxidase 4 axis was down regulated at serum,mRNA and protein expression levels in EAM group(t=7.73-30.14,all P<0.001).Global circumferential and longitudinal strains were significantly associated with ferroptosis biomarkers(r=-0.854-0.829,all P<0.05).Conclusion Cardiac magnetic resonance feature tracking has the potential to quantitatively evaluate myocardial damage of EAM which involves ferroptosis.The strains are related with ferroptosis biomarkers.

Objective:To explore the effect of miR-3591-3p targeting P53 on cisplatin resistance of ovarian cancer (OC) SKOV3/DDP cells.Methods:Target prediction and dual luciferase assay were used to validate miR-3591-3p targeting P53. SKOV3/DDP cells were divided into control group, DDP group, miR-3591-3p knockdown group (anti-miR-3591-3p), miR-3591-3p knockdown control group (anti-miR-NC), cisplatin+miR-3591-3p knockdown group (DDP+anti-miR-3591-3p), cisplatin+control group (DDP+anti-miR-NC), cisplatin+miR-3591-3p knockdown+P53 knockdown group (DDP+anti-miR-3591-3p+sh-P53), cisplatin+miR-3591-3p knockdown+P53 knockdown control group (DDP+anti-miR-3591-3p+sh-NC). CCK-8 assay was used to detect cell survival rate and IC 50 value; Flow cytometry were used to detect cell cycle and apoptosis; RT-qPCR was used to detect miR-3591-3p and P53 mRNA levels in cells; Western blot was used to detect P53, P-gp, MRP1, Ki-67, CyclinD1, Bcl-2, and Bax protein levels in cells. Nude mice were divided into control group, DDP group, miR-3591-3p knockdown group (anti-miR-3591-3p), miR-3591-3p knockdown control group (anti-miR-NC), and cisplatin+miR-3591-3p knockdown group (DDP+anti-miR-3591-3p). Subcutaneous injection of SKOV3/DDP cells was used to prepare transplanted tumor model. Tumor volume, mass, miR-3591-3p, P53 mRNA and protein levels in tumor tissue were detected. Results:MiR-3591-3p and P53 had binding sites. After overexpression of miR-3591-3p, wild-type P53 luciferase activity was decreased ( P＜0.05); However, there was no significant difference in the luciferase activity of mutant P53 ( P＞0.05). After DDP treatment or knockdown of miR-3591-3p expression, miR-3591-3p level in cells was decreased, the mRNA and protein levels of P53 were increased; the cell survival rate and IC 50 value were decreased [DDP group 24, 36, 48 h IC 50 (21.26±2.95)mg/L,(17.38±1.93)mg/L and (13.76±1.46)mg/L, control group (41.06±4.39)mg/L, (36.15±3.46)mg/L and(29.87±1.39)mg/L; anti-miR-3591-3p group 24,36,48 h IC 50 (19.96±2.19)mg/L, (17.62±3.52)mg/L and (13.05±1.53)mg/L,anti-miR-NC group (43.37±3.83)mg/L, (40.47±2.82)mg/L and (31.41±0.73)mg/L], the proportion of S phase was decreased, the proportion of G 0/G 1 phase and cell apoptosis rate [DDP group (27.00±2.00)%, Control group (3.33±1.53)%; anti-miR-3591-3p group (28.98±3.14)%, anti-miR-NC group (4.05±1.96)%] were increased; P-gp, MRP1, Ki-67, CyclinD1, Bcl-2 protein levels were decreased, while Bax protein level was increased (all P＜0.05). Knocking down miR-3591-3p could enhance the impact of DDP on the above indicators (all P＜0.05). Knocking down P53 expression could inhibit the impact of miR-3591-3p deletion on the above indicators (all P＜0.05). After DDP treatment or knockdown of miR-3591-3p, the tumor volume and weight of nude mice were decreased [DDP group 14,21,28 d volume (284.26±24.51)mm 3,(563.21±44.17)mm 3 and (741.32±72.01)mm 3,control group (384.25±41.25)mm 3, (840.32±71.27)mm 3 and (1 242.47±100.54)mm 3; anti-miR-3591-3p group 14,21,28 d volume (274.47±27.77)mm 3, (584.68±61.14)mm 3 and (815.24±73.19)mm 3, anti-miR-NC group (355.47±46.84)mm 3, (804.24±79.54)mm 3 and (1 350.47±108.37)mm 3; DDP group weight (0.85±0.15)g,control group (1.34±0.12)g; anti-miR-3591-3p group (0.88±0.14)g, anti-miR-NC group (1.34±0.10)g],miR-3591-3p level in tumor tissue was decreased, and the mRNA and protein levels of P53 were increased (all P＜0.05); Knocking down miR-3591-3p could enhance the effect of DDP on the above indicators (all P＜0.05). Conclusion:MiR-3591-3p targeting P53 enhances cisplatin resistance in SKOV3/DDP cells.

Objective To systematically evaluate the safety and efficacy of replacing tyrosine kinase inhibitors(TKIs)with similar drugs after they cause liver injury,based on case reports and case series studies.Methods PubMed,Embase,Cochrane,Web of Science,CNKI,Wanfang,and VIP databases were searched up to October 2023.Two reviewers independently screened the literature,extracted data,and assessed the quality of the studies.Descriptive and statistical analyses were performed.Results Twenty-six studies(22 case reports and 4 case series)were included,involving 75 patients who switched to similar drugs for TKI-induced liver injury,primarily targeting the epidermal growth factor receptor(EGFR),anaplastic lymphoma kinase(ALK),and multiple targets.The results indicate that majority of patients have favorable safety profiles after switching drugs,with normal liver function or no severe liver injury.Only one patient reported a serious liver adverse reaction,characterized by(grade 3 total bilirubin elevation).In terms of clinical efficacy,most patients responded well to the new TKIs,maintaining stable disease,or showing no progression during follow-up.Disease progression occurred in only two patients who switched from gefitinib to erlotinib after dose reduction due to non-hepatic adverse effects.Additionally,one patient who switched from erlotinib to afatinib experienced worsening tumor symptoms.Conclusion Evidence from published case reports and case series suggests that continuing treatment with similar drugs after TKI-induced liver injury,targeting EGFR,ALK,and multiple targets,demonstrates a certain degree of safety,efficacy,and clinical practicability.This can be a strategy after TKI discontinuation due to liver injury.However,there are no clear guidelines on drug selection,timing,and dosage,and further research is urgently needed.