Objective:To evaluate the value of a combined model based on primary lesion 18F-fluorodeoxyglucose ( 18F-FDG) PET/CT radiomics for predicting lymph node metastasis in non-small cell lung cancer (NSCLC) . Methods:A retrospective analysis was conducted on the clinical data of 203 NSCLC patients who underwent pre-treatment PET/CT imaging at Nanjing Drum Tower Hospital from June 2013 to July 2023. Patients were randomly assigned to the training set ( n=142) and the validation set ( n=61) at a ratio of 7∶3. A predictive model was developed in the training set, and its predictive performance and clinical application value were assessed in both the training and validation sets. Traditional PET/CT parameters and PET/CT radiomics features of the primary lesion were obtained by 3D-slicer software. Least absolute shrinkage and selection operator (LASSO), random forest, and extreme gradient boosting were performed to extract features. Support vector machine was used to construct a radiomics score (Radscore). Univariate and multivariate logistic regression analysis was used to predict the influencing factors of lymph node metastasis in NSCLC patients and to establish models. Predictive performance of the models was evaluated by receiver operator characteristic (ROC) curves and clinical application value was assessed by calibration curves and decision curve analysis (DCA) . Results:Among 203 NSCLC patients, 116 had lymph node metastasis, with 64 cases in the training set and 52 cases in the validation set. Three complementary classical machine learning methods were used for feature screening, and finally 10 radiomics features were obtained. The optimal threshold for Radscore-PET was 0.43 and the optimal threshold for Radscore-CT was 0.39. Univariate analysis showed that, sex ( OR=0.48, 95% CI: 0.24-0.95, P=0.036), tumor marker levels ( OR=3.81, 95% CI: 1.84-7.91, P<0.001), long diameter of tumor ( OR=2.56, 95% CI: 1.27-5.16, P=0.009), short diameter of tumor ( OR=3.73, 95% CI: 1.75-7.92, P=0.001), vacuolar sign ( OR=0.32, 95% CI: 0.12-0.86, P=0.024), ring-like metabolism ( OR=3.67, 95% CI: 1.33-10.13, P=0.012), maximum standardized uptake value (SUV max) ( OR=6.57, 95% CI: 3.03-14.25, P<0.001), metabolic tumor volume (MTV) ( OR=2.91, 95% CI: 1.43-5.92, P=0.003), total lesion glycolysis (TLG) ( OR=4.23, 95% CI: 2.08-8.59, P<0.001), Radscore-PET ( OR=21.93, 95% CI: 9.04-53.20, P<0.001) and Radscore-CT ( OR=13.72, 95% CI: 6.12-30.76, P<0.001) were all influencing factors for predicting lymph node metastasis in NSCLC patients. Multivariate analysis showed that, tumor marker levels ( OR=2.55, 95% CI: 1.11-5.90, P=0.028), vacuolar sign ( OR=0.26, 95% CI: 0.08-0.83, P=0.023), SUV max ( OR=5.94, 95% CI: 1.99-17.75, P=0.001), Radscore-PET ( OR=25.51, 95% CI: 5.92-110.22, P<0.001), and Radscore-CT ( OR=8.68, 95% CI: 2.73-27.61, P<0.001) were independent influencing factors for predicting lymph node metastasis in patients with NSCLC. Based on the above independent influencing factors, models were constructed: the traditional model (tumor marker levels, vacuolar sign, SUV max), the PET model (SUV max, Radscore-PET), the CT model (vacuolar sign, Radscore-CT), and the combined model (tumor marker levels, vacuolar sign, SUV max, Radscore-PET, Radscore-CT). ROC curve analysis showed that, the area under curve (AUC) of the traditional, PET, CT, and combined models in the training set were 0.75 (95% CI: 0.67-0.82), 0.90 (95% CI: 0.84-0.95), 0.85 (95% CI: 0.78-0.90), and 0.94 (95% CI: 0.88-0.97), respectively. The predictive value of the combined model was higher than that of the traditional model ( Z=5.01, P<0.001), the PET model ( Z=1.99, P=0.047), and the CT model ( Z=3.25, P=0.001). In the validation set, the AUCs for the traditional model, PET model, CT model, and combined model were 0.65 (95% CI: 0.52-0.77), 0.86 (95% CI: 0.74-0.93), 0.85 (95% CI: 0.73-0.93), and 0.90 (95% CI: 0.80-0.96), respectively. The predictive value of the combined model was superior to that of the traditional model ( Z=3.23, P=0.001). The sensitivity and specificity of the combined model in the training set were 84.37% and 91.03%, while in the validation set, the sensitivity and specificity were 82.61% and 94.74%, respectively. Calibration curves showed a good agreement between the predicted and actual probabilities in both the training and validation sets. DCA showed that the combined models had good discriminative ability in both the training and validation sets. Conclusions:Tumor marker levels, vacuolar sign, SUV max, Radscore-PET, and Radscore-CT are all independent influencing factors for predicting lymph node metastasis in patients with NSCLC. The combined model based on these factors demonstrates excellent predictive performance and clinical application value for predicting lymph node metastasis in NSCLC.

Objective To analyze the medication law and academic thoughts of national TCM master Qian Ying in the treatment of chronic hepatitis B through data mining.Methods Totally 168 cases of chronic hepatitis B treated by Professor Qian Ying from Mar.2000 to Dec.2020 were retrospectively collected,and the properties,tastes and tropism meridians,core prescriptions and drug groups of the prescription drugs were analyzed by using the famous doctor inheritance platform.Results Totolly 168 medical cases involved 168 patients and 227 kinds of Chinese materia medica,with a total frequency of 2 158 times.The characteristics of properties,tastes and tropism meridians showed that the main property was cold,and the main taste was bitter,and the main meridian was liver meridian.34 kinds of high-frequency Chinese materia medica(mainly were tonics,heat-clearing medicines,and medicines for activating blood circulation and reducing stasis),28 kinds of core Chinese materia medica,10 pairs of highly co-occurring drugs,and 10 potential drug groups were mined.Conclusion Professor Qian Ying believes that the pathogenesis of chronic hepatitis B is deficiency in nature and excess in superficiality,and the treatment focuses on tonifying deficiency.It is often treated from the liver and emphasizes the harmonization of liver,spleen and kidney.Tonifying deficiency,clearing heat,promoting blood circulation and removing blood stasis are the main treatment methods,followed by dispelling dampness,promoting qi,eliminating phlegm,opening stagnation and relieving the exterior,etc.He pays attention to the harmonization of body and use,is good at using multiple methods.

Objective:To explore the value of baseline PET/CT parameters for predicting prognosis in patients with double-expression lymphoma (DEL).Methods:The clinical and 18F-FDG PET/CT data of 118 patients (66 males, 52 females; age: 28-85 years) with diffuse large B-cell lymphoma (DLBCL) diagnosed in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University and the First Affiliated Hospital of Nanjing Medical University from June 2015 to September 2022 were retrospectively analyzed. The optimal thresholds for SUV max, total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in predicting overall survival (OS) rate were determined using ROC curve analysis. Univariate and multivariate analyses, along with Kaplan-Meier survival analysis were performed to construct a survival prediction model. The effect of the model was evaluated by the calibration curve for the model, the time-dependent ROC curve analysis and decision curve analysis. Results:As of the last follow-up, 25 patients died, and the OS rate was 78.8%(93/118). The AUC of the ROC curve for TMTV was 0.705, with a corresponding optimal threshold of 230.9 cm 3. In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG PS) score (hazard ratio ( HR)=3.886, 95% CI: 1.455-10.375; P=0.007) and TMTV ( HR=4.649, 95% CI: 1.665-12.979; P=0.003) were identified as independent predictors of OS. The combined model of ECOG PS score and TMTV was superior to ECOG PS score model and TMTV model alone in predicting OS. Conclusion:TMTV, a metabolic indicator, and ECOG PS score, a clinical risk factor, are independent predictors of OS in patients with DEL, and their combination can provide more accurate prognostic predictions.

Objective To study the medication law of Professor Qian Ying in the treatment of primary liver cancer based on data mining technology;To provide ideas for the clinical treatment of primary liver cancer.Methods Outpatient TCM prescriptions of Professor Qian Ying for the treatment of liver cancer from November 2008 to August 2020 were collected,and a data table was established after sorting.The drug frequency,property and taste and tropism were analyzed using Excel 2019.The medical case analysis module of the Great Physician Inheritance Platform was used to analyze the core drugs,the symbiosis analysis between drug pairs,the drug association analysis,and the drug clustering analysis of the screened TCM prescriptions.Results Totally 108 prescriptions were included,involving 188 kinds of Chinese materia medica,with a total frequency of 1 322 times.High-frequency drugs included Hedyotis Sinensis,Angelicae Sinensis Radix,Visci Herba,Curcumae Radix,Salviae Miltiorrhizae Radix et Rhizoma,etc.The medicinal properties were mainly cold,mild and warm,and the tastes were mainly bitter,sweet and pungent,and the main meridians were liver meridians,spleen meridians,kidney meridians and stomach meridians.There were 9 pairs of high frequency drug combinations in drug association,such as Curcumae Radix-Polygoni Orientalis Fructus,Visci Herba-Curcumae Rhizoma.In the correlation analysis of drug disease,the ones with higher correlations include"stomachache-Salviae Miltiorrhizae Radix et Rhizoma""abdominal mass-Paeoniae Radix Rubra and Citri Reticulatae Pericarpium""tinnitus-Adenophorae Radix,Lycii Fructus,Visci Herba""prolonged sublingual collaterals-Curcumae Rhizoma,Polygoni Orientalis Fructus,Salviae Miltiorrhizae Radix et Rhizoma"and so on.Drug clustering could be divided into three potential drug clusters.Conclusion Professor Qian Ying often uses heat-clearing drugs,tonifying drugs,and promoting qi and blood circulation drugs to treat liver cancer,with Huqi Powder as the main formula and modified according to the syndromes.Clearing heat and detoxifying,soothing liver and relieving depression,removing blood stasis and regulating collatrals are used to treat its symptoms,and tonifying qi and invigorating spleen,regulating liver and nourishing liver and kidney are used to treat its essence.

Objective:To explore whether baseline PET metabolic parameters combined with B-cell lymphoma-2 (Bcl-2)/cellular-myelocytomatosis viral oncogene (c-Myc) dual expression (DE) can improve the prognostic stratification of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).Methods:From March 2011 to November 2019, 74 patients (33 males, 41 females; age: 20-87 years) pathologically diagnosed with PGI-DLBCL prior to treatment in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and the First Affiliated Hospital of Nanjing Medical University were retrospectively included. Baseline PET/CT scans were calculated automatically using the boundaries of voxels presenting a SUV max≥2.5, and metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were determined. Expressions of Bcl-2 and c-Myc were detected at protein levels by immunohistochemistry (IHC). A predicting model comprised of MTV and DE was constructed and patients were divided into 3 groups, including low-risk group (low MTV and non-DE), mediate-risk group (high MTV or DE) and high-risk group (high MTV and DE). The distributions of progression-free survival (PFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results:Of 74 patients, 20 relapsed or progressed, 13 died, and 29.7%(22/74) patients were DE positive. Multivariate analysis revealed that MTV (hazard ratio ( HR)=9.110, 95% CI: 1.429-18.615, P=0.012) and DE ( HR=9.837, 95% CI: 1.690-57.260, P=0.011) were independent predictors of PFS, while MTV ( HR=12.470, 95% CI: 3.356-46.336, P<0.001) was the only independent predictor of OS. In the predicting model for PFS, low-risk group ( n=42) and mediate-risk group ( n=20) exhibited significant difference ( χ2=7.84, P=0.005), and mediate-risk group and high-risk group ( n=12) also exhibited significant difference ( χ2=18.72, P<0.001). Conclusions:MTV and DE can independently predict PFS of patients with PGI-DLBCL, and MTV can independently predict OS. The predicting model for PFS combining MTV with DE may further improve the ability of clinicians to stratify patients in terms of differential prognoses.

Objective:To explore the prognostic role of baseline 18F-FDG PET/CT metabolic parameters for patients with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Methods:From February 2010 to January 2019, 47 PTCL-NOS patients (29 males, 18 females, age: (59.7±13.6) years) from Nanjing Drum Tower Hospital were retrospectively enrolled. Each patient underwent baseline 18F-FDG PET/CT imaging before treatment. The total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) were computed by using the margin threshold of 41% SUV max. Kaplan-Meier survival analysis, univariate and multivariate Cox proportional hazards regression models were used to evaluate progression-free survival (PFS) and overall survival (OS). Results:Over the follow-up of 5-119 months, 25 patients had disease progression, including 24 deaths. SUV max (hazard ratio ( HR)=8.581, 95% CI: 1.950-37.764, P=0.004), TMTV( HR=9.677, 95% CI: 3.521-26.593, P<0.001), TLG( HR=3.647, 95% CI: 1.245-10.682, P<0.001) and prognostic index for T-cell lymphoma (PIT; HR=4.593, 95% CI: 1.792-11.773, P=0.002) were significant predictors of PFS and OS( HR=8.720, 95% CI: 1.982-83.354, P=0.004; HR=9.325, 95% CI: 3.423-25.408, P<0.001; HR=3.439, 95% CI: 1.170-10.110, P<0.001; HR=4.437, 95% CI: 1.728-11.393, P=0.002). After multivariate analysis, TMTV was the independent predictor of PFS ( HR=4.371, 95% CI: 1.066-16.541, P<0.001) and OS ( HR=4.978, 95% CI: 1.123-21.329, P<0.001). The substratification analysis showed that patients with high TMTV(≥168.3 cm 3) had worse prognosis than those with low TMTV (<168.3 cm 3) for PFS ( χ2=14.60, P<0.001) and OS ( χ2=16.81, P<0.001) in low PIT (0-1) group, while patients with high TMTV had worse prognosis than those with low TMTV for PFS ( χ2=4.09, P=0.043) in high PIT (≥2) group. Conclusions:Baseline PET/CT metabolic parameters including SUV max, TMTV, TLG and PIT are able to predict survival in PTCL-NOS patients. TMTV is the independent predictor of PFS and OS, which can substratify PTCL-NOS patients in PIT group.

Objective:To improve the understanding of the diagnosis and treatment of early T-cell precursor acute lymphoblastic leukemia (ETP-ALL).Methods:The clinical data of a patient with ETP-ALL who was misdiagnosed as peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) admitted to the Second Hospital of Lanzhou University in October 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:The patient who presented "inguinal lymphadenopathy" as the first symptom underwent lymph node biopsy and pathological examination at local hospital, and he was diagnosed as PTCL-NOS according to the consultation of another 2 hospitals. After 2 courses of chemotherapy (CHOPE regimen, GLD regimen, unknown specific medication and dosage), the therapeutic efficacy was poor. For further diagnosis and treatment, this patient came to Lanzhou University Second Hospital. Flow cytometry found blast cells in the bone marrow, and then other related examinations were completed, he was finally diagnosed as ETP-ALL. The chemotherapy regimens of Hyper-CVAD and EA were alternatively used, progressive disease (PD) occurred after 3 courses of treatment, and chidamide was added in the 4th and 5th courses of treatment, the disease still progressed, and the patient died after follow-up. The disease course of the patient was about 12 months.Conclusions:ETP-ALL has unique immunophenotypic characteristics. ETP-ALL patients have a low remission rate after conventional induction therapy, high recurrence rate and poor prognosis. Currently, there is no effective standard treatment regimen, and allogeneic hematopoietic stem cell transplantation or timely addition of new drugs may improve the prognosis.

Objective:To explore the value of 18F-FDG PET/CT in detecting Richter syndrome (RS) in chronic lymphocytic leukemia (CLL) patients. Methods:From August 2010 to November 2019, 101 histologically confirmed CLL patients (62 males, 39 females; age (58.0±12.7) years) who underwent PET/CT in Nanjing Drum Tower Hospital and the First Affiliated Hospital of Nanjing Medical University were retrospectively included. ROI was drawn and PET/CT images were semi-quantitatively examined by estimating SUV max. Mann-Whitney U test was used to compare the SUV max of RS and non-RS patients. ROC curve analysis was utilized to analyze the optimal cut-off value of SUV max in detecting RS. Results:RS was histologically confirmed in 27 CLL patients. The SUV max of RS patients was 13.7(11.0, 20.1), which was significantly higher than that of non-RS patients (4.1(3.1, 5.8); z=-6.48, P<0.001). ROC curve analysis identified the optimal cut-off value of SUV max was 10.0 and the AUC was 0.923, with accuracy of 94.1%(95/101), sensitivity of 85.2%(23/27), specificity of 97.3%(72/74), positive predictive value of 92.0%(23/25) and negative predictive value of 94.7%(72/76). Conclusion:As the semi-quantitative index measured by 18F-FDG PET/CT, SUV max can help to diagnose RS and provide important information for clinical use.

Objective: To evaluate the safety, feasibility and operational effectiveness of master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ in upper gastrointestinal endoscopy examination in living pigs. Methods: Seven Guangxi BA-MA Mini-pigs underwent upper gastrointestinal endoscopy examination with master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ and Olympus GIF-Q260J gastroendoscope (Japan). The experiment divided into manual operation group and robot operation group. Nine gastroenterologists skilled with endoscopy operation handled the robot once in vitro to familiar with the mechanism and method of robot operation. And then performed manual operation and robot operation four times each. Endoscopy pictures and operation time were recorded. T test and one-way analysis of variance were performed for statistical analysis. Results: Both manual operation and robot operation could successfully finish standard esophagus and stomach endoscopic examination. There were no complications such as hemorrhage, perforation, mistaken insertion into of trachea, injures of pharynx and larynx and inhalation pneumonia. Esophagus, gastric cardia, gastric fundus, gastric body, gastric angle, gastric antrum and gastric pylorus could be clearly observed in both groups. The manual operating time of nine gastroenterologists was (3.67±1.95) minutes, which was shorter than that of robot operating time ((7.60±2.00) minutes), and the difference was statistically significant (t=8.445, P<0.01). The time of first in vitro operation performed by nine gastroenterologist was (13.10±6.32) minutes. The operation times of each case of nine gastrienterologist were (8.49±0.90) minutes, (7.50±1.19) minutes, (7.30±1.33) minutes and (7.12±1.61) minutes. The difference was statistically significant (F=7.901, P<0.01). Operation time gradually shortened and operation proficiency significantly improved. Conclusion Master-slave system controlled Robot-assisted flexible endoscopy 'YunSRobot’ which provides a clear observation of esophagus and stomach is safe in endoscopic examination of living animal.

Objective To provide safety reference for the development of anti-cancer drugs by evaluating thetoxicological safety of the anticancer bioactive fraction AMH-T of lichen through the understanding of its poisonous nature and the intensity.Methods Acute toxicity test,bone marrow micronucleus test in mice,sperm malformation test in rats,Ames test and short-term repeat drug test in mice were conducted.Results Male mice were injected LD50 of 147 mg/kg and female mice 171 mg/kg.Conclusion Injection of AMH-T has acute toxicity and liver toxicity,but has no genetic toxicity.