Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Objectives:To assess the impact of intravascular ultrasound(IVUS)guidance for drug-eluting stent(DES)implantation on the long-term outcomes in coronary artery disease(CAD)patients with chronic kidney disease(CKD).Methods:A retrospective study was conducted on 1 800 CAD and CKD patients who underwent coronary DES implantation at Nanjing First Hospital from January 2018 to December 2022.Patients were divided into IVUS-guided group(IVUS group,n=333)and angiography-guided group(angiography group,n=1 467).Propensity score matching(PSM)was performed at a 1:2 ratio to adjust for differences in baseline clinical and angiographic characteristics between the two groups.Major adverse cardiovascular events(MACE),including cardiac death,target vessel myocardial infarction,and clinically driven target vessel revascularization,were evaluated over a 2-year follow-up.Cox proportional hazards regression was performed to identify independent predictors of MACE.Results:After propensity score matching,333 patients in the IVUS group were matched with 666 patients in the angiography group.Following matching,there were no significant differences in clinical characteristics and angiographic data between the two groups(all P>0.05).Regarding procedural data,IVUS group had a higher number of stents implanted,longer total stent length,larger average stent diameter,more frequent use of post-dilation balloons,larger post-dilation balloon diameter,and greater contrast agent usage(all P<0.05).MACE rate was significantly higher in the angiography group than that in the IVUS group(23.9%vs.18.0%,P=0.037).The difference was mainly attributed to a higher rate of cardiac death in the angiography group(16.1%vs.10.8%,P=0.013).Additionally,patients in angiography group had a significantly higher all-cause mortality rate compared to IVUS group(19.7%vs.13.8%,P=0.022).Multivariate cox regression analysis showed that IVUS guidance(HR=0.73,95%CI:0.55-0.99,P=0.042)was an independent protective factor,while hypertension(HR=1.60,95%CI:1.13-2.26,P=0.008),type 2 diabetes(HR=1.56,95%CI:1.19-2.05,P=0.001),acute coronary syndrome(HR=1.92,95%CI:1.12-3.30,P=0.018),and moderate to severe calcification(HR=1.55,95%CI:1.18-2.04,P=0.002)were independent risk factors for MACE at 2 years after DES implantation in CKD patients.Conclusions:Patients with CAD and CKD,IVUS-guided DES implantation is associated with a reduced risk of MACE and all-cause mortality at 2 years post-procedure compared to coronary angiography-guided implantation.

Objectives:To assess the impact of intravascular ultrasound(IVUS)guidance for drug-eluting stent(DES)implantation on the long-term outcomes in coronary artery disease(CAD)patients with chronic kidney disease(CKD).Methods:A retrospective study was conducted on 1 800 CAD and CKD patients who underwent coronary DES implantation at Nanjing First Hospital from January 2018 to December 2022.Patients were divided into IVUS-guided group(IVUS group,n=333)and angiography-guided group(angiography group,n=1 467).Propensity score matching(PSM)was performed at a 1:2 ratio to adjust for differences in baseline clinical and angiographic characteristics between the two groups.Major adverse cardiovascular events(MACE),including cardiac death,target vessel myocardial infarction,and clinically driven target vessel revascularization,were evaluated over a 2-year follow-up.Cox proportional hazards regression was performed to identify independent predictors of MACE.Results:After propensity score matching,333 patients in the IVUS group were matched with 666 patients in the angiography group.Following matching,there were no significant differences in clinical characteristics and angiographic data between the two groups(all P>0.05).Regarding procedural data,IVUS group had a higher number of stents implanted,longer total stent length,larger average stent diameter,more frequent use of post-dilation balloons,larger post-dilation balloon diameter,and greater contrast agent usage(all P<0.05).MACE rate was significantly higher in the angiography group than that in the IVUS group(23.9%vs.18.0%,P=0.037).The difference was mainly attributed to a higher rate of cardiac death in the angiography group(16.1%vs.10.8%,P=0.013).Additionally,patients in angiography group had a significantly higher all-cause mortality rate compared to IVUS group(19.7%vs.13.8%,P=0.022).Multivariate cox regression analysis showed that IVUS guidance(HR=0.73,95%CI:0.55-0.99,P=0.042)was an independent protective factor,while hypertension(HR=1.60,95%CI:1.13-2.26,P=0.008),type 2 diabetes(HR=1.56,95%CI:1.19-2.05,P=0.001),acute coronary syndrome(HR=1.92,95%CI:1.12-3.30,P=0.018),and moderate to severe calcification(HR=1.55,95%CI:1.18-2.04,P=0.002)were independent risk factors for MACE at 2 years after DES implantation in CKD patients.Conclusions:Patients with CAD and CKD,IVUS-guided DES implantation is associated with a reduced risk of MACE and all-cause mortality at 2 years post-procedure compared to coronary angiography-guided implantation.

Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Boron neutron capture therapy(BNCT)is an advanced radiotherapy combined with targeted therapy and heavy ion therapy. BNCT is based on the nuclear reaction 10B (n, α) 7Li that occurs when boron-10 isotopes is irradiated with neutrons of the appropriate energy to produce high-energy recoiling 7Li nuclei and α particles. The released high linear energy transfer (LET) particles have path lengths of approximately one cell diameter (5-9 μm) and deposit most of their energy within the boron-containing tumor cells. BNCT has the advantages of precise tumor targeting, less damage to normal tissue and fewer irradiation fractionations (1-3 fractionations) than conventional radiotherapy (30 fractionation). The neutrons used in BNCT are produced by reactors or accelerators. The boron drugs used in clinical trials include BPA and BSH. In this paper, we review the clinical trial status and the significant progress of BNCT for head and neck tumors. The clinical data have approved the effectiveness of BNCT in the treatment of head and neck cancer. With the technical improvement of accelerator neutron source and the development of new boron drugs, BNCT will play a more important role in the field of clinical radiotherapy in the future.

Objective:To investigate the diagnostic value and cutoff value of the basal luteinizing hormone (LH) level for central precocious puberty (CPP) in girls with different body mass index (BMI) values.Methods:A total of 1 087 girls aged 6 to 8 years old with breast development and visiting the Department of Endocrine Genetics and Metabolism, Fuzhou Children′s Hospital of Fujian Medical University from January 2014 to December 2018 were enrolled.The girls had the breast development of Tanner stage B2 or B3.They were divided into groups of normal weight (840 cases), overweight (133 cases) and obesity (114 cases) according to BMI percentiles corresponding to their age and sex.All individuals underwent gonadotropin-releasing hormone (GnRH) agonist test.Statistical analysis was performed using SPSS 18.0 software, and the receiver operating characteristic (ROC) curve was drawn.Results:In the normal weight group, 393 girls were positive and 447 girls were negative for GnRH test.In the overweight group, 72 girls were positive and 61 girls were negative for GnRH test.In the obesity group, 40 girls were positive and 74 girls were negative for GnRH test.The areas under the ROC curve (AUC) of the basal LH level for the diagnosis of CPP in the normal weight, overweight, and obese girls were 0.826, 0.774, and 0.801, respectively.When the Youden index was maximum, the cutoff values of the basal LH level were 0.245 IU/L, 0.225 IU/L and 0.145 IU/L, respectively; the sensitivities were 63.9%, 65.3%, and 80.0%, respectively; the specificities were 87.9%, 82.0%, and 71.6%, respectively.When the cutoff value of the basal LH level was 0.455 IU/L in the normal weight group, 0.480 IU/L in the overweight group, and 0.335 IU/L in the obesity group, the specificities of the 3 groups were all above 96.6%.Conclusions:It is reliable to use the basal LH level for CPP diagnosis for girls with different BMI values.The cutoff value of the basal LH level for CPP diagnosis in obese girls is the lowest.

Objective: To investigate the correlation between c-kit mRNA expression and prognosis in patients with rectal carcinoma. Methods: The expression of c-kit mRNA in rectal carcinoma tissues(n=66) was detected by multiplex branched-DNA liquid chip method. According to the expression level, the patients were classified into the c-kit mRNA high expression group and the low group. We analyzed the relationship between the c-kit mRNA expression and the clinicopathological characteristics of patients, as well as the factors affecting patients′prognosis. Results: Of the 66 rectal carcinoma patients, 18(27.3%)cases were c-kit mRNA high expression. No significant correlation was found between the c-kit mRNA expression and gender, age, preoperative carcinoembryonic antigen, preoperative hemoglobin, distance to verge, lymph node metastasis, tumor thrombus, T stage, TNM stage and tumor differentiation (P>0.05). In follow-up, 34 patients died, 32 patients and 36 patients were recurrence or metastasis. The 1-, 3-, 5-year overall survival(OS) of c-kit mRNA high expression group were 100.0%, 77.8%, 77.8%, respectively, while those of the low one were 93.8%, 56.3%, 45.8%, respectively. The difference was statistically significant(P=0.025). Lymph node metastasis, T stage and TNM stage were also significant associated with OS(P<0.05). The 1-, 3-, 5-year disease free rate (DFS)of the c-kit mRNA high expression group were 100.0%, 77.8% and 77.8%, respectively, while those of the low one were 77.1%、43.8% and 41.7%, respectively, and the difference between the two groups was significant (P=0.044). As a reslut, c-kit mRNA expression (P=0.038) and TNM stage (P=0.039) were the independent prognostic factors affecting the OS in rectal cancer patients. Conclusions Low expression of c-kit was associated with poor prognosis of rectal carcinoma. And the mechanism underlying this phenomenon deserves further exploration.

Objective To investigate the diagnostic value of growth hormone(GH) stimulating test in dwarfism of children and related influencing factors .Methods Arginine and L‐dopa were applied to perform GH stimulating test in 642 children with dwarf‐ism .GH levels were detected at 30 ,60 ,90 ,120 ,150 ,180 min after stimulation .All children were divided into GH deficiency (GHD) group ,with peak value of GH less than 10 ng/mL ,and non‐GHD group ,with peak value of GH at least 10 ng/mL .Physical and la‐boratory data of the two groups were compared .Results The proportion of children with GHD and without GHD were 68 .69%and 31 .31% ,respectively ,and with statistical difference(χ2 =6 .19 ,P<0 .05) .The GH peak value ,with a delay ,mainly appeared at 30 and 150 min after stimulation ,accounting for 22 .42% and 34 .27% .Levels of age ,body height standard deviation ,body mass in‐dex ,alanine aminotransferase ,aspartate aminotransferase ,insulin growth factor‐1 and 25‐hydroxyl vitamin D were statistically dif‐ferent between the two groups(P<0 .05) .Conclusion Arginine and L‐dopa combined stimulating test could be used for the diagno‐sis of GHD in children with dwarfism .GH level might be correlated with various physical and laboratory parameters ,which should be considered for the diagnosis of GHD .

Objective To analyze the clinical characteristic s of an infant with congenital lipoid adrenal hyperplasia (CLAH),and to sequence the acute regulatory protein (steroid acute regulatory,StAR) gene of the infant patient and her pedigree.Methods Physical examination,laboratory tests,and imaging examination of the 11-month-old patient with CLAH were collected.DNA was extracted from blood samples of the patient and her parents.The 7 exons of StAR gene were amplified by PCR and then sequenced.Results Dark skin,girl vulva,and one each 1.0 cm×1.0 cm palpable lump in inguinal area bilaterally were observed.The adrenocorticotropic hormone (ACTH) was 253 pg/ml,cortisol was 27.6 nmol/L at 8 am,17-hydroxyprogesterone was 3 nmol/L.Uhrasound showed that sign of testicular ultrasonography existed in bilateral inguinal regions.Karyotype analysis showed 46,XY.Sequencing of PCR amplified fragments showed that there were two heterozygous mutations c.229C ＞ T,p (Gln77X) and C.659A＞G,p (His220Arg) of StAR gene in this patient.By rectifying the disturbance of electrolyte,and treating with hydrocortisone and 9α fludrocortisone,etc,the patient has been stable so far.Conclusion The patient presents typical clinical manifestations.Two heterozygous mutations including c.229C ＞T,p (Gln77X) from maternal and C.659A＞G,p (His220Arg) from paternal of StAR gene were detected.Wherein the c.659A＞G,p.(His220Arg) as a novel point mutation of StAR gene,has not been reported so far.

Objective Turner syndrome (TS) is characterized with reduced adult height and gonadal dysgenesis and associated with a number of complications including thyroid disease.The purpose of this study was to investigate the prevalence of thyroid diseases and the association between thyroid autoantibodies (TAA) and thyroid dysfunction,age,and karyotype.Methods Fifty-five girls with TS were diagnosed by chromosome analyses and were divided into 2 groups according to whether there was TAA-positive or not:TAA-positive group and TAA-negative group.Thyroid autoantibodies (antithyroglobulin antibody,thyroperoxidase antibody),thyroid function (free T3,free T4,and TSH) were determined with immunochemiluminescent.Ultrasound was applied in TAA-positive group.Results Thyroid functions in 34 TAA-negative girls were normal.Of the 21 TAA-positive girls (21/55,38.2％),7 girls suffered from hypothyroidism and 3 girls had hyperthyroidism.All of 21 TAA-positive girls were diagnosed as cases of Hashimoto's thyroiditis.As compared with the girls in TAA-negative group,the age of girls in TAA-positive group was significantly higher [(12.16 ± 2.55 vs 9.95 ± 4.50) years,P＜0.05].6 cases under 5 years old were TAA-negative.31.3 ％ (5/16) of patients aged 5-10 years old,48.1％ (13/27) aged 10-15 years old and 50.0％ (3/6) above the age of 15 were TAA-positive.There were no significant differences in the numbers of TAApositive cases among different karyotypes (P ＞ 0.05).Thyroid ultrasound in girls with positive-TAA showed the abnormal echogenicity in bilateral lobus lateralis of thyroid.Conclusion Patients with TS are prone to suffer from Hashimoto's thyroiditis leading to thyroid dysfunction,when they are older than 5 years.Thyroid function should be evaluated yearly in girls with TS after 5 years old.There is no specific association between the incidence of autoimmune thyroid disease and certain karyotypes.