In recent years, the application of artificial intelligence technology in rectal cancer radiotherapy has become increasingly significant. By constructing models from patient clinical information, accurate prediction of dose distribution, treatment effect, and toxic side effects of rectal cancer can be achieved. This allows optimizing the radiotherapy plan, ensuring the dose is focused on the tumor target area while reducing the radiation damage to the bladder, rectum, and other surrounding tissues. Thus, it can achieve precision and personalization in radiotherapy. In this review, the construction method of artificial intelligence predictive models was described, and the value of different predictive factors to the model was systematically analyzed, including patient clinical data, radiomics, and dosimetry. Moreover, the application and limitations of artificial intelligence predictive models in radiotherapy were summarized. This information can serve as a reference for the clinical application of artificial intelligence predictive models in rectal cancer radiotherapy.

Objective:To investigate resting-state regional homogeneity in patients with bipolar disorder in different mood states and the potential trait imaging markers of bipolar disorder.Methods:This is a cross-sectional study involving 169 patients who met the diagnosis criteria of bipolar disorder in DSM-Ⅳ-TR (including 68 patients with bipolar depression, 29 patients with bipolar (hypo)mania, 72 patients with bipolar euthymia) and 113 controls matched by age and gender. The severity of depression, mania, and the positive and negative affects were assessed by the Hamilton Depression Scale (HAMD 17), Young Mania Rating Scale (YMRS), and Positive and Negative Affect Schedule (PANAS). Resting-state fMRI data were obtained. After fMRI data processing, 64 patients with bipolar depression, 28 patients with bipolar (hypo)mania, 66 patients with bipolar euthymia, and 112 controls were included in the final analysis. The regional homogeneity (ReHo) values were computed, and analysis of covariance was performed on ReHo values among the four groups. Post hoc analysis was conducted based on the ReHo values extracted from the brain regions with significant differences. The relationship between the ReHo values and clinical scores was examined. Results:Significant ReHo differences were observed in the bilateral posterior cerebellum ( F=11.41 for left, F=10.45 for right), bilateral calcarine cortex ( F=10.60 for left, F=9.59 for right), and right superior temporal gyrus ( F=10.58). Compared to controls, bipolar patients in all mood states demonstrated decreased ReHo in the left posterior cerebellum ( P<0.01 for all) and increased ReHo in the right posterior cerebellum ( P<0.05 for all), bilateral calcarine cortex and right superior temporal gyrus ( P<0.01 for all). The clinical score of negative affects was negatively correlated with the ReHo values in the right calcarine cortex ( r=-0.17, P=0.04, uncorrected). Conclusions:Bipolar disorder is characterized by regional homogeneity changes in the bilateral posterior cerebellum, bilateral calcarine cortex and right superior temporal gyrus across different mood states. The functional abnormalities in the cerebellum, visual network and sensorimotor network could comprise a trait biomarker for bipolar disorder.

Objective:To investigate resting-state regional homogeneity in patients with bipolar disorder in different mood states and the potential trait imaging markers of bipolar disorder.Methods:This is a cross-sectional study involving 169 patients who met the diagnosis criteria of bipolar disorder in DSM-Ⅳ-TR (including 68 patients with bipolar depression, 29 patients with bipolar (hypo)mania, 72 patients with bipolar euthymia) and 113 controls matched by age and gender. The severity of depression, mania, and the positive and negative affects were assessed by the Hamilton Depression Scale (HAMD 17), Young Mania Rating Scale (YMRS), and Positive and Negative Affect Schedule (PANAS). Resting-state fMRI data were obtained. After fMRI data processing, 64 patients with bipolar depression, 28 patients with bipolar (hypo)mania, 66 patients with bipolar euthymia, and 112 controls were included in the final analysis. The regional homogeneity (ReHo) values were computed, and analysis of covariance was performed on ReHo values among the four groups. Post hoc analysis was conducted based on the ReHo values extracted from the brain regions with significant differences. The relationship between the ReHo values and clinical scores was examined. Results:Significant ReHo differences were observed in the bilateral posterior cerebellum ( F=11.41 for left, F=10.45 for right), bilateral calcarine cortex ( F=10.60 for left, F=9.59 for right), and right superior temporal gyrus ( F=10.58). Compared to controls, bipolar patients in all mood states demonstrated decreased ReHo in the left posterior cerebellum ( P<0.01 for all) and increased ReHo in the right posterior cerebellum ( P<0.05 for all), bilateral calcarine cortex and right superior temporal gyrus ( P<0.01 for all). The clinical score of negative affects was negatively correlated with the ReHo values in the right calcarine cortex ( r=-0.17, P=0.04, uncorrected). Conclusions:Bipolar disorder is characterized by regional homogeneity changes in the bilateral posterior cerebellum, bilateral calcarine cortex and right superior temporal gyrus across different mood states. The functional abnormalities in the cerebellum, visual network and sensorimotor network could comprise a trait biomarker for bipolar disorder.

Objective： ：To detect the gene mutation in cholangiocarcinoma patients using the next generation sequencing (NGS) technology, and to analyze its correlation to the prognosis of the patients. Methods: From June 2016 to June 2018, 40 patients diagnosed with cholangiocarcinoma received NGS examination to screen the possible mutations (single base mutation, structural variation, copy number variation and gene fusion, etc.). The disease control rates (DCR), progression-free survival (PFS) and overall survival (OS) of the patients, who received the first line therapy, were retrospectively reviewed to analyze the relationship between signaling pathway as well as its genetic variation and the prognosis of cholangiocarcinoma patients. Results: The median PFS of patients with and without TP53 mutation was 11.0 and 8.3 months, respectively (P=0.332), while OS was 14.3 and 32.9 months, respectively (P=0.041). The median PFS of patients with and without PI3K mutations was 8.3 and 11.0 months, respectively (P=0.285), while OS was 14.3 and 37.0 months, respectively (P=0.020). The median PFS of patients with and without mTOR pathway mutations was 6.3 and 10.3 months, respectively (P=0.020), while OS was 15.6 and 19.6 months, respectively (P=0.892). There was no significant effect of pathway-related gene mutations on patients’survival. Conclusion: The prognosis of cholangiocarcinoma patients with TP53 and PI3K pathway activation had obviously poor prognosis than those without. No significant difference was observed between the patients with and without mTOR pathway activation and IDH mutation.

Objective To explore the changes of functional connectivity patterns of dorsolateral prefrontal cortex(DLPFC)related to emotion management in patients with bipolar Ⅱdepression under the resting state. Methods The general demographic and clinical data of 30 patients with bipolar Ⅱdepression and gender-and age-matched healthy controls were collected.All subjects completed the resting-state functional magnetic resonance scans. After the imaging preprocessing, seed- based functional connectivity analysis was performed on the bilateral DLPFC using REST software.The single sample t test was used to analyze the connection distribution pattern of each DLPFC region of interest in the group.The independent sample t test was used to compare the differences between two groups of DLPFC functional connections with age and sex covariate.Subsequently,Pearson correlation analysis was performed between the mean connectivity values of regions showing significant group differences and depressive severity (HAMD17scores). Results Compared with healthy controls, patients with bipolar Ⅱ depression showed abnormally increased functional connectivity between the left DLPFC seed and the right superior medial frontal gyrus, left superior, middle, inferior temporal gyri, right superior temporal gyrus and right parahippocampal gyrus(t=4.809,4.689,4.912;all P<0.05), while the functional connectivity was abnormally decreased between the left DLPFC and the left inferior parietal lobule, left superior medial frontal gyrus(t=-4.065,4.625; both P<0.05). The right DLPFC showed abnormally reduced functional connectivity with the right middle frontal gyrus(MNI:x=42,y=36,z=30;t=-5.093,P<0.05)and the right inferior frontal gyrus(MNI:x=6,y=21,z=45;t=-4.553,P<0.05). No significant correlations were found between the mean connectivity values of the regions showing significant group differences and depressive severity (HAMD17scores). Conclusion The results suggest that patients with bipolar Ⅱ depression have altered resting state functional connectivity in the bilateral DLPFC, which may be a biological basis for abnormal emotion management of bipolar Ⅱ depression patient. Its specificity still needs to be compared with other related diseases.

Objective To explore the changes of functional connectivity patterns of dorsolateral prefrontal cortex(DLPFC)related to emotion management in patients with bipolar Ⅱdepression under the resting state. Methods The general demographic and clinical data of 30 patients with bipolar Ⅱdepression and gender-and age-matched healthy controls were collected.All subjects completed the resting-state functional magnetic resonance scans. After the imaging preprocessing, seed- based functional connectivity analysis was performed on the bilateral DLPFC using REST software.The single sample t test was used to analyze the connection distribution pattern of each DLPFC region of interest in the group.The independent sample t test was used to compare the differences between two groups of DLPFC functional connections with age and sex covariate.Subsequently,Pearson correlation analysis was performed between the mean connectivity values of regions showing significant group differences and depressive severity (HAMD17scores). Results Compared with healthy controls, patients with bipolar Ⅱ depression showed abnormally increased functional connectivity between the left DLPFC seed and the right superior medial frontal gyrus, left superior, middle, inferior temporal gyri, right superior temporal gyrus and right parahippocampal gyrus(t=4.809,4.689,4.912;all P<0.05), while the functional connectivity was abnormally decreased between the left DLPFC and the left inferior parietal lobule, left superior medial frontal gyrus(t=-4.065,4.625; both P<0.05). The right DLPFC showed abnormally reduced functional connectivity with the right middle frontal gyrus(MNI:x=42,y=36,z=30;t=-5.093,P<0.05)and the right inferior frontal gyrus(MNI:x=6,y=21,z=45;t=-4.553,P<0.05). No significant correlations were found between the mean connectivity values of the regions showing significant group differences and depressive severity (HAMD17scores). Conclusion The results suggest that patients with bipolar Ⅱ depression have altered resting state functional connectivity in the bilateral DLPFC, which may be a biological basis for abnormal emotion management of bipolar Ⅱ depression patient. Its specificity still needs to be compared with other related diseases.

OBJECTIVETo investigate the significance of serum IgD quantitation in evaluation of clinical efficacy in IgD myeloma.

METHODSSerum IgD and free light chain (sFLC) levels were determined by immune scatter turbidimetry with SPA plus analysis machine in 29 patients with IgD multiple myeloma (MM) achieving VGPR or better response following previous treatments. The concurrent immunofixation electrophoresis (IFE) results were also incorporated and analyzed.

RESULTSIncreased IgD levels were detected in 1 of 12 patients achieving sCR, 2 of 5 patients achieving CR and 4 of 12 patients achieving VGPR, respectively. The median progression-free survival (PFS) was 38.5 months, 34.1 months and 15.5 months for patients achieving sCR, CR and VGPR, respectively, with a significant difference between sCR and VGPR groups (P=0.022), and between CR and VGPR groups (P=0.018). There was no difference in overall survival (OS) among sCR, CR and VGPR groups (P>0.05). The median PFS were 7.8, 33.7 and 43.9 months, respectively for the patients with both abnormal sFLC ratios and IgD levels (6 cases, Group A), with either abnormal sFLC ratios or increased IgD levels (10 cases, Group B) or with normal sFLC ratios and IgD levels (13 cases, Group C). A significant PFS benefit of Group A over Group C was found (P=0.033), and no differences in terms of OS among three groups (P>0.05).

CONCLUSIONIgD levels may remain abnormal in IgD MM patients who have achieved VGPR or better response, and IgD quantitation represented a useful assay complementary to the current lab examinations. IgD quantitation assay was of significance in clinical efficacy evaluation and survival judgement, and should be incorporated into the evaluation parameters used for IgD MM in addition to sFLC and IFE assays.

Disease-Free Survival ; Humans ; Immunoglobulin D ; blood ; Immunoglobulin Light Chains ; blood ; Multiple Myeloma ; blood ; diagnosis ; Nephelometry and Turbidimetry ; Remission Induction ; Treatment Outcome

OBJECTIVETo explore the efficacy and prognostic factors of induction therapy combined with autogenetic peripheral blood stem cells transplantation (APBSCT)in patients with multiple myeloma (MM).

METHODSFrom January 1998 to May 2015, 201 patients with MM were enrolled. All patients received APBSCT after induction therapy. With the follow up to 20 June 2015, the overall survival (OS), progression free survival (PFS)and prognostic factor were analyzed.

RESULTS① With a media follow up of 36.67 months, the median PFS and OS were 22.87 (17.48- 28.26)and 69.63 (63.57- 75.69)months, 5-year PFS and OS were 17% and 49%, respectively. ②After APBSCT, when the subgroup (n= 112) achieved complete response (CR)compared with the subgroup (n=89) not achieved CR, the median PFS were 32.93 (21.03-44.83) and 18.13 (14.46-21.80) months (P<0.001), respectively; And the media OS were 96.77 (71.79- 121.75)and 54.70 (49.53- 59.87) months (P=0.004), respectively. The risks for disease progression and death declined in CR subgroup. ③ Two subgroups included or not included bortezomib/thalidomide at induction therapy (123 patientsvs 21 patients), the media PFS were 31.67 (24.36- 38.98)and 15.20 (10.11- 20.29) months (P=0.013), respectively; And the media OS were 76.30 (55.44- 97.15)and 52.03 (33.76- 70.30) months (P=0.014), respectively. ④According to the ISS stage, the media OS of stageⅠ, Ⅱ, Ⅲ were 99.47 (59.58-139.36), 66.77 (52.17-81.37), 53.97 (28.71-79.23) (P< 0.001), respectively. The risk for death of stage Ⅱ, Ⅲ were 2.16 and 3.04 times higher than stage Ⅰ, with no difference in terms of PFS. ⑤ The media PFS in IgD (n=22) and IgG (n=101) type MM were 11.17 (10.27- 13.13)and 35.43 (22.69- 48.17)months (P=0.007) , respectively; The media OS were 30.83 (0.24-61.42)and 70.70 (53.52-87.88) months (P=0.039), respectively. The risk for disease progression of IgD type was 2.47 times higher than IgG type. ⑥ Patients received 1 line induction therapy (n=132) compared with more than 1 line (n=69), the media PFS were 25.43 (16.09- 34.77)and 20.27 (15.04- 25.50) months (P=0.042). ⑦Cox analysis showed that CR after APBSCT and ISS stage were independent prognostic factors for OS. IgD type MM and CR after APBSCT were independent prognosis factor for PFS.

CONCLUSIONCR after APBSCT and ISS stage were independent prognostic factors for OS in MM. CR after APBSCT was independent prognostic factor for PFS in MM. However, disease progression more likely occurred in IgD type MM, which was independent negative prognostic factor for PFS in MM.

Antineoplastic Combined Chemotherapy Protocols ; Bortezomib ; therapeutic use ; Disease-Free Survival ; Humans ; Multiple Myeloma ; diagnosis ; therapy ; Neoadjuvant Therapy ; Peripheral Blood Stem Cell Transplantation ; Prognosis ; Remission Induction ; Survival Rate ; Thalidomide ; therapeutic use ; Transplantation, Autologous ; Treatment Outcome

Objective:To evaluate the benefit of autologous stem cell transplantation (ASCT) as a consolidation therapy in the survival of multiple myeloma (MM) patients at different risks. Methods:A total of 67 MM patients who received ASCT as consolida-tion therapy between August 2006 and July 2011 were enrolled in the retrospective study. The cases were divided into three risk groups on the basis of the International Staging System and fluorescence in situ hybridization. Another 67 patients who accepted consolidation chemotherapy at the same period were selected as case-paired controls matched in terms of age, sex, optimal response after induction, and risk stratifications. All the patients received bortezomib-and/or thalidomide-based induction therapies. Results:No statistical differ-ences in non-complete remission (nCR)/complete remission (CR) rate were observed between the ASCT and chemotherapy groups (44.8%vs. 37.3%, P=0.380) after the induction therapy. The progression-free survival (PFS) was longer in the ASCT group than in the chemotherapy group (32.4 months vs. 15.1 months, P<0.001). The overall survival (OS) was longer in the ASCT group than in the che-motherapy group (58.8 months vs. 42.1 months, P=0.009). both the PFS (median:30.5 months vs. 11.2 months, P<0.001) and the OS (median:85.5 months vs. 34 months, P=0.015) rates were significantly prolonged in the high-risk subgroup after ASCT. In the interme-diate-risk subgroup, neither PFS nor OS showed any significance after ASCT (P>0.05). In the low-risk subgroup, only PFS was extend-ed (median: 34.8 months vs. 17.6 months, P=0.012) after ASCT, without significant improvements in the OS (P>0.05). Conclusion:The MM patients obtained cytogenetic high-risk benefits mostly from ASCT consolidation after inductions based on novel agents.

Multiple myeloma (MM) is a hematological malignancy. Osteolytic lesion is the commonest complication in patients with MM. Skeletal-related events severely affect the survival quantity and prognosis. Current therapeutic approach for the treatment of myeloma bone disease (MBD) is based on the use of bisphosphonates. AS the recent advance in the pathogenesis and therapeutics of MBD,more factors related to this disease are found. In this article important factors related to the pathogenes of MBD and the cytokine targeted therapies are reviewed.