Objective·To develop a machine learning approach for early identification of metabolic syndromes associated with inflammatory metabolic state changes in breast cancer patients after neoadjuvant therapy,using common laboratory and transthoracic echocardiography indices.Methods·Female patients with primary invasive breast cancer diagnosed at the Department of Breast Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,between September 2020 and September 2022,were included.General patient information,laboratory test results,and transthoracic echocardiography data were collected.After feature extraction,five machine learning algorithms,including random forest(RF),gradient boosting(GB),support vector machine(SVM),K-nearest neighbor(KNN),and decision tree(DT),were applied to construct a prediction model for the changes of the patients' metabolic state after neoadjuvant therapy,and the prediction performances of the five models were compared.Results·A total of 232 cases with valid clinical data were included,comprising 135 cases before neoadjuvant therapy and 97 cases after completing 4 cycles of neoadjuvant therapy.Feature extraction identified five key features:white blood cell count,hemoglobin,high-density lipoprotein(HDL),interleukin-2 receptor,and interleukin-8.In the multi-feature analysis,the area under the receiver operating characferistic curve(AUC)was higher in the combination of white blood cell count,hemoglobin and HDL compared to the combination of interleukin-2 receptor and interleukin-8(RF:0.928 vs 0.772,GB:0.900 vs 0.792,SVM:0.941 vs 0.764,KNN:0.907 vs 0.762,DT:0.799 vs 0.714).The RF,SVM,and GB models showed higher AUC(0.928,0.941,0.900)and accuracy(0.914,0.897,0.776).The SVM model exhibited superior accuracy in the training data compared to the RF and GB models(P=0.394,0.122 and 0.097,respectively).Conclusion·The SVM model can be used to establish a prediction model for identifying breast cancer patients at high risk of developing inflammatory metabolic state-related metabolic syndrome after neoadjuvant therapy by incorporating five common clinical indicators,namely,white blood cell count,hemoglobin,high-density lipoprotein,interleukin-2 receptor,and interleukin-8.SVM modeling may be useful for clinicians to establish individualized screening protocols based on a patient's inflammatory metabolic state.

The proteolysis targeting chimeras (PROTACs) technology has been rapidly developed since its birth in 2001, attracting rapidly growing attention of scientific institutes and pharmaceutical companies. At present, a variety of small molecule PROTACs have entered the clinical trial. However, as small molecule PROTACs flourish, non-small molecule PROTACs (NSM-PROTACs) such as peptide PROTACs, nucleic acid PROTACs and antibody PROTACs have also advanced considerably over recent years, exhibiting the unique characters beyond the small molecule PROTACs. Here, we briefly introduce the types of NSM-PROTACs, describe the advantages of NSM-PROTACs, and summarize the development of NSM-PROTACs so far in detail. We hope this article could not only provide useful insights into NSM-PROTACs, but also expand the research interest of NSM-PROTACs.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Objective:To evaluate the efficacy of individualized preoperative planning combined with various fixations in the treatment of complex multiplanar deformities at lower extremity.Methods:Four patients with complex multiplanar deformities at lower extremity were treated at Department of Orthopedics, The First Affiliated Hospital to Harbin Medical University from January 2018 to May 2019. They were one male and 3 females, aged from 12 to 65 years (average, 28.8 years). All patients underwent thin-layer (1 mm) CT scan before surgery. Individualized preoperative planning and surgical simulation were conducted using the CT data. 3D printing technology was used to fabricate individualized surgical templates to facilitate osteotomy. Recorded were operation time, frequency of intraoperative fluoroscopy, fracture healing time, Lysholm scores before and after operation, Hospital for Special Surgery (HSS) knee function scores, pain scores of visual analogue scale (VAS) and postoperative complications in this cohort.Results:The operation time averaged 160.0 min, the frequency of intraoperative fluoroscopy 5.0 times, the follow-up duration for the 4 patients 8.8 months, the fracture healing time 6.3 months, the Lysholm scores before and after operation 55.8 and 80.5 points respectively, the HSS scores before and after operation 61.0 and 80.8 points respectively, and the VAS scores before and after operation 3.8 and 1.0 points respectively. Accurate osteotomy was achieved with assistance of the templates and no deformation or breakage of the templates was observed. Follow-ups showed fine alignment of the lower extremities by the full-length X-ray films and no recurrence of deformity, infection, implant breakage, or delayed union or non-union of the osteotomy sites.Conclusions:For patients with multiplanar deformities at lower extremity, individualized preoperative planning can be made before surgery to obtain the accurate parameters relevant to the osteotomy. In combination with various fixations, a patient-specific template made by 3D printing can be used to achieve accurate osteotomy, ensuring good efficacy, safety, efficiency and accuracy of the surgery.

Immune metabolism is an emerging highlight in recent years.Revealing the metabolic characteristics of different immune cells in different responses may provide new perspective and direction for the pathogenesis and therapy of many immune-related diseases.Sepsis is a complex systemic inflammation caused by trauma,infection and other pathogenic factors.The immune cells have different metabolic features at different stages of the disease.These metabolic features are also involved in the regulation of immune cell proliferation,differentiation and function.By summarizing and analyzing the relevant literatures of immune cell metabolism and inflammation regulation in recent years,the metabolic regulatory factors of different immune cell subgroups and the related characteristics of immune cell metabolism in patients with sepsis were summarized.The in-depth understanding of the metabolic state in different immune cells,and the pathophysiological mechanism of septic immune disorders,especially the immune paralysis stage,would provide a theoretical basis for the clinical application of immune metabolic therapy.

Objective: To explore the value of quantitative CT radiomics features in predicting the anaplastic lymphoma kinase (ALK) mutation status in lung adenocarcinoma patients. Methods: This retrospective study reviewed one hundred and ninety-five lung adenocarcinoma patients (including 60 patients with ALK mutation) whose ALK genetic test results were available from Nov 2015 to May 2018 in PUMCH. VOIs were labeled by an automatic pulmonary nodule detection and segmentation algorithm and were later revised and confirmed by two senior radiologists. The PyRadiomics tools were used to resample the labeled regions, followed by image pre-processing (Wavelet filter or Laplacian of Gaussian (LoG) filter) and feature extraction. Normalized features were selected based on their representativeness on Dr. Wise research platform. Multivariate logistic regression was performed to develop prediction models of ALK mutation gene based on different image pre-processing techniques and different radiomics feature types. The results were validated by ten runs of five-fold cross validation. ROC curve analysis and Delong test were used to compare the predictive performance among models. Results: Fifteen radiomics features with the highest representativeness were selected from the original 1 232 features. The prediction model based on these radiomics features showed good performance (AUC=0.88 in the training set and 0.78 in the validation set) and was not significantly different from the prediction models based on radiomics features of different pre-processing images (AUC=0.76, P=0.1, original CT images; AUC=0.75, P=0.3, Wavelet-filtered images; AUC=0.76, P=0.2, LoG-filtered images). Among the models built with radiomics features of different types, the one based on GLCM feature (a subtype of texture feature) showed the best performance in predicting ALK genetic status (AUC=0.83, accuracy=0.74, sensitivity=0.85 and specificity=0.69). The model based on first-order statistic features had an AUC of 0.80. Conclusion Quantitative CT radiomics features have a good potential to anticipate the expression of ALK fused gene in patients with lung adenocarcinoma.

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system.

Objective: To explore the role of MRI in the pre-operative diagnosis and classification of oblique vaginal septum syndrome (OVSS) . Methods: A retrospective analysis of the clinical records and pre-operative MRI images of 19 patients with surgery proved OVSS was carried out. Two experienced radiologists reviewed the pre-operative pelvic MRI of the 19 patients in consensus blind to the surgery results. Characteristics including malformations of the uterus, cervix and vagina, the diagnosis of the disorder and classification were evaluated. Pre-operative MRI diagnosis and classification were correlated with surgical findings. Results: Mean age of onset of symptoms for the 19 patients was 15 years (ranged 9-25 years) , and mean age of menarche was 12 years. Ten patients suffered from dysmenorrhea or lower abdominal pain, 5 patients complained of vaginal discharge, 3 patients had a history of irregular menstruation, 1 patient suffered from primary infertility. All 19 patients showed uteri didelphys. Eighteen patients showed vaginal oblique septum.One patient showed cervical atresia.MRI was completely correlated with the surgery in the pre-operative diagnosis of OVSS. MRI classification was in line with surgery in 17 patients, including 9 patients with imperforate septum (typeⅠ) , 6 patients with perforate septum (type Ⅱ) , 1 patient with imperforate septum and cervical fistula (type Ⅲ) , and another one with cervical agenesis (type Ⅳ) . One case of type Ⅱ was misdiagnosed as type Ⅰ, another one of type Ⅰ was misdiagnosed as type Ⅲ. Pre-operative MRI classification was correlated with surgery in 17 out of 19 patients. Conclusion Pre-operative MRI allows excellent manifestation and accurate diagnosis of OVSS, and could also facilitate the evaluation of the classification.

Objective 　To investigate the optimized range of body mass index (BMI) selection for patients undergoing 70 kV high-pitch dual-source coronary CT angiography (CCTA) on the third-generation dual-source CT (DSCT). Methods 　Patients undergoing prospective high-pitch ultra-low contrast media (CM) CCTA on the third-generation DSCT using the automatic tube voltage selection at 70 kV were included and divided into three groups:group A,with BMI≤24 kg/m;group B,with 24 kg/m0.05). Subjective image quality in group A(Z=2.91,P=0.004) and B(Z=2.27,P=0.021) were both significantly better than that in group C. Conclusion 　The ultra-low tube voltage (70 kV) combined with ultra-low CM CCTA protocol on third-generation high-pitch DSCT may be better for patients with BMI<28 kg/m2 than those with BMI ≥28 kg/min China.
Body Mass Index ; China ; Computed Tomography Angiography ; methods ; Contrast Media ; Heart Rate ; Humans ; Prospective Studies ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Signal-To-Noise Ratio

A series of 5-amino-2-( benzylthio ) thiazole-4-carboxamide derivatives were designed and synthesized to discover novel compounds with anti-tumor activity. Compounds DDO-5401-DDO-5416 were synthesized using 2-amino-2-cyanoacetamide as the start material. The structures of the synthesized compounds were confirmed by IR, 1 H NMR and ESI-MS. The in vitro anti-tumor activities of the synthesized compounds were determined by MTT assay in HCT116 , HepG2 , A549 , MDA-MB-231 and MCF-7 cell lines. Target compounds showed good anti-tumor activity especially in A549 cell line. SAR study showed that electron donating groups were more favorable than electron absorption ones. Compound DDO-5413 exhibited noteworthy activity in MDA-MB-231 and MCF-7 cell lines with IC50 value lower than the positive reference dasatinib. It suggested that DDO-5413 might be the candidate for further investigation.