Objective To investigate the predictive value of CT perfusion imaging(CTP)parameters com-bined with platelet activator combined-1(PAC-1)level and hemorrhage after thrombolysis(HAT)score for hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods A total of 162 patients with ACI who were treated with intravenous thrombolysis in Cheng-du 363 Hospital from January 2022 to April 2023 were selected.All patients underwent head CT examination(including plain scan and CTP)before intravenous thrombolytic therapy,and serum PAC-1 level and HAT score were measured at admission.According to whether HT occurred after intravenous thrombolysis,the pa-tients were divided into HT group(HT group)and non-HT group(non-HT group).The differences of CTP parameters,serum PAC-1 level and HAT score between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of HT after intravenous thrombolysis in ACI pa-tients.The predictive value of CTP parameters combined with serum PAC-1 and HAT scores alone and in combination for HT after intravenous thrombolysis in ACI patients was evaluated by drawing the receiver op-erating characteristic(ROC)curve and calculating the area under the curve(AUC).Results The cerebral blood flow and blood volume in the HT group were significantly lower than those in the non-HT group(P＜0.05),while the serum PAC-1 level,peak time,mean transit time,flow extraction product,and HAT score were significantly higher than those in the non-HT group(P＜0.05).Multivariate Logistic regression analysis showed that CTP integration parameters which were composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,serum PAC-1 level and HAT score were independ-ent risk factors for HT after intravenous thrombolysis in ACI patients(P＜0.05).ROC curve analysis showed that CTP integration parameters,serum PAC-1 level and HAT score all had certain predictive value for HT in ACI patients after intravenous thrombolysis,and their AUC and 95％CI were 0.766(95％CI:0.605-0.915),0.702(95％CI:0.451-0.955)and 0.741(95％CI:0.551-0.923),respectively.The com-bined application of CTP integration parameters,serum PAC-1 levels,and HAT scores significantly improved the predictive performance,and its AUC was 0.856(95％CI:0.750-0.951),which was higher than those of each index alone(Zcombination-CTP=2.177,P=0.032,Zcombination-PAC-1=2.917,P=0.004,Zcombination-HAT=2.537,P=0.013).Conclusion The combination of CTP integration parameters which are composed of cerebral blood flow,cerebral blood volume,peak time,mean transit time and flow extraction product,and serum PAC-1 level and HAT score has high predictive value for HT after intravenous thrombolysis in ACI patients,and has high clinical application potential.

ObjectiveUsing the Delphi method and analytic hierarchy process （AHP） to screen diagnostic items for qi stagnation syndrome and determine their weights， providing a reference for the development of a diagnostic scale of qi stagnation syndrome. MethodsLiterature related to qi stagnation syndrome were screened from databases including CNKI， Wanfang， VIP， SinoMed （from inception to October 31， 2020）. Through systematic review of literature and expert discussions， the information on the four examinations of traditional Chinese medicine were organized and an item pool was constructed. The Delphi method was used to screen the item indicators， while the AHP was employed to determine their weights. Statistical methods such as mean value， full score ratio， rank sum， unimportant percentage， and coefficient of variation were used for item screening， with the weights calculated by AHP serving as the item weights. ResultsA total of 235 articles and books were included for analysis， resulting in an item pool of 16 items. After three rounds of expert consultation， a total of 84 valid questionnaires were collected， with a total expert enthusiasm coefficient of 99% and authority coefficient of 0.86， 0.84， 0.83， respectively， and the coordination coefficients were 0.45， 0.49， and 0.29， respectively. Through the statistics analysis， 8 diagnosis items were screened out， including distension （stuffi-ness） or distending pain or scurrying pain， wiry pulse， depressed emotions， frequent sighing， deep and wiry pulse， irritability， pale red tongue， and thin white coating. The AHP showed that the order of weights of the first-level indicators from high to low was clinical symptoms， pulse manifestation， and tongue manifestation； the order of weights of the second-level indicators from high to low was distension （stuffiness） or distending pain or scurrying pain， wiry pulse， depressed emotions， frequent sighing， deep and wiry pulse， irritability， pale red tongue， and thin white coating. ConclusionBy applying the Delphi method and AHP to analyze and evaluate the diagnostic items for qi stagnation syndrome， key diagnostic items were screened and their weights determined， laying the foundation for the development of a diagnostic scale for qi stagnation syndrome.

Objective To develop a nomogram based on pulmonary nodules preoperative CT signs and 3D quantitative parameters for predicting mediastinal lymph node metastases in patients with clinical stage ⅠA lung adenocarcinoma.Methods The imaging data of 164 patients who underwent preoperative CT scan and systematic lymph node dissection were analyzed retrospectively.Commercially available AI software was used to extract 3D quantitative parameters of pulmonary nodules automatically,and CT signs of pulmonary nodules were analyzed.Logistic regression was used to explore the role of these parameters in predicting pathological nodal involvement.A nomogram prediction model was established,then discrimination and calibration of the model were evaluated.Results Among 164 enrolled patients,19(11.6％)were tested positive for mediastinal lymph node metastases at pathology review.The nomogram incorporated spiculation,lobulation,the largest cross-sectional area,and carcinoembryonic antigen(CEA).The model showed great discrimination and calibration,with a C-index of 0.942[95％confidence interval(CI)0.923-0.961].The predicted value of the model fitted well with the actual observed value on the calibration curve.Conclusion The nomogram prediction model based on preoperative CT signs,3D quantitative parameters,and CEA can estimate the probability of mediastinal lymph node metastases in clinical stage ⅠA lung adenocarcinoma.This model may help with clinical decision-making and individualized evaluation.

Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann?Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi?square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparoscopic right hemi-hepatectomy successfully, with the surgical margin as negative. The operative time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases undergoing dissection of the trunk of right anterior hepatic pedicle and its operation time, cases undergoing dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient undergoing postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, cases with postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.

Objective:To investigate the application value of cystic plate approach (CPA) for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy (MIALR).Methods:The retrospective cohort study was conducted. The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi-hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected. There were 36 males and 6 females, aged (55±13)years. Of the 42 patients, 25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group, and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non‐parameter rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent laparos-copic right hemi-hepatectomy successfully, with the surgical margin as negative. The operation time, volume of intraoperative blood loss, time of dissection of the targeted hepatic pedicle, cases under-going dissection of the trunk of right anterior hepatic pedicle and its operation time, cases under-going dissection of the trunk of right posterior hepatic pedicle and its operation time, cases with hepatic pedicle injury, cases with hepatic tissue injury, cases with dissection space as large and small were 150.00(130.00)minutes, 100.00(100.00)mL, 472.00(201.00)seconds, 10 and 366.00(94.75)seconds, 9 and 564.00(138.50)seconds, 2, 2, 25, 0 in patients of the CPA group, versus 140.00(113.00)minutes, 100.00(125.00)mL, 670.00(107.00)seconds, 8 and 663.00(136.00)seconds, 7 and 783.00(189.00)seconds, 8, 5, 2, 19 in patients of the traditional approach group. There were significant differences in the time of dissection of the targeted hepatic pedicle, time of dissection of the trunk of right anterior hepatic pedicle, time of dissection of the trunk of right posterior hepatic pedicle, hepatic pedicle injury, dissection space between the two groups ( Z=-4.809, -3.254, -3.188, χ2=6.493, 34.314, P<0.05) and there was no significant difference in the operation time, volume of intraoperative blood loss, dissection of the trunk of right anterior hepatic pedicle, dissection of the trunk of right posterior hepatic pedicle, hepatic tissue injury between the two groups ( Z=-0.282, -0.412, χ2=0.095, 0.002, 1.976, P>0.05). (2) Postoperative situations. There was no patient under-going postoperative hemorrhage in both of the two groups. The alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil) and prothrombin time (PT) at postoperative day 3, cases with postoperative biliary fistula, pathological type of tumor (hepatocellular carcinoma, intrahepatic cholangiocarcinoma) were 68.00(48.50)U/L, 52.00(35.50)U/L, 28.30(12.35)mmol/L, 12.40(2.40)seconds, 2, 21, 4 in patients of the CPA group. The above indicators were 58.00(25.00)U/L, 41.00(19.50)U/L, 26.80(14.25)mmol/L, 12.50(2.95)seconds, 5, 15, 2 in patients of the traditional approach group. There was no significant difference in the ALT, AST, TBil, PT at postoperative day 3, postoperative biliary fistula between the two groups ( Z=-1.218, -1.488, -0.205, -0.320, χ2=1.976, P>0.05), and there was no significant difference in the pathological type of tumor between the two groups ( P>0.05). Conclusion:Application of CPA for extrahepatic right hepatic pedicle dissection in MIALR is safe and feasible.

Tumor-specific neoantigens have attracted much attention since they can be used as biomarkers to predict therapeutic effects of immune checkpoint blockade therapy and as potential targets for cancer immunotherapy. In this study, we developed a comprehensive tumor-specific neoantigen database (TSNAdb v1.0), based on pan-cancer immunogenomic analyses of somatic mutation data and human leukocyte antigen (HLA) allele information for 16 tumor types with 7748 tumor samples from The Cancer Genome Atlas (TCGA) and The Cancer Immunome Atlas (TCIA). We predicted binding affinities between mutant/wild-type peptides and HLA class I molecules by NetMHCpan v2.8/v4.0, and presented detailed information of 3,707,562/1,146,961 potential neoantigens generated by somatic mutations of all tumor samples. Moreover, we employed recurrent mutations in combination with highly frequent HLA alleles to predict potential shared neoantigens across tumor patients, which would facilitate the discovery of putative targets for neoantigen-based cancer immunotherapy. TSNAdb is freely available at http://biopharm.zju.edu.cn/tsnadb.
Antigens, Neoplasm ; metabolism ; Data Analysis ; Databases, Genetic ; Humans ; Immunotherapy ; Mutation ; genetics ; Neoplasms ; genetics ; immunology ; Tumor Suppressor Protein p53 ; genetics ; Urinary Bladder Neoplasms ; genetics

Side effects from targeted drugs remain a serious concern.One reason is the nonselective binding of a drug to unintended proteins such as its paralogs,which are highly homologous in sequences and have similar structures and drug-binding pockets.To identify targetable differences between paralogs,we analyzed two types (type-Ⅰ and type-Ⅱ) of functional divergence between two paralogs in the known target protein receptor family G-protein coupled receptors (GPCRs) at the amino acid level.Paralogous protein receptors in glucagon-like subfamily,glucagon receptor (GCGR) and glucagon-like peptide-1 receptor (GLP-1R),exhibit divergence in ligands and are clinically validated drug targets for type 2 diabetes.Our data showed that type-Ⅱ amino acids were significantly enriched in the binding sites of antagonist MK-0893 to GCGR,which had a radical shift in physicochemical properties between GCGR and GLP-1R.We also examined the role of type-Ⅰ amino acids between GCGR and GLP-1R.The divergent features between GCGR and GLP-1R paralogs may be helpful in their discrimination,thus enabling the identification of binding sites to reduce undesirable side effects and increase the target specificity of drugs.

Objective To analyze pharmacologic action features of single Chinese herbal medicine for the treatment of fatty liver based on literature; To provide references for clinical treatment of fatty liver.Methods Animal research literature about single Chinese herbal medicine for the treatment of fatty liver in CNKI, Wanfang database, and VIP from January 2003 to December 2014 was retrieved by computers. The number of single Chinese herbal medicine and the pharmacologic action features of active ingredients (or extracts) were statistically concluded. Results A total of 279 articles were retrieved, including 67 kinds of single Chinese herbal medicine, among which 8 were used to treat AFLD, 45 were used to treat NAFLD, and 14 were used to treat AFLD and NAFLD simultaneously. Pharmacologic action features of the medicine for AFLD mainly included reducing lipid, protecting liver, antioxidation, and anti-inflammation. Pharmacologic action features of the medicine for NAFLD had the effects of improving insulin resistance additionally.Conclusion Chinese herbal medicine for the treatment of AFLD and NAFLD shows significant efficacy, having the features of multiple pathways and liver damage resistance, which provide references for clinical treatment of fatty liver.

Objective To explore the change of signal value in the fetal frontal lobe with gestational age in normal second-third trimester fetuses.Methods MRI findings of 125 normal second-third trimester fetuses were divided into 5 groups according to gesta-tional age (unit:week)including 1 7-21,22-26,27 -31,32 -36,37 -40,respectively.The signal values were measured in inferior frontal,middle and upper,respectively.Results The signal value of fetal frontal lobe in 5 groups were 387.38 ± 1 66.75,354.46 ± 1 74.78,342.24±141.23,338.90±1 10.94,310.23±1 18.62,respectively.The signal value was 341.77 ±149.22,35 1.00±145.1 6, 342.85±140.61 in inferior frontal,middle and upper,respectively.The signal value of frontal lobe was 350.34±147.68 in the left and 340.73±144.29 in the right.There were no significant statistical differences on fetal frontal lobe signal value in each group (P>0.05).But the signal value in the frontal lobe had a gradually decreasing trend with fetal age,along with the signal value in the central frontal was higher than the other two parts of the frontal lobe and the left is slightly higher than the right.Conclusion The signal values in frontal lobe of normal second-third trimester fetuses were gradually decreased as gestational age increasing,with the signal values in central frontal lobe was higher than that of in margin of frontal lobe,and the left side was slightly higher than the right.

Objective To explore the growing change of sizes of lateral cerebral ventricle in second-third trimester normal fetuses in MRI,to provide the normal reference for clinical monitoring.Methods MRI findings in 98 normal second-third trimester fetuses were retrospectively analyzed.The fetuses were divided into 6 groups according to gestational age (unit:week)including 18-21,22-25,26-29,30-33,34-37 and 38-40 weeks,respectively.The maximum transverse sizes of fetal atrium and occipital horns of lateral ventricle (cm)were measured.The SigmaStat statistical program was used for statistical analysis.Results The length of lateral ventricle atrium horn in 6 groups were 0.35 ± 0.03,0.33 ± 0.05,0.31 ± 0.04,0.30 ± 0.03,0.26 ± 0.05 and 0.25 ± 0.04,respectively,and the ventricle length of occipital horns were 0.91± 0.09,0.84 ± 0.09,0.84 ± 0.1 1,0.81 ± 0.13,0.80 ± 0.1 1 and 0.74 ± 0.13,respectively.The length of lateral ventricle atrium horn and ventricle occipital horns among some differ-ent groups showed significant differences (P <0.05).The length of fetal ventricle atrium and occipital horn were reduced gradually with gestational ages.Conclusion The ventricular length of atrium and occipital horn in second-third trimester normal fetuses reduce gradually with gestational ages.