Objective:To investigate the different expression levels of programmed cell death 1 ligand 1 (PD-L1) in non-small cell carcinoma (NSCLC) of distribution characteristics of TCM constitutions and prognosis.Methods:The clinical data of 355 NSCLC patients who had been treated with immune checkpoint inhibitors (ICIs) from January 2019 to June 2023 in the Cancer Medical Center of the First Affiliated Hospital of Hunan University of Chinese Medicine were retrospectively analyzed, and their TCM constitutions were determined. According to the expression level of PD-L1, they were divided into three groups: low expression group (TPS≤1%), medium expression group (1% < TPS < 49%) and high expression group (TPS≥50%). Overall survival (OS) of patients was followed up, and the median OS were compared. Kaplan-Meier method was used to draw survival curves, and Log-rank test was used to compare the difference of survival curves. The independent risk factors of OS were analyzed by COX regression.Results:The distribution of different TCM constitutions showed statistical significance across the three groups ( P<0.05). The median OS for the medium and high expression groups were 21.082 months and 25.714 months, respectively, both significantly higher than the 14.437 months for the low expression group ( P<0.05). The survival curve of TCM constitutions showed that the constitutions significantly correlated with the prognosis of ICIs treatment were qi deficiency, phlegm dampness, and blood stasis ( P<0.05 or P<0.01). The median OS from high to low was 44.971 months for phlegm-dampness constitution, 23.297 months for qi-deficiency constitution, and 11.763 months for blood-stasis constitution. COX regression analysis indicated that medium PD-L1 expression ( HR=0.622, 95% CI=0.459,0.844, P=0.002), high PD-L1 expression ( HR=0.509, 95% CI=0.361,0.718, P<0.001), phlegm-dampness constitution ( HR=0.556, 95% CI=0.335,0.924, P=0.024), and blood-stasis constitution ( HR=2.952, 95% CI=1.929,4.518, P<0.001) were independent prognostic factors. Conclusions:The higher the expression level of PD-L1 in NSCLC patients, the better the prognosis of ICIs treatment. The prognosis of ICIs treatment is better for people with phlegm-dampness constitution and poor for those with blood stasis constitution.

Objective To examine the existing Framingham Risk Score (FRS) and Chinese Risk Score (CRS) in predicting the development of ischemic cardiovascular diseases (ICVD),and determine potential added value of novel risk factors.Methods The China Multi-Provincial Cohort Study (CMCS) was a population-based prospective cohort study in 11 provinces of China.An annual follow up was conducted in 840 men aged 35 to 64 years in Shanghai cohort,who were without coronary heart disease and stroke at baseline examination in 1992,to collect the incidence data of ICVD events (coronary death,myocardial infarction,and ischemic stroke).The detection of novel risk factors were conducted for the cohort in 2007.The basic Framingham and Chinese prediction scores power were assessed by using C-statistic of ICVD events associated with risk scores,then the novel risk factors were evaluated by adding them independently to the basic Chinese models.The area under the curve (AUC),net reclassification improvement (NRI),and integrated discrimination improvement (IDI) were calculated to determine if each of the novel risk factors improved risk prediction.Results By the end of December 2014,24 cases of coronary heart disease (myocardial infarction or/and coronary death),45 cases of ischemic stroke had occurred in 840 subjects in Shanghai cohort with a follow-up of 22.3 years averagely.Both the FRS and CRS had predicting power for ICVD,the AUCs were 0.657 6 (95％ CI:0.594 2-0.724 0) and 0.726 5 (95％ CI:0.664 3-0.788 7),respectively.The incremental AUC was 0.068 9 (95％ CI:0.019 6-0.117 1) (P=0.006).None of the novel risk factors significantly improved the AUC.High-sensitive-CRP (hs-CRP) was the only novel risk factor resulting in a significant increase of NRI.CRS in 2007 significantly improved the IDI,but net changes were small.Conclusions CRS had high power in the 20-year risk prediction for ICVD in middle-aged men in Shanghai.The inclusion of hs-CRP could make some improvement in risk prediction,but is unlikely to be meaningful when reclassification or new discrimination strategy are made which can change the clinical risk.

Cardiology ; trends ; China

Obiective To compare the sensitivity and specificity of strain imaging(SI)and restredistribution Tl-201(RR-201 TI)SPECT imaging in evaluating myocardial viability among patients with STelevation acute myocardial infarction(AMI).Methods Twenty-six AMI patients underwent echocardiography and RR-201 Tl-SPECT imaging a week(baseline)after percutaneous coronary intervention(PCI)therapy.At baseline,wall motion score(WMS)and systolic strain were assessed,SPECT scoring were performed on 16 segments of left ventricle(LV).WMS was repeated more than 3 months later to assess myocardial viability,which is deemed as reference.Results ①Two hundred and sixty segments in the"at risk"regions were followed up for(5±2)months,among which 201 were identified as viable and 59 were not,according to the WMS.②In comparison to the reference standard,the sensitivity and specificity of RR-201 Tl-SPECT to predict myocardial viability were 87%(175/201)and 58%(34/59)respectively.③The sensitivity and specificity of systolic strain(Set)to predict myocardial viability after AMl were 81% and 66% respectively at the optimal cut-off value of-60%.④Set was moderately concordant with SPECT scoring(Kappa=0.40)and the agreement between the two methods was 77%(199/260).Conclusions In ST-elevation AMI,SI and RR-201 Tl-SPECT appears equivalent in predicting segmental recovery after reperfusion,and SI could be a convenient and low-cost alternative for the non-invasive evaluation of myocardial viability.

Objective To investigate the value of real-time three-dimensional transesophageal echocardiography(RT-3DTEE) in mitral valve repair. Methods RT-3DTEE was performed in six patients[5 male,1 female,mean age (45.7±12.6)years] with mitral valve prolapse by using Philips IE33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical repair. Results RT-3DTEE could display dynamic morphology of mitral valve,the location of prolapse,and spatial relation tO the surrounding tissues.It could provide surgical views of the valves and the valvular apparatus.RT-3DTEE results were consistant with surgical findings.Conclusions RT-3DTEE is a unique new modality for rapid and accurate evaluation of mitral prolapse and mittal repair.

Background and objective Pre-operative assessment of mitral valve(MV)anatomy is essential to surgical design in patientsundergoing MV repair.Although 2-dimensional(2D)echocardiography provides precise information regarding MV anatomy,RT-3DTEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT-3DTEE in MV repair. Methods RT-3DTEE was performed in six patients with mitral valve prolapse(MVP) by using Philips IE33with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valverepair,and quantitative evaluation was performed by QLab 6.0 software before and after surgicalmitralvalve repair.Results RT-3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It couldprovide surgical views of the valves and the valvular apparatus.These resuIts were consistent with surgical findings.The quantitativeevahuation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annalus.anterior to posteriordiameter of annulus,perimeter of annullus.,and area of annalus in projectionplane were significantlv smaller after operation comparedwith those before operation(P＜0.05).The length of posterior leaflet,,the area of anterior and posterior leaflet,the maximal prolapseheight,the volume of leaflet prolapse and the length of coaptation in projection planewere significantly reduced after operation(P＜0.05).Conclusion RT-3DTEE is a unique new medality for rapid and accurate evaluation of mitral valve prolapse and miwal valverepair.