BACKGROUND: The proportion of patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations is relatively high in China. However, these patients currently lack significant benefits from available neoadjuvant treatment options. This study aims to explore the potential application value of neoadjuvant targeted therapy by evaluating its efficacy and safety in patients with EGFR-mutant resectable lung adenocarcinoma. METHODS: A multicenter retrospective study was used to analyze the treatment effect of patients with stage IIA-IIIB EGFR-mutant lung adenocarcinoma who underwent surgical resection after receiving neoadjuvant targeted therapy from July 2019 to October 2024. RESULTS: A total of 24 patients with EGFR-mutant lung adenocarcinoma from three centers were included in this study. All patients successfully underwent surgery and achieved R0 resection of 100.0%. The objective response rate (ORR) was 83.3% (20/24) . The major pathologic response (MPR) rate was 37.5% (9/24), with 2 patients (8.3%) achieving pathological complete response (pCR). During neoadjuvant therapy, 13 out of 24 patients (54.2%) experienced adverse events of grade 1-2, with no occurrences of ≥ grade 3. The most common treatment-related adverse events were rash (n=4, 16.7%), mouth sores (n=2, 8.3%), and diarrhea (n=2, 8.3%). The median follow-up time was 33.0 months, no deaths occurred in all patients, and the overall survival (OS) rate was 100.0%. The 1-year disease-free survival (DFS) rate was 91.1%, and the 2-year DFS rate remained at 86.2%. CONCLUSIONS The application of neoadjuvant targeted therapy in patients with EGFR-mutant resectable lung adenocarcinoma is safe and feasible, and is expected to become a highly promising neoadjuvant treatment option for the patients with EGFR-mutant lung adenocarcinoma.
Humans ; ErbB Receptors/metabolism* ; Male ; Female ; Middle Aged ; Adenocarcinoma of Lung/surgery* ; Neoadjuvant Therapy ; Lung Neoplasms/surgery* ; Aged ; Retrospective Studies ; Mutation ; Adult

Objective To observe the value of whole brain CT perfusion(CTP)-derived arterial phase images combined with artificial intelligence iterative reconstruction(AIIR)for evaluating acute ischemic stroke(AIS).Methods Fifty AIS patients were prospectively enrolled,and whole brain CTP followed by routine CT angiography(CTA)were performed.CTP images were reconstructed using AIIR(CTP-AIIR group)and hybrid iterative reconstruction(HIR,CTP-HIR group),respectively,and CTA images were derived from CTP at the arterial phase.Meanwhile,routine CTA images were obtained using HIR(CTA-HIR group).Then image quality was subjectively evaluated with a 5-point scale.The noise of basilar artery trunk,cavernous segment of internal carotid artery,M1 segment of middle cerebral artery and the brain parenchyma were calculated,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the above 3 arteries were measured.Taken digital subtraction angiography as the reference standard,the accuracy of CTP and CTA for localizing the responsible vessel of AIS was assessed.Results In CTP-AIIR group,the subjective scoring of 4 subjective metrics,including image noise,sharpness of vessel margin,small vessel visibility and overall diagnosability were significantly higher than,the noise of 3 arteries and brain parenchyma were lower than,and SNR and CNR of 3 arteries were higher than those in CTP-HIR group and CTA-HIR group(all P＜0.017).The diagnostic accuracy of responsible vessel based on CTP-AIIR group and CTA-HIR group were both 96.00％ (48/50),not significantly different with that in CTP-HIR group(44/50,88.00％ )(P=0.142).Conclusion Whole brain CTP-derived arterial phase CTA combined with AIIR could achieve comparable image quality and diagnostic performance of routine CTA for evaluating AIS.

Objective To evaluate the status of latent tuberculosis infection(LTBI)with Mycobacterium tubercu-losis and the risk of LTBI activation after glucocorticoid therapy in patients with anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Methods Clinical data of AAV patients who visited Xiangya Hospital of Central South University from May 2018 to May 2023 were retrospectively analyzed.According to the results of in-terferon-γ release assay(IGRA),they were divided into a LTBI group and a non-LTBI group.The LTBI group was subdivided into an active TB group(ATB group)and a non-ATB group according to the presence of ATB.General conditions and biochemical indicator characteristics of the two groups were compared.The COX regression model was used to analyze the risk factors for LTBI activation in AAV patients.Results A total of 302 AAV patients were included in this study,with an age of 64.0(53.0,71.0)years old,169 male cases(55.96％),and an IGRA positive rate of 24.17％(n=73).The proportion of patients with renal insufficiency in the LTBI group was higher than that in the non-LTBI group(79.45％vs 60.70％),with statistically significant difference(P＜0.05).In the LTBI group,the age of patients was 62.0(53.5,72.0)years old,44 cases were male(60.27％),out of which 11 cases(15.07％)had ATB.In the non-LTBI group,4 male cases(1.75％)had ATB.In the LTBI group,there were statistically significant differences between the ATB group and the non-ATB group in terms of daily average glucocorticoid levels,age,renal dysfunction,neutrophils,and blood creatinine(all P＜0.05).COX univariate re-gression analysis showed that statistically significant differences existed among the groups in terms of daily average glucocorticoid levels,daily average glucocorticoid levels＞11.75 mg/day,age,age＞65 years old,and blood crea-tinine levels ≥150 μmol/L(all P＜0.05).COX multivariate regression analysis showed that daily average glucocor-ticoid levels＞11.75 mg/day(OR=0.14,95％CI:1.30-79.01)and age＞65 years(OR=0.08,95％CI:0.01-0.85)were independent influencing factors for LTBI activation.Conclusion AAV patients have a high rate of LT-BI,and daily average glucocorticoid levels＞11.75 mg/day is an independent risk factor for LTBI activation in AAV patients.Age＞65 years may benefit from receiving lower doses of immunosuppressive therapy,but it is necessary to expand sample size for further study.

Objective To observe the value of whole brain CT perfusion(CTP)-derived arterial phase images combined with artificial intelligence iterative reconstruction(AIIR)for evaluating acute ischemic stroke(AIS).Methods Fifty AIS patients were prospectively enrolled,and whole brain CTP followed by routine CT angiography(CTA)were performed.CTP images were reconstructed using AIIR(CTP-AIIR group)and hybrid iterative reconstruction(HIR,CTP-HIR group),respectively,and CTA images were derived from CTP at the arterial phase.Meanwhile,routine CTA images were obtained using HIR(CTA-HIR group).Then image quality was subjectively evaluated with a 5-point scale.The noise of basilar artery trunk,cavernous segment of internal carotid artery,M1 segment of middle cerebral artery and the brain parenchyma were calculated,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the above 3 arteries were measured.Taken digital subtraction angiography as the reference standard,the accuracy of CTP and CTA for localizing the responsible vessel of AIS was assessed.Results In CTP-AIIR group,the subjective scoring of 4 subjective metrics,including image noise,sharpness of vessel margin,small vessel visibility and overall diagnosability were significantly higher than,the noise of 3 arteries and brain parenchyma were lower than,and SNR and CNR of 3 arteries were higher than those in CTP-HIR group and CTA-HIR group(all P＜0.017).The diagnostic accuracy of responsible vessel based on CTP-AIIR group and CTA-HIR group were both 96.00％ (48/50),not significantly different with that in CTP-HIR group(44/50,88.00％ )(P=0.142).Conclusion Whole brain CTP-derived arterial phase CTA combined with AIIR could achieve comparable image quality and diagnostic performance of routine CTA for evaluating AIS.

Objective To evaluate the status of latent tuberculosis infection(LTBI)with Mycobacterium tubercu-losis and the risk of LTBI activation after glucocorticoid therapy in patients with anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Methods Clinical data of AAV patients who visited Xiangya Hospital of Central South University from May 2018 to May 2023 were retrospectively analyzed.According to the results of in-terferon-γ release assay(IGRA),they were divided into a LTBI group and a non-LTBI group.The LTBI group was subdivided into an active TB group(ATB group)and a non-ATB group according to the presence of ATB.General conditions and biochemical indicator characteristics of the two groups were compared.The COX regression model was used to analyze the risk factors for LTBI activation in AAV patients.Results A total of 302 AAV patients were included in this study,with an age of 64.0(53.0,71.0)years old,169 male cases(55.96％),and an IGRA positive rate of 24.17％(n=73).The proportion of patients with renal insufficiency in the LTBI group was higher than that in the non-LTBI group(79.45％vs 60.70％),with statistically significant difference(P＜0.05).In the LTBI group,the age of patients was 62.0(53.5,72.0)years old,44 cases were male(60.27％),out of which 11 cases(15.07％)had ATB.In the non-LTBI group,4 male cases(1.75％)had ATB.In the LTBI group,there were statistically significant differences between the ATB group and the non-ATB group in terms of daily average glucocorticoid levels,age,renal dysfunction,neutrophils,and blood creatinine(all P＜0.05).COX univariate re-gression analysis showed that statistically significant differences existed among the groups in terms of daily average glucocorticoid levels,daily average glucocorticoid levels＞11.75 mg/day,age,age＞65 years old,and blood crea-tinine levels ≥150 μmol/L(all P＜0.05).COX multivariate regression analysis showed that daily average glucocor-ticoid levels＞11.75 mg/day(OR=0.14,95％CI:1.30-79.01)and age＞65 years(OR=0.08,95％CI:0.01-0.85)were independent influencing factors for LTBI activation.Conclusion AAV patients have a high rate of LT-BI,and daily average glucocorticoid levels＞11.75 mg/day is an independent risk factor for LTBI activation in AAV patients.Age＞65 years may benefit from receiving lower doses of immunosuppressive therapy,but it is necessary to expand sample size for further study.

Objective To identify the cross-reactive antigens shared by Mycobacteria smegmatis(MS) and Mycobacteria tuberculosis(MTB) and to analyze their antigenicity.Methods Bacterial antigens were extracted from strains of MS and MTB by ultrasonication.Western blot assay was performed to analyze common antigens that reacted with both of the antiserum samples against MS and MTB.The extracted bacterial antigens were mixed with incomplete Freund′s adjuvant and then were injected into muscles of mice.Cytokines secreted by murine spleen lymphocytes following stimulation with various antigens of MS and MTB were determined by ELISPOT and flow cytometry on the 7th day.IgG levels in serum samples were detected by ELISA 7 days after injection.Results There were cross-reactive antigens shared by MS and MTB.Potent humoral immune responses and cellular immunity against both MS and MTB could be induced by those cross-reactive antigens after sensitization the mice by either MS or MTB antigens.Cytokines of IL-2 and IFN-γ in CD4+ and CD8+T cells of mice stimulated with MS or MTB antigens were significantly increased as compared with those of non-sensitization group and those of Brucella antigens stimulation group.ConclusionCross-reactive antigens shared by MS and MTS can effectively promote specific immune reactions to the infection of MTB, which provides a scientific basis for the development of tuberculosis vaccines.

Objective To study the clinical significance of the novel tumor marker Cytokerantin?19?fragment( CYFRA 21?1) of peripheral blood in patients with esophageal cancer. Methods The CYFRA 21?1 level in peripheral blood of 72 patients with benign tumor of esophagus or reflux esophagitis and 60 patients with esophageal cancer was examined before and 7 days after operation by enzyme?linked immuno sorbent assay ( ELISA) . At the same time, patients with esophageal cancer were followed up for 3 years, and the level of CYFRA21?1 was examined. Results (1)Before the operation,the level of CYFRA 21?1 was 0-3. 30 μg/L in 51. 67%( 31/60 ) of the patients with esophageal cancer, higher than that of the control group ( 16. 67%(12/72),χ2=3. 88,P<0. 05). (2)Before the operation,the level of CYFRA21?1 in patients with esophageal cancer,stage Ⅰ,Ⅱ and stage Ⅲ,Ⅳ were (3. 27±0. 33) μg/L and (4. 88±1. 21) μg/L,and of the control group was (2. 24±1. 17) μg/L. The levle of CYFRA21?1 in patients with esophageal cancer,stage Ⅰ,Ⅱ andⅢ,Ⅳ were significantly higher than that of the control group( t=2. 37,2. 00,P<0. 05) . ( 3) On the 7th day after operation,the level of CYFRA21?1 was (2. 26±1. 16) μg/L,and the difference was not significant compared with the control group(t=0. 95,P>0. 05). The level of CYFRA21?1 with the palliative resection of esophageal cancer was (3. 31±0. 66) μg/L,and the difference was significant compared with the control group(t=4. 33,P<0. 05) . ( 4 ) After 3 years of follow?up, the factors affecting the survival rate of esophageal cancer were as following:the pathologic stages of tumor(OR 4. 423,95%CI 1. 943-4. 972,P<0. 05),types of operation(OR 0. 023,95%CI 0. 012-0. 036,P<0. 05),the level of CYFRA21?1 before operation(OR 6. 798,95%CI 4. 328-8. 105,P<0. 05),and the decreased level of CYFRA21?1 after operation(OR 0. 117,95%CI 0. 074-0. 202,P<0. 05) . ( 5) During the follow?up period,the level of CYFRA21?1 in patients with local recurrence and distant metastasis of esophageal carcinoma was (7. 97±0. 44) μg/L,significantly more than that of the control group(t=5. 11,P <0. 05) . Conclusion CYFRA21?1 is a useful tumor marker in the positive rate of preoperative diagnosis of esophageal cancer, postoperative monitoring of recurrence, distant metastasis and prediction of prognosis.

Objective To investigate the methods and effects in repairing fracture of the fifth metatarsal base bone with Acutrak headless compression screws.Methods From May 2006 to October 2012,75 patients with fracture of the fifth metatarsal base bone were reduced and fixed using Acutrak headless compression screws.There were 38 males and 37 females with a mean age of 36 years (range,21-65 years).Injury arose from fall from height (35 cases),road traffic accidents (23 cases),and fall of heavy objects (17 cases).Fracture of the left foot occurred in 29 cases and the right foot in 46 cases.Results were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) ankle and midfoot score.Results Seventy-two patients were followed up for mean 15 months (range,13 months5 years).Operative incision obtained primary healing without any complications.Mean AOFAS ankle and midfoot score increased to (93.0 ± 6.5) points (range,79-100 points) at postoperative 1 year,compared with the preoperative (28.0 ± 3.9) points (range,0-42 points) (t =7.650,P ＜ 0.05).Muscle force and valgus or abduction of mid-forefoot of the affected and unaffected sides demonstrated no significant difference after operation.Conclusion Acutrak headless compression screw system shows advantages of rigid fixation,few complications,and early healing in treatment of the fifth metatarsal base fracture.

Objective To explore the clinical significance of plasma vWF and platelet pa-rameters in patients with type 2 diabetes mellitus (T2DM)complicated with cerebral infraction. Methods A total of 32 patients with T2DM complicated with cerebral infraction from December 2011 to October 2013 and another 32 patients with single T2DM were selected as combination group and T2DM group,while another 30 healthy people served as control group.Glycated hemoglobin (HbA1c)level,von Willebrand factor (vWF)level and platelet parameters were detected in 3 groups to observe their differences and the relationship between HbA1c level and vWF level and platelet parameters were analyzed.Results HbA1c and vWF levels decreased gradually in combina-tion and T2DM groups than that in control group,and the differences were significant (P <0.01). There was no significant difference in platelet count (PLT)among 3 groups (P >0.05).However, platelet distribution width (PDW)and mean platelet volume (MPV)decreased evidently and gradu-ally in 3 groups (P <0.01).Additionally,HbA1c level was positive associated with vWF,PMV and PDW (P <0.01).Conclusion Level of vWF increases significantly in patients with T2DM complicated with cerebral infarction,whose detection combined with platelet parametes can provide references for the early diagnosis and treatment.

Objective To explore the clinical significance of plasma vWF and platelet pa-rameters in patients with type 2 diabetes mellitus (T2DM)complicated with cerebral infraction. Methods A total of 32 patients with T2DM complicated with cerebral infraction from December 2011 to October 2013 and another 32 patients with single T2DM were selected as combination group and T2DM group,while another 30 healthy people served as control group.Glycated hemoglobin (HbA1c)level,von Willebrand factor (vWF)level and platelet parameters were detected in 3 groups to observe their differences and the relationship between HbA1c level and vWF level and platelet parameters were analyzed.Results HbA1c and vWF levels decreased gradually in combina-tion and T2DM groups than that in control group,and the differences were significant (P <0.01). There was no significant difference in platelet count (PLT)among 3 groups (P >0.05).However, platelet distribution width (PDW)and mean platelet volume (MPV)decreased evidently and gradu-ally in 3 groups (P <0.01).Additionally,HbA1c level was positive associated with vWF,PMV and PDW (P <0.01).Conclusion Level of vWF increases significantly in patients with T2DM complicated with cerebral infarction,whose detection combined with platelet parametes can provide references for the early diagnosis and treatment.