SARS-CoV-2 caused severe threat to people's health all over the world,and has attracted widespread attention from researchers.The spike protein of SARS-CoV-2 is a key structure mediating the binding of the virus to its host.Therefore,it is im-portant to elucidate the mechanism of spike protein-induced immune responses.We've reviewed the structure of spike protein from al-pha to omicron variant,as well as the potential mechanisms of spike-induced in multiple systems,so as to provide a reference for dis-ease prevention and treatment.

Objective:To explore the value of coronary CT angiography (CCTA) in the diagnosis of vulnerable plaques using intravascular ultrasound (IVUS) as the gold standard.Methods:A retrospective analysis was conducted on the clinical and imaging data of coronary artery disease patients who underwent both IVUS and CCTA examinations at Fuwai Central China Cardiovascular Hospital from December 2017 to March 2022. Based on the IVUS results, the coronary plaques were divided into vulnerable and non-vulnerable plaque groups. Finally, 43 patients with a total of 88 coronary artery plaques were included, of which 26 were vulnerable plaques. Plaque analysis were performed on the CCTA images, including qualitative parameters such as low-density plaques (LAP), "napkin-ring" sign (NRS), spotty calcification (SC) and positive remodeling (PR), and the quantitative parameters such as minimum lumen area (MLA), total plaque volume (TPV), lesion length, volume and proportion of calcified plaque and fibrous plaque. The differences of CCTA parameters between the two groups were compared using t-test, chi-square test, and rank sum test. The association between CCTA parameters and the risk of vulnerable plaque was evaluated by logistic regression. Different CCTA parameters were used to establish qualitative, quantitative, and hybrid models, and the diagnostic efficacy of different models for vulnerable plaque was evaluated using the receiver operating characteristic (ROC) curve. Results:There were significant differences in NRS ( χ2=14.22, P<0.001), MLA ( Z=3.25, P=0.001), lesion length ( Z=-3.28, P=0.001), TPV ( Z=-2.04, P=0.041), calcified plaque volume ( Z=-2.52, P=0.012) and fibrous plaque volume ( Z=-2.10, P=0.035) between vulnerable and non-vulnerable plaque groups. The logistic regression analysis showed that NRS ( OR=9.66, 95% CI 2.36-39.54), MLA ( OR=0.76, 95% CI 0.59-0.99) and lesion length ( OR=1.03, 95% CI 1.00-1.07) were independent risk factors for vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters was superior to the qualitative model [hybrid model: area under the ROC curve (AUC)=0.82, 95% CI 0.72-0.89; qualitative model: AUC=0.68, 95% CI 0.57-0.78; Z=2.57, P=0.010]. Conclusions:CCTA parameters NRS, MLA, and lesion length are independent risk factors for coronary vulnerable plaques. The diagnostic efficacy of the hybrid model based on CCTA parameters is superior to the qualitative model for vulnerable plaques.

Objective:To investigate the clinical value of prospective ECG-gated high-pitch protocol scanning of third generation DSCT in the diagnosis of pediatric congenital heart disease (CHD).Methods:A total of 243 children with confirmed CHD who were expected to undergo surgical treatment were prospectively collected and randomly divided evenly into 3 groups, with first group for prospective ECG-gated high-pitch scanning in third generation DSCT (Flash 3rd), second group for prospective ECG-gated high-pitch scanning in second generation DSCT (Flash 2nd) and third group for prospective sequential scanning in third generation DSCT (Sequence 3rd). The SD value and SNR of aortic root and pulmonary artery of each child were recorded. The 5-point system is adopted with subjective scoring. Based on the result of operation, the diagnosis accuracy in 3 groups was analyzed. Results:The E values in Flash 3rd, Flash 2nd and Sequence 3rd group were 0.24 (0.19, 0.27), 0.11 (0.10, 0.14) and 0.44 (0.39, 0.48) mSv ( H=207.04, P<0.05), respectively. Subjective scores of group Flash 3rd and Sequence 3rd were significantly higher than that of group Flash 2nd [4 (4, 4) vs. 4(3, 4) vs. 3(3, 3), H=124.05, P<0.05] and no difference between these two groups. SD value of aortic root and pulmonary artery of group Flash 3rd and Sequence 3rd were significantly lower than that of group Flash 2nd( H= -40.27-33.38, P<0.05). SNR of aortic root and pulmonary artery of group Flash 3rd was significantly higher than that of group Flash 2nd and Sequence 3rd ( H=-0.90-51.42, P<0.05). Diagnosis accuracy of intracardiac malformation for group Flash 2nd was significantly lower than that of Flash 3rd and Sequence 3rd (77.7%, 90.9%, 88.9%, K=9.36, P<0.05), and there was no significant difference between the latter two groups. There was no difference in diagnosis accuracy of extracardiac malformation among 3 groups (88.6%, 94.8%, 92.2%, K=3.11, P=0.21). Conclusions:The prospective ECG-gated high-pitch scanning in third generation DSCT can take into account radiation dose and image quality, which has important clinical value in the diagnosis of CHD.

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
Breast Neoplasms/surgery* ; Female ; Humans ; Mastectomy, Segmental ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Background::This study aimed to reveal the treatment patterns and clinical outcomes of diverse palbociclib-based regimens in Han patients with estrogen receptor-positive (ER+) metastatic breast cancer in routine clinical practice.Methods::The clinical data of patients with ER+ metastatic breast cancer treated with palbociclib were collected from the National Cancer Center database. The efficacy profile of palbociclib in this Han population was evaluated, especially for various combination regimens. The efficacy of palbociclib-based therapy in patients with prior everolimus treatment was also assessed.Results::A total of 186 patients from 89 cities in 18 provinces in China were enrolled. The median progression-free survival (PFS) was similar among different palbociclib-combined groups ( P = 0.566): 10.0 months (95% confidence interval [CI] 3.8–16.1) in the +exemestane group, 9.7 months (95% CI 6.3–13.1) in the +letrozole group, 7.8 months (95% CI 5.5–10.2) in the +fulvestrant group, 7.2 months (95% CI 3.2–11.3) in the +toremifene group, and 6.1 months (95% CI 1.2–11.0) in the +anastrozole group. Thirty-four patients (18.3%) had received everolimus for their metastatic disease before the prescription of palbociclib. The disease control rate was significantly lower in patients who had received previous everolimus than in the everolimus-na?ve group (50.0% vs. 82.2%, P < 0.001). Patients pre-treated with everolimus had significantly worse PFS than those in the everolimus-na?ve group (3.4 months vs. 8.8 months, P = 0.001). After propensity score matching, patients pre-treated with everolimus had similar PFS (4.4 months, 95% CI 0.5–8.2) compared with everolimus-na?ve patients (6.1 months, 95% CI 4.7–7.5, P = 0.439). Conclusions::Various palbociclib-based regimens have promising efficacy in ER+ metastatic breast cancer in real-world settings, even in patients who had been pre-treated with everolimus.

Objective:The 6th edition American Joint Committee on Cancer (AJCC) staging system for breast cancer classifies ipsilateral supraclavicular lymph node metastasis (ISLM) downing stage from M1 to N3, suggesting more patients might receive radical treatment. The aim of this study was to analyze the effect of ISLM on the prognosis of N3 breast cancer and verify the rationality of modified staging.Methods:A total of 321 breast cancer patients with N3 according to the 6th edition AJCC staging system were retrospectively analyzed. Propensity Score Matching (PSM) was used to pair the different subgroups of N3. The primary end point was disease-free survival (DFS), the secondary end point was overall survival (OS). Kaplan-Meier method was used to calculate the DFS and OS. The differences between two groups were analyzed by the Log-rank test.Results:After PSM pairing twice, 78 patients with none-ISLM and 78 patients with ISLM were enrolled in the first group; 51 patients with none-ISLM was compared patients with isolated ISLM in the second group. The results of the two groups showed that patients with none-ISLM have a prolonged DFS (the first group: 58.9 months vs 32.1 months, P=0.101; the second group: 59.0 months vs 44.0 months, P=0.533), while the OS was opposite (the first group: 87.4 months vs 140.4 months, P=0.289; the second group: 87.4 months vs 137.1 months, P=0.289). Conclusions:The prognosis of breast cancer patients with ISLM is similar to that of patients with none-ISLM in stage N3. It is reasonable to include ISLM in N3 in the 6th edition AJCC staging system. Yet, prospective studies with larger sample size are needed to further confirmation.

Objective:The 6th edition American Joint Committee on Cancer (AJCC) staging system for breast cancer classifies ipsilateral supraclavicular lymph node metastasis (ISLM) downing stage from M1 to N3, suggesting more patients might receive radical treatment. The aim of this study was to analyze the effect of ISLM on the prognosis of N3 breast cancer and verify the rationality of modified staging.Methods:A total of 321 breast cancer patients with N3 according to the 6th edition AJCC staging system were retrospectively analyzed. Propensity Score Matching (PSM) was used to pair the different subgroups of N3. The primary end point was disease-free survival (DFS), the secondary end point was overall survival (OS). Kaplan-Meier method was used to calculate the DFS and OS. The differences between two groups were analyzed by the Log-rank test.Results:After PSM pairing twice, 78 patients with none-ISLM and 78 patients with ISLM were enrolled in the first group; 51 patients with none-ISLM was compared patients with isolated ISLM in the second group. The results of the two groups showed that patients with none-ISLM have a prolonged DFS (the first group: 58.9 months vs 32.1 months, P=0.101; the second group: 59.0 months vs 44.0 months, P=0.533), while the OS was opposite (the first group: 87.4 months vs 140.4 months, P=0.289; the second group: 87.4 months vs 137.1 months, P=0.289). Conclusions:The prognosis of breast cancer patients with ISLM is similar to that of patients with none-ISLM in stage N3. It is reasonable to include ISLM in N3 in the 6th edition AJCC staging system. Yet, prospective studies with larger sample size are needed to further confirmation.

Objective: We aimed to examine the feasibility and toxicity of EC-T dose-dense regimen and to demonstrate the suitable dose of epirubicin in a Chinese early-stage breast cancer population with high recurrence risk. Methods: 370 patients with early-stage breast cancer at high risk of recurrence were treated with EC-T dose-dense adjuvant chemotherapy and prophylactic administration of recombinant human granulocyte stimulating factor (G-CSF). The incidence of delayed chemotherapy, drug reduction and adverse reactions were retrospectively analyzed. Results: 370 patients completed the planned eight cycles of chemotherapy, 50 patients experienced chemotherapy delay, and 90 had chemotherapy dose reductions. Overall, 61.1% of the patients experienced grade 3 or 4 hematology toxicities, 4.1% of the patients experienced grade 3 gastrointestinal toxicity, 16.3% experienced grade 3 or 4 liver malfunction, and 1.9% experienced grade 3 alopecia. In the multivariate analysis, pretreatment epirubicin levels were associated with comprehensive and hematology toxicity risk (OR=1.268, P=0.046; OR=1.244, P=0.036). With G-CSF support, the probability of grade 3-4 dose limiting toxicity, i. e. neutropenia, abnormal liver function, and gastrointestinal adverse effects did not increase as the epirubicin dose level increased(P>0.05). However, there were no statistically significant associations between epirubicin grade and treatment delay (P=0.814) or dose reduction (P=0.282). Conclusions EC-T dose-dense chemotherapy shows tolerable toxicity. High dose level is not a limiting factor for this regimen. With G-CSF support, epirubicin 85-90 mg/m² is appropriate tolerance dose for Chinese early breast cancer patients with high recurrence risk.

Objective We aimed to examine the feasibility and toxicity of EC?T dose?dense regimen and to demonstrate the suitable dose of epirubicin in a Chinese early?stage breast cancer population with high recurrence risk. Methods 370 patients with early?stage breast cancer at high risk of recurrence were treated with EC?T dose?dense adjuvant chemotherapy and prophylactic administration of recombinant human granulocyte stimulating factor (G?CSF). The incidence of delayed chemotherapy, drug reduction and adverse reactions were retrospectively analyzed. Results 370 patients completed the planned eight cycles of chemotherapy, 50 patients experienced chemotherapy delay, and 90 had chemotherapy dose reductions. Overall, 61.1% of the patients experienced grade 3 or 4 hematology toxicities, 4.1% of the patients experienced grade 3 gastrointestinal toxicity, 16.3% experienced grade 3 or 4 liver malfunction, and 1.9%experienced grade 3 alopecia. In the multivariate analysis, pretreatment epirubicin levels were associated with comprehensive and hematology toxicity risk ( OR＝1.268, P＝0.046; OR＝1.244, P＝0.036). With G?CSF support, the probability of grade 3?4 dose limiting toxicity, i.e. neutropenia, abnormal liver function, and gastrointestinal adverse effects did not increase as the epirubicin dose level increased ( P＞0.05). However, there were no statistically significant associations between epirubicin grade and treatment delay (P＝0.814) or dose reduction (P＝0.282). Conclusions EC?T dose?dense chemotherapy shows tolerable toxicity. High dose level is not a limiting factor for this regimen.With G?CSF support, epirubicin 85?90 mg／m2 is appropriate tolerance dose for Chinese early breast cancer patients with high recurrence risk.

Objective We aimed to examine the feasibility and toxicity of EC?T dose?dense regimen and to demonstrate the suitable dose of epirubicin in a Chinese early?stage breast cancer population with high recurrence risk. Methods 370 patients with early?stage breast cancer at high risk of recurrence were treated with EC?T dose?dense adjuvant chemotherapy and prophylactic administration of recombinant human granulocyte stimulating factor (G?CSF). The incidence of delayed chemotherapy, drug reduction and adverse reactions were retrospectively analyzed. Results 370 patients completed the planned eight cycles of chemotherapy, 50 patients experienced chemotherapy delay, and 90 had chemotherapy dose reductions. Overall, 61.1% of the patients experienced grade 3 or 4 hematology toxicities, 4.1% of the patients experienced grade 3 gastrointestinal toxicity, 16.3% experienced grade 3 or 4 liver malfunction, and 1.9%experienced grade 3 alopecia. In the multivariate analysis, pretreatment epirubicin levels were associated with comprehensive and hematology toxicity risk ( OR＝1.268, P＝0.046; OR＝1.244, P＝0.036). With G?CSF support, the probability of grade 3?4 dose limiting toxicity, i.e. neutropenia, abnormal liver function, and gastrointestinal adverse effects did not increase as the epirubicin dose level increased ( P＞0.05). However, there were no statistically significant associations between epirubicin grade and treatment delay (P＝0.814) or dose reduction (P＝0.282). Conclusions EC?T dose?dense chemotherapy shows tolerable toxicity. High dose level is not a limiting factor for this regimen.With G?CSF support, epirubicin 85?90 mg／m2 is appropriate tolerance dose for Chinese early breast cancer patients with high recurrence risk.