Nonalcoholic steatohepatitis （NASH） is a chronic metabolic disease characterized by hepatocyte fatty degeneration and ballooning degeneration， and it plays an important role in the progression of hepatic steatosis. Recent studies have shown that immune homeostasis imbalance between T helper 17 （Th17） and regulatory T （Treg） cells are closely associated with the pathological process of NASH. Transforming growth factor-β1 （TGF-β1） is a key cytokine for regulating the differentiation and proliferation of Th17/Treg cells， and TGF-β1 binds to its receptor and activates the Smad signaling pathway， thereby regulating the immune balance of Th17/Treg cells and the expression of inflammatory factors and participating in the repair of liver inflammation. This article systematically reviews the molecular mechanism of the TGF-β1/Smad signaling pathway in affecting NASH by regulating the immune balance of Th17/Treg cells， in order to provide a theoretical basis for the research on the pathogenesis of NASH and related treatment strategies.

BACKGROUND: The protective effectiveness of an N95 respirator depends on the filtration efficiency of the material from which the N95 respirator is made of, as well as the wearers' facial fit. The facial fit of an N95 respirator mainly depends on the degree of matching between the wearers' facial dimension characteristics and the N95 respirator. Quantitative fit testing objectively evaluates the fit of N95 respirators; however, it is not easy to promote because of the limitations of testing conditions. The aim of this study is to establish a fit prediction model of N95 respirator based on facial images. METHODS: Facial images and fit factor (FF) value of 5 N95 respirators were gathered from 299 medical staffs in 10 hospitals in Beijing. Face geometry measurement was based on 3D face modelling, and the American TSI-8038 Porta Count Pro+ was used to conduct quantitative fit test. Multiple linear regression analysis was employed to identify facial dimensional features that significantly influenced the fit of N95 respirators. Through matching training of facial image and FF values, a fit prediction model has been established, enabling rapid recommendation of N95 respirators meeting the fit standard via facial image recognition. RESULTS: A fit prediction model for N95 respirators based on facial images has been developed, which enables the rapid recommendation of N95 respirators with acceptable FF value for healthcare personnel. The model demonstrated an accuracy of 55.93%, a precision of 98.43%, a recall of 51.65%, and an F1 score of 0.68. CONCLUSIONS It is feasible to utilize computer-based facial recognition technology to rapidly recommend N95 respirators for medical personnel. Given the high level of accuracy achieved, the model demonstrates significant potential for practical application.
Humans ; Face/anatomy & histology* ; N95 Respirators/standards* ; Male ; Adult ; Female ; Middle Aged ; Beijing

OBJECTIVES: There is currently no consensus on whether extra-gastrointestinal stromal tumors (EGISTs) and gastrointestinal stromal tumors (GISTs) are the same type of tumor, and whether the diagnosis and treatment of EGISTs can directly replicate the current diagnostic and treatment standards for GISTs. This study aims to further elucidate the clinical and pathological characteristics, diagnosis, treatment, and prognosis of EGISTs by analyzing the research results of domestic scholars in the field of EGISTs in the past decade. METHODS: A review was conducted on original Chinese and English research articles published from 2013 to 2022 focusing on EGISTs. A descriptive approach was used to extract key information from the literature, including patient demographics, tumor location, tumor diameter, mitotic figures, risk stratification, immunohistochemical markers, cell type, and prognostic factors. The data were subjected to statistical analysis. RESULTS: A total of 12 articles containing 780 EGIST patients were included. The male-to-female incidence of EGISTs was 0.92꞉1. The most common sites of EGISTs were mesentery (30.96%), peritoneum or retroperitoneum (28.53%), omentum (20.32%), and pelvic cavity (12.52%). 52.77% of EGISTs had tumor diameters greater than 10 cm, and the proportions of EGISTs with nuclear fission patterns greater than 5/50 high power field (HPF) and greater than 10/50 HPF were 51.24% and 26.11%, respectively. The proportion of high-risk EGISTs was 79.05%. The positive rates of immune markers CD117, CD34, and DOG-1 in EGISTs were 82.3%, 69.0%, and 79.5%, respectively. The proportion of Ki-67 >5% was 49.2%, and the proportion of Ki-67 >10% was 24.8%. The proportions of EGISTs in spindle cells, epithelial cells, and mixed cells were 74.4%, 14.8%, and 13.1%, respectively. The diameter of the tumor, resection method, risk level, Ki-67 index, mitotic counts, presence of rupture/bleeding/necrosis/peripheral tissue invasion/recurrence and metastasis, as well as the use of imatinib treatment after surgery were important factors affecting the prognosis of EGISTs. CONCLUSIONS Current medical research is relatively well cognizant of GISTs with primary sites in the gastrointestinal tract. Compared with GISTs, EGISTs have large tumor diameters, high mitotic counts, a high percentage of high-risk grades, relatively unique molecular expression, and high aggressiveness. EGISTs differ from GISTs in clinicopathological characteristics. Whether EGISTs and GISTs share a common origin remains unclear. If they are distinct tumor entities, separate diagnostic and treatment guidelines for EGISTs should be established. If EGISTs are ultimately confirmed to be a special subtype of GISTs, then directly applying existing GIST-based standards to EGISTs may be inappropriate. A more scientific approach would involve subclassifying EGISTs based on anatomical location and then tailoring treatment strategies accordingly with reference to GIST guidelines.
Humans ; Gastrointestinal Stromal Tumors/epidemiology* ; Male ; Female ; Prognosis ; Proto-Oncogene Proteins c-kit/metabolism*

SMARCA4-deficient non small cell lung cancer (SMARCA4-dNSCLC) has recently garnered increasing attention due to its high malignancy and poor prognosis. The literature suggests that in non small cell lung cancer (NSCLC), the loss of SMARCA4 frequently co-occurs with mutations in KRAS, KEAP1, and STK11 rather than in EGFR, ALK, and ROS1. Herein, we present the first documented case of SMARCA4-dNSCLC accompanied with rare mutations of EGFR exon 20 S768I and exon 18 G719X. The patient achieved partial response with afatinib for 17 months. Our case highlights the importance of EGFR mutations in the precision targeted treatment of SMARCA4-dNSCLC.
Humans ; Afatinib/therapeutic use* ; Antineoplastic Agents/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/pathology* ; DNA Helicases/genetics* ; ErbB Receptors/genetics* ; Lung Neoplasms/pathology* ; Mutation ; Nuclear Proteins/genetics* ; Transcription Factors/genetics*

ObjectiveTo analyze the polarized light microscopic characteristics， the composition of physical phases and their relative contents of Maifanitum from different origins， and to establish the Fourier characteristic fingerprint of Maifanitum powder crystals by X-ray diffraction（XRD）. MethodA total of 26 batches of Maifanitum samples were selected， and the microscopic characteristics of the sample powders and grinding flakes were observed by polarized light microscopy under single polarized light and orthogonal polarized light， and the main phase compositions and their relative contents were analyzed by powder crystal XRD technique， and the XRD Fourier characteristic fingerprint of Maifanitum was established. The incident light source of XRD was Cu target Kβ radiation， the light tube voltage and light tube current were 40 kV and 40 mA， respectively， the divergence slit was 1°， the scattering slit was 1°， the receiving slit was 0.2 mm， the scanning speed was 5°·min^-1 with continuous scanning and scanning range of 5-90°（2θ）， and the step length was 0.02°. ResultThe polarized light micrographs of powders and grinding flakes of Maifanitum were obtained， and the main phases were plagioclase， potassium feldspar and quartz， and a few samples also contained illite， pyrite， iron dolomite， calcite， iron amphibole and chlorite， etc. The relative total content of feldspar phases was 61.9%-82.4%， and the relative content of quartz was 12.6%-33.6%. The XRD Fourier fingerprint analysis method of Maifanitum with 13 common peaks as the characteristic fingerprint information was established， and the similarity calculated by the mean correlation coefficient method was 0.920 9-0.997 7， the similarity calculated by the mean angle cosine method was 0.940 5-0.998 4， the similarity calculated by the median correlation coefficient method was 0.921 1-0.997 5， and the similarity calculated by the median angle cosine method was 0.947 5-0.998 2. ConclusionThe polarized light microscopic identification characteristics of Maifanitum are mainly plagioclase， quartz and potassium feldspar， and the technique of powder crystal XRD Fourier fingerprint analysis can be used for the identification of Maifanitum.

Lymph node metastasis is rare in gastrointestinal stromal tumors. Lymph node metastasis of gastrointestinal stromal tumors is related to many factors such as age, gender, pathological features and so on. The treatment and prognosis of gastrointestinal stromal tumors are also controversial. This article reviewed the case reports of lymph node metastasis in gastrointestinal stromal tumors from 2003 to 2022, and summarized the related studies on lymph node metastasis of gastrointestinal stromal tumors in recent years, so as to review the mechanism of lymph node metastasis of gastrointestinal stromal tumors, its correlation with age, gender and pathological features, diagnosis, treatment and prognosis.

Objective:To investigate the optimal treatment modalities and prognostic factors of adenoid cystic carcinoma of the head and neck salivary gland.Methods:From January 2016 to December 2018, clinical data of 166 patients with adenoid cystic carcinoma of the head and neck salivary gland who received postoperative radiotherapy at Department of Radiation Oncology of the Ninth People′s Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by log-rank test. Multivariate prognostic analysis was carried out by Cox proportional hazard regression model.Results:Among 166 enrolled patients, 70 cases were male and 96 female with an average age of 53 years (18 to 71 years). The median follow-up time was 31.2 months (8.6-63.1 months). Sixty-six patients underwent radical surgery (extended resection across the anatomical areas outside the tumor bed, pursuing negative margins of various resections), and the remaining 100 patients underwent conservative surgery (only extended resection of lesions, not pursuing negative nerve resection margins). The median dose of postoperative radiotherapy was 66 Gy (54-70 Gy). Seventy-three patients were treated with TP regime due to positive or close margins and 9 cases of cervical lymph node metastasis. The 3-and 5-year overall survival (OS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) rates were 95% and 95%, 93% and 93%, 74% and 66%, 73% and 65%, respectively. Seven patients experienced primary lesion recurrence, 5 cases of regional lymph node recurrence and 38 cases of distant metastasis. T 3-T 4 stage, lymph nodes (+ ), stage IV, solid pathologic subtype, Ki-67≥10% and perineural invasion were associated with worse PFS and DMFS. Multivariate analysis demonstrated that only solid pathologic subtype was the independent prognostic factor of OS, LRRFS, PFS and DMFS. Conclusions:The local control rate of salivary gland adenoid cystic carcinoma can be improved by postoperative intensity-modulated radiotherapy (IMRT) with a recommended dose of ≥66 Gy. Solid pathologic subtype is the most important adverse prognostic factor.

Objective To assess the efficacy and safety of post operative adjuvant concurrent chemoradiotherapy for patients with high-risk salivary gland tumors (SGT).Methods Fifty-two patients with moderate or high malignant pathological stage complicated with locally advanced stage Ⅲ/ⅣA±positive margin/close margin admitted to Shanghai Ninth People's Hospital from 2016 to 2018 were enrolled in this study.Among them,35 patients were male and 17 female with a median age of 55.5 years old (range:21-73 years old).All 52 patients were treated with intensity-modulated radiotherapy and concurrent chemotherapy.Patients with adeno carcinoma of the salivary gland receives concurrent chemotherapy with TP regimen.Patients with lympho epithelial cancer and squamous cell carcinoma were treated with cisplatin regimen.Results Forty-seven patients (90％) completed two cycles of concurrent chemotherapy,and five patients (10％) completed one cycle of concurrent chemotherapy.The median follow-up time was 15.7 months (3.2-34.8 months).The 2-year disease-free survival (DFS) and overall survival (OS) rates were 74％ and 98％.Three patients experienced regional lymph recurrence and 6 cases had distant metastasis.Grade Ⅲ oral mucositis was observed in 30 patients.Grade Ⅲ dermatitis occurred in 5 cases.Only one patient experienced Grade Ⅳ neutropenia,and 2 patients developed Grade Ⅲ neutropenia.DFS was positively correlated with the cycle of postoperative adjuvant concurrent chemotherapy (P=0.006).Conclusions Patients with high-risk SGT can obtain higher 2-year DFS and OS rates and tolerable adverse events after postoperative concurrent chemoradiotherapy.Nevertheless,the long-term outcomes remain to be validated by randomized controlled clinical trials.

Objective The current meta-analysis was performed to update the evidcnce on anti-melanoma differentiation-associated gene 5 (MDA5) antibody for the diagnosis of rapid progressive interstitial lung disease (RPILD) and chronic ILD in adult or juvenile dermatomyositis (JDM).Methods The electronic search on PubMed,Embase,Cochrane Library,CNKI,WangFang Data,VIP and China Biology Medicine database was conducted from their inception to May,2017.Meta-disc1.4 was used to calculate heterogeneity and obtain the pool sensitivity,specificity,diagnostic odds ratio,positive and negative likelihood ratios and summarized receiver operating characteristic (SROC) curve.Quality assessment and publication bias were determined by QUADAS-2 and STATA 12.0.Results A total of 32 studies with high quality and middle heterogeneity were selected for the final data synthesis.Anti-MDA5 showed a higher diagnostic and prognostic value for RPILD (AUC =0.927,Q * =0.862),compared with chronic ILD (AUC =0.717,Q * =0.667) in adult dermatomyositis patients.For diagnosing RPILD in JDM,the value of MDA5 detection (AUC =0.836,Q * =0.768)was weak.For the prediction of RPILD,the validity of anti-MDA5 detection in clinical amyopathic dermatomyositis (CADM) (AUC =0.942,Q* =0.880) was higher than that in DM (AUC =0.926,Q * =0.860),which was also more applicable to East-Asia populations (AUC =0.960,Q* =0.891),compared with Chinese (AUC =0.925,Q* =0.859) and Western populations (AUC =0.928,Q* =0.863).The methodological assessment for different anti-MDA5 detection implied ELISA (AUC =0.929,Q* =0.864) was superior in performance as immunoprecipitation (AUC =0.927,Q* =0.859),and there was no publication bias according to Deek's plot.Conclusion Anti-MDA5 antibody should be a significant laboratory index for diagnosis and prediction of ILD in adult DM and JDM with high sensitivity and specificity.

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.