1.Analysis of Mechanism of Astragaloside Ⅳ in Regulating Ferroptosis Through SLC7A11/GPX4 Pathway Against Vascular Smooth Muscle Cell Proliferation
Guoting LI ; Changchao YANG ; Lin LIU ; Weikang LI ; Zixian ZHAO ; Quan SHEN ; Jingshan ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(10):159-167
ObjectiveTo investigate the effect of astragaloside Ⅳ(AS-Ⅳ) on the proliferation of vascular smooth muscle cells(VSMCs) induced by angiotensin Ⅱ(Ang Ⅱ) based on solute carrier family 7 member 11/glutathione peroxidase 4(SLC7A11/GPX4) pathway. MethodsPrimary rat thoracic aortic VSMCs were cultured by tissue explant method, and the cell types were identified by immunofluorescence. Cell counting kit-8(CCK-8) was used to determine the optimal concentration and time of AS-Ⅳ after Ang Ⅱ stimulation. The experiment was divided into blank group, model group, AS-Ⅳ group(40 μmol·L-1), Erastin group(0.5 μmol·L-1), Erastin+AS-Ⅳ group(0.5 μmol·L-1+40 μmol·L-1). The blank group was cultured in normal medium, the model group was cultured in medium containing Ang Ⅱ(0.1 μmol·L-1), and each administration group was cultured in medium containing Ang Ⅱ(0.1 μmol·L-1) and the corresponding doses of drug. CCK-8 and plate clone formation assay were used to detect the proliferation of cells in each group, Prussian blue staining was used to detect cell iron deposition, the content of reactive oxygen species(ROS) in cells was detected by fluorescence probe method, the content of malondialdehyde(MDA) was detected by thiobarbituric acid(TBA) method, and the protein levels of SLC7A11 and GPX4 in each group were detected by Western blot. ResultsPrimary rat thoracic aortic VSMCs were successfully cultured by tissue explant method, and immunofluorescence detection showed that positive expression of α-smooth muscle actin(α-SMA) and negative expression of vimentin in the cells, identifying them as VSMCs. The optimal concentration and time of AS-Ⅳ determined by CCK-8 were 40 μmol·L-1 and 24 h, respectively. Pharmacodynamic studies showed that compared with the blank group, the cell proliferation in the model group increased, the iron deposition in the cells increased, the contents of ROS and MDA increased, and the expression levels of SLC7A11 and GPX4 proteins decreased(P<0.05, P<0.01). Compared with the model group, the cell proliferation of the AS-Ⅳ group was inhibited, the iron deposition in the cells was decreased, the contents of ROS and MDA were decreased, and the expression levels of SLC7A11 and GPX4 proteins were increased(P<0.05, P<0.01). While in the Erastin group, the cell proliferation was increased, the iron deposition was increased, ROS and MDA contents were increased, and the expression levels of SLC7A11 and GPX4 proteins were decreased(P<0.05, P<0.01). Compared with the AS-Ⅳ group, Erastin+AS-Ⅳ group showed increased cell proliferation, increased iron deposition in cells, increased ROS and MDA contents, and decreased expression of SLC7A11 and GPX4 proteins(P<0.05). Compared with the Erastin group, the cell proliferation in Erastin+AS-Ⅳ group was inhibited, the iron deposition was decreased, the contents of ROS and MDA were decreased, and the expression levels of SLC7A11 and GPX4 proteins were increased(P<0.05, P<0.01). ConclusionAS-Ⅳ can inhibit ferroptosis by regulating the SLC7A11/GPX4 pathway, so as to weaken the proliferation of VSMCs, thus playing a role in the treatment of atherosclerosis.
2.Development and application on a full process disease diagnosis and treatment assistance system based on generative artificial intelligence.
Wanjie YANG ; Hao FU ; Xiangfei MENG ; Changsong LI ; Ce YU ; Xinting ZHAO ; Weifeng LI ; Wei ZHAO ; Qi WU ; Zheng CHEN ; Chao CUI ; Song GAO ; Zhen WAN ; Jing HAN ; Weikang ZHAO ; Dong HAN ; Zhongzhuo JIANG ; Weirong XING ; Mou YANG ; Xuan MIAO ; Haibai SUN ; Zhiheng XING ; Junquan ZHANG ; Lixia SHI ; Li ZHANG
Chinese Critical Care Medicine 2025;37(5):477-483
The rapid development of artificial intelligence (AI), especially generative AI (GenAI), has already brought, and will continue to bring, revolutionary changes to our daily production and life, as well as create new opportunities and challenges for diagnostic and therapeutic practices in the medical field. Haihe Hospital of Tianjin University collaborates with the National Supercomputer Center in Tianjin, Tianjin University, and other institutions to carry out research in areas such as smart healthcare, smart services, and smart management. We have conducted research and development of a full-process disease diagnosis and treatment assistance system based on GenAI in the field of smart healthcare. The development of this project is of great significance. The first goal is to upgrade and transform the hospital's information center, organically integrate it with existing information systems, and provide the necessary computing power storage support for intelligent services within the hospital. We have implemented the localized deployment of three models: Tianhe "Tianyuan", WiNGPT, and DeepSeek. The second is to create a digital avatar of the chief physician/chief physician's voice and image by integrating multimodal intelligent interaction technology. With generative intelligence as the core, this solution provides patients with a visual medical interaction solution. The third is to achieve deep adaptation between generative intelligence and the entire process of patient medical treatment. In this project, we have developed assistant tools such as intelligent inquiry, intelligent diagnosis and recognition, intelligent treatment plan generation, and intelligent assisted medical record generation to improve the safety, quality, and efficiency of the diagnosis and treatment process. This study introduces the content of a full-process disease diagnosis and treatment assistance system, aiming to provide references and insights for the digital transformation of the healthcare industry.
Artificial Intelligence
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Humans
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Delivery of Health Care
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Generative Artificial Intelligence
3.Effects of laminarin on non-proliferative diabetic retinopathy in C57BL/6 mice based on transcriptomics analysis
Lei Zhang ; Sumei Zhang ; Zhen Yang ; Weikang Hu ; Hongmei Bai ; Wenjing Zhou ; Zihan Wang ; Mingcong Li ; Shengquan Zhang ; Rongfeng Liao
Acta Universitatis Medicinalis Anhui 2025;60(3):392-398
Objective :
To investigate the effect of laminarin(LAM) on nonproliferative diabetes retinopathy by high throughput sequencing(RNA-seq).
Methods :
The diabetes model was established by intraperitoneal injection of streptozotocin(STZ), and the effect of LAM on diabetic mice was observed.C57BL/6 mice were randomly divided into three groups: Control group, Model group, and LAM group, with 8 mice in each group. After 8 weeks of modeling, the LAM group received a 4-week intraperitoneal injection of LAM treatment. Changes in blood glucose and body weight of the three groups of mice were recorded, HE staining was performed to examine retinal lesions, and RNA-seq was used to identify differentially expressed genes(DEGs) in diabetic retinopathy(DR) under the action of STZ and LAM.
Results :
STZ successfully established the model of DR, and LAM reduced the blood sugar in diabetic mice to a certain extent and improved the pathological morphology of retinal structural looseness in diabetic mice. After RNA-seq analysis of DEGs, it was found that there were a total of 214 DEGs in the retina of the Model group mice compared to the Control group. Enrichment analysis revealed that DR could exacerbate the lesions through the PI3K Akt signaling pathway. There were a total of 42 DEGs in the retina of the Model group and LAM group mice, and enrichment showed that LAM improved the lesions through the neutrophil extracellular trap pathway. Early growth response factor 1(Egr1), FBJ osteosarcoma oncogene(Fos), nuclear receptor subfamily 4A member 1(Nr4a1), and salt-induced kinase 1(Sik1) were regulated by STZ, and LAM significantly regulated their expression, which might be closely related to LAM′s treatment of diabetic retinopathy.
Conclusion
DEGs can exacerbate the severity of diabetic retinopathyviathe PI3K-Akt signaling pathway. LAM can mitigate diabetic retinopathyviathe neutrophil extracellular trap pathway. Egr1, Fos, Nr4a1, and Sik1 are key genes involved in LAM treatment of STZ-induced DR.
4.Effects of LSS function deficiency on intestinal function in NAFLD model mice
Hongmei Bai ; Zhen Yang ; Weikang Hu ; Zihan Wang ; Wenjing Zhou ; Qingya He ; Jian Zhong ; Mingcong Li ; Li Liu ; Chaoyang Zhang ; Sumei Zhang ; Shengquan Zhang
Acta Universitatis Medicinalis Anhui 2025;60(9):1653-1660
Objective:
To investigate the effect of loss of function of lanosterol synthase( LSS) gene on intestinal function in a mouse model of non-alcoholic fatty liver disease( NAFLD) induced by a high-fat diet.
Methods:
LSS gene heterozygous knockout C57 mice ( LSS + / -) were established using the CRISRP / Cas9 system.After being fed a high-fat diet with 60% fat content for 6 months,the fat deposition in liver tissues was detected by HE and Oil red O staining,the morphological changes of small intestine tissue were detected by HE staining.The changes in total cholesterol content in intestinal tissue were detected by kits.The gastrointestinal motility function of mice was detected by phenol red paste.The intestinal permeability was detected by Evans blue staining,and the expression of LSS,tight junction protein ( Claudin) -1,Claudin-5,cluster of differentiation 36 ( CD36) ,and Niemann-Pick type C1-like 1 protein ( NPC1L1) proteins in small intestinal tissues were detected by Western blot.
Results :
The results of HE and Oil red O staining of liver tissues showed that liver fat deposition in LSS gene heterozygous knockout mice was lower than that in wild-type mice in the high-fat diet group.The total cholesterol content in intestinal tis- sue of LSS gene heterozygous knockout mice decreased ( P <0. 01) ,but no morphological differences were ob- served between the two groups of mice by HE staining of intestinal tissues.The gastrointestinal motility function of LSS gene heterozygous knockout mice did not show significant changes.The intestinal permeability of LSS gene het- erozygous knockout mice in the high-fat diet group decreased as detected by Evans blue ( P<0. 05) .The expres- sion levels of Claudin-5 protein in the intestinal tissue of LSS gene heterozygous knockout mice in the high-fat diet group increased ( P <0. 05 ) ,while the expression of LSS protein in the intestinal tissues of LSS heterozygous knockout mice decreased ( P <0. 05) .
Conclusion
In the NAFLD model induced by a high-fat diet,LSS gene heterozygous knockout reduces liver fat deposition induced by a high-fat diet and improves intestinal barrier function by regulating cholesterol metabolism in intestinal tissues and up-regulating the expression of Claudin-5.
5.Changes in behavior and spatial memory of C57BL/6J mice of different ages
Zhen Yang ; Hongmei Bai ; Weikang Hu ; Mingcong Li ; Xiaoli Jiang ; Chaoyang Zhang ; Zihan Wang ; Wenjing Zhou ; Qingya He ; Jian Zhong ; Shengquan Zhang
Acta Universitatis Medicinalis Anhui 2025;60(8):1410-1417
Objective :
To explore the changes in behavior and spatial memory of C57BL/6J female mice of different ages (youth , middle-aged , and elderly) .
Methods:
C57BL/6J female mice were divided into female youth group (YG group) , female middle-aged group ( MG group) and female elderly group ( OG group) according to age. The Morris water maze test measured spatial memory ability , and the open field and elevated cross maze test observed activity level and anxiety level. Western blot was used to determine the protein expressions of CREB , CaMKⅡ(pan) and CaMKⅡ(p) in the hippocampus of the brain tissues of female mice in each group.
Results:
Compared with the YG group , the weight of the MG group and the OG group significantly increased (P < 0. 01 , P < 0. 001) . Compared with the OG group , the third quadrant escape latency and the number of crossings in the YG group and MG group were shortened , and the difference was not statistically significant. Compared with the OG group , there was a statistically significant difference in the exercise speed in the open field of the YG group (P < 0. 01) , there was no significant difference in the movement speed in the open field of the MG group , the number of entries into the central zone significantly increased in the MG group ( P < 0. 05 ) , and there was no significant difference in the number of entries in the YG group (P > 0. 05) . Compared with the OG group , the YG group had a statistically significant difference in the elevated cross maze (P < 0. 05) , the MG group had no statistically signif- icant difference in the elevated cross maze , and the number of closed arm entries in the YG group and MG group significantly increased (P < 0. 001 , P < 0. 01) . Compared with the YG group , the relative expression level of CaMKⅡ(pan) in the OG group was statistically significant ( P < 0. 05 ) , while the relative expression level of CaMKⅡ(pan) in the MG group was not statistically significant ( P > 0. 05) .
Conclusion
With the increase of age , the weight of C57BL/6J female mice gradually increased , the activity level and desire to explore gradually de- creased , the spatial memory ability also declined , and the anxiety level and anxiety-like behavior increased. This study helps to reveal the effect of age on the activity level and cognitive function of females , and provides a refer- ence for studying cognitive and memory decline in older females.
6.Effect of Shugan Yishen Recipe on Microenvironment Gene Expression Profile and Immune-Related Gene Expression in Lung Metastasis of Breast Cancer
Xinyi LI ; Chuang CUI ; Wanqing CHEN ; Weikang ZHU
Journal of Nanjing University of Traditional Chinese Medicine 2025;41(3):352-362
OBJECTIVE To investigate the mechanism of inhibition of breast cancer lung metastasis by Shugan Yishen Recipe by studying the effects of Shugan Yishen Recipe(SGYSR)on gene expression in the lung microenvironment of mice with breast cancer.METHODS A high metastasis model of breast cancer was constructed,and the mice were randomly divided into saline group,low,medium,high(0.5,1,2 g·kg-1)Shugan Yishen Recipe groups,and docetaxel group(5 mg·kg-1),and intervened for 28 days.HE staining was used to observe the lung tissue structure;transcriptome analysis was performed on the metastatic foci,and the key differential gene expression was screened by bioinformatics analysis of the GO and KEGG pathway characteristics of the gene ex-pression profiles,and the expression of key immune genes was analyzed by qPCR and Western blot.The expression of MDSCs was de-tected by flow cytometry;the expression of cytokines and chemokines including Cxcl2,and GM-CSF was detected by ELISA.RE-SULTS Compared with the saline group,the number of metastatic nodules in lung tissues of the middle and high dose groups of Shu-gan Yishen Recipe and docetaxel group were correspondingly lower;HE staining suggested that the degree of lung pathology was im-proved.There were 814 differentially expressed genes in the lung microenvironment of the high-dose group of Shugan Yishen Recipe and the saline group,of which 713 genes were down-regulated and 101 genes were up-regulated;screening for key inflammatory medi-ator genes in the Shugan Yishen Recipe group,Nfkbiz,Tnfaip3,Maff,Hspa1a,Hspb1 and Cxcl2,the inflammatory genes in the Shu-gan Yishen Recipe,as compared with that of the saline group,were significantly down-regulated(P<0.05,P<0.01),and ultimately its results were consistent with the trend of the transcriptome results.Western blot was used to verify the results at the protein level,and it was found that compared with the saline group,the protein expression levels of Nfkbiz,Tnfaip3,Maff,Hspa1a and Cxcl2 in the Shugan Yishen Recipe group were decreased(P<0.05,P<0.01),while the protein expression of Hspb1 was up-regulated(P<0.01).Both the Shugan Yishen Recipe group and the docetaxel group could inhibit the expression of MDSCs(P<0.001),and the ex-pression of Cxcl2,and GM-CSF decreased to a certain extent(P<0.05,P<0.01).CONCLUSION Shugan Yishen Recipe can in-hibit breast cancer lung metastasis and regulate the lung immune microenvironment genes in a wide range.
7.Nano-ITO induce pulmonary alveolar proteinosis through oxidative stress and activation of NF-κB/Nrf2 signaling pathway
Yinqiao LIN ; Yi ZHANG ; Xiaoyang CHEN ; Weikang LI ; Yujing NIU ; Xuefei WANG ; Nan LIU ; Gai LI
Chinese Journal of Industrial Hygiene and Occupational Diseases 2025;43(2):81-90
Objective:To investigate the role of the nuclear factor-kappa B (NF-κB) /nuclear factor E2 related factor 2 (Nrf2) pathway in the occurrence of lung tissue in the pulmonary alveolar proteinosis (PAP) model of rats induced by indium tin oxide nanoprticles (Nano-ITO) .Methods:In October 2019, 120 SD rats were divided into 3, 7, 14, 28, 56, and 84 day Nano ITO exposure groups and corresponding time point control groups, with 10 rats in each group; the exposure group was treated with 6 mg/kg·bw Nano-ITO via non exposed tracheal injection, twice a week. Time-course studies were performed to examine the pulmonary toxicity induced by Nano-ITO. At the end of the experiment, cytokines levels and oxidative stress were analyzed in the bronchoalveolar lavaged fluid (BALF). Rat lung tissues were also harvested for staining with HE, PAS, Masson, and Oil Red O. Ultrastructure of lung tissue cells was observed by transmission electron microscope. The localization and expression of NF-κB p65, IκB-α, IKK-β, Nrf2, NQO1, HO-1 were observed by immunohistochemistry, Western blot and real-time fluorescent quantitative PCR. The comparison between the two groups was analyzed by independent sample T test, and the comparison between the multiple groups was analyzed by one-way ANOVA.Results:Nano-ITO intratracheal instillation caused pulmonary toxicity by inducing acute inflammation, granuloma (nodule) formation, and alveolar proteinosis. ELISA analysis showed that, compared with the corresponding time points control groups, the levels of superoxide dismutase (SOD), total antioxidant capacity (T-AOC), malondialdehyde (MDA), interleukin (IL) -1β, IL-6, tumor necrosis factor alpha (TNF-α), IL-10, total protein (TP), and lactate dehydrogenase (LDH) in BALF of rats exposed to Nano ITO were all increased ( P<0.05) ; The protein expression of Nrf2 and NF-κB p65 was upregulated in rat lung tissue, while the protein expression of KK-β was increased ( P<0.01). Nrf2 and its downstream proteins NQO1 and HO-1 were highly expressed in Nano-ITO-induced PAP rat. Conclusion:NF-κB/Nrf2 signal pathway is involved in the process of Nano-ITO induced pulmonary alveolar proteinosis in rats.
8.Effect of Shugan Yishen Recipe on Microenvironment Gene Expression Profile and Immune-Related Gene Expression in Lung Metastasis of Breast Cancer
Xinyi LI ; Chuang CUI ; Wanqing CHEN ; Weikang ZHU
Journal of Nanjing University of Traditional Chinese Medicine 2025;41(3):352-362
OBJECTIVE To investigate the mechanism of inhibition of breast cancer lung metastasis by Shugan Yishen Recipe by studying the effects of Shugan Yishen Recipe(SGYSR)on gene expression in the lung microenvironment of mice with breast cancer.METHODS A high metastasis model of breast cancer was constructed,and the mice were randomly divided into saline group,low,medium,high(0.5,1,2 g·kg-1)Shugan Yishen Recipe groups,and docetaxel group(5 mg·kg-1),and intervened for 28 days.HE staining was used to observe the lung tissue structure;transcriptome analysis was performed on the metastatic foci,and the key differential gene expression was screened by bioinformatics analysis of the GO and KEGG pathway characteristics of the gene ex-pression profiles,and the expression of key immune genes was analyzed by qPCR and Western blot.The expression of MDSCs was de-tected by flow cytometry;the expression of cytokines and chemokines including Cxcl2,and GM-CSF was detected by ELISA.RE-SULTS Compared with the saline group,the number of metastatic nodules in lung tissues of the middle and high dose groups of Shu-gan Yishen Recipe and docetaxel group were correspondingly lower;HE staining suggested that the degree of lung pathology was im-proved.There were 814 differentially expressed genes in the lung microenvironment of the high-dose group of Shugan Yishen Recipe and the saline group,of which 713 genes were down-regulated and 101 genes were up-regulated;screening for key inflammatory medi-ator genes in the Shugan Yishen Recipe group,Nfkbiz,Tnfaip3,Maff,Hspa1a,Hspb1 and Cxcl2,the inflammatory genes in the Shu-gan Yishen Recipe,as compared with that of the saline group,were significantly down-regulated(P<0.05,P<0.01),and ultimately its results were consistent with the trend of the transcriptome results.Western blot was used to verify the results at the protein level,and it was found that compared with the saline group,the protein expression levels of Nfkbiz,Tnfaip3,Maff,Hspa1a and Cxcl2 in the Shugan Yishen Recipe group were decreased(P<0.05,P<0.01),while the protein expression of Hspb1 was up-regulated(P<0.01).Both the Shugan Yishen Recipe group and the docetaxel group could inhibit the expression of MDSCs(P<0.001),and the ex-pression of Cxcl2,and GM-CSF decreased to a certain extent(P<0.05,P<0.01).CONCLUSION Shugan Yishen Recipe can in-hibit breast cancer lung metastasis and regulate the lung immune microenvironment genes in a wide range.
9.Nano-ITO induce pulmonary alveolar proteinosis through oxidative stress and activation of NF-κB/Nrf2 signaling pathway
Yinqiao LIN ; Yi ZHANG ; Xiaoyang CHEN ; Weikang LI ; Yujing NIU ; Xuefei WANG ; Nan LIU ; Gai LI
Chinese Journal of Industrial Hygiene and Occupational Diseases 2025;43(2):81-90
Objective:To investigate the role of the nuclear factor-kappa B (NF-κB) /nuclear factor E2 related factor 2 (Nrf2) pathway in the occurrence of lung tissue in the pulmonary alveolar proteinosis (PAP) model of rats induced by indium tin oxide nanoprticles (Nano-ITO) .Methods:In October 2019, 120 SD rats were divided into 3, 7, 14, 28, 56, and 84 day Nano ITO exposure groups and corresponding time point control groups, with 10 rats in each group; the exposure group was treated with 6 mg/kg·bw Nano-ITO via non exposed tracheal injection, twice a week. Time-course studies were performed to examine the pulmonary toxicity induced by Nano-ITO. At the end of the experiment, cytokines levels and oxidative stress were analyzed in the bronchoalveolar lavaged fluid (BALF). Rat lung tissues were also harvested for staining with HE, PAS, Masson, and Oil Red O. Ultrastructure of lung tissue cells was observed by transmission electron microscope. The localization and expression of NF-κB p65, IκB-α, IKK-β, Nrf2, NQO1, HO-1 were observed by immunohistochemistry, Western blot and real-time fluorescent quantitative PCR. The comparison between the two groups was analyzed by independent sample T test, and the comparison between the multiple groups was analyzed by one-way ANOVA.Results:Nano-ITO intratracheal instillation caused pulmonary toxicity by inducing acute inflammation, granuloma (nodule) formation, and alveolar proteinosis. ELISA analysis showed that, compared with the corresponding time points control groups, the levels of superoxide dismutase (SOD), total antioxidant capacity (T-AOC), malondialdehyde (MDA), interleukin (IL) -1β, IL-6, tumor necrosis factor alpha (TNF-α), IL-10, total protein (TP), and lactate dehydrogenase (LDH) in BALF of rats exposed to Nano ITO were all increased ( P<0.05) ; The protein expression of Nrf2 and NF-κB p65 was upregulated in rat lung tissue, while the protein expression of KK-β was increased ( P<0.01). Nrf2 and its downstream proteins NQO1 and HO-1 were highly expressed in Nano-ITO-induced PAP rat. Conclusion:NF-κB/Nrf2 signal pathway is involved in the process of Nano-ITO induced pulmonary alveolar proteinosis in rats.
10.Genomic analysis and biomarker discovery of thymic cancer based on whole exome sequencing: A retrospective cohort study
Run XIANG ; Shaohua XIE ; Qiong LIAO ; Qiang LI ; Weikang SHAO ; Juan LI
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2024;31(02):288-303
Objective To examined gene mutations in thymic carcinoma (TC) patients and to explore prognostic correlates and potential targets for therapy. Methods We retrospectively included TC patients in Sichuan Cancer Hospital between January 2015 and Febuary 2021.Whole-exome sequencing was performed on tumor tissues from TC patients and their control peripheral blood samples, and the raw data were subjected to bioinformatics analysis and statistical analysis. Results We finally included 24 TC patients with 16 males and 8 females at a median age of 55 (42-74) years. The highest frequency of single nucleotide mutations in this cohort were in the TTN gene (42%), HSPG2 (29%), and OBSCN (29%). Higher frequency of copy number variations occurred in ZNF276 gene (54%, loss), BEND3 (50%, loss), DHODH (50%, loss), and VAC14 (50%, loss). Microsatellite instability (MSI) phenotype was found in 25% of the patients, and the mean tumor mutation burden (TMB) was 9.86. Conclusion This study is the first comprehensive analysis of the mutation profile of thymic carcinoma in China to date. The mutation frequencies of TTN, OBSCN, and ZNF276 genes were high. The biomarker analysis suggests that patients may benefit from immunotherapy and have a long effective survival.


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