Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.

As an increasing number of emerging anti-tumor drugs are approved and marketed,the imperative for clinical safety monitoring and risk information management has grown significantly.Drug-induced neuropathy associated with these drugs exhibit characteristics such as insidious onset,rapid progression,and challenging treatment,ultimately leading to treatment failures.Therefore,a comprehensive understanding of the risk of neuropathy induced by emerging anti-tumor drugs,coupled with risk surveillance and early warning,as well as management and reporting,can significantly reduce the incidence and severity of drug-related diseases.This paper provides a review of the neuropathy caused by emerging anti-tumor drugs,introduces the pharmacovigilance system and risk information management measures in clinical usage,aiming to provide a reference for guiding the rational clinical use and minimizing the incidence of drug-induced diseases.

Objective To assess the predictive value of computed tomography pulmonary angiography(CTPA)cardiovascular parame-ters for chronic thromboembolic pulmonary hypertension(CTEPH)under the 2022 European Society of Cardiology/European Respiratory Society(ESC/ERS)guidelines,and to compare with the 2021 Chinese guidelines.Methods A total of 201 suspected CTEPH patients were retrospectively selected.All patients underwent right heart catheterization(RHC)and CTPA evaluation.According to the Euro-pean guidelines,they were divided into three groups:mean pulmonary artery pressure(mPAP)≤20 mmHg control group(63 cases)(1 mmHg=0.133 kPa),mPAP＞20 mmHg CTEPH group(138 cases),and mPAP≥25 mmHg CTEPH group(123 cases).Inter-group comparison of CTPA cardiovascular parameters was performed,and receiver operating characteristic(ROC)curve analysis was performed for each parameter.Results Under the 2022 European guidelines,the diagnostic efficacy of the diameter of the main pulmonary artery trunk(MPAd)was the highest[area under the curne(AUC)was 0.933].The binary logistic regression analysis revealed that the MP Ad,right ventricular free wall thickness(RVWT),and interventricular septal angle(IVSA)were inde-pendent risk factors for the diagnosis of CTEPH(P＜0.05).Under both the Chinese and European guidelines,the MPAd,the transverse diameter and area of the right atrium,the transverse diameter and area of the bi-ventricle,the RVWT,and the IVSA showed significant statistical differences in CTEPH and control groups(P＜0.05).Conclusion Under both the Chinese and European guidelines,the MP Ad measured by CTPA has the highest diagnostic efficacy for CTEPH,while the IVSA has the strongest correlation with clinical prognostic indicators.The right atrium structure also has evaluation value.

BACKGROUND: The switch/sucrose nonfermentable chromatin-remodeling (SWI/SNF) complex is a pivotal chromatin remodeling complex, and the genomic alterations (GAs) of the SWI/SNF complex are observed in several cancer types, correlating with multiple biological features of tumor cells. However, their role in liver metastasis of non-small cell lung cancer (NSCLC) remains unclear. Our study aims to investigate the role and potential mechanisms underlying NSCLC liver metastasis induced by the GAs of SWI/SNF complex. METHODS: The GAs of SWI/SNF complex in NSCLC cell lines (H1299, H23 and H460) were identified by whole-exome sequencing (WES). ARID1A knockout H1299 cell was constructed with the CRISPR/Cas9 technology. The mouse model of liver metastasis from NSCLC was established to simulate lung cancer liver metastasis and observe the metastasis rate under different gene mutation conditions. RNA sequencing and Western blot were conducted for differential gene expression analysis. Immunohistochemistry (IHC) analysis was used to assess protein expression levels of SWI/SNF-regulated target molecules in mouse liver metastases. RESULTS: WES analysis revealed intracellular gene mutations. The animal experiments demonstrated a correlation between the GAs of SWI/SNF complex and a higher liver metastasis rate in immunodeficient mice. Transcriptome sequencing and Western blot analysis showed upregulated expression of ALDH1A1 and APOBEC3B in SWI/SNF-mut cells, particularly in ARID1A-deficient H460 and H1299 sgARID1A cells. IHC staining of mouse liver metastases further demonstrated elevated expression of ALDH1A1 in the H460 and H1299 sgARID1A group. CONCLUSIONS This study underscores the critical role of the GAs of SWI/SNF complex, such as ARID1A and SMARCA4, in promoting liver metastasis of lung cancer cells. The GAs of SWI/SNF complex may promote liver-specific metastasis by upregulating ALDH1A1 and APOBEC3B expression, providing novel insights into the molecular mechanisms underlying lung cancer liver metastasis.
Animals ; Mice ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation ; Liver Neoplasms/genetics*

With the continuous progress of tumor treatment methods in recent years, more and more emerging antitumor drugs have been approved to market and put into clinical use. In addition, some treatments that are in clinical trials such as gene therapy are also continuously making new breakthroughs. In this review, we mainly give a brief introduction to the novel antineoplastic therapies that have been clinically used in recent years, as well as the ones with remarkable efficacy and are expected to be approved for marketing.

Objective:To evaluate the efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway (LMA) insertion.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing elective surgery with ventilation using LMA under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: paraffin oil group (group A), compound lidocaine cream group (group B), and compound chamomile and lidocaine hydrochloride gel group (group C). The paraffin oil, compound lidocaine cream, and compound chamomile and lidocaine hydrochloride gel were evenly applied on the front, shoulder and back of the LMA before inserting the LMA in A, B and C groups, respectively.The severity of sore throat, oropharyngeal mucositis score, hoarseness score and occurrence in each time period (0-1 h, >1-6 h, >6-24 h, > 24-48 h) were recorded at 1, 6, 24 and 48 h after removal of the laryngeal mask.The stress responses during removal of the LMA and occurrence of drug-related adverse reactions within 48 h after removal of LMA were recorded. Results:Twenty-nine cases in group A, 28 cases in group B and 27 cases in group C completed the trial.Compared with group A, the severity of sore throat at each time point after removal of the LMA and incidence of sore throat in each time period were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and the incidence of oropharyngeal mucositis in the time period >1-48 h were decreased, and the incidence of drug-related adverse reactions was increased in group C ( P<0.05). Compared with group B, the severity of sore throat at 6 h after removal of the LMA and incidence of sore throat > 1-48 h after removal of the LMA were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and incidence of oropharyngeal mucositis in the time period >1-48 h after LMA removal were reduced, and the incidence of drug-related adverse reactions was decreased in group C ( P<0.05). There was no significant difference in the hoarseness score and incidence of hoarseness after removal of the LMA and incidence of stress responses during removal of the LMA among the three groups ( P>0.05). Conclusions:Compound chamomile and lidocaine hydrochloride gel has a certain efficacy in preventing complications related to LMA placement.

Objective:To investigate the relationship between the expression of serum exsomal miRNA-155-5p (miR-155-5p) and prognosis in patients with esophageal squamous cell carcinoma (ESCC).Methods:A total of 336 samples from ESCC patients in Fujian Provincial Cancer Hospital from October 2014 to December 2015 were collected. The relative expression levels of serum exsomal miR-155-5p were detected by using real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). Cut-off value of the expression levels of serum exsomal miR-155-5p was determined by using X-tile software. Based on the optimal cut-off value, patients were divided into miR-155-5p low expression group and miR-155-5p high expression group. The survival curve was drawn by using Kaplan-Meier method and Cox proportional hazards regression model was used to make survival analysis.Results:The cut-off value of serum exsomal miR-155-5p expression level was 2.340. According to the cut-off value, patients were divided into miR-155-5p low expression group (<2.340) of 51 cases and miR-155-5p high expression group (≥2.340) of 285 cases. There were no statistical differences in age ( χ2 = 0.020, P = 0.887), gender ( χ2 = 0.283, P = 0.595), tumor location ( χ2 = 0.063, P = 0.977), differentiation grade ( P = 0.474), clinical staging ( χ2 = 3.996, P = 0.136) and surgery treatment ( χ2 = 0.941, P = 0.332) of patients in both groups. ESCC patients in serum exsomal miR-155-5p high expression had a higher risk of death compared with patients in miR-155-5p low expression group ( HR = 1.763, 95% CI 1.049-2.961, P = 0.032). Conclusion:The high expression level of serum exsomal miR-155-5p is associated with poor prognosis in ESCC patients and it could be used as a prognostic new marker in ESCC patients.

Objective To observe the regulation of Panx1 on ATP/IP3 signaling pathway and its mechanism during cisplatin-induced apoptosis of lung adenocarcinoma cells. Methods Human lung adenocarcinoma cell line A549 was used as the research object and carbenoxolone (CBX) was used as a drug interference tool. A549 cells were divided into normal control group, the CBX group, the cisplatin (DDP) group and the CBX+DDP group. MTT assay and Annexin V/PI assay were used to detect the survival and apoptosis rates of A549 cells. The relative concentrations of extracellular adenosine triphosphate (ATP) and intracellular inositol triphosphate (IP3) were measured by Chemiluminescence and ELISA. Results Compared with DDP group, the cell survival rate of CBX+DDP group increased, while the early and late apoptotic rates and the release concentration of extracellular ATP and intracellular IP3 decreased (all P < 0.01). Conclusion Panx1 can increase the sensitivity of lung adenocarcinoma cells to cisplatin by regulating the ATP/IP3 signaling pathway.

Objective:To systematically evaluate the incidence of coronavirus disease 2019 (COVID-19) syndrome in traditional Chinese medicine (TCM), and to provide a basis for the standard of COVID-19 syndrome differentiation.Methods:CNKI, China Medical Journal Network, PubMed and Embase databases were searched by computer, and TCM syndrome data of COVID-19 cross-sectional surveys and case series were collected from the establishment of the database to March 31st in 2020. Two researchers independently screened the literature, extracted relevant data such as TCM syndromes, and evaluated the quality of the literature according to the quality assessment tool recommended by the JBI Evidence-Based Health Care Center. Stata 14.0 software was used to perform a single-group Meta-analysis of TCM syndromes.Results:Thirteen cross-sectional studies and 5 case series studies were included, with a total of 2 139 patients. The analysis of the cross-sectional studies showed that the risk bias was higher in the identification, control and accuracy of the confounding factors, and the description of the reliability and validity of the outcome indicators was unclear. The analysis of the case series studies showed that the overall risk bias was small, but there was a lack of a comprehensive description of the assessment when selecting patients. A total of 33 TCM syndromes of COVID-19 were sorted out by combining the TCM syndromes with the same disease position and pathogenic syndrome in the included 18 literatures, and there were 10 types of TCM syndromes of which the number of occurrences was ≥50, the incidence rate was ≥10%, and had statistical significance [indicated that 95% confidence interval (95% CI) didn't cross the meaningless line 0], including cold dampness syndrome (469 cases, incidence rate was 28.2%, 95% CI was 5.9%-50.6%), damp heat syndrome (247 cases, incidence rate was 32.1%, 95% CI was 10.7%-53.6%), epidemic closed lung syndrome (228 cases, incidence rate was 28.9%, 95% CI was 12.5%-45.2%), pulmonary and spleen Qi deficiency syndrome (202 cases, incidence rate was 22.1%, 95% CI was 9.5%-34.7%), dampness stagnation lung syndrome (180 cases, incidence rate was 41.2%, 95% CI was 18.4%-64.1%), dampness obstructing lung and spleen syndrome (81 cases, incidence rate was 56.3%, 95% CI was 48.1%-64.4%), evil heat syndrome lung syndrome (76 cases, incidence rate was 31.1%, 95% CI was 25.3%-36.9%), dampness-blocking lung and stomach syndrome (70 cases, incidence rate was 13.4%, 95% CI was 10.4%-16.3%), heat poisoning lung closure syndrome (55 cases, incidence rate was 16.9%, 95% CI was 8.3%-25.5%), and Qi-Yin deficiency syndrome (53 cases, incidence rate was 13.7%, 95% CI was 2.7%-24.8%). Subgroup analysis showed that there were 6 types of TCM syndromes that met the above conditions in cross-sectional studies, namely cold and damp lung syndrome (200 cases, incidence rate was 20.9%, 95% CI was 12.6%-29.2%), damp heat syndrome (221 cases, incidence rate was 41.8%, 95% CI was 9.4%-74.2%), dampness-disease lung syndrome (120 cases, incidence rate was 41.4%, 95% CI was 8.6%-74.3%), lung and spleen Qi deficiency syndrome (115 cases, incidence rate was 19.2%, 95% CI was 6.8%-31.7%), heat-fever lung syndrome (76 cases, incidence rate was 31.1%, 95% CI was 25.3%-36.9%) and Qi-Yin deficiency syndrome (53 cases, incidence rate was 13.7%, 95% CI was 2.7%-24.8%). There were 3 kinds of TCM syndromes in case series studies, which were virus closed lung syndrome (133 cases, incidence rate was 44.0%, 95% CI was 24.5%-63.4%), lung and spleen Qi deficiency syndrome (87 cases, incidence rate was 38.7%, 95% CI was 32.3%-45.0%), and dampness and depression lung syndrome (60 cases, incidence rate was 40.6%, 95% CI was 29.3%-52.0%). Conclusions:The TCM syndromes of COVID-19 syndrome were widely distributed and complex. The main TCM syndromes were cold dampness syndrome, damp heat syndrome, epidemic closed lung syndrome, pulmonary and spleen Qi deficiency syndrome, dampness stagnation lung syndrome, dampness obstructing lung and spleen syndrome, evil heat syndrome lung syndrome, dampness-blocking lung and stomach syndrome, heat poisoning lung closure syndrome, Qi-Yin deficiency syndrome, which can provide reference for the standard of TCM syndrome differentiation of COVID-19.