Background::Response to immune checkpoint inhibitors (ICIs) is affected by multiple factors. This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer (NSCLC) patients.Methods::The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People’s Hospital between May 2019 and July 2020 were retrospectively analyzed. Metastatic sites included liver, bone, brain, adrenal gland, pleura, and contralateral lung. Progression-free survival (PFS) and overall survival (OS) were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method. Organ-specific disease control rate (OSDCR) of different individual metastatic sites was evaluated.Results::Forty NSCLC patients meeting the criteria were identified. The presence of liver metastasis was significantly associated with shorter PFS (3.1 vs. 15.5 months, P = 0.0005) and OS (11.1 months vs. not reached, P = 0.0016). Besides, patients with bone metastasis tend to get shorter PFS (4.2 vs. 15.5 months, P = 0.0532) rather than OS ( P = 0.6086). Moreover, the application of local treatment could numerically prolong PFS in patients with brain metastasis (15.5 vs. 4.3 months, P = 0.1894). More metastatic organs involved were associated with inferior PFS ( P = 0.0052) but not OS ( P = 0.0791). The presence of liver metastasis or bone metastasis was associated with more metastatic organs (Phi[φ]: 0.516, P = 0.001). The highest OSDCR was observed in lung (15/17), and the lowest in the liver (1/4). Conclusions::Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC. ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis, thus patients with this type of metastasis might require more aggressive combination strategies.

Objective To investigate the influencing factors of portal vein tumor thrombus in patients with primary liver cancer(PLC).Methods A total of 483 patients with PLC in the Second People's Hospital of Fuyang from January 2012 to December 2016 were included in this retrospective study.Univariate analysis and multi-variate logistic regression analysis were employed to analyze the association between portal vein tumor thrombus and routine clinical parameters.Results The univariate analysis showed that alanine aminotransferase,aspartate aminotransferase,total bilirubin,γ-glutamyltranspeptidase,alkaline phosphatase,alpha-fetoprotein,the size and the number of tumors,ascites and center location of cancer performed a close relationship with the formation of portal vein tumor thrombus in patients with PLC,and the differences were statistically significant(P values were 0.010,0.000,0.010,0.000,0.001,0.000,0.000,0.004 and 0.010).Multivariate logistic regression analysis showed that potential significant predictors of portal vein tumor thrombus in patients with PLC were alpha-fetoprotein and ascites,and the differences were statistically significant(P values were 0.000 and 0.040).Conclusion PLC patients with high level of alpha-fetoprotein and ascites are easier to induce the formation of portal vein tumor thrombus.

Objective To investigate the common initial clinical presentations of primary Sj(o)gren's syndrome (pSS) with pulmonary complications,and to explore the differences between patients with extraglandular manifestations at disease onset (EGM) and those with glandular manifestations at disease onset (GM).Methods A total of 1 341 hospitalized SS patients from 2003 to 2012 were retrospectively reviewed.Of them,102 hospitalized patients with pSS'associated lung disease were analyzed and included.Case control study was performed to explore the differences between the EGM group and the GM group.Results Fifty-one percent of patients were presented with EGM at onset,with significantly shorter disease duration [36 (12,156) m vs 102 (48,159) m,x2=-2.41,P=0.016].Although the mean diagnose time was similiar,only 4％ of the EGM group could be confirmed the pSS diagnose at onset,which was significantly less frequently than that of the GM group (34％,22=15.29,P＜0.01).Case control study revealed that hyperglobulinemia,elevated RF titers and anti-SSA and/or anti-SSB test positive were less predominant in the EGM group [IgG 16(12,21) g/L vs 21 (15,28) g/L,x2=-2.15,P=0.032;22 (20,171) U/ml vs 104 (20,238) U/ml,x2=-l.98,P=0.048;33％ vs 72％,x2=15.78,P＜0.01].The predicted value of TLC and FVC were lower [(87±23)％ vs (97±20)％,x2=-1.96,P=0.050;(8±28)％ vs (100±27)％,x2=-1.70,P=0.089] and HRCT score was higher in EMG group [12(88,15) vs 8(5,13),x2=-1.82,P=0.070].Conclusion EMG at onset is the common initial manifestation of pSS'associated lung involvement.Pulmonary complication is more progressively and severe than those with MG at onset.Anti'SSA positive,elevated RF titer and hyperglobulinemia are not predominant for patients with EMG at onset.

OBJECTIVETo explore the clinical diagnostic features and treatment of desmoplastic small round cell tumor (DSRCT), and to improve the understanding and management of this tumor.

METHODSThe clinicopathological data of nine patients treated in our hospital from October 2004 to June 2014 were retrospectively analyzed and a review of the literature was made. The clinical manifestations, pathological characteristics, diagnosis and differential diagnosis, treatment and prognosis of this tumor were summarized and analyzed.

RESULTSNine patients with DSRCT, 5 males and 4 females, with an average age of 21 years (range 8-56 years) were included in this study. Ultrasound examination revealed irregular low-density mass shadow in the abdominal cavity. CT examination found that 6 cases had abdominal and retroperitoneal multiple solid tumor nodules, uneven density, and visible low density fluid area. Postoperative pathological examination revealed that the tumor cells were small, mostly elliptic, gathered to form clear structure of nests with clear irregular boundaries. The central portion of large tumor nests often showed necrosis. Scattered fibroblasts and large amount of hyalinization of collagen fibers were seen in the interstitial tissue around the nests. Six patients received laparotomy surgery, however, all failed to resect the tumor completely. Three patients received postoperative chemotherapy, i. e. two cases had carboplatin and paclitaxel chemotherapy, and one case of chemotherapy regimen not specified. Two patients had radiation and chemotherapy (no concrete plan was available). Another case was lost to follow-up. Two of the three patients without surgery received chemotherapy with CAP (cyclophosphamide+adriamycin+carboplatin) and total rectal lesions, pelvic and inguinal lymph nodes, ilium metastases radiation therapy. Another one patient received EP regimen (DDP+VP16) which was then changed into a TP chemotherapy alone. Eight of the nine cases died shortly after surgery, and only one patient treated with chemotherapy alone was still alive after 11 months of follow-up.

CONCLUSIONSDesmoplastic small round cell tumor is a very rare, special type of soft tissue tumor, with very poor prognosis. This tumor may be preliminarily diagnosed according to the imaging characteristics and detection of tumor markers, however, final diagnosis is made by pathology. Surgery is the priority of treatment, combined with complementary radiation and chemotherapy.

Abdominal Neoplasms ; complications ; diagnosis ; mortality ; therapy ; Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Biomarkers, Tumor ; analysis ; Carboplatin ; administration & dosage ; Child ; Combined Modality Therapy ; methods ; Cyclophosphamide ; administration & dosage ; Desmoplastic Small Round Cell Tumor ; complications ; diagnosis ; mortality ; therapy ; Doxorubicin ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; analysis ; Prognosis ; Retrospective Studies

Objective To test reliability and validity on the scale of hurting factors participation for mental disorders (SHFP-MD).Methods 402 cases were retrospectively evaluated by SHFP-MD from 13 forensic psychiatric appraisal agencies in China,and all cases were involved causal relationships in mental injury from July 2010 to June 2012.42 cases were evaluated a month later again.13 raters evaluated respectively for five cases.52 cases involved causal relationship of mental impairment were evaluated prospectively in January 2013 to June 2014.The validity of the scale was tested by experts assessed as a criterion level of relationship.Results ①The retest correlation coefficient on all items of SHFP-MD were between 0.746-0.989,and the time reliability of test-retest on the full scale score was 0.970 interval of one month.Raters reliability between 0.57 to 1.00; overall average reliability was 0.84 (P＜0.01).②The total coincidence rate was 90.4％-91.0％ between the demarcation scores of SHFP-MD and the grade identification of forensic psychiatrists respectively and prospectively(P＞0.05).Conclusion SHFP-MD has good reliability and validity,and met the basic requirements of scale assessment.

Objective To explore the clinical diagnostic features and treatment of desmoplastic small round cell tumor ( DSRCT ) , and to improve the understanding and management of this tumor. Methods The clinicopathological data of nine patients treated in our hospital from October 2004 to June 2014 were retrospectively analyzed and a review of the literature was made. The clinical manifestations, pathological characteristics, diagnosis and differential diagnosis, treatment and prognosis of this tumor were summarized and analyzed. Results Nine patients with DSRCT, 5 males and 4 females, with an average age of 21 years ( range 8?56 years) were included in this study. Ultrasound examination revealed irregular low?density mass shadow in the abdominal cavity. CT examination found that 6 cases had abdominal and retroperitoneal multiple solid tumor nodules, uneven density, and visible low density fluid area. Postoperative pathological examination revealed that the tumor cells were small, mostly elliptic, gathered to form clear structure of nests with clear irregular boundaries. The central portion of large tumor nests often showed necrosis. Scattered fibroblasts and large amount of hyalinization of collagen fibers were seen in the interstitial tissue around the nests. Six patients received laparotomy surgery, however, all failed to resect the tumor completely. Three patients received postoperative chemotherapy, i.e. two cases had carboplatin and paclitaxel chemotherapy, and one case of chemotherapy regimen not specified. Two patients had radiation and chemotherapy ( no concrete plan was available) . Another case was lost to follow?up. Two of the three patients without surgery received chemotherapy with CAP ( cyclophosphamide + adriamycin + carboplatin) and total rectal lesions, pelvic and inguinal lymph nodes, ilium metastases radiation therapy. Another one patient received EP regimen ( DDP+VP16) which was then changed into a TP chemotherapy alone. Eight of the nine cases died shortly after surgery, and only one patient treated with chemotherapy alone was still alive after 11 months of follow?up. Conclusions Desmoplastic small round cell tumor is a very rare, special type of soft tissue tumor, with very poor prognosis. This tumor may be preliminarily diagnosed according to the imaging characteristics and detection of tumor markers, however, final diagnosis is made by pathology. Surgery is the priority of treatment, combined with complementary radiation and chemotherapy.

Objective To explore the clinical diagnostic features and treatment of desmoplastic small round cell tumor ( DSRCT ) , and to improve the understanding and management of this tumor. Methods The clinicopathological data of nine patients treated in our hospital from October 2004 to June 2014 were retrospectively analyzed and a review of the literature was made. The clinical manifestations, pathological characteristics, diagnosis and differential diagnosis, treatment and prognosis of this tumor were summarized and analyzed. Results Nine patients with DSRCT, 5 males and 4 females, with an average age of 21 years ( range 8?56 years) were included in this study. Ultrasound examination revealed irregular low?density mass shadow in the abdominal cavity. CT examination found that 6 cases had abdominal and retroperitoneal multiple solid tumor nodules, uneven density, and visible low density fluid area. Postoperative pathological examination revealed that the tumor cells were small, mostly elliptic, gathered to form clear structure of nests with clear irregular boundaries. The central portion of large tumor nests often showed necrosis. Scattered fibroblasts and large amount of hyalinization of collagen fibers were seen in the interstitial tissue around the nests. Six patients received laparotomy surgery, however, all failed to resect the tumor completely. Three patients received postoperative chemotherapy, i.e. two cases had carboplatin and paclitaxel chemotherapy, and one case of chemotherapy regimen not specified. Two patients had radiation and chemotherapy ( no concrete plan was available) . Another case was lost to follow?up. Two of the three patients without surgery received chemotherapy with CAP ( cyclophosphamide + adriamycin + carboplatin) and total rectal lesions, pelvic and inguinal lymph nodes, ilium metastases radiation therapy. Another one patient received EP regimen ( DDP+VP16) which was then changed into a TP chemotherapy alone. Eight of the nine cases died shortly after surgery, and only one patient treated with chemotherapy alone was still alive after 11 months of follow?up. Conclusions Desmoplastic small round cell tumor is a very rare, special type of soft tissue tumor, with very poor prognosis. This tumor may be preliminarily diagnosed according to the imaging characteristics and detection of tumor markers, however, final diagnosis is made by pathology. Surgery is the priority of treatment, combined with complementary radiation and chemotherapy.

Adult ; Cytomegalovirus ; Cytomegalovirus Infections ; Humans ; Liver Failure

Objective To test the cut-off point and empirical validity of psychiatric assessment scale of cognitive and volition capacity for suspects in crime (PASCVC).Methods One thousand of forensic psychiatry cases from fifteen bodies of the seven administrative regions in China were collected for forensic assessment by the three scales of PASCVC,DCRRS and CRRSV in August 2009 to December 201 l.in all cases by the appraiser to make six grade judgment of the cognitive and volition capacity including completely lost,lost most,partial loss,partial loss of a small,slightly damaged and normal.Results ① Based on the results of frequency distribution table: complete loss of demarcation divided ＜ 56 minutes,lost most 57-66,partial loss 67-76,partial loss of a small 77-87,slightly damaged 88-100 and normal ≥ 101.②The correlation coefficient of six demarcation point grading assessment results and expert opinion was 0.939(P＜0.001).③PASCVC consistency with DCRRS and CRRSV,the Kappa values were 0.838 and 0.835 respectively(P＜0.001).④Discriminant function were established by two methods of PASCVC and expert assessment,the correct rates of PASCVC and expert judgment on back substitution determine were 86.9％ and 85.1％.Two kinds of classification results,the Kappa value of 0.857 (P＜0.001).Conclusion PASCVC has good empirical validity,and can be used as an objective assessment tool for forensic assessment of criminal cognitive and volition capacity.

Objective To examine the reliability and validity of the Rating Scale of the Reliability in Mental Disorder Medical History (RSRMDMH) in order to develop a reliable measure to determine the reliability in mental disorder medical history.Methods RSRMDMH was conducted by concept,clinical feature in mental disorder medical history and assessment scales for malingering and compensationneurosis.Final 14 items was decided after initial usage and modification.It was administered to 600 subjects including the cases involved forensic problems,patients in general psychiatric clinic.Results ①The Cronbach' s α coefficients of RSRMDMH was 0.901.The split-half reliability was 0.803-0.924.The test-retest reliability and scorer reliability were more than 0.588 (P＜0.01).②The cut score of assessing different degree of the reliability in mental disorder medical history separately was ≤ 11,12-22,≥23.③Based on the experts diagnosis,the accuracy rate of RSRMDMH for evaluating different degree of the reliability in mental disorder medical history were more than 86.1％,and total accuracy rate was 94.8％.④Correlation analysis showed significantly correlation between RSRMDMH and assessment scales for malingering(self-report scale of brief psychopathological symptoms,SBPS).Conclusion The RSRMDMH has acceptable psychometrics properties on reliability and validity.It is a clinically reliable measure to determine the reliability in mental disorder medical history.