Lung cancer is currently one of the most aggressive malignant tumors in the world,and ra-diomics as an emerging technology can transform the image features into the quantifiable and computable data features,plays a crucial role in the diagnosis and treatment process of lung cancer.With the construction of medical big data,artificial intelligence(AI)and radiomics can make use of imaging images to provide more valuable information in screening and diagnosis,histopathological assessment and prediction of treatment re-sponse in lung cancer,thus assisting in the formulation of individualized treatment regimen,realizing accurate diagnosis and treatment and improving the patient's prognosis.However,there are still many problems to be solved in the application of AI systems to clinical practice.This paper reviews the research progress of AI and radiomics in lung cancer screening and diagnosis,staging and grading,and efficacy assessment,and discusses the limitations and challenges that still exist in the clinical practice in order to provide reference for subsequent research.

Objective:To observe the efficacy of gemcitabine and oxaliplatin combined with targeted drug apatinib in the treatment of gallbladder cancer.Methods:The data of 82 patients with gallbladder cancer who were admitted to Haiyang People's Hospital, Yantaishan Hospital and Rongjun Hospital of Yantai City in Shandong Province from May 2017 to December 2018 were retrospectively analyzed. The patients were divided into control group and observation group according to the medication, with 41 cases in each group. Patients in the control group were treated with gemcitabine combined with oxaliplatin regimen (gemcitabine 1 000 mg/m 2 was injected intravenously for 30 minutes on the 1st and 8th day, and oxaliplatin 100 mg/m 2 was injected intravenously for 3 hours on the 1st day), the observation group was combined with apatinib mesylate 500 mg/d based on the treatment method of the control group. The treatment effect, serum tumor marker levels, adverse reactions and survival were compared between the two groups. Results:The disease control rate of the control group was 70.73% (29/41), which was significantly lower than that of the observation group [92.68% (38/41)] ( χ2 = 6.609, P < 0.05). After treatment, the levels of vascular endothelial growth factor (VEGF), carcinoembryonic antigen (CEA), soluble interleukin-2 receptor (sIL-2R) and Dickkopf-1 in the observation group were significantly lower than those in the observation group, and the differences were statistically significant ( t values were 6.011, 3.048, 4.444, and 4.514, all P < 0.05). The incidence of proteinuria and hand-foot syndrome in the observation group were significantly lower than those in the control group, and the differences were statistically significant ( χ2 values were 6.116 and 4.986, both P < 0.05). During the 1-year follow-up, 2 patients in the observation group died, and the survival rate was 95.13% (39/41); 8 patients in the control group died, and the survival rate was 80.49% (33/41). There was a statistical difference in the survival rate between the two groups ( χ2 = 4.100, P < 0.05). Conclusion:Gemcitabine and oxaliplatin combined with apatinib mesylate are effective in treating gallbladder cancer, which can effectively reduce serum tumor marker levels and improve the prognosis of gallbladder cancer patients.

Objective To investigate the surgical methods and experience of laparoscopic radical cystectomy and orthotopic ileal neobladder for invasive bladder cancer. Methods The clinical data of 14 patients with invasive bladder cancer underwent laparoscopic radical cystectomy and orthotopic ileal neobladder were collected retrospectively during March 2011 and October 2014. Results The 13 patients with invasive bladder cancer were successfully completed laparoscopic radical cystectomy and orthotopic ileal neobladder. 1 case was treated with laparotomy because of unsatisfactory surgery ifeld caused by excessive tumor bleeding. Twelve cases of the urethra-neobaldder anastomosis were completed through the abdominal incision, while for the other 2 cases, the anastomosis was done under the laparoscope, 2 cases were performed neovesicourethral anastomosis using single-needle running sutures through laparoscopy. The median operative time was 444 minutes, the mean intraoperative blood loss was 490 ml. Postoperative pathologic results conifrmed that 12 cases were bladder transitional cell carcinoma (1 case with partial squamous cell carcinoma) and 2 cases with bladder adenocarcinoma. No severe complication occurred except for 2 cases of urinary leakage and 1 case of urinary incontinence. Patients were followed up for 6-56 months,within which 3 patients were died of distant metastasis, 1 case was detected with intracranial metastasis, 1 case was found with urethra-vesical anastomotic stenosis while cured after urethrotomy. Ten cases were well recovered and the mean volume of the neobladder was 300 ml. Conclusions Laparoscopic radical cystectomy and orthotopic ileal neobladder have the advantage of better therapeutic effects, safety, minimal invasion and rapid recovery, which are the preferred therapeutic methods for invasive bladder cancer.

Objective: To evaluate the relationship between platelet distribution width(PDW) and the extent of coronary artery disease and 2-year outcome in patients received percutaneous coronary artery intervention(PCI) because of stable coronary artery disease(SCAD). Methods: We consecutively enrolled 4 293 patients who received PCI because of SCAD in Fuwai Hospital from Jan 2013 to Dec 2013, patients were followed up for 2 years. Patients were divided into three groups according to tertiles values of PDW as follows: PDW≤11.4%(1 402 patients), 11.4%12.9% (1 450 patients). Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the occurrence of death, myocardial infarction, target vessel revascularization, intra stent thrombosis and stroke during follow-up. Multivariable logistic regression was used to evaluate the relationship between PDW and the extent of CAD. Multivariable Cox regression was used to evaluate the relationship between PDW and prognosis of SCAD patients. Results: PDW was associated with diabetes mellitus, body mass index, red cell distribution width, mean platelet volume (MPV), platelet counts and glycosylated haemoglobin (P<0.05), but not associated with age, sex, estimated glomerular filtration rate (P>0.05). PDW was not correlated with the extent of CAD(P=0.990), SYNTAX score(P=0.721), no-reflow phenomenon after PCI(P=0.978). Multivariable logistic regression also showed no relationship between PDW and extent of CAD (OR=0.994, 95%CI 0.961-1.029, P=0.73). PDW was found to be an independent risk factor of 2-year cardiac death (HR=1.242, 95%CI 1.031-1.497, P=0.022), but was not an independent risk factor of all-cause death and MACCE. Conclusions PDW is not related with the extent of coronary artery disease. PDW is an independent risk factor of 2-year cardiac death, but is not an independent risk factor of all-cause death and MACCE in this patient cohort.

Objective To investigate the value of fast track surgery (FTS) principles in the perioperative management of liver cancer patients after hepatectomy.Methods Forty patients with primary liver cancer who were admitted to the First People's Hospital of Qinzhou from September 2011 to July 2013 were enrolled in this prospective study.All the patients were randomly divided into the FTS group (20 patients) and the control group (20 patients) according to the random number table.The perioperative management of patients in the FTS group was guided by the FTS principles,patients in the control group were managed with traditional methods.The intraoperative condition,time for portal occlusion,operation time,volume of intraoperative blood loss and blood transfusion,time to drainage tube removal,time to flatus and defecation,duration of postoperative hospital stay,expenses,changes of C-reactive protein on postoperative day 1,3,6,recovery of hepatic function and incidence of postoperative complications.All patients were followed up via phone call and out-patient examination till September 2013.All data were analyzed using the t test or chi-square test.The non-normal distribution paramenters were analyzed using the rank sum test.Results All patients were cured with no perioperative death.The time for postoperative drainage tube removal,time to flatus and defecation,duration of postoperative hospital stay and expenses were (2.3 ± 1.0)days,(2.5 ±0.5)days,(3.1 ±0.7)days,(7.0 ±0.8)days and (3.6 ±0.3) × 104 yuan in the FTS group,and (4.6 ± 0.7) days,(4.3 ± 0.7) days,(4.8 ± 0.4) days,(8.5 ± 0.9) days and (4.1 ± 0.3) ×104 yuan,with significant differences between the 2 groups (t =0.74,0.34,1.70,0.23,0.57,P ＜ 0.05).The levels of C-reactive proteins at postoperative day 1,3,6 were (56 ±7)mg/L,(122 ±7)mg/L and (35 ±7)mg/L in the FTS group,and (198 ± 24) mg/L,(137 ± 5) mg/L and (49 ± 8) mg/L,with significant differences between the 2 groups (F =64.91,P ＜0.05).The levels of prealbumin at postoperative day 1,3,6 were (196 ± 14) mg/L,(243 ± 17) mg/L,(260 ± 10) mg/L in the FTS group,and (198 ± 24) mg/L,(199 ± 16) mg/L and (245 ± 7) mg/L in the control group,with significant differences between the 2 groups (F =22.69,P ＜ 0.05).The levels of alanine transaminase at postoperative day 1,3,6 were (379 ±34)U/L,(166 ± 12)U/L,(49 ± 14)U/L in the FTS group,and (367 ±75)U/L,(210 ±28)U/L,(197 ±22)U/L in the control group,with significant differences between the 2 groups (F =4.51,P ＜ 0.05).One patient was complicated with peritoneal effusion and 1 with thoracic effusion in the FTS group; 4 patients was complicated with peritoneal effusion,3 with thoracic effusion,4 with pulmonary infection and 2 with incisional infection in the control group,with no significant difference in the complication between the 2 groups (x2 =0.78,1.11,4.44,2.11,P ＞ 0.05).All the patients were followed up for 2-24 months,no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of FTS principle in the perioperative management of liver cancer patients after hepatectomy is safe and effective,it could alleviate the post-operative stress reaction and accelerate the recovery of liver function and patients' condition.

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.

ObjectiveTo evaluate the impact of iFlow in the auxiliary diagnosis of cerebral vascular diseases.Methods Totally 65 patients with cerebral vascular diseases underwent whole brain 2D DSA.Then the data were converted to color coded images with iFlow.The vascular anatomy,the shape and size of lesions,the blood dynamics on 2D DSA and iFlow images were evaluated by junior and senior physicians,who then reported whether iFlow images had supplementary diagnosis value.ResultsiFlow images displayed whole information of lesions more clearly than those of 2D DSA in brain vascular dynamic sequence,including vascular anatomy,hemodynamic changes and tissues perfusions.The evaluation of 2D DSA and iFlow images with junior and senior physicians had statistical difference (x2 =6.032,P=0.014).ConclusionCompared to single DSA,iFlow can facilitate the diagnosis and evaluation of cerebral vascular diseases,especially for junior physicians.

Mechano-growth factor (MGF) is one of IGF-1 isoforms. MGF is mechanosensitive and has important functions in muscle hypertrophy, regeneration and nerve injury recovery. In this study, MGF cDNA (330 bp) was cloned from stretched osteoblasts by RT-PCR. In order to avoid prolin residue inhibiting enterokinase cleavage, 9bp of MGF cDNA 5' end sequence was truncated by primer, then the obtained truncated MGF (des(1-3)MGF) cDNA (321 bp) was subcloned in pET32a(+) vector to construct a prokaryotic recombination expression plasmid. Trx/des(1-3)MGF fusion protein, existing in forms of solution, was expressed in transformed Escherichia coli strain BL21(DE3) by IPTG induction at 30 degres C. The supernatant of cell lysates was subjected to ion exchange chromatography and Ni2+ metal affinity chromatography, and the fusion protein was obtained with the purity over 95%. After the fusion protein was cleaved by enterokinase, Trx and des(1-3)MGF was isolated by reverse-phase HPLC. Through these procedures, des(1-3) MGF was obtained with the purity of 98%. The protein molecular mass was conformity to the theoretical value by SDS-PAGE and mass spectrometry analysis. The purified des(1-3)MGF was incubated with MC3T3-E1 for cell proliferation and migration assays. The results show that des(1-3)MGF exhibited more facilitative effects on proliferation and migration of MC3T3-E1 than that of des(1-3)IGF-1.
Cloning, Molecular ; DNA, Complementary ; genetics ; Escherichia coli ; genetics ; metabolism ; Humans ; Insulin-Like Growth Factor I ; Osteoblasts ; metabolism ; Protein Isoforms ; biosynthesis ; genetics ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; pharmacology ; STAT5 Transcription Factor ; biosynthesis ; genetics ; Tumor Suppressor Proteins ; biosynthesis ; genetics