Background and purpose:Despite Radiation-induced lymphopenia has been associated with poor survival outcomes in certain solid tumors,there is limited evidence for small cell lung cancer(SCLC).The purpose of this study was to investigate whether the absolute lymphocyte count before and after radiotherapy could predict the clinical outcomes for limited-stage SCLC(LS-SCLC)patients.Methods:This was a single-center,retrospective cohort study.A retrospective analysis of patients evaluated at Fudan University Shanghai Cancer Center from January 2007 to December 2017 was conducted.Inclusion criteria:⑴ pathologically confirmed small-cell lung cancer;⑵ limited-stage disease defined by positron emission tomography and computed tomography(PET/CT)and contrast-enhanced brain magnetic resonance imaging(MRI)[American Joint Committee on Cancer(AJCC)8th edition TNM stage M0];⑶ receipt of definitive chemoradiotherapy;⑷ availability of complete blood counts before,during and within 1 month after radiotherapy;⑸ complete survival,relapse,and last-follow-up information retrievable.Exclusion criteria:⑴ distant metastasis at baseline(AJCC 8th edition TNM stage M1,including any distant nodal,visceral,or bone-marrow involvement);⑵ total radiotherapy dose＜50 Gy[calculated as an equivalent biological dose at 2 Gy/fraction,i.e.,a biological effective dose(BED)＜40 Gy];⑶ incomplete laboratory data at any scheduled time point;⑷ inability to ascertain survival or relapse status or insufficient follow-up records.The study protocol was approved by the ethics committee of Fudan University Shanghai Cancer Center(approval number:2303271-15),and the requirement for informed consent was waived.Clinical data extracted comprised age,sex,Eastern Cooperative Oncology Group performance status(ECOG PS)score,smoking history,TNM stage,chemotherapy regimen and number of cycles,radiotherapy dose and fractionation schedule,use of concurrent chemoradiotherapy and administration of prophylactic cranial irradiation(PCI).Laboratory data comprised serial absolute lymphocyte counts obtained within 1 month before,during and after radiotherapy;lymphopenia was graded according to the Common Terminology Criteria for Adverse Events(CTCAE)version 4.0.Progression-free survival(PFS)and overall survival(OS)were estimated using the Kaplan-Meier method and compared with the log-rank test.Results:A total of 170 patients were included.The median age of the patients was 57 years,with 77.6%being male.The median radiation therapy dose was 60 Gy(range:45-66 Gy).For the entire cohort,the median PFS was 22.0 months,the 5-year PFS rate was 31.3%,and the 10-year PFS rate was 19.8%.The median OS was 38.0 months,the 5-year OS rate was 37.5%,and the 10-year OS rate was 24.2%.Before radiation therapy,14 patients(8.2%)had grade 1-2 lymphocytopenia.During radiation therapy,the number of patients with grade 1,2,3 and 4 lymphocytopenia was 7(4.1%),22(12.9%),111(65.3%),and 24(14.1%),respectively.One month after radiation therapy,the number of patients with grade 1,2,3 and 4 lymphocytopenia was 36(21.2%),36(21.2%),11(6.5%)and 1(0.6%),respectively.There were no significant differences in PFS and OS among patients with different grades of lymphocytopenia before,during,or after radiation therapy.Conclusion:Before immunotherapy,radiotherapy-induced lymphopenia did not appear to affect the prognosis of patients with LS-SCLC.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Background and purpose:Despite Radiation-induced lymphopenia has been associated with poor survival outcomes in certain solid tumors,there is limited evidence for small cell lung cancer(SCLC).The purpose of this study was to investigate whether the absolute lymphocyte count before and after radiotherapy could predict the clinical outcomes for limited-stage SCLC(LS-SCLC)patients.Methods:This was a single-center,retrospective cohort study.A retrospective analysis of patients evaluated at Fudan University Shanghai Cancer Center from January 2007 to December 2017 was conducted.Inclusion criteria:⑴ pathologically confirmed small-cell lung cancer;⑵ limited-stage disease defined by positron emission tomography and computed tomography(PET/CT)and contrast-enhanced brain magnetic resonance imaging(MRI)[American Joint Committee on Cancer(AJCC)8th edition TNM stage M0];⑶ receipt of definitive chemoradiotherapy;⑷ availability of complete blood counts before,during and within 1 month after radiotherapy;⑸ complete survival,relapse,and last-follow-up information retrievable.Exclusion criteria:⑴ distant metastasis at baseline(AJCC 8th edition TNM stage M1,including any distant nodal,visceral,or bone-marrow involvement);⑵ total radiotherapy dose＜50 Gy[calculated as an equivalent biological dose at 2 Gy/fraction,i.e.,a biological effective dose(BED)＜40 Gy];⑶ incomplete laboratory data at any scheduled time point;⑷ inability to ascertain survival or relapse status or insufficient follow-up records.The study protocol was approved by the ethics committee of Fudan University Shanghai Cancer Center(approval number:2303271-15),and the requirement for informed consent was waived.Clinical data extracted comprised age,sex,Eastern Cooperative Oncology Group performance status(ECOG PS)score,smoking history,TNM stage,chemotherapy regimen and number of cycles,radiotherapy dose and fractionation schedule,use of concurrent chemoradiotherapy and administration of prophylactic cranial irradiation(PCI).Laboratory data comprised serial absolute lymphocyte counts obtained within 1 month before,during and after radiotherapy;lymphopenia was graded according to the Common Terminology Criteria for Adverse Events(CTCAE)version 4.0.Progression-free survival(PFS)and overall survival(OS)were estimated using the Kaplan-Meier method and compared with the log-rank test.Results:A total of 170 patients were included.The median age of the patients was 57 years,with 77.6%being male.The median radiation therapy dose was 60 Gy(range:45-66 Gy).For the entire cohort,the median PFS was 22.0 months,the 5-year PFS rate was 31.3%,and the 10-year PFS rate was 19.8%.The median OS was 38.0 months,the 5-year OS rate was 37.5%,and the 10-year OS rate was 24.2%.Before radiation therapy,14 patients(8.2%)had grade 1-2 lymphocytopenia.During radiation therapy,the number of patients with grade 1,2,3 and 4 lymphocytopenia was 7(4.1%),22(12.9%),111(65.3%),and 24(14.1%),respectively.One month after radiation therapy,the number of patients with grade 1,2,3 and 4 lymphocytopenia was 36(21.2%),36(21.2%),11(6.5%)and 1(0.6%),respectively.There were no significant differences in PFS and OS among patients with different grades of lymphocytopenia before,during,or after radiation therapy.Conclusion:Before immunotherapy,radiotherapy-induced lymphopenia did not appear to affect the prognosis of patients with LS-SCLC.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

With the intensify of aging population,accurate assessment of brain health becomes more and more important.Brain age can reflect brain health and cognitive function.Based on different algorithms,modal data and central datasets,imaging is helpful for predicting brain age.The progresses of imaging researches for predicting brain age were reviewed in this article.

Objective:To explore the clinical and imaging characteristics of patients with unruptured intracranial aneurysms accompanied by sentinel headache.Methods:Forty patients with unruptured intracranial aneurysms confirmed by DSA/CTA and accompanied by sentinel headache admitted to Department of Neurology, First Affiliated Hospital of Xiangnan University from January 2018 to August 2023 were selected as the study subjects; the clinical and imaging characteristics of these patients were summarized. Forty-four patients with unruptured intracranial aneurysms without sentinel headache and 40 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms admitted to the hospital at the same period were selected as controls. The differences in aneurysm length (maximum diameter), morphology, tumor length (maximum diameter)/neck width (AR), and risk score for rupture of intracranial aneurysms (scores of population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm [PHASES]) among the 3 groups were analyzed.Results:Among the 40 patients with unruptured intracranial aneurysms accompanied by sentinel headache, 20 (50%) presented with pain localized at the lateral frontal and orbital regions, 3 (7.5%) with pain at the posterior neck region, and 17 (42.5%) with irregular headache sites; 34 (85%) had new onset headache, and 6 (15%) had changes in headache nature besides chronic headache; 24 patients (60%) had posterior communicating artery aneurysm, 12 (30%) had internal carotid artery aneurysm, 1 (2.5%) had middle cerebral artery aneurysm, and 3 (7.5%) had vertebral artery dissection aneurysm; 36 (90%) had irregular aneurysm morphology. Compared with patients with unruptured intracranial aneurysms without sentinel headache, patients with unruptured intracranial aneurysms accompanied by sentinel headache and those with subarachnoid hemorrhage caused by ruptured intracranial aneurysms had larger aneurysm length (maximum diameter), higher proportion of irregular morphology, higher AR value, and higher PHASES scores, with significant differences ( P<0.05). Compared with patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms, patients with unruptured intracranial aneurysms accompanied by sentinel headache had larger aneurysm length (maximum diameter) and higher PHASES scores, with significant differences ( P<0.05). Conclusion:Sentinel headache is common in patients with unruptured posterior communicating artery aneurysms, and the relatively specific headache pattern is sudden periorbital pain or posterior neck pain; patients with unruptured intracranial aneurysms accompanied by sentinel headache have a higher rupture risk due to the larger size, more irregular shape, higher AR value of the aneurysm, therefore, same attention should be payed to these patients as those with ruptured aneurysms in clinical practice.

Objective:To investigate the factors influencing the prognosis of anaplastic thyroid cancer (ATC) and to evaluate the application value of established random survival forest (RSF) model in the prognosis prediction of ATC.Methods:A total of 707 ATC patients diagnosed by histopathology in the Surveillance, Epidemiology and End Results (SEER) database of the National Cancer Institute from 2004 to 2015 were selected and randomly divided into the training set (495 cases) and the validation set (212 cases). Univariate Cox regression risk model was used to analyze the related factors affecting overall survival (OS) of patients in the training set. The multivariate Cox proportional risk model based on the minimum Akaike information criterion (AIC) was used to analyze the above variables and then the variables were screened out. The traditional Cox model for predicting OS was constructed based on the screened variables. The RSF algorithm was used to analyze the variables with P < 0.05 in the univariate Cox regression analysis, and 5 important features were selected. Multivariate Cox proportional risk model was selected based on the minimum AIC. Then the RSF-Cox model for predicting OS was constructed by using screened variables. The time-dependent receiver operating characteristic (tROC) curve and the area under the curve (AUC), calibration curve, decision curve and integrated Brier score (IBS) in the training set and the validation set were used to evaluate the prediction performance of the models. Results:Univariate Cox regression analysis showed that age, chemotherapy, lymph node metastasis, radiotherapy, surgical method, tumor infiltration degree, tumor number, tumor diameter and diagnosis time were factors affecting the prognosis of ATC (all P < 0.05). Multivariate Cox regression analysis based on minimal AIC (4 855.8) showed that younger age (61-70 years vs. > 80 years: HR = 0.732, 95% CI 0.56-0.957, P = 0.023; ≤ 50 years vs. > 80 years: HR = 0.561, 95% CI 0.362-0.87, P = 0.010), receiving chemotherapy (receiving or not: HR = 0.623, 95% CI 0.502-0.773, P < 0.001), receiving radiotherapy (receiving or not: HR = 0.695, 95% CI 0.559-0.866, P = 0.001), receiving surgery (lobectomy, no surgery or unknown: HR = 0.712, 95% CI 0.541-0.939, P = 0.016; total resection or subtotal resection vs. no surgery or unknown: HR = 0.535, 95% CI 0.436-0.701, P < 0.001), and tumor diameter (≤ 2 cm vs. > 6 cm: HR = 0.495, 95% CI 0.262-0.938, P = 0.031; > 2 cm and ≤ 4 cm vs. > 6 cm: HR = 0.714, 95% CI 0.520-0.980, P = 0.037; > 4 cm and ≤ 6 cm vs. > 6 cm: HR = 0.699, 95 % CI 0.545-0.897, P = 0.005) were independent protective factors for OS of ATC patients. Lymph node metastasis (N 1 unknown vs. N 0: HR = 1.664, 95% CI 1.158-2.390, P = 0.006; N 1b: HR = 1.312, 95% CI 1.029-1.673, P = 0.028), more aggressive tumor infiltration degree (group 3 vs. group 1: HR = 1.492, 95% CI 1.062-2.096, P = 0.021; group 4 vs. group 1: HR = 1.636, 95% CI 1.194 - 2.241, P = 0.002) were independent risk factors for OS of ATC patients. Although diagnosis time was not statistically significant (2010-2015 vs.2004-2009: HR = 1.166, 95% CI 0.962-1.413, P = 0.118), the inclusion of it could improve the efficacy of the traditional Cox model. RFS algorithm was used to select out 5 important variables: surgical method, tumor diameter, age group, chemotherapy, and tumor number. Multivariate Cox regression analysis based on minimum AIC (4 884.6) showed that chemotherapy (receiving or not: HR = 0.574, 95% CI 0.476-0.693, P < 0.001), surgical method (lobectomy, no surgery or unknown: HR = 0.730, 95% CI 0.567-0.940, P = 0.015; total resection or subtotal resection vs. no surgery or unknown: HR = 0.527, 95% CI 0.423-0.658, P < 0.001), tumor diameter (≤ 2 cm vs. > 6 cm: HR = 0.428, 95% CI 0.231-0.793, P = 0.007; > 2 cm and ≤ 4 cm vs. > 6 cm: HR = 0.701, 95% CI 0.513-0.958, P = 0.026; > 4 cm and ≤ 6 cm vs. > 6 cm: HR = 0.681, 95% CI 0.536-0.866, P = 0.002) were independent factors for OS of ATC patients. RSF-Cox model was constructed based on 3 variables. The tAUC curve analysis showed that RSF-Cox model for predicting the 6-month, 12-month, and 18-month OS rates were 93.56, 92.62, and 90.80, respectively in the training set, and 93.05, 92.47, and 90.20, respectively in the validation set; in the traditional Cox model, the corresponding OS rates were 89.00, 87.76, 85.24, respectively in the training set, and 86.22, 83.68, 82.86, respectively in the validation set. When predicting OS rate at 6-month, 12-month and 18-month, the calibration curve of RSF-Cox model was closer to 45° compared with that of traditional Cox model, and the clinical net benefit of decision curve in RSF-Cox model was higher than that in traditional Cox model. The IBS of RSF-Cox model (0.089) was lower than that of traditional Cox model (0.111). Conclusions:The RSF model based on chemotherapy, surgical method and tumor diameter can effectively predict the OS of ATC patients.

OBJECTIVE: To explore the treatment of malignant arrhythmia induced by acute poisoning. METHODS: To analyze the treatment of 11 cases of malignant arrhythmia caused by acute poisoning. The therapeutic effect of malignant arrhythmia treated by drug, electrical cardioversion and detoxification was observed. RESULTS: The arrhythmias in the patients included premature ventricular beats, ventricular tachycardia, ventricular fibrillation, sinus tachycardia, sinus bradycardia, atrial premature beats, and ST-T changes. After treatment with cardioerter drug such as amiodarone, lidocaine, esmolol and other drugs, electric defibrillation, removeing poisons with hemoperfusion and specific antidotes, and multiple organ protection symptomatic treatment, 10 cases were successfully rescued and 1 case died. CONCLUSION: Malignant arrhythmias caused by acute poisoning could be given combined treatment with anti-arrhythmias and relief of etiology.

Objective To observe the level changes and clinical diagnostic value of follicular statin -1 (FSTL1)in the serum of patients with different types of acute coronary syndrome(ACS).Methods Collected the clinical diagnosis of acute coronary syndrome patients 98 cases,which contained ST segment elevation my-ocardial infarction(STEMI)in 34 cases,non ST elevation myocardial infarction(NSTEMI)in 28 cases,unsta-ble angina pectoris(UA)in 36 cases,while the examination resuLts of healthy people as a control group of 20 cases.The Venous blood was collected and the FSTL1 levels of the 4 groups were detected by ELISA.Results The levels of Serum FSTL1 in ACS group was significantly higher than that in normal control group(P<0.05).Serum FSTL1 of the ACS group were significant correlated with Gensini score,cTNT,hs-CRP(related coefficient:0.210,0.236,0.219 separately).The AUC of FSTL1 was 0.910(95% CI:0.832 -0.988),which was lower than cTNT.The best cut-off value of FSTL1 as a biomarker was 5.65 μg/L(specificity:84.2% and sensitivity:77.5%).Moreover the combination of FSTL1,HDL and cTNT exhibited significantly higher AUC=0.945(95% CI:0.909 -0.981)than did other biomarkers alone or pair combinations.Conclusion In pa-tients with acute coronary syndrome,serum FSTL1 levels has a positive correlation with the degree of coro-nary stenosis and inflammation reaction,and has certain value in the diagnosis of acute coronary syndrome.

Objective To investigate the relationship between lymph nodes count after selective neck lymph node dissection and the prognosis of patients with pathologically lymph node-negative (pN0) hypopharyngeal squamous cell carcinoma (HPSCC). Methods The clinical data of 96 patients with pN0 HPSCC undergoing selective neck dissection (bilateralⅡ-Ⅳregion) from October 1995 to October 2012 in Shanxi Provincial Cancer Hospital were analyzed retrospectively. The optimal lymph nodes count cutoff values were determined by using the X-tile program in different prognostic groups, and the univariate and multivariate survival analysis in different groups were analyzed by using SPSS 19.0 software. Results A total of 2116 lymph nodes were detected in this cohort, with a median number of 22 (3-52). Except for the tumor site (P= 0.011), there were no statistical differences in lymph nodes count of patients with different age, gender, history of smoking or drinking, T stage, and differentiation degree (all P> 0.05). Applying 9 and 23 nodes as the cutoff values determined by using X-tile program, all patients could be divided into the high-risk (13 cases, lymph nodes count 3-9), the middle-risk (37 cases, lymph nodes count 10-22) and the low-risk (46 cases, lymph nodes count 23-52) groups. And the 5-year overall survival (OS) rate was 23.1 ％, 55.9％and 86.0％in the high, middle, low risk groups respectively (χ2= 21.73, P< 0.001). Multiple-factor analysis showed that lymph nodes count, T stage and degree of tumor differentiation were independent prognostic factors in patients with pN0 HPSCC (all P< 0.05). Further analysis showed that when the cutoff value of lymph nodes count was 9, the patients could be divided into two groups with significantly differentprognosis. The 5-year OS rate was 23.1％ in the high-risk group and 73.2 ％ in the low-risk group, and the difference was statistically significant (χ2 = 17.87, P< 0.001). Conclusions Lymph nodes count after selective neck lymph node dissection can be used to predict the prognosis of patients with pN 0 HPSCC. It is likely that 9 is the minimum number of lymph nodes in pN0 HPSCC patients.