Objective:To investigate the prognosis of postoperative adjuvant therapy for hepatocellular carcinoma after conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 103 patients with initially unresectable hepatocellular carcinoma (HCC) who were admitted to 11 medical centers in China, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from November 2019 to May 2023 were collected. There were 83 males and 20 females, aged (54±12)years. All 103 patients underwent conversion therapy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) successfully followed by sequential hepatectomy, of which 72 patients undergoing postoperative adjuvant therapy were divided into the adjuvant therapy group, and 31 patients undergoing postoperative follow-up monitoring were divided into the follow-up monitoring group. Observation indicators: (1) follow-up and postoperative condi-tions; (2) analysis of factors influencing recurrence-free survival time of patients; (3) stratified ana-lysis. Comparison of count data between group was conducted using the chi-square test or Fisher exact probability. The R software was used to draw survival curves, and the Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Results:(1) Follow-up and postoperative conditions. All 103 patients were followed up for 21.0(range, 1.9?47.2)months, with the median recurrence-free survival time of 28.7 months and the 1-, 2-, 3-year recurrence-free survival rates of 68.6%, 55.6%, 41.2%. The median overall survival time of 103 patients was unreached, and the 1-, 2-, 3-year overall survival rates were 90.9%, 82.1%, 69.6%, respectively. The median recurrence-free survival time was 33.1 months in patients of the adjuvant therapy group, with the 1-, 2-year recurrence-free survival rates as 77.2%, 61.5%. The median recurrence-free survival time was 11.1 months in patients of the follow-up monitoring group, with the 1-, 2-year recurrence-free survival rates as 46.6%, 40.8%. There was a significant difference in recurrence-free survival between the two groups of patients ( χ2=5.492, P<0.05). (2) Analysis of factors influencing recurrence-free survival time of patients. Results of multivariate analy-sis showed that pathologic complete response and postoperative adjuvant therapy were independent factors influencing recurrence-free survival time of HCC patients undergoing conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy ( hazard ratio=0.297, 0.492, 95% confidence interval as 0.137?0.647, 0.268?0.903, P<0.05). (3) Stratified analysis. Of the 71 patients with non-pathologic complete response, the median recurrence-free survival time of 48 patients in the adjuvant therapy group was 24.0 months, with the 1-, 2-year recurrence-free survival rates as 67.4%, 48.8%. The median recurrence-free survival time of 23 patients with non-pathological complete response in the follow-up monitoring group was 7.4 months, with the 1-, 2-year recurrence-free survival rates as 35.0%, 26.3%. There was a significant difference in recurrence-free survival between the 48 patients with non-pathologic complete response in the adjuvant therapy group and the 23 patients with non-pathologic complete response in the follow-up monitoring group ( χ2=5.241, P<0.05). Conclusion:For HCC patients with conversion therapy of TKIs and ICIs followed by sequential hepatectomy, postoperative adjuvant therapy, compared to postoperative follow-up monitoring, can prolong the recurrence-free survival time of patients, of whom cases with non-pathologic complete response can benefit from adjuvant therapy.

Objective:To investigate the prognosis of postoperative adjuvant therapy for hepatocellular carcinoma after conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 103 patients with initially unresectable hepatocellular carcinoma (HCC) who were admitted to 11 medical centers in China, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from November 2019 to May 2023 were collected. There were 83 males and 20 females, aged (54±12)years. All 103 patients underwent conversion therapy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) successfully followed by sequential hepatectomy, of which 72 patients undergoing postoperative adjuvant therapy were divided into the adjuvant therapy group, and 31 patients undergoing postoperative follow-up monitoring were divided into the follow-up monitoring group. Observation indicators: (1) follow-up and postoperative condi-tions; (2) analysis of factors influencing recurrence-free survival time of patients; (3) stratified ana-lysis. Comparison of count data between group was conducted using the chi-square test or Fisher exact probability. The R software was used to draw survival curves, and the Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Results:(1) Follow-up and postoperative conditions. All 103 patients were followed up for 21.0(range, 1.9?47.2)months, with the median recurrence-free survival time of 28.7 months and the 1-, 2-, 3-year recurrence-free survival rates of 68.6%, 55.6%, 41.2%. The median overall survival time of 103 patients was unreached, and the 1-, 2-, 3-year overall survival rates were 90.9%, 82.1%, 69.6%, respectively. The median recurrence-free survival time was 33.1 months in patients of the adjuvant therapy group, with the 1-, 2-year recurrence-free survival rates as 77.2%, 61.5%. The median recurrence-free survival time was 11.1 months in patients of the follow-up monitoring group, with the 1-, 2-year recurrence-free survival rates as 46.6%, 40.8%. There was a significant difference in recurrence-free survival between the two groups of patients ( χ2=5.492, P<0.05). (2) Analysis of factors influencing recurrence-free survival time of patients. Results of multivariate analy-sis showed that pathologic complete response and postoperative adjuvant therapy were independent factors influencing recurrence-free survival time of HCC patients undergoing conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy ( hazard ratio=0.297, 0.492, 95% confidence interval as 0.137?0.647, 0.268?0.903, P<0.05). (3) Stratified analysis. Of the 71 patients with non-pathologic complete response, the median recurrence-free survival time of 48 patients in the adjuvant therapy group was 24.0 months, with the 1-, 2-year recurrence-free survival rates as 67.4%, 48.8%. The median recurrence-free survival time of 23 patients with non-pathological complete response in the follow-up monitoring group was 7.4 months, with the 1-, 2-year recurrence-free survival rates as 35.0%, 26.3%. There was a significant difference in recurrence-free survival between the 48 patients with non-pathologic complete response in the adjuvant therapy group and the 23 patients with non-pathologic complete response in the follow-up monitoring group ( χ2=5.241, P<0.05). Conclusion:For HCC patients with conversion therapy of TKIs and ICIs followed by sequential hepatectomy, postoperative adjuvant therapy, compared to postoperative follow-up monitoring, can prolong the recurrence-free survival time of patients, of whom cases with non-pathologic complete response can benefit from adjuvant therapy.

OBJECTIVE To establish an HPLC method for determination of the related substances in papaverine hydrochloride. METHODS NanoChrom ChromCore 120 C8 column was used; the mobile phase A consisted of 3.4 g·L−1 potassium dihydrogen phosphate aqueous solution, adjust pH to 3.5 with phosphoric acid-acetonitrile(90∶10), the mobile phase B was methanol, with gradient elution at the flow rate of 0.8 mL·min−1; the detection wavelength was 238 nm; the column temperature was 50 ℃. RESULTS The minimum separation between the main component and each impurity was >1.5; Papaverine and its thirteen impurities showed a good linear relationship in the self-concentration range(r>0.999); and the average recoveries were 93.1%−101.2% with RSDs of 2.3%−8.1%. CONCLUSION The method is accurate, sensitive and reliable, which is suitable for the determination of related substances in papaverine hydrochloride.

Objective:To explore the expressions of serum N-terminal osteocalcin (N-MID) and cytokeratin (CK) 5/6 in primary lung cancer patients with bone metastasis and their clinical significances.Methods:The clinical data of 96 patients with primary lung cancer admitted to Chengdu Second People's Hospital between February 2019 to February 2022 were retrospectively analyzed. All patients were divided into the bone metastasis group (38 cases) and the non-bone metastasis group (58 cases) according to whether bone metastasis occurred, and 45 healthy people who underwent physical examination during the same period were treated as the healthy control group. The expression levels of serum N-MID and CK5/6 in the bone metastasis group, the non-bone metastasis group and the healthy control group were compared. Logistic regression was used to analyze the factors affecting bone metastasis in patients with primary lung cancer; receiver operating characteristic (ROC) curve analysis was used to analyze the value of the expression levels of serum N-MID and CK5/6 in predicting bone metastasis in patients with primary lung cancer.Results:The composition ratio of patients with pathological stage Ⅲ-Ⅳ, serum bone-derived alkaline phosphatase and N-MID expression levels in the bone metastasis group were higher than those in the non-bone metastasis group (all P < 0.05). The expression level of serum N-MID in the bone metastasis group and non-bone metastasis group was higher than that in the healthy control group [(26.0±5.3) ng/ml, (15.3±3.1) ng/ml vs. (9.9±1.7) ng/ml, F = 224.27, P < 0.001], and there were statistically significant differences in the serum N-MID expression level of the pairwise comparison among the three groups (all P < 0.05). The expression level of serum CK5/6 in the bone metastasis group and the non-bone metastasis group was lower than that in the healthy control group [(3.6±0.7) ng/ml, (7.3±1.4) ng/ml vs. (10.6±2.4) ng/ml, F = 178.11, P < 0.001], and there were statistically significant differences in the serum CK5/6 expression level of the pairwise comparison among the three groups (all P < 0.05). Multivariate analysis showed that CK5/6, N-MID and bone-derived alkaline phosphatase were independent affecting factors for bone metastasis in patients with primary lung cancer ( OR = 4.088, 3.615, 2.892, all P < 0.05). ROC curve analysis showed that the optimal cut-off values of serum N-MID and CK5/6 expression levels for predicting bone metastasis in patients with primary lung cancer were 18.59 ng/ml and 4.71 ng/ml; the corresponding the area under the curve (AUC) was 0.881 and 0.862, respectively; and the specificity and AUC of the combination of serum N-MID and CK5/6 in predicting the bone metastasis in patients with primary lung cancer was 98.28% and 0.937 (95% CI 0.869-0.977), respectively; the AUC predicted by the combination of both was higher than that by serum N-MID or CK5/6 single (all P < 0.001). Conclusions:The expression levels of serum N-MID and CK5/6 in primary lung cancer patients with bone metastasis are abnormally changed. Clinical detection of serum N-MID and CK5/6 expression levels may be used as sensitive indicators for predicting the bone metastasis in patients with primary lung cancer.

OBJECTIVE: To develop a noninvasive method for prediction of 1p/19q codeletion in diffuse lower-grade glioma (DLGG) based on multimodal magnetic resonance imaging (MRI) radiomics. METHODS: We collected MRI data from 104 patients with pathologically confirmed DLGG between October, 2015 and September, 2022. A total of 535 radiomics features were extracted from T₂WI, T₁WI, FLAIR, CE-T₁WI and DWI, including 70 morphological features, 90 first order features, and 375 texture features. We constructed logistic regression (LR), logistic regression least absolute shrinkage and selection operator (LRlasso), support vector machine (SVM) and Linear Discriminant Analysis (LDA) radiomics models and compared their predictive performance after 10-fold cross validation. The MRI images were reviewed by two radiologists independently for predicting the 1p/19q status. Receiver operating characteristic curves were used to evaluate classification performance of the radiomics models and the radiologists. RESULTS: The 4 radiomics models (LR, LRlasso, SVM and LDA) achieved similar area under the curve (AUC) in the validation dataset (0.833, 0.819, 0.824 and 0.819, respectively; P>0.1), and their predictive performance was all superior to that of resident physicians of radiology (AUC=0.645, P=0.011, 0.022, 0.016, 0.030, respectively) and similar to that of attending physicians of radiology (AUC=0.838, P>0.05). CONCLUSION Multiparametric MRI radiomics models show good performance for noninvasive prediction of 1p/19q codeletion status in patients with in diffuse lower-grade glioma.
Humans ; Magnetic Resonance Imaging ; Chromosome Aberrations ; Area Under Curve ; Glioma/genetics* ; ROC Curve

Objective:To conduct a systematic review of clinical manifestations, treatment, and associated genotyping of Sorsby fundus dystrophy (SFD).Methods:An evidence-based medicine study. Sorsby fundus dystrophy, anti-vascular endothelial growth factor therapy, choroidal neovascularization, macular neovascularization, and TIMP3 gene were hereby used as search terms. Relevant literature was searched in CNKI, Wanfang, PubMed of the National Library of Medicine, and Embase of the Netherlands. The time span for literature searching ranged from the establishment of the database to April 2022, and two reviewers independently screened the literature and extracted relevant data, with duplicates, incomplete or irrelevant articles, and review articles excluded. SPSS26.0 software was used for analysis. The 95% confidence interval ( CI) was used as an estimate of the effect size. The clinical manifestations, treatment and related pathogenic genes of SFD were counted and recorded. Results:According to the search strategy, 157 pieces of literature were initially retrieved, and 49 eyes of 35 patients from 16 articles were finally included for analysis, among which, 17 patients were male, 13 patients were female, and 5 patients were unknown gender; 16 involved left eyes, 19 involved right eyes, and 14 involved unidentified eyes. The age of the disease onset was 42.33±2.19 years (28-59) years old. There were 19 cases with a positive family history, and the total positive rate was 54.3% (19/35, 95% CI 36%-72%). There were 31 cases of gene mutation, all of which were TIMP3. In the included literature, there were 2 and 2 cases with no mutation and unreported loci, respectively, with a total positive rate of 93.9% (31/33, 95% CI 85%-100%). Among the 31 cases with gene mutation, 22, 4, 1, and 4 cases were in the UK, Germany, Switzerland, and Chinese, respectively, and the detection rates were all 100% (22/22, 4/4, 1/1, 4/4). The clinical manifestations of SFD were mainly yellow-white deposits in the fundus and choroidal neovascularization (CNV) in the macula, thereby leading to a decrease in central vision, followed by the expansion of the deposits to the periphery, the further development of CNV, and a severe decline in vision caused by peripheral retinal and choroidal atrophy. The treatment methods for SFD include photodymatic therapy, anti-VEGF drugs, glucocorticoids, vitamin A, etc., among which, anti-VEGF drugs were considered the first-line treatment, and the combined treatment was provided with a better prognosis than a single treatment. Conclusions:Variations in the TIMP3 gene cause SFD, the fundus characteristic manifestations of which, are yellowish-white deposits and CNV, which develop from the center to the periphery, thus resulting in progressive decline of visual acuity. Current studies have shown that combined therapy presents a better prognosis than monotherapy.

Objective To evaluate and compare the subjective and objective visual quality of YAG laser posterior capsulotomy.Methods A series of case observation study was designed.Twenty-eight patients (38 eyes)underwent Nd:YAG laser posterior capsulotomy in the Eye Hospital of Wenzhou Medical University were retrospectively collected from 2015 to 2016.Patients were divided into circular capsulotomy group (20 patients 23 eyes) and cruciate capsulotomy group (12 patients 15 eyes) based on the capsulotomy technique (round incision of posterior capsule or cross incision of posterior capsule).The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were examined before and 2 weeks after operation,the intraocular pressure was also measured before operation,1 hour after operation and 2 weeks after operation.The Strehl ratio (SR),modulation transfer function (MTF) cut-off,objective scatter index (OSI),OQAS values (OVs) were analyzed by Two-channel visual quality analysis system OQAS Ⅱ at 1 h and 2 weeks after operation.The changes of intraocular scattering and visual quality at 1 h and 2 weeks after operation with different posterior capsulotomy methods were compared and analyzed.Results At 2 weeks after operation,the UCVA was 0.18±0.15 and 0.16±0.14,and the BCVA was 0.10±0.10 and 0.10±0.11,respectively in the circular capsulotomy group and cruciate capsulotomy group,which was higher than those before operation (all at P＜0.05),but there was no significant difference in UCVA and BCVA between the two groups (all at P＞0.05).There was no significant difference in intraocular pressure between the two groups at 1 hour and 2 weeks after operation (both at P＞0.05).In the circular capsulotomy group,the incidence of black shadow drift was 39.1％ and 30.4％ respectively at 1 hour and 2 weeks after operation,which was higher than that in the cruciate capsulotomy group (6.7％ and 6.7 ％),with no significant differences between the two groups (P =0.065,0.177).No significant difference were found in the incidence of black shadow drift before eyes between the two groups (P＞0.05),and there was no significant differences in the OQAS parameters OSI,MTF,SR,OV100％,OV20％ and OV9％ between the two groups (all at P＞0.05).Conclusions After Nd:YAG laser capsulotomy,the incidence of black shadow drift in the cruciate capsulotomy group is lower than that in the circular capsulotomy group.There is no significant difference in the visual acuity,intraocular pressure,intraocular scattering and visual quality parameters between circular posterior capsulotomy and cross posterior capsulotomy.

Objective　To evaluate the effect of anterior cervical fusion or non-fusion surgery for the treatment of Hirayama disease.Methods　The patients with Hirayama disease who underwent anterior cervical surgery in our hospital from July 2008 to December 2015 were retrospectively enrolled in this study.These cases were divided into two groups:fusion group(11 cases)and non-fusion group(12 cases).In fusion group,there were 9 males and 2 females,with an average age of 17.92±0.61 years(range,15-29).In the non-fusion group,there were 10 males and 1 female,with an average age of 19.18±1.14 years(range,15-23).Muscle strength,muscular atrophy,and the Michigan score for hand function were compared between the two groups preoperatively and postoperatively.The indexes such as arc cervical physiological curvature index,the maximum flexion angle,the maximal range of motion(ROM),flexion ROM of adjacent segments of lower(cervical vertebra were measured from the X-ray of the two groups,and the cross-sectional area of spinal cord was measured and compared on neutral position MRI.Results　There were no significant differences between the two groups in grip strength,preoperative hand function Michigan score,cervical physiological(curvature index,the maximum flexion angle,the maximal ROM,flexion ROM of adjacent segments of lower cervical vertebra,and cross-sectional area of spinal cord on neutral position MRI(P>0.05).Patients in fusion group were followed up for 38-103 months with an average of 59.73±5.57 months,while patients in non-fusion group were followed up for 40-95 months with an aver-age of 56.25±4.57 months.Clinical outcomes:At the last follow-up,the finger tremor and cold paralysis were alleviated in all patients,but the symptoms in fusion group and non-fusion group were not completely disappeared in 2 and 3 cases,respectively.The grip strength of fusion group(preoperative 17.14±6.09,postoperative 17.47±5.64)and the non-fusion group(preoperative 17.75±5.49,postoperative 17.40±4.58)were not significantly improved compared with preoperative(P>0.05).The Michigan score for hand function of fusion group(preoperative 10.27±0.41,postoperative 6.64±0.24)and the non-fusion group(preoperative 9.25±0.35,postoperative 6.83±0.24)were significantly improved compared with preoperative(P<0.05).There was no significant difference in postoperative Michigan score between the two groups(P>0.05).Radiological outcomes:The cervical physiological curvature index and cross-sectional area of the spinal cord of the two groups increased after operation,while the maximum flexion angle,the maximal ROM decreased.There was no significant difference in these indexes between the two groups postoperatively(P>0.05).The spinal cord had no compression on flexion MRI.The cross-sectional area of C4-C7 spinal cord in Neutral MRI were significantly increased at C6 and C7 levels in both groups.There was no significant difference in the cross-sectional area of C4-C7 spinal cord between the two groups postoperatively(P>0.05).Two cases of internal fixation loosening occurred in non-fusion group 3 years after the operation,while there were no cases of loosening in the fusion group.Conclusion　Anterior cervical fusion or nonfusion surgery can limit excessive cervical kyphosis in patients with Hirayama disease,reduce atrophy of compressed cervical spinal cord,and alleviate the disease progress of muscular atrophy of the distal upper limb.It can be selected as a treatment method for Hirayama disease.However,there is a risk of internal fixation loosening in non-fusion cases,and also a risk of adjacent segment degeneration in fusion cases.The appropriate cases should be selected carefully for surgery.

Objective To cvaluate the efficacy and safety of HabibTM VesOpen intravascular radiofrequency catheter percutaneous radiofrequency ablation combined with TACE in the treatment of portal vein tumor thrombus of primary hepatocellular carcinoma.Methods Thirty-nine patients with primary hepatocellular carcinoma complicated with portal vein thrombosis were treated with HabibTM VesOpen intracavitary catheter ablation combined with TACE.The postoperative success rate,complication,blood index,α-fetoprotein (AFP),portal vein patency and tumor thrombus imaging changes were assessed.Results All of 39 patients underwent surgery successfully without occurrence of perforation,infection,hepatapostema,intra-abdominal hemorrhage nor other complications associated with surgery.Blood routine examinations (WBC,RBC,PLT) after 2 weeks and 4 weeks of surgery had no statistical difference compared with those of preoperation.Liver function indexes including ALT,AST,ALB had statistical difference before and after the surgery except for TBIL.AFP had statistical difference before and after surgery.Doppler ultrasonography after 4 weeks showed blood flow in original blocked portal vein.Enhanced CT or MR examinations after 8 weeks on the abdomen,suggested that tumors were shrinked or disappeared.Conclusion Radiofrequency catheter ablation with intracavitary radiofrequency catheter of HabibTM VesOpen is an effective method in the treatment of portal vein tumor thrombus in primary hepatocellular carcinoma.

In view of the fact that medical inspection equipment sold in the domestic market is mainly imported from abroad and very expensive, we developed a full-automatic fluorescence analyzer in our center, presented in this paper. The present paper introduces the hardware architecture design of FPGA/DSP motion controlling card+PC+ STM32 embedded micro processing unit, software system based on C# multi thread, design and implementation of double-unit communication in detail. By simplifying the hardware structure, selecting hardware legitimately and adopting control system software to object-oriented technology, we have improved the precision and velocity of the control system significantly. Finally, the performance test showed that the control system could meet the needs of automated fluorescence analyzer on the functionality, performance and cost.
Automation, Laboratory ; Equipment Design ; Fluorescence ; Software