Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.

Objective To establish and assess the new method of APTT assay based on the combinations of Mg2+and Ca2+for lupus anticoagulants(LA)measurements.Methods This prospective study included 309 trisodium citrate anticoagulated plasma samples from 244 random patients and 65 patients with different autoimmune diseases(AID)to establish and assess the method of LA measurement, respectively.Final concentrations of 0,2.0, 4.0, 8.0,16.0 mmol/L Mg2+were added into 25 mmol/L Ca2+solution, and Actin reagent was used to measured plasma APTT of 94 patients.The applied concentration of Mg2+-Ca2+solution was confirmed through the special and significant alteration of APTT from LA-positive and -negative plasma observed in the presence of Mg 2+(test solution).Based on Actin reagent use,the test solution and 25 mmol/L Ca2+solution were applied to measure APTT of patients and normal individuals, respectively, and the ratio of Mg2+-Ca2+-APTT to Ca2+-APTT(Mg2+-Ca2+-APTT indices)and normalized Mg2+-Ca2+-APTT indices(NAR)were calculated, respectively.Mixed plasma NAR was measured,and CV%was calculated to evaluate the repeatability and stability of Mg 2+-Ca2+-APTT method.APTT of 150 patients was measured with the test solution and Actin reagent to calculate Mg 2+-Ca2+-APTT indices, and normalized LA ratio was determined with dRVVT method.The applicability of Mg2+-Ca2+-APTT assay was assessed through comparisons of the results from the two methods.Finally, NAR and NLR of 65 patients with AID(including 26 SLE patients)were measured with Mg2+-Ca2+-APTT assay and dRVVT method, respectively, and ROC curve was also used to assess the efficacy of the two methods for LA measurements.Results In all LA-negative plasma,APTT increased from 28.1 ±4.5 s to 61.2 ±7.9 s in normal APTT group,47.2 ±8.9 s to 97.5 ±10.3 s in increased APTT group,and 27.6 ± 5.1 s to 61.2 ±7.9 s in ACA-positive group when Mg2+increased from 0 to 8 mmol/L in Mg2+-Ca2+solution(F=34.12, 38.9 and 28.35,P<0.01).Following increased Mg2+concentration, APTT shortened from 0 to 4.0 mmol/L, but simultaneously prolonged from 4.0 to 16.0 mmol/L in LA-positive plasma with prolonged or normal APTT(F=31.55 and 39.51, P<0.01), and APTT was significantly higher in 8.0 mmol/L than that in 4.0 mmol/L(P<0.001).The test concentration of Mg 2+/Ca2+solution was 4.0 mmol/L.The within, inter-day CV% of NAR was 1.39%,2.30%, and 3.44%, respectively. According to the judging criteria of <0.966 and >1.034 of Mg2+/Ca2+indices, there was 141 patients with increased indices and NLR <1.20, and 9 patients with decreased ones and NLR≥1.20 in all 150 patients.The area under ROC curve of NAR and NLR for LA detection was 0.913(95%CI:0.848-0.978) and 0.892(95%CI:0.817-0.966), respectively, and the cut-off value was 0.87 and 1.13, respectively. The sensitivity and specificity of NAR(85% and 77%)was higher than that of NLR(81% and 74%), respectively.The accordant rate of positive,negative,and total results between NAR and NLR was 94.4%, 98.5%,and 98%,respectively.Conclusion The method of APTT assay based on Mg2+combining Ca2+for LA measurements is feasible,and can be used to detect plasma LA of patients.

Objective To explore the role of NT-proBNP in the differentiation of acute pulmonary embolism (APE) from congestive heart failure (CHF) in patients with acute dyspnea.Methods Consecutive 260 patients aged ≥ 60 years complaining of acute dyspnea were collected between June 2010 and October 2015.The patients were divided into two groups of APE and CHF according to their diagnosis standards.The levels of NT-proBNP between the two groups were compared using t test,and receiver operating characteristic curve (ROC curve) was made to show the value of NT-proBNP in differentiation of APE from CHF.Results Patients in APE group had significantly lower median levels of NT-proBNP as compared with patients in CHF group [(2 478.8±1 473.9)ng/L vs.(5 955.4±3 180.1)ng/L,t =-12.020,P ＜ 0.01].The ROC curve of APE existence against serum levels of NT-proBNP showed an optimal cut-point of NT-proBNP of 1 518 ng/L,with specificity up to 98.8％,and the area under the ROC curve for NT-proBNP was 0.877.Conclusions NT-proBNP as a simple and bedside approach to identify APE versus CHF patients with acute dyspnea can help clinicians identify APE early and reduce the rates of misdiagnosis and missed diagnosis of APE.But the confirmative diagnosis of APE is still based on spiral CT angiography.

Objective:To investigate the clinical effects and safety of triple therapy based on ipratropium bromide inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary diseases ( AECOPD) . Methods:Totally 150 patients with acute exac-erbation of AECOPD were randomly divided into control group (75 patients) treated with budesonide combined with salbutamol by in-halation, and treatment group (75 patients) treated with ipratropium bromide inhalation additionally. The clinical effects, dyspnea score, pulmonary function index and blood gas analysis index before and after the treatment and the incidence of adverse reactions of the two groups were compared. Results:The clinical effects of the treatment group was significantly better than that of the control group (P<0. 05). The dyspnea score, pulmonary function index in and blood gas analysis index in the two groups after the treatment were significantly better than those before the treatment(P<0. 05), and the improvement of the treatment group was significantly better than that of control group (P<0. 05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0. 05). Conclusion:Triple therapy including ipratropium bromide inhalation in the treatment of acute exacerbation of AECOPD can ef-fectively alleviate clinical symptoms and signs and improve the lung ventilation function without increased risk of adverse reactions.

Objective To observe the inhibition of amikacin in vitro on platelet aggregation and blood coagulation tests, and to study its effects on hemostasis and the related mechanisms.Methods Plateletrich plasma and platelet-poor plasma from donors were mixed with different concentration of amikacin, which was divided into four groups:0 mg/L, 30 mg/L, 91 mg/L and 910 mg/L group.The maximial ratio of platelet aggregation induced by ADP were measured with Platelet Aggregation Analyzer.The expression levels of P-selectin, GP Ⅱ b/Ⅲ a and Fg-R were determined with Flow Cytometer.The PT, APTT, TT and Fg of platelet-poor plasma were detected with Blood Coagulation Analyzer. The four concentration of amikacin mentioned above and two anticoagulants (62.5 U/ml of sodium heparin and 109 mmol/L of sodium citrate)were interacted with fresh whole blood, in which the blood CT and plasma Ca2+ were detected. Blood samples were collected from 10 patients with acute lower respiratory tract infection before and 30 minutes after routine amikcin treatment respectively.The maximial ratio of platelet aggregation, the expression levels of P-selectin, GPⅡ b/Ⅲa and Fg-R induced by ADP were measured; while PT, APTT, CT and plasma Ca2+ were determined.Results At 30 mg/L of amikacin group, the maximal ratios of platelet aggregation (65.8±3.9)%, the expression levels of P-selectin (9.2 ± 1.0)% and Fg-R (12.6 ± 1.7)% were statistically lower than those [(88.0 ±4.6%, (16.1 ± 1.3)% and (31.0 ±2.5)%]at 0 mg/L of amikacin group ( t = 9.442,8.432,9.993,P ＜ 0.01 ).At 30 mg/L of amikacin group, the APTT (80.5 ±6.8) s and CT ( 857 ± 66) s were significantly higher than those [(33.0 ± 3.6) s and (447 ± 35 ) s] at 0 mg/L of amikacin group ( t = 11.312, 13.211, P ＜ 0.01 ). There was a negative correlation between amikacin concentration and maximial ratio of platelet aggregation ( r = - 0.832, P ＜ 0.05 ), but a positive correlation between amikacin concentration and inhibitory rates of platelet aggregation ( r = 0.939, P ＜0.05) was observed, as well as APTT (r ＞0.870, P＜0.05).At 30 mg/L, 91 mg/L, and 910 mg/L of amikacin groups, the P-selectin and Fg-R expression were remarkably inhibited with a dose-dependent manner, the CT was notably enhanced [Fwithin subjects =21.44, 26.24, ( ＞29.81 ), P ＜0.01].At 0 mg/L,30 mg/L, 91 mg/L and 910 mg/L of amikacin groups, the PT values were ( 14.7 ± 1.9) s, ( 15.2 ± 1.7) s,(15.6±1.5) s and (22.1 ±2.1) s, respectively (F=8.21,P＜0.05), but there was no markeddifference for the levels of GP Ⅱ b/Ⅲ a, TT, Fg and plasma Ca2+ among the four groups ( P ＞ 0.05 ).After 30 minutes of amikacin treatment, the maximial ratio of platelet aggregation (51.6 ± 10.1)%, the expression levels of P-selectin (6.8 ± 1.8) % and Fg-R ( 20.1 ± 5.8 ) % were significantly lower than those [(66.8 ± 11.4)%, ( 10.9 ±3.1 )% and (28.5 ±7.4)%] before amikacin treatment, but APTT (49.8 ±5.9) s and CT (660 ±59) s were remarkably higher than those [(26.9 ±3.8) s and (410 ±45) s] before amikacin treatment, respectively ( t = 5.456,8.875,7.423,10.012,11.322, P ＜ 0.01 ), while the GP Ⅱ b/Ⅲ a expression, PT and Ca2+ concentration had no significant changes ( P ＞ 0.05).Conclusions There are inhibitory effects of amikacin on platelet aggregation mainly through the inhibition of both fibrinogen receptor activation and secretion reaction of activated platelet. Amikacin may also inhibit pathway of coagulation system factor to prevent blood coagulation.Therefore, risk of hemorrhage may be investigated in the patients with amikacin for anti-infection treatment.

Objective: To evaluate the efficacy and toxicity of rituximab combined with cyclophosphamide, pirarubicin, vincristine, and prednisone (R-CTOP regimen) for B cell non-Hodgkin's lymphoma and to analyze the influential factors for patient response.Methods: The clinical data of patients with CD20 antigen treated with R-CTOP regimen were reviewed and the influence of sex, age, clinical stage, pathological type, and level of LDH and IPI on patient response was analyzed.Results: A total of 33 patients were evaluated for objective response.The complete response (CR) rate was 51.5%, the par-ticel response (PR) rate was 33.3%, and the overall response rate was 84.8%.For the 23 de novo patients, the CR rate was 56.5 %, the PR rate was 34.8%, and the OR rate was 91.3%.While in the 10 recurrent patients, the CR rate was 40%, the PR rate was 30%, and the OR rate was 70%.Sex, clinical stage, pathological type, and the level of LDH and IPI were not significantly related to clinical response.While patient age was related to clinical response.None of the patients died of therapy-related side effects.The most frequent adverse event was myelosuppression (Ⅲ-Ⅳ decrease of leukocyte account-ed for 32.1%).Cardiotoxicity and alopecia were mostly grade Ⅰ to grade Ⅱ.Other side effects can be tolerated after symp-tomatic treatment.Conclusion: R-CTOP regimen is a highly effective and well-toleraed therapy and should be the first choice in the treatment for B cell non-Hodgkin's lymphoma (NHL), especially for senior patients.

Objective To investigate the clinical features and prognostic factors of primary thyroid lymphoma. Methods Records of 44 patients with pathologically confirmed primary thyroid lymphoma were reviewed. Detailed clinical and laboratory data were included in univariate analysis, and statistically significant factors in univariate analysis were then included in multivariate analysis.Results In univariate analysis, Ann Arbor stage, performance status, IPI, number of extra-lymphatic site, B symptoms, Hb, LDH and β_2-MG level, therapy model, histology type and tumor mass were found to be the prognostic factors associated with overall survival in primary thyroid lymphoma. In multivariate analysis, performance status, IPI, LDH, β_2-MG level, histology type, and tumor mass were independent prognostic factors of overall survival. Conclusion Performance status, IPI, LDH and β_2-MG level, histology type and tumor mass were demonstrated as independent prognostic factors of the overall survival in primary thyroid lymphoma.

Objective To investigate the expression of ki-67 and the development of the intimal hyperplasia(IH) of the irradiated human umbilical artery incorperated with nofloxacin and silver(IHUAINS) grafts into the carotid arteries of the rabbit. Methods Twenty IHUAINSs were sterilely produced. Thirty rabbit were performed bilateral carotid bypass grafting. The IHUAINS(experimental group)and the left carotid arteries (control group) were implanted in the left and right carotid arteries respectively. Graft patency was checked at the 2nd and 6th week after implantation, and the grafts were studied with standard histological techniques and immunohistochemieal method for meas-urement of intimal thickness and the expression of ki-67. Results The total patency rate of the grafts was 89.6%. Light microscopic exami-nation of the grafts revealed intimal and media proliferation, cellular in-filtration. The endothelial cells covered the vascular lumen. There was no significant difference of the intimal thickness between two groups at the 2nd week after grafting (P>0.05). The intimal thickness of the experimental group was larger than that in control group at the 6th week after implantation without statistical significance (P>0.05). At the same time, immunocytochemical analysis showed that the expression of ki-67 in the experimental group was stronger than that in control group without statistical significance(P>0.05). Conclusion The IH of the IHUAINS was larger than that of the autologous artery, but there is no difference between these two groups. Thus, IHUAINS may be an ideal graft in the field of coronary surgery.

Revascularization technique is a favorable approach to solve the insufficient compensation of cerebral blood flow for intractable intracranial aneurysms that needed to occlude parent arteries.With the development microsurgical technique and the improving of patency rate of vasotransplantation,the efficacy of revascularization for the treatment of intractable intracranial aneurysms is also improving constantly.

BACKGROUNDTo explore the clinical and prognostic values of serum carbohydrate antigen (CA125), neuron-specific enolase (NSE), calcitonin (CT) levels in patients with lung cancer before operation.

METHODSNinety two untreated patients with lung cancer confirmed histologically were studied. Serum CA125, NSE, and CT were detected in 92 lung cancer patients by ELISA before operation. Thirty healthy volunteers were chosen as controls.

RESULTSThe sensitivity of CA125, NSE, and CT for the diagnosis of lung cancer were 48.9%, 21.7%, and 7.6% respectively. The level of CA125 in lung cancer patients was significantly higher than that of control (P < 0.05). The level of NSE in patients with small cell lung cancer was significantly higher than that of control (P < 0.01). The level of CT in lung cancer patients was higher than that of control, but without significant difference. The 3-year survival rate of patients with increased serum CA125 level before operation was 44.4% (20/45), whereas that of patients with normal CA125 level was 66.0% (31/47) (P < 0.05). The 3-year survival rate of patients with increased serum NSE and CT levels was 45.0% (9/20) and 42.8% (3/7) respectively, whereas that of patients with normal serum NSE and CT level was 58.3% (42/72) and 56.5% (48/85) respectively. The 3-year survival rate of patients with increased serum NSE or CT level had no significant difference with that of patients with normal level (P > 0.05).

CONCLUSIONSThe diagnostic values of CA125, NSE and CT are limited. CA125 can be used as an prognostic parameter in patients with lung cancer after operation.