Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience

Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.

应用阈值光电子-光离子符合成像研究能态选择的离子解离动力学（英文）

阈值光电子-光离子符合测量是制备和分析能态选择离子性质的高效实验方法.本文回顾了这一技术与合肥同步辐射真空紫外光电离相结合的近期应用,特别是在离子基本参数测量和解离动力学中的研究.通过对电子和符合离子的同步速度聚焦测量,带电粒子的收集效率、电子能量分辨和离子平动能分辨率都得到了大幅提高.通过对特定能态离子解离碎片平动能和角度分布的直接测量,研究了各种非绝热效应,如椎间贯穿、内转换等,在解离过程中的重要作用.此外,在此基础上质量选择的阈值光电子能谱在复杂体系的同分异构体甄别方面也展示出超乎寻常的优势.

Ex vivo expansion of tumor-infiltrating lymphocytes from nasopharyngeal carcinoma patients for adoptive immunotherapy

Establishing Epstein-Barr virus (EBV)-specific cytolytic T lymphocytes (EBV-CTLs) from peripheral blood mononuclear cells (PBMCs) for adoptive immunotherapy has been reported in EBV-associated malignancies including Hodgkin's lymphoma and nasopharyngeal carcinoma (NPC). In the current study,we performed ex vivo expansion of tumor-infiltrating lymphocytes (TILs) obtained from NPC biopsy specimens with a rapid expansion protocol using anti-CD3 monoclonal antibody (OKT3), recombinant human interleukin (IL)-2, and irradiated PBMCs from healthy donors to initiate the growth of TILs. Young TIL cultures comprised of more than 90% of CD3+T cells, a variable percentage of CD3+CD8+and CD3+CD4+T cells, and less than 10% of CD3-CD16+natural killer cells, a similar phenotype of EBV-CTL cultures from PBMCs. Interestingly, TIL cultures secreted high levels of the Th1 cytokines, interferon gamma (IFNγ) and tumor necrosis factor-alpha (TNF-α), and low levels of the Th2 cytokines, IL-4 and IL-10. Moreover, young TILs could recognize autologous EBV-transformed B lymphoblast cell lines, but not autologous EBV-negative blast cells or allogeneic EBV-negative tumor cells. Taken together, these data suggest that ex vivo expansion of TILs from NPC biopsy tissue is an appealing alternative method to establish T cell-based immunotherapy for NPC.

Comparison and development of advanced machine learning tools to predict nonalcoholic fatty liver disease:An extended study

Background:Nonalcoholic fatty liver disease(NAFLD)is a public health challenge and significant cause of morbidity and mortality worldwide.Early identification is crucial for disease intervention.We recently proposed a nomogram-based NAFLD prediction model from a large population cohort.We aimed to explore machine learning tools in predicting NAFLD.Methods:A retrospective cross-sectional study was performed on 15315 Chinese subjects(10373 training and 4942 testing sets).Selected clinical and biochemical factors were evaluated by different types of machine learning algorithms to develop and validate seven predictive models.Nine evaluation indicators including area under the receiver operating characteristic curve(AUROC),area under the precision-recall curve(AUPRC),accuracy,positive predictive value,sensitivity,F1 score,Matthews correlation coefficient(MCC),specificity and negative prognostic value were applied to compare the performance among the models.The selected clinical and biochemical factors were ranked according to the importance in prediction ability.Results:Totally 4018/10373(38.74%)and 1860/4942(37.64%)subjects had ultrasound-proven NAFLD in the training and testing sets,respectively.Seven machine learning based models were developed and demonstrated good performance in predicting NAFLD.Among these models,the XGBoost model revealed the highest AUROC(0.873),AUPRC(0.810),accuracy(0.795),positive predictive value(0.806),F1 score(0.695),MCC(0.557),specificity(0.909),demonstrating the best prediction ability among the built models.Body mass index was the most valuable indicator to predict NAFLD according to the feature ranking scores.Conclusions:The XGBoost model has the best overall prediction ability for diagnosing NAFLD.The novel machine learning tools provide considerable beneficial potential in NAFLD screening.

Effect of massive blood transfusion on blood coagulation function and fibrinolytic system in patients with acute trauman

Objective:To investigate the effect of a large number of blood transfusion on coagulation function and fibrinolytic system in patients with acute trauma.Methods:A total of 86 cases of traumatic blood transfusion emergency and hospitalized patients during January 2014 to January 2016 in our hospital, divided into two groups according to the early blood transfusion, acute trauma patients need a lot of blood transfusion for the observation group (47 cases), trauma patients need a small amount of blood transfusion as the control group (39 cases). Statistical analysis and comparison of two groups patients of four blood coagulation [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB)], platelet count (PLT), protein C (PC) and fiber soluble system index [D dimer (D-D), fibrin degradation products (FDP) levels before and after blood transfusion of 1 d, 5 d'. Results:Before blood transfusion, there was no significant difference between the two groups. There was no significant difference in the level of the observed indexes in the control group before and after transfusion. 1 d after blood transfusion, compared with blood transfusion before and the control group at the same time , the observation group PT[(18.4±4.3) s], APTT[(42.9±7) s], TT[(21.4±4.8) s] were significantly prolonged, D-D[(282.2±115) g/L] and FDP[(6.3±2.1) mg/L] were significantly increased, and FIB[(2.9±1.3) g/L], PLT[(72.5±34.4) 109] and PC[(2.4±1.2) mg/L] levels were significantly decreased. 5 d after blood transfusion, compared with blood transfusion before and the control group at the same time ,the observation indexes showed no significant difference;5 D after blood transfusion compared with 1 D, the observation group PT[(14.8±1.7) s], APTT[(34.7±5.4) s], TT[(14.7±2.5) s] was significantly shortened, D-D[(151.8±62.4) g/L] and FDP[(3.7±1.2) mg/L] were significantly decreased, FIB[(3.7±0.8) g/L], PLT[(179±70.8) 109] and PC[(3.9±1.5) mg/L] levels were significantly higher.Conclusion:Large amount of blood transfusion has great influence on the coagulation function and fibrinolysis system in acute trauma patients. It is necessary to monitor coagulation status in time and avoid complications such as coagulation dysfunction, so as to improve the success rate of implementation of massive transfusion regimen.