Radiomics-based predictive risk score: A scoring system for preoperatively predicting risk of lymph node metastasis in patients with resectable non-small cell lung cancer

Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

First-line pemetrexed-platinum doublet chemotherapy with or without bevacizumab in non-squamous non-small cell lung cancer: A real-world propensity score-matched study in China

Objective: To evaluate the efficacy and safety profile of first-line bevacizumab(Bev)-containing pemetrexedplatinum chemotherapy in a real-world Chinese cohort with advanced non-squamous non-small cell lung cancer(NS-NSCLC).Methods: A total of 415 eligible patients with NS-NSCLC who received first-line pemetrexed-platinum chemotherapy at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between February 2010 and September 2017 were reviewed retrospectively: 309 Bev(-) and 106 Bev(+) cases. Bev was administered at 7.5 mg/kg every 3 weeks in the Bev(+) group. To reduce the risk of a selection bias, a propensity score-matching(PSM) was conducted and 105 pairs of Bev(-) and Bev(+) cases were identified.Results: The median duration of follow-up was 15.8 months. The median progression-free survival(PFS) was prolonged significantly in the Bev(+) group than in the Bev(-) group in overall(9.8 vs. 7.8 months, P=0.006) and PSM pairs(9.8 vs. 6.6 months, P<0.001). Moreover, patients receiving maintenance therapy with pemetrexed plus Bev had longer PFS than those interrupted after induction chemotherapy, or those receiving mono-maintenance with pemetrexed(12.3 vs. 4.8 vs. 8.6 months;P<0.001). Multivariate analyses revealed Bev to be one of the favorable prognostic factors for PFS, along with the predictor of maintenance therapy.Conclusions: First-line induction and maintenance therapy with Bev(7.5 mg/kg every 3 weeks) combined with pemetrexed-platinum chemotherapy was efficacious and superior to non-Bev chemotherapy in Chinese patients with advanced NS-NSCLC.

Survival difference between EGFR Del19 and L858R mutant advanced non-small cell lung cancer patients receiving gefitinib:a propensity score matching analysis

Objective： Although superior clinical benefits of epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） in the treatment of advanced non-small-cell lung cancer （NSCLC） had been reported, the survival difference between exon 19 deletion （Dell9） and exon 21 Leu858Arg substitution （L858R） remains controversial. The purpose of this study is to investigate the differences in progression-free survival （PFS） and overall survival （OS） between different EGFR mutant subtypes among advanced NSCLC patients receiving gefitinib. Methods： There were 204 advanced NSCLC patients with EGFR mutations treated with gefitinib were enrolled in this retrospective cohort study. Patients were divided into the EGFR Dell9 group and the L858R mutated group according to their mutant subtype. Propensity score matching （PSM） was conducted by using a nearest-neighbor algorithm （1：1） to adjust for demographical and clinical covariates. Survival curves were constructed with the Kaplan-Meier method and compared by using the log-rank test. Results： The PFS in Dell9 group was similar to that in the L858R group [before PSM 8.6 vs. 7.2 months, P=0.072; after PSM 7.3 vs. 7.2 months, P=0.155]. No differences were detected in OS between the L858R and the Dell9 group （before PSM 17.8 vs. 13.1 months, P=0.253; after PSM 16.9 vs. 13.1 months, P=0.339）. The Dell9 group was significantly younger compared with the L858R mutation group in age （P=0.015）. Conclusions： No significant difference was found in the PFS or OS between the Dell9 and L858R mutant NSCLC patients receiving gefitinib. The age gap might contribute to the survival differences between Dell9 and L858R groups. PSM is of important value to the elimination of potential bias.

A radiomics prognostic scoring system for predicting progression-free survival in patients with stageⅣnon-small cell lung cancer treated with platinum-based chemotherapy

Objective:To develop and validate a radiomics prognostic scoring system(RPSS)for prediction of progressionfree survival(PFS)in patients with stageⅣnon-small cell lung cancer(NSCLC)treated with platinum-based chemotherapy.Methods:In this retrospective study,four independent cohorts of stageⅣNSCLC patients treated with platinum-based chemotherapy were included for model construction and validation(Discovery:n=159;Internal validation:n=156;External validation:n=81,Mutation validation:n=64).First,a total of 1,182 three-dimensional radiomics features were extracted from pre-treatment computed tomography(CT)images of each patient.Then,a radiomics signature was constructed using the least absolute shrinkage and selection operator method(LASSO)penalized Cox regression analysis.Finally,an individualized prognostic scoring system incorporating radiomics signature and clinicopathologic risk factors was proposed for PFS prediction.Results:The established radiomics signature consisting of 16 features showed good discrimination for classifying patients with high-risk and low-risk progression to chemotherapy in all cohorts(All P<0.05).On the multivariable analysis,independent factors for PFS were radiomics signature,performance status(PS),and N stage,which were all selected into construction of RPSS.The RPSS showed significant prognostic performance for predicting PFS in discovery[C-index:0.772,95%confidence interval(95%CI):0.765-0.779],internal validation(C-index:0.738,95%CI:0.730-0.746),external validation(C-index:0.750,95%CI:0.734-0.765),and mutation validation(Cindex:0.739,95%CI:0.720-0.758).Decision curve analysis revealed that RPSS significantly outperformed the clinicopathologic-based model in terms of clinical usefulness(All P<0.05).Conclusions:This study established a radiomics prognostic scoring system as RPSS that can be conveniently used to achieve individualized prediction of PFS probability for stageⅣNSCLC patients treated with platinumbased chemotherapy,which holds promise for guiding personalized pre-therapy of stageⅣNSCLC.

Coronary artery calcium score on low-dose computed tomography for lung cancer screening

AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed to-mography(gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner(Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores(Volume, Mass, Agatston) as previ-ously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered sig-nificant.RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT(Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high(Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2(33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1(33%) showed an Agatston score of 0 in the ngCCT. Overall, 23(38%) patients were reclassified in a different car-diovascular risk category, mostly(18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT(DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

Quantitative CT Indexes and CT Visual Score in Interstitial Lung Abnormality as Indicators of Concurrent Lung Cancer

Background: The associations between the severity of interstitial lung disease and the stage and histologic type of concurrent lung cancer remain unknown. Purpose: To evaluate whether the severity of interstitial lung abnormality (ILA), as indicated by quantitative computed tomographic (CT) indexes and CT visual score, was correlated with the stage and histological type of concurrent lung cancer. Materials and Methods: Twenty-eight patients with surgically diagnosed lung cancer and ILA on CT were enrolled in this retrospective study. The subjects were allocated to one of three groups by histological type: adenocarcinoma group (13 subjects);squamous cell carcinoma group (10 subjects);and the other histological diagnosis group (5 subjects). Two independent observers evaluated the CT findings to determine the CT visual score, and the kurtosis and skewness of CT-based density histograms were determined. The relationships between severity of ILA and the pathological stage and histological type of concurrent lung cancer were evaluated. Results: There were no significant differences in the CT visual scores and quantitative indexes among the three groups. CT visual score was significantly negatively correlated with pathological stage (r = &#8722;0.43, P = 0.025). Conclusion: Patients can have only mild ILA on visual scoring but advanced lung cancer. Therefore, the frequency of follow-up examination should not be based on the severity of ILA on CT.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

The applied value of modified POSSUM score in evaluating lung cancer surgery’s risk

Objective: The aim of this study was to explore the modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system and the relationship between predicted data and actual data of complication and surgical mortality of lung cancer radical surgery made by such score system. Methods: Retrospective analysis on the 86 cases of the clinical materials of patients with primary lung cancer radical surgery for thoracic surgery of line lung cancer in the 81st Hospital of PLA from October 2010 to October 2011 and using the POSSUM scoring system to predict the cases of postoperative complication and death toll, then making a comparison with the actual cases. Results: The POSSUM scoring system predicting 29 cases of postoperative complications, but 32 cases of practical complications, the difference between them has no statistical significance (P﹥0.05), 8 cases of predicted postoperative deaths, 2 cases of practical deaths, by comparison, there was statistical significance (P﹤0.05). Conclusion: The modified POSSUM scoring system can be used to predict the postoperative complication of lung surgery patients, but sometimes overestimates the postoperative death cases.

Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus

BACKGROUND Patent ductus arteriosus(PDA)is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights.When PDA persists,interstitial lung water content increases,which could lead to abnormal circulation hemodynamics and pulmonary edema.It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA.AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA.METHODS From January 2018 to March 2020,69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group.At the same time,89 very low-weight preterm neonates without PDA were randomly selected as the control group.All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth.The clinical characteristics and main ultrasonography results were compared between the two groups.Pearson’s analysis was used to analyze the correlation between lung ultrasonography score(LUS)and other related clinical and ultrasonography results in all neonates.In the PDA group,PDA diameters were recorded,and the correlation with LUS and left atrium to aortic(LA/AO)dimension ratio were also analyzed.LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA.When the ratio is≥1.5,it suggests the possibility of hemodynamic changes in persistent PDA.A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa.RESULTS A total of 158 neonates were enrolled in this study,including 69 in the PDA group and 89 in the control group.There were no statistical differences in sex,gestational age,birth weight,ventilator dependence,hospitalization length and left ventricular ejection fraction between the two groups(P>0.05).The LUS and LA/AO ratio in the PDA group were higher than those in the control group(P<0.05),but there was no difference of LUS in neonates with or without use of the ventilator(t=0.58,P=0.16).In all cases,LUS was negatively correlated with gestational age(r=-0.28,P<0.01)and birth weight(r=-0.36,P<0.01),while positively correlated with the LA/AO ratio(r=0.27,P<0.01).In the PDA group,PDA diameter was positively correlated with the LA/AO ratio(r=0.39,P<0.01)and LUS(r=0.31,P<0.01).Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA(area under the curve=0.741;sensitivity=93.75%;specificity=50.94%).CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.

Low-depth whole genome sequencing reveals copy number variations associated with higher pathologic grading and more aggressive subtypes of lung non-mucinous adenocarcinoma

Objective:Histology grade,subtypes and TNM stage of lung adenocarcinomas are useful predictors of prognosis and survival.The aim of the study was to investigate the relationship between chromosomal instability,morphological subtypes and the grading system used in lung non-mucinous adenocarcinoma(LNMA).Methods:We developed a whole genome copy number variation(WGCNV)scoring system and applied next generation sequencing to evaluate CNVs present in 91 LNMA tumor samples.Results:Higher histological grades,aggressive subtypes and more advanced TNM staging were associated with an increased WGCNV score,particularly in CNV regions enriched for tumor suppressor genes and oncogenes.In addition,we demonstrate that 24-chromosome CNV profiling can be performed reliably from specific cell types(<100 cells)isolated by sample laser capture microdissection.Conclusions:Our findings suggest that the WGCNV scoring system we developed may have potential value as an adjunct test for predicting the prognosis of patients diagnosed with LNMA.

Expression of triggering receptor-1 in myeloid cells of mice with acute lung injury

BACKGROUND： Myeloid cell （TREM-1） is an important mediator of the signal transduction pathway in inflammatory response. In this study, a mouse model of acute lung injury （ALl） by intraperitoneal injection of lipopolysaccharide （LPS） was established to observe the expression pattern of TREM-1 in lung tissue and the role of TREM-1 in pulmonary inflammatory response to ALl.METHODS： Thirty BALB/C mice were randomly divided into a normal control group （n=6） and an ALl group （n=24）. The model of ALl was made by intraperitonal injection of LPS in dose of 10 mg/ kg. Specimens from peripheral blood and lung tissue were collected 6, 12, 24 and 48 hours after LPS injection. RT-PCR was used to detect TREM-1 mRNA, and ELISA was employed for detection of TREM-1 protein and TNF-a protein, and HE staining was performed for the pathological Smith lung scoring under a light microscope.RESULTS： The expressions of TREM-1 mRNAin lung tissue and blood of the ALl group 6, 12, 24, and 48 hours after injection of LPS were higher than those in the control group. The levels of TREM- 1 protein and the levels of TNF-a protein in lung tissue of the ALl group 6, 12, 24, and 48 hours after LPS injection were higher than those of the control group; the level of TREM-1 protein peaked 12 hours after LPS injection, but it was not significantly correlated with the expression of TREM-1 mRNA （P=0.14）; the TNF-a concentration was positively correlated with TREM-1 levels in lung tissue and with Smith pathological score （r=0.795, P=0.001 ：r=0.499, P=0.034）, but not with the expression of TREM-1 mRNA （P=0.176）.CONCLUSION： The expression of TREM-1 mRNA in lung tissue of mice with ALl is elevated, and the expression of TREM-1 mRNA is related to the level of TNF-a and the severity of inflammatory response to ALl. The expressions of the TREM-1 gene are not consistent with the levels of TREM-1 protein, suggesting a new functional protein involved in immune regulation.

5-mRNA-based prognostic signature of survival in lung adenocarcinoma

BACKGROUND Lung adenocarcinoma(LUAD)is the most common non-small-cell lung cancer,with a high incidence and a poor prognosis.AIM To construct effective predictive models to evaluate the prognosis of LUAD patients.METHODS In this study,we thoroughly mined LUAD genomic data from the Gene Expression Omnibus(GEO)(GSE43458,GSE32863,and GSE27262)and the Cancer Genome Atlas(TCGA)datasets,including 698 LUAD and 172 healthy(or adjacent normal)lung tissue samples.Univariate regression and LASSO regression analyses were used to screen differentially expressed genes(DEGs)related to patient prognosis,and multivariate Cox regression analysis was applied to establish the risk score equation and construct the survival prognosis model.Receiver operating characteristic curve and Kaplan-Meier survival analyses with clinically independent prognostic parameters were performed to verify the predictive power of the model and further establish a prognostic nomogram.RESULTS A total of 380 DEGs were identified in LUAD tissues through GEO and TCGA datasets,and 5 DEGs(TCN1,CENPF,MAOB,CRTAC1 and PLEK2)were screened out by multivariate Cox regression analysis,indicating that the prognostic risk model could be used as an independent prognostic factor(Hazard ratio=1.520,P<0.001).Internal and external validation of the model confirmed that the prediction model had good sensitivity and specificity(Area under the curve=0.754,0.737).Combining genetic models and clinical prognostic factors,nomograms can also predict overall survival more effectively.CONCLUSION A 5-mRNA-based model was constructed to predict the prognosis of lung adenocarcinoma,which may provide clinicians with reliable prognostic assessment tools and help clinical treatment decisions.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

Background: Fluid overload is frequent in Haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic HD patients. The main challenge with chronic haemodialysis patients is indeed the maintenance of a normal extracellular volume through dry weight determination. Our study aimed at assessing the role of lung ultrasound in the detection of B-lines for the determination of hydration status in chronic HD patients. Methods: We conducted a cross-sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in the Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between clinical and ultrasound variables before and after dialysis were measured to assess the effects of dialysis. Association between categorical variables was assessed with the Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results: There was a reduction in the median of B-lines score after dialysis [12 (7 - 26) versus 8 (5 - 13)], clinical score [2 (1 - 3) versus 0 (-1 - 2)], mean of systolic blood pressure (164.74 ± 26.50 versus 158.48 ± 27.89), frequency of dyspnoea in patients (32.3% versus 6.5%);and raising of the frequency of cramps in patients (0% versus 19.4%) and all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p Conclusion: Lung ultrasound for the detection of B-lines reflects the variation of extracellular volume during dialysis and can even capture pulmonary oedema at a pre-clinical stage. It is then a reliable and sensible method for assessing extravascular lung water and thus hydration status of haemodialysis patients. It could constitute a better alternative for an objective and accurate definition of dry weight, specifically in the African and Cameroonian context, with its assets being low cost, availability, and easiness to perform in a large population of HD patients. We, therefore, recommend further multicentric studies in order to design a standardized protocol of ultrasound follow-up for all chronic HD patients’ hydration status assessments.

The Role of Chest X-Ray in Monitoring Lung Changes among COVID-19 Patients in Gaza Strip

Objective: To investigate the time course and findings severity of COVID-19 infection at chest radiography based on a 6-point radiological severity score, and correlates these with patients’ age and gender. Methods: This is a retrospective study of COVID-19 patients who were admitted at European Gaza Hospital and evaluated between October 6, 2020, and November 30, 2020. Baseline and serial chest radiographs, up to 4 images per patient, were reviewed and assessed for predominant pattern, side, and location of lung opacity. Utilized a 6-point scoring system, which divides the chest X-ray into 6 zones, to assess chest X-ray changes and correlate them with the severity of infection, age, and gender of patients. Results: The study included 136 COVID-19 patients: (51/136, 37%) were males and (85/136, 62.5%) were females, while age ranged from 7 months to 90 years with a mean age of 41.7 ± (19.5) years. Negative Chest x-rays were more observed than positive images. Ground-glass opacity was the most frequent pattern with a decreasing trend from 1st to 4th chest X-ray (from 33.8% to 3.7%), followed by consolidation (from 16.2% to 2.9%). Also, the commonest pattern of opacity was seen in peripheral areas (27/136, 19.9%), lower zone location (23/136, 16.9%), and bilateral opacity involvement (43/136;31.6%). No significant correlation was noticed between the patient’s gender, age, and severity score (P > 0.05). Conclusions: The 6-point chest X-ray severity score as a predictive tool in assessing the severity due to provide an assessment of the progression or regression pathway.

自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者的影响

目的:探讨自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者疾病控制率、中医症候积分及不良反应的影响。方法:选取2020年10月—2022年10月在我院就诊的102例晚期非小细胞肺癌患者,随机分为观察组和对照组,每组各51例,对照组在吉西他滨+顺铂化疗的基础上给予信迪利单抗,观察组在对照组基础上联合自拟健脾除积方治疗。比较两组患者临床疗效、治疗前后中医症候积分、肿瘤标志物水平及不良反应。结果:观察组有效率和疾病控制率明显高于对照组(P<0.05);观察组和对照组治疗后中医症候积分均显著低于治疗前;治疗后,观察组中医症候积分显著低于对照组(P<0.05)。两组治疗后血清铁蛋白(SF)、鳞状细胞癌抗原(SCCA)及癌胚抗原(CEA)水平均显著低于同组治疗前,观察组SF、SCCA、CEA水平均显著低于对照组。观察组白细胞计数减少、恶心、呕吐症状总发生率显著低于对照组(P<0.05)。结论:自拟健脾除积方联合信迪利单抗对晚期非小细胞肺癌患者治疗效果较好,可改善患者中医症候,具有较高的安全性。

基于CPIS的护理模式在胰十二指肠切除术后预防肺部感染中的应用

目的探讨基于临床肺部感染评分(CPIS)的护理模式在胰十二指肠切除术(PD)后预防肺部感染中的应用价值。方法选取2020年1月至2024年2月郑州大学第一附属医院收治的204例PD患者作为研究对象,按随机数表法分为对照组和研究组各102例。对照组患者给予常规护理干预,研究组患者在对照组基础上给予基于CPIS的护理模式,两组患者均干预至出院。比较两组患者干预前后的肺部感染指标[白细胞计数(WBC)、C反应蛋白(CRP)、可溶性白细胞介素-2(SIL-2R)]及康复指标,同时比较两组患者的肺部感染发生率、并发症发生率和护理满意度。结果干预后研究组患者的WBC、SIL-2R、CRP分别为(4.47±1.06)×10^(9)/L、(316.77±20.16)IU/mL、(6.37±1.93)mg/L,明显低于对照组的(6.25±1.63)×10^(9)/L、(357.63±24.73)IU/mL、(8.64±2.05)mg/L,差异均有统计学意义(P<0.05);研究组患者的发热时间、抗生素使用时间及住院时间分别为(3.75±0.38)d、(9.45±1.28)d、(17.22±3.15)d,明显短于对照组的(6.18±1.03)d、(17.14±3.87)d、(27.59±4.36)d,差异均有统计学意义(P<0.05);研究组患者的肺部感染率及并发症总发生率分别为0.98%、1.96%,明显低于对照组的8.82%、9.80%,差异均有统计学意义(P<0.05);研究组患者的总护理满意度为95.10%,明显高于对照组的86.27%,差异有统计学意义(P<0.05)。结论基于CPIS的护理模式可有效降低PD术后肺部感染风险,预防并发症发生,加速病情改善,提升护理满意度。

老年慢性阻塞性肺疾病稳定期患者外周血CircDCUN1D4的水平及临床意义

目的检测慢性阻塞性肺疾病(COPD)患者外周血CircDCUN1D4的水平,探讨circDCUN1D4在COPD中的作用及临床意义。方法选取2022年11月1日—2023年4月30日在上海市第六人民医院金山分院呼吸科就诊的老年COPD稳定期患者40例(设为观察组),以同期院40例体检中心年龄和性别匹配的老年体检健康者为对照组。对COPD患者进行慢阻肺评估测试(CAT评分)、肺功能检查,记录FEV_(1)/FVC及FEV_(1)pred%;检测并比较2组外周血CircDCUN1D4的表达水平。将COPD患者分为60~80岁亚组(n=24)及年龄≥80岁亚组(n=16),对比分析2亚组CAT评分、FEV_(1)pred%及外周血circDCUN1D4水平的差异。结果COPD患者外周血CircDCUN1D4表达水平(3.47±1.55)高于健康对照组(1.15±0.56),组间差异有显著统计学意义(P<0.01);年龄≥80岁组患者circDCUN1D4水平、CAT评分高于60~80岁组,FEV_(1)pred%低于60~80岁组,差异均有统计学意义(P<0.05)。结论老年COPD稳定期患者外周血circDCUN1D4水平的变化可能与COPD发病、病情发展有关;通过检测外周血circDCUN1D4表达水平,有可能作为COPD早期诊断、预后评估的潜在指标。

痰热清注射液联合清燥救肺汤立体时相给药治疗放射性肺炎的临床研究

目的:观察痰热清注射液联合清燥救肺汤加减立体时相给药对放射性肺炎(RP)的治疗效果。方法:选择接受胸部三维适形放射治疗,同时中医辨证为痰热阻肺型的肺癌患者100例作为研究对象,随机分为对照组和观察组,每组50例。对照组患者采用单纯放疗,观察组在放疗基础上,给予痰热清静脉注射联合清燥救肺汤加减立体时相给药,于治疗结束后评估2组患者临床疗效及RP发生率,观察2组放疗前、中、后中医证候评分及血清肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、白细胞介素-6(IL-6)的水平变化,观察患者放疗前后肺功能指标卡诺夫斯凯计分(KPS)评分的变化。结果:观察组RP发生率较对照组明显降低,临床总有效率明显优于对照组(P<0.05);2组中医证候评分及血清TNF-α、TGF-β1、IL-6水平于放疗后不同时期均明显降低(P<0.05),与对照组比较,观察组放疗后2个月、4个月及放疗结束时中医证候评分及血清TNF-α、TGF-β1、IL-6水平明显降低(P<0.05);观察组肺活量(VC)、用力肺活量(FVC)、第一秒用力呼气量(FEV1)、FEV1/FVC肺功能指标及KPS评分较对照组显著提高(P<0.05)。结论:痰热清注射液联合清燥救肺汤立体时相给药可有效减轻放射治疗所致的放射性肺炎,通过降低血清炎症介质水平,改善肺功能起到减毒增效作用,对提升患者生命质量,提高放疗安全性和有效性具有积极意义。

温润辛金方治疗微寒恋肺型咳嗽变异型哮喘的临床疗效研究

目的:观察温润辛金方治疗微寒恋肺型咳嗽变异型哮喘(CVA)的临床疗效及安全性,为CVA的中医临床治疗提供依据和思路。方法:选取2017年6月~2019年12月期间于某院就诊的60例微寒恋肺型CVA患者,根据随机数字表法分为对照组和观察组,每组30例。对照组给予沙美特罗替卡松吸入粉雾剂,观察组给予温润辛金方,两组均治疗6周。观察两组患者的中医证候疗效以及不良反应,比较两组患者治疗前后呼出气一氧化氮(FeNO)及咳嗽症状积分的变化。结果:对照组和观察组分别脱落2例和4例。两组临床治疗总有效率比较无统计学差异(P>0.05)。治疗后,两组咳嗽症状积分、FeNO均较治疗前下降(P<0.05),且观察组咳嗽症状积分低于对照组(P<0.05),但两组FeNO水平比较无统计学差异(P>0.05)。观察组有2例患者在服药期间出现恶心等胃部不适,嘱其改为饭后服药后症状消失;对照组有2例患者出现轻微不良反应,但不影响后续治疗。结论:温润辛金方可有效改善微寒恋肺型CVA患者的临床症状和咳嗽症状积分,临床疗效较佳且安全性良好。