Compare clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Meta-analysis

BACKGROUND To compare the efficacy and safety of total neoadjuvant therapy(TNT)and neoadjuvant chemoradiotherapy(nCRT)in the treatment of middle and low locally advanced rectal cancer.Our study will systematically collect and integrate studies to evaluate the ability of these two treatments to improve tumor shrinkage rates,surgical resection rates,tumor-free survival,and severe adverse events.AIM To provide clinicians and patients with more reliable treatment options to optimize treatment outcomes and quality of life for patients with locally advanced rectal cancer by comparing the advantages and disadvantages of the two treatment options.METHODS A full search of all clinical studies on the effectiveness and safety of TNT and nCRT for treating locally advanced rectal cancer identified in Chinese(CNKI,Wanfang,China Biomedical Literature Database)and English(PubMed,Embase)databases was performed.Two system assessors independently screened the studies according to the inclusion and exclusion criteria.Quality evaluation and RESULTS Finally,14 studies were included,six of which were randomized controlled studies.A total of 3797 patients were included,including 1865 in the TNT group and 1932 in the nCRT group.The two sets of baseline data were comparable.The results of the meta-analysis showed that the pCR rate[odds ratio(OR)=1.57,95%confidence interval(CI):1.30-1.90,P<0.00001],T stage degradation rate(OR=2.16,95%CI:1.63-2.57,P<0.00001),and R0 resection rate(OR=1.42,95%CI:1.09-1.85,P=0.009)were significantly greater in the nCRT group than in the nCRT group.There was no significant difference in the incidence of grade 3/4 acute toxicity or perioperative complications between the two groups.The 5-year OS[hazard ratio(HR)=0.84,95%CI:0.69-1.02,P=0.08]and DFS(HR=0.94,95%CI:0.03-1.39,P=0.74)of the TNT group were similar to those of the nCRT group.CONCLUSION TNT has greater clinical efficacy and safety than nCRT in the treatment of locally advanced rectal cancer.

Effects of omeprazole in improving concurrent chemoradiotherapy efficacy in rectal cancer

AIM To explore the effects of omeprazole on chemoradiotherapy efficacy and tumor recurrence in rectal cancer. METHODS The medical data of 125 rectal cancer patients who received the same neoadjuvant chemoradiotherapy(CRT) followed by surgery were retrospectively collected. Patients who received omeprazole(OME) orally at a dose of 20 mg at least once daily for six days and/or intravenously at 40 mg a day were recognized as eligible OME users(EOU). Otherwise, patients were regarded as non-eligible OME users(non-EOU).Moreover, a preferred OME dose cut-off of 200 mg on tumor recurrence was obtained by receiver operating characteristic(ROC) curves. Patients were divided into two groups: the effective OME group(EOG, OME ≥ 200 mg) and the non-effective OME group(non-EOG, OME < 200 mg). RESULTS The good response rate of CRT efficacy(50.8%) in EOU was significantly increased compared with nonEOU(30.6%)(P = 0.02). The recurrence rate in the EOG was 10.3%, which was significantly lower compared with 31.3% in non-EOG(P = 0.025). The good response rate of CRT efficacy in EOG was 55.2%, which was obviously higher compared with 36.5% in non-EOG, with a significant difference(P = 0.072). Multivariate Cox analysis demonstrated that OME(nonEOG and EOG) was an independent and significant impact factor for DFS(P = 0.048, HR = 0.30, 95%CI: 0.09-0.99).CONCLUSION When applied as an adjuvant drug in cancer treatment for relieving common side effects of chemotherapy, omeprazole has a synergetic effect in improving CRT efficacy and decreasing rectal cancer recurrence.

Efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on advanced cervical cancer

Background and Objective: Concurrent chemoradiotherapy for cervical carcinoma develops rapidly and has become a common and standard therapy in recent years. Both the local control rate and survival rate of patients were increased and the risk of death fell by 30%-50%. This study aimed to explore the efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on and the treatment compliance of the patients with advanced cervical squamous cell carcinoma. Methods: A total of 156 patients with stage IIa-IIIb cervical squamous cell carcinoma were randomly divided into the concurrent chemoradiotherapy group (experimental group) and radiotherapy group (control group). Intracavity and external beam radiation therapy were administered. At point A, 40-48 Gy were given by 10-12 fractions; at point B, 46-50 Gy were given by 23-25 fractions. In the same time, experimental group was treated by cisplatin (DDP, 40 mg) on day 1, repeated every week. Ten days after radiation therapy, TP regimen was administered as adjuvant chemotherapy. Results: For the experimental and control groups, the objective response rates were 88.61% and 75.32%, 1-year survival rates were 88.57% and 70.77%, 1-year local control rates were 81.43% and 64.62%, 3-year survival rates were 82.14% and 57.69%, and 3-year local control rates were 75.00% and 46.15%, with significant differences (P < 0.05). Quality of life of all patients were significantly improved after treatment (P< 0.05). Conclusion: Concurrent chemoradiotherapy plus adjuvant chemotherapy for advanced cervical cancer can improve short-term and long-term survival and local control rates of patients, improve the quality of life, and the toxicity can be tolerated.

To set up a logistic regression prediction model for hepatotoxicity of Chinese herbal medicines based on the efficacy of Chinese herbal medicines

In our previous research,a logistic regression prediction model for hepatotoxicity of Chinese herbal medicines based on the four properties,five flavors and channel tropism has been successfully established.However,could Chinese herbal medicines efficacy also be applied to predict the hepatotoxicity of Chinese herbal medicines?Therefore,a logistic regression prediction model for hepatotoxicity of Chinese herbal medicines based on Chinese herbal medicines efficacy has been tentatively set up to study the correlations of hepatotoxic and nonhepatotoxic Chinese herbal medicines with efficacy by using a chi-square test for two-way unordered categorical data.Logistic regression prediction model was established and the accuracy of the prediction by this model was evaluated.It has been found that the hepatotoxicity and nonhepatotoxicity of Chinese herbal medicines were weakly related to the efficacy,and the coefficient was 0.295.There were 20 variables from Chinese herbal medicines efficacy analyzed with unconditional logistic regression,and 6 variables,rectifying Qi and relieving pain,clearing heat and disinhibiting dampness,invigorating blood and stopping pain,invigorating blood and relieving swelling,killing worms and relieving fright were chosen to establish the logistic regression prediction model,with the optimal cutoff value being 0.250.Dissipating cold and relieving pain(DCRP),clearing heat and disinhibiting dampness,invigorating blood and relieving pain(IBRP),invigorating blood and relieving swelling,killing worms,and relieving fright were the variables to affect the hepatotoxicity and the established logistic regression prediction model had predictive power for hepatotoxicity of Chinese herbal medicines to a certain degree.

Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma

AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.

Predictive value of a serum tumor biomarkers scoring system for clinical stage Ⅱ/Ⅲ rectal cancer with neoadjuvant chemoradiotherapy

BACKGROUND Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer(RC)response.Carcinoembryonic antigen(CEA)is the most widely used blood-based marker of RC and has proven to be an effective predictive marker.Cancer antigen 19-9(CA19-9)is another tumor biomarker used for RC diagnosis and postoperative monitoring,as well as monitoring of the therapeutic effect.Using a panel of tumor markers for RC outcome prediction is a practical approach.AIM To assess the predictive effect of pre-neoadjuvant chemoradiotherapy(NCRT)CEA and CA19-9 levels on the prognosis of stage II/III RC patients.METHODS CEA and CA19-9 levels were evaluated 1 wk before NCRT.According to the receiver operating characteristic curve analysis,the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01,respectively.The novel serum tumor biomarker(NSTB)scores were as follows:score 0:Pre-NCRT CEA<3.55 and CA19-9<19.01;score 2:Pre-NCRT CEA>3.55 and CA19-9>19.01;score 1:Other situations.Pathological information was recorded according to histopathological reports after the operation.RESULTS In the univariate analysis,pre-NCRT CEA<3.55[P=0.025 for overall survival(OS),P=0.019 for disease-free survival(DFS)],pre-NCRT CA19-9<19.01(P=0.014 for OS,P=0.009 for DFS),a lower NSTB score(0-1 vs 2,P=0.009 for OS,P=0.005 for DFS)could predict a better prognosis.However,in the multivariate analysis,only a lower NSTB score(0-1 vs 2;for OS,HR=0.485,95%CI:0.251-0.940,P=0.032;for DFS,HR=0.453,95%CI:0.234-0.877,P=0.019)and higher pathological grade,node and metastasis stage(0-I vs II-III;for OS,HR=0.363,95%CI:0.158-0.837,P=0.017;for DFS,HR=0.342,95%CI:0.149-0.786,P=0.012)were independent predictive factors.CONCLUSION The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT,and the combined index had a stronger predictive effect.

S2B-1 A Study of Diagnosis and Early Efficacy Prediction Biomarkers for Major Depressive Disorder

Background:Currently,diagnosis of major depressive disorder(MDD)still relies on symptoms.There are some problems for the diagnostic criteria,like low diagnostic consistency and difficulty in differentiation of MDD and bipolar depression(BD)in the early stage.In terms of treatment,there are also many problems,such as low overall efficiency,slow onset effect,and large differences between individuals.At present,there are a lot of researches on MDD biomarkers,most focus on genomics,transcriptomics,proteomics and brain imaging both from domestic and foreign counterparts,but the main research focuses are genetics and imaging.This study is mainly combine genetics and imaging to conduct the discussions of MDD diagnosis and efficacy prediction biomarkers.Methods:Proteomics mainly included patients who met the diagnostic criteria.Blood samples were taken from the participants.Serum was collected after centrifugation for serum protein concentration detection.Receiver operation curve(ROC)analysis was used to test the diagnostic and differential powers of the single serum proteins or combined serum proteins.In the imageology groups,the 3.0T cranial magnetic resonance imaging(MRI)scan was performed on the subjects meeting the inclusion criteria,and the methods based on the deep learning of the resting-state fMRI data was used.The biological marker spectrums from molecular levels(genotyping or measuring genetic products)to clinical levels(depicting cognitive and motivational areas or clinical symptoms)to predict the outcome of the treatment.Results:In the diagnosis of MDD,accord to the results of previous animal experiments and clinical studies,we developed a highly accurate MDD diagnostic platform based on the serum levels of proteins in the P11-tPA-BDNF pathway.The sensitivity of the MDD diagnostic platform was 88.1%,specificity was 92.7%,and accuracy was as high as 90.6%.Based on the above findings,we further studied the diagnosis and differential diagnosis efficacy of serum proteins levels in this pathway for five common psychiatric diseases:schizophrenia(SZ),MDD,bipolar mania(BM),BD,and panic disorder(PD).The results suggest that the combination of serum proteins levels(tPA,PAI-1,BDNF,proBDNF,TrkB,p75NTR)in this pathway has a high accuracy not only in the diagnosis and differential diagnosis of MDD,but also in the diagnosis and identification of SZ,BM,BD and PD,which can be used as a diagnostic platform for common mental diseases.After that,we further studied serum VGF and BICC1 proteins upstream or downstream of this pathway.We found that serum VGF levels decreased in MDD while increased in BD patients compared with healthy controls(HC),had a significant ability for identifying MDD and BD,and its sensitivity is 95%,specificity is 100%,and the accuracy is up to 95%.Similarly,BICC1 also has a good diagnostic and differential efficacy in MDD,BM,and BD.We also found that facial expressions also contribute to the diagnosis and severity of MDD.In addition,imaging studies also showed that MDD patients have characteristics of small-world networks that are different from other populations,showing an increase in the characteristic path length(Lp)and a decrease in network efficiency(E),which is beneficial to the diagnosis and differential diagnosis of MDD.In the efficacy of MDD,we found that CMHC differences are existed in the precuneus and infraorbital gyrus between responsive depression(RD)group and non-responding depression(NRD)group,and the precuneus VMHC values of RD group were significantly negatively associated with the baseline scores of Hamilton depression rating scale(HAMD).ROC analysis showed that combining the VMHC values of above-mentioned brain regions can distinguish NRD more effectively.Similarly,imaging studies also found that the left ORBsup node was lower than that of the HC group,while the right ORBinf was increased;right dorsolateral superior frontal gyrus(SFGdor)nodes are lower when compare to NRD that may be the basis for different therapeutic effects.The combined ROC analysis showed that the degree of right SFGdor node and the characteristic path length can predict NRD well.We also found that there are significant correlations between bilateral NAcc network connectivity property and the severity as well as early efficacy of MDD,and the temporal variability between different efficacy MDD groups is different.The bimodal analysis based on CBF+ALFF showed that ALFF values of the bilateral occipital gyrus(MOG),left lentiform nuclear(lentiform),right superior temporal gyrus,and CBF and ALFF of right calcarine gyrus(Calcarine)and left caudate nucleus(Caudate)are significantly correlated with the severity or early efficacy of MDD at baseline.Including CBF of left Caudate and right middle frontal gyrus as well as ALFF of right inferior temporal gyrus can predict NRD better.Conclusion:Both proteomics and imaging have the feasibility of developing an objective tool for the diagnosis and efficacy evaluation of MDD.In the future,larger samples of clinical studies are needed to obtain repeatable,scientific,and reliable specific biomarkers for the differential diagnosis of MDD and BD,and the precise clinical diagnosis and treatment of MDD.

Predictive value of serum levels of transforming growth factor beta 1 for the short-term effects of radiotherapy and chemotherapy in patients with esophageal cancer

Objective To investigate variation in levels of transforming growth factor beta 1(TGF-β1)before and after radiotherapy in patients with esophageal cancer in order to evaluate the predictive value of TGF-β1 for the effects of radiotherapy Methods A total of 140 patients with esophageal squamous carcinoma undergoing radical radiation therapy in the Department of Oncology from March 2015 to December 2017 were enrolled.The patients were divided into the effective(115 cases)and ineffective(25 cases)groups according to World Health Organization(WHO)criteria for the evaluation of solid tumors(2009 RECIST standard).TGF-β1 levels were measured in all patients by using enzyme-linked immunosorbent assay(ELISA).Multiple-factor analysis of the predictive value of the treatment efficacy was performed by Cox regression analysis.Results After radiotherapy,36,79,and 25 cases experienced complete response(CR),partial response(PR),and no response(NR),respectively,with a total effective rate of 82.14%.The TGF-β1 level was significantly lower in the effective group than that in the ineffective group(P<0.05)and covariance analysis revealed significantly reduced TGF-β1 level in esophageal cancer patients following radiotherapy.The multi-factor Cox regression model revealed that the predictive value of TGF-β1 for the effect of radiotherapy was largest,with a hazard ratio[HR]of 1.955(P=0.002),followed by exposure dose,with(HR=1.367;P=0.035).Conclusion Serum TGF-β1 level can serve as a predictor for the short-term effects of radiotherapy in patients with esophageal cancer.

Evaluation of 30 DNA damage response and 6 mismatch repair gene mutations as biomarkers for immunotherapy outcomes across multiple solid tumor types

Objective:DNA damage response(DDR)genes have low mutation rates,which may restrict their clinical applications in predicting the outcomes of immune checkpoint inhibitor(ICI)treatment.Thus,a systemic analysis of multiple DDR genes is needed to identify potential biomarkers of ICI efficacy.Methods:A total of 39,631 patients with mutation data were selected from the cBioPortal database.A total of 155 patients with mutation data were obtained from the Fudan University Shanghai Cancer Center(FUSCC).A total of 1,660 patients from the MSK-IMPACT cohort who underwent ICI treatment were selected for survival analysis.A total of 249 patients who underwent ICI treatment from the Dana-Farber Cancer Institute(DFCI)cohort were obtained from a published dataset.The Cancer Genome Atlas(TCGA)level 3 RNA-Seq version 2 RSEM data for gastric cancer were downloaded from cBioPortal.Results:Six MMR and 30 DDR genes were included in this study.Six MMR and 20 DDR gene mutations were found to predict the therapeutic efficacy of ICI,and most of them predicted the therapeutic efficacy of ICI,in a manner dependent on TMB,except for 4 combined DDR gene mutations,which were associated with the therapeutic efficacy of ICI independently of the TMB.Single MMR/DDR genes showed low mutation rates;however,the mutation rate of all the MMR/DDR genes associated with the therapeutic efficacy of ICI was relatively high,reaching 10%–30%in several cancer types.Conclusions:Coanalysis of multiple MMR/DDR mutations aids in selecting patients who are potential candidates for immunotherapy.

Down-staging depth score could be a survival predictor for locally advanced gastric cancer patients after preoperative chemoradiotherapy

Objective:The predictive effect of preoperative chemoradiotherapy(CRT)is low and difficult in guiding individualized treatment.We examined a surrogate endpoint for long-term outcomes in locally advanced gastric cancer patients after preoperative CRT.Methods:From April 2012 to April 2019,95 patients with locally advanced gastric cancer who received preoperative concurrent CRT and who were enrolled in three prospective studies were included.All patients were stage T_(3/4) N_(+).Local control,distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)were evaluated.Clinicopathological factors related to long-term prognosis were analyzed using univariate and multivariate analyses.The down-staging depth score(DDS),which is a novel method of evaluating CRT response,was used to predict long-term outcomes.Results:The median follow-up period for survivors was 30 months.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve predicted by the DDS was 0.728,which was better than the pathological complete response(pCR),histological response and ypN0.Decision curve analysis further affirmed that DDS had the largest net benefit.The DDS cut-off value was 4.pCR and ypN0 were associated with OS(P=0.026 and 0.049).Surgery and DDS are correlated with DMFS,DFS and OS(surgery:P=0.001,<0.001 and<0.001,respectively;and DDS:P=0.009,0.013 and 0.032,respectively).Multivariate analysis showed that DDS was an independent prognostic factor of DFS(P=0.021).Conclusions:DDS is a simple,short-term indicator that was a better surrogate endpoint than pCR,histological response and ypN0 for DFS.

Research progress on the electrophysiological indicators to predict the efficacy of vagus nerve stimulation for drug-refractory epilepsy

Vagus nerve stimulation(VNS)is an important treatment option for drug-refractory epilepsy(DRE),with well-established efficacy and safety in clinical practice for more than 20 years.However,it is very difficult to find the optimal electrophysiological indicators for the effectiveness of VNS on DRE because the mechanism of action is unknown.In this review,we provide an update of the potential applications of VNS outcomes in patients with drug-resistant epilepsy.Electroencephalographic(EEG)activity,event-related potentials,EEG synchronization levels,magnetoencephalographic,laryngeal muscle evoked potentials,and heart rate variability are potential biomarkers for VNS outcomes in people with DRE.

Correlations between alterations of T-helper 17 cells and treatment efficacy after concurrent radiochemotherapy in locally advanced cervical cancer (stage IIB-IIIB): a 3-year prospective study

Background::Recently,T-helper 17(Th17)cells have been proved to play an important role in promoting cervical cancer.But,till now,few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments.This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer(LACC)patients before and after concurrent chemoradiotherapy(cCRT)and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.Methods::A prospective study with 49 LACC(International federation of gynecology and obstetrics[FIGO]stage IIB-IIIB)patients and 23 controls was conducted.Patients received the same cCRT schedule and were followed up for 3 years.Circulating Th17 cells(CD3+CD8-interleukin[IL]-17+T cells)and related cytokines IL-17,transforming growth factor-β(TGF-β),IL-10,IL-23,IL-6,and IL-22 were detected before and after cCRT.Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed.Kaplan-Meier analysis was used for overall survival(OS)and progression-free survival(PFS).Results::We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study.The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls,and it significantly decreased after cCRT(P<0.05).After cCRT,patients were divided into two groups based on the average of the Th17 cells declined.The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times.Compared with the control patients,LACC patients had higher IL-6,IL-10,IL-22,TGF-βlevels and a lower IL-23 level(P<0.05).After cCRT,IL-6,IL-10,IL-17,IL-23 level significantly increased and TGF-βlevel significantly decreased compared with the levels before cCRT(P<0.05).Conclusion::Circulating Th17 cells in the LACC patients(FIGO stage IIB-IIIB)were higher than those in the controls,but they generally decreased after cCRT.A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

Predicting the 7^(th)Day Efficacy of Acupoint Application of Chinese Herbs(Xiao Zhong Zhi Tong Tie)in Patients with Diarrhea——A Machine-Learning Model Based on XGBoost Algorithm

Objective:Extreme gradient boosting(XGBoost)was used to predict the 7^(th)day efficacy of the acupoint application(AP)of Chinese herbs(Xiao Zhong Zhi Tong Tie)in patients with diarrhea.Materials and Methods:We consecutively collected medical records of patients with diarrhea nationwide on the Chun Bo Wan Xiang cloud platform from August 22 to November 5,2020.Demographic and clinical data and the fecal properties were included in this study.We established the XGBoost model to predict the 7^(th)day efficacy of AP in patients with diarrhea.The XGBoost model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).We next compared the performance of XGBoost with that of artificial neural network(ANN),ANN+boosting,ANN+bagging,and support vector machine(SVM).Results:The XGBoost model provided a prediction accuracy of 84.86%(95%confidence interval=82.74%to 86.81%)and the ROC curve analysis showed an AUC of 0.81.The top-three variables with the highest importance are age,duration of diarrhea,and region(North).Our study revealed that XGBoost was not superior to ANN,ANN+boosting,ANN+bagging,and SVM.Conclusions:The established XGBoost model for predicting the 7^(th)day efficacy of AP in patients with diarrhea exhibited good accuracy and precision,which can be used for efficacy prediction.

Serum squamous cell carcinoma antigen is a predictive factor of outcomes in patients with locally advanced unresectable esophageal squamous cell carcinoma treated by definitive chemoradiotherapy

Aim:Definitive chemoradiotherapy(dCRT)is the standard treatment for locally advanced unresectable esophageal squamous cell carcinoma(LU-ESCC).This study aimed to describe the results of dCRT for T4 ESCC and evaluate the pretherapeutic predictive factors of the outcomes.Methods:A total of 133 patients with T4 ESCC who received dCRT were grouped into those who achieved a complete response(CR)or those who had residual disease(RD).The clinicopathologic variables were compared between the groups and the overall survival(OS)was evaluated.The predictive factor of RD was assessed and the prognostic factor for OS was identified.Results:Among the 133 patients,31(23%)achieved CR.The CR group had a significantly better OS than the RD group(89.9 months vs.10.7 months;hazard ratio=0.096;95%confidence interval:0.05-0.19;P<0.001).Multivariate analysis showed that a supracarinal tumor(OR=3.21;P=0.016),higher pretherapeutic serum SCC-Ag level(>1.6 ng/mL)(OR=2.86;P=0.018),and metastatic node invasion(OR=3.19;P=0.048)were independent predictors of RD.The increased level of pretherapeutic serum squamous cell carcinoma antigen(>1.6 ng/mL)(OR=1.61;P=0.022)was an independent predictor of poor survival.Conclusions:Among the patients who underwent dCRT for LU-ESCC,23%achieved CR,and the long-term outcome of these patients was favorable.Increased levels of pretherapeutic serum squamous cell carcinoma antigen were also found to be predictive of treatment failure.

二维超声联合剪切波弹性成像在老年肌少症诊断及疗效预测中的临床价值

目的探讨二维超声联合剪切波弹性成像在老年肌少症诊断及疗效预测中的临床应用价值。方法选取我院收治的84例老年肌少症患者(观察组)和同期42例健康老年人(对照组),两组均行二维超声和剪切波弹性成像检查,比较两组肌肉厚度、羽状角、肌束长度及收缩状态下腓肠肌杨氏模量平均值(以下简称杨氏模量值)的差异。观察组患者行常规药物治疗和弹力带训练,记录其治疗后总有效率,比较入院时与干预1、3、6个月后握力、四肢骨骼肌指数(ASMI)、简易躯体能力测试表(SPPB)评分的差异。绘制受试者工作特征(ROC)曲线分析二维超声和剪切波弹性成像参数单独及联合应用对老年肌少症诊断和疗效预测的效能。结果观察组肌肉厚度、羽状角、肌束长度及杨氏模量值均低于对照组,差异均有统计学意义(均P<0.05)。观察组患者治疗后总有效率86.90%(73/84);干预1、3、6个月后握力、ASMI、SPPB评分均高于入院时,差异均有统计学意义(均P<0.001)。ROC曲线分析显示,肌肉厚度、羽状角、肌束长度、杨氏模量值诊断老年肌少症的曲线下面积(AUC)分别为0.775、0.716、0.621、0.749,各参数联合应用的AUC为0.911,高于其单独应用,差异均有统计学意义(均P<0.05);肌肉厚度、羽状角、肌束长度、杨氏模量值预测老年肌少症疗效的AUC分别为0.805、0.846、0.785、0.775,各参数联合应用的AUC为0.889,高于单独应用,差异均有统计学意义(均P<0.05)。结论二维超声联合剪切波弹性成像在老年肌少症诊断及疗效预测中均有较好的临床应用价值,可为临床评估提供参考。

血清细胞因子表达水平与非小细胞肺癌PD-1抑制剂疗效研究进展

程序性死亡受体-1(PD-1)/程序性死亡分子配体-1信号通路抑制剂激活机体免系统后产生的细胞因子在抗肿瘤细胞过程中发挥关键作用。本文回顾近年来接受PD-1抑制剂治疗的非小细胞肺癌患者血清细胞因子表达水平与临床获益的相关性研究,揭示非小细胞肺癌患者PD-1治疗前后白介素-6、白介素-8、肿瘤坏死因子、干扰素、白介素-17A等细胞因子水平变化,为寻找经济、便捷的PD-1抑制剂疗效生物标志物提供思路和线索。

压力性尿失禁患者物理治疗效果及其早期相关因素

目的对尿失禁患者物理治疗的疗效及其早期影响因素进行分析。方法将2019年6月至2021年12月于河北医科大学第一医院诊治的200例压力性尿失禁患者纳入研究,采用随机数字表法分为干预组及对照组,比较两组患者年龄、性别等一般临床资料,对照组予常规治疗,干预组在常规治疗基础上联合物理治疗,比较两组患者症状及生活质量等指标,并根据治疗结果将干预组患者分为有效组及无效组,比较两组患者一般临床资料,采用多因素logistics回归模型对影响患者疗效指标进行分析,采用R软件绘制疗效预测风险列线图,建立疗效预测评分模型,并对其预测价值进行验证。结果两组患者年龄、体质指数(BMI)、治疗前两组患者1 h漏尿量、I-QOL评分、快速收缩盆底肌电位等基线指标差异无统计学意义(均P>0.05)。治疗后及随访截止时两组患者1 h漏尿量、I-QOL评分等指标均较治疗前好转,且干预组改善情况显著优于对照组(均P<0.05)。有效组患者年龄、BMI、阴道分娩次数、既往盆腔手术史患者比例及站立休息肛提肌裂孔面积显著低于无效组,仰卧位休息膀胱颈高度、站立休息膀胱颈高度显著高于无效组(均P<0.05)。多因素logistics回归示高龄(OR=1.243,P=0.000)、高BMI(OR=1.792,P=0.000)、多阴道分娩次数(OR=6.537,P=0.003)是物理治疗无效的独立危险因素,而高站立休息膀胱颈高度(OR=0.855,P=0.024)是物理治疗疗效独立保护因素;SUI患者疗效预测列线图示疗效预测评分模型预测SUI临床疗效的一致性指数为0.986(0.912~0.997),疗效预测发生率与实际发生率的平均绝对误差为0.013,二者一致性良好。结论基于年龄、BMI及膀胱颈高度等指标构建的疗效预测模型可有效预测患者临床疗效,有助于早期制定干预措施。

首次复治菌阳肺结核合并糖尿病患者血清IAP、25(OH)D水平及对疗效的预测价值

目的探讨首次复治菌阳肺结核(TB)合并糖尿病(DM)患者血清免疫抑制酸性蛋白(IAP)、25-羟基维生素D[25(OH)D]表达变化及2者对治疗疗效的预测价值。方法选取本院2019年1月至2022年4月首次复治菌阳TB合并DM患者48例为实验组,另选同期单纯TB患者48例为对照组。测定并比较两组患者治疗前后血清IAP、25(OH)D水平;多因素Logistic回归分析影响菌阳TB合并DM患者痰菌阴转的可能因素;受试者工作特征(ROC)曲线评估IAP、25(OH)D对患者痰菌未转阴的预测价值。结果实验组痰菌阴转患者31例(64.58%)显著低于对照组痰菌阴转患者40例(83.33%)。治疗2个月后,实验组、对照组血清IAP均显著降低,25(OH)D水平均显著升高(P<0.05);且治疗2个月后实验组血清IAP水平显著低于对照组,25(OH)D水平显著高于对照组(P<0.05)。多因素Logistic回归分析显示,IAP高水平是首次复治菌阳TB合并DM患者痰菌未阴转的危险因素(P<0.05),25(OH)D高水平是首次复治菌阳TB合并DM患者痰菌未阴转的保护因素(P<0.05)。ROC曲线显示,IAP预测痰菌未阴转的AUC为0.719,25(OH)D预测痰菌未阴转的AUC为0.791,2者联合预测痰菌未阴转的AUC为0.871,明显高于2者单独诊断(Z_(联合vs IAP)=2.605、P=0.009;Z_(联合vs 25(OH)D)=2.408、P=0.016),且灵敏度、特异性分别为78.46%、82.86%。结论首次复治菌阳TB合并DM患者经治疗后血清IAP水平降低、25(OH)D水平升高,2者联合对菌阳TB合并DM患者痰菌未阴转具有一定预测价值。

心电图碎裂QRS波联合血清SF、S100A4对急性心肌梗死诊断和预后的评估价值

目的探讨心电图碎裂QRS与血清SF、S100A4指标联合应用在急性心肌梗死(AMI)诊断及预后评估中的应用价值方法选取我院2020年12月—2022年12月期间收诊的87例AMI患者作为观察组,并根据是否发生心力衰竭分为单纯AMI组和心力衰竭组(AMI伴心衰组),并选取87例健康体检者作为对照组,比较两组研究对象的心电图指标特征,以及血清SF、S100A4水平,分析单项及联合应用模式下的诊断效能。结果对照组的QRS波时限明显短于观察组,且对照组的血清SF、S100A4均显著低于观察组(P<0.05);单纯AMI组的QRS波时限、血清SF及S100A4水平均显著低于心衰组(P<0.05);三项联合诊断AMI的AUC面积是0.908,灵敏度、特异度分别是97.72%、97.72%,均优于任一单项联合检测;三项联合模式下,评估AMI患者是否出现心衰的AUC面积是0.945,灵敏度、特异度分别是79.49%、95.83%。结论心电图碎裂QRS波时限联合血清SF、S100A4可有效判断AMI的发生及预后,其诊断效能优于单项评估模式,值得临床推广应用。