Radiomics signature as a new biomarker for preoperative prediction of neoadjuvant chemoradiotherapy response in locally advanced rectal cancer

PURPOSEWhether radiomics methods are useful in prediction of therapeutic response to neoadjuvant chemoradiotherapy (nCRT) is unclear. This study aimed to investigate multiple magnetic resonance imaging (MRI) sequence-based radiomics methods in evaluating therapeutic response to nCRT in patients with locally advanced rectal cancer (LARC).METHODSThis retrospective study enrolled patients with LARC (06/2014–08/2017) and divided them into nCRT-sensitive and nCRT-resistant groups according to postoperative tumor regression grading results. Radiomics features from preoperative MRI were extracted, followed by dimension reduction using the minimum redundancy maximum relevance filter. Three machine-learning classifiers and an ensemble classifier were used for therapeutic response prediction. Radiomics nomogram incorporating clinical parameters were constructed using logistic regression. The receiver operating characteristic (ROC), decision curves analysis (DCA) and calibration curves were also plotted to evaluate the prediction performance.RESULTSThe machine learning classifiers showed good prediction performance for therapeutic responses in LARC patients (n=189). The ROC curve showed satisfying performance (area under the curve [AUC], 0.830; specificity, 0.794; sensitivity, 0.815) in the validation group. The radiomics signature included 30 imaging features derived from axial T1-weighted imaging with contrast and sagittal T2-weighted imaging and exhibited good predictive power for nCRT. A radiomics nomogram integrating carcinoembryonic antigen levels and tumor diameter showed excellent performance with an AUC of 0.949 (95% confidence interval, 0.892–0.997; specificity, 0.909; sensitivity, 0.879) in the validation group. DCA confirmed the clinical usefulness of the nomogram model.CONCLUSIONThe radiomics method using multiple MRI sequences can be used to achieve individualized prediction of nCRT in patients with LARC before treatment.

Colorectal cancer is one of the most common malignancies. It ranks fourth for morbidity and third for mortality among malignant tumors, among which the proportion of rectal cancer with poor prognosis is over 60% (1, 2). Neoadjuvant therapy, combined with total mesorectal excision, has become a common strategy for rectal cancer (3). Response to neoadjuvant chemoradiotherapy (nCRT) is a marker of good prognosis in patients with locally advanced rectal cancer (LARC) (4). Tumor regression grading (TRG) is a reliable biomarker for evaluating the efficacy of nCRT (5, 6). TRG reflects the treatment effect of nCRT by evaluating fibrosis and the ratio of residual tumor cells (4). The accurate nCRT evaluation can only be achieved by postoperative histopathological TRG (3, 4), and there is still no technology that can noninvasively evaluate the therapeutic response.Magnetic resonance imaging (MRI) is commonly used in the diagnosis, preoperative staging, and therapeutic efficacy evaluation of rectal cancer. Prediction of the efficacy of nCRT by MRI has been rarely reported, partly due to the heterogeneity of the tumor combined with the prevalence of fibrosis and edema of lesions and surrounding tissue after nCRT. Over the recent years, a magnetic resonance TRG system was proposed for the evaluation of nCRT efficacy by using MRI and evaluating residual tumor and fibrosis. Nevertheless, the magnetic resonance TRG method has a low predictive value for pathological TRG and poor consistency, which hinders its clinical applications (7, 8).In recent years, radiomics has drawn increasing attention in oncology. Radiomics features selected from medical images have shown to be highly associated with the diagnosis and prognosis of cancers, and even with gene expression patterns (9). Studies highlighted the value of radiomics approaches in determining tumor status, preoperative staging, and efficacy evaluation (9, 10). Nevertheless, the application of the radiomics methods in evaluating therapeutic responses to nCRT is limited (11).Accordingly, the aim of the present study was to establish an nCRT prediction model based on multiple MRI sequences combined with tumor anatomy and biological characteristics so as to achieve a comprehensive preliminary prediction of nCRT efficacy for rectal cancer before treatment, to provide an essential basis for the rational formulation of clinical diagnosis and treatment decisions, and to avoid unnecessary exposure to radiotherapy and chemotherapy and the related risks such as toxicity and delayed definitive surgery.     

罗仁治疗儿童肾病综合征蛋白尿经验介绍＊

本文介绍了罗仁教授治疗儿童肾病综合征蛋白尿的学术思想及理法方药。肾病综合征蛋白尿属中医学的“水肿”“尿浊”“虚劳”“腰痛”范畴，发病主要与肺、脾、肾三脏功能失调有关。蛋白尿是肾病综合征的必要诊断条件，不仅可直接导致低蛋白血症，引发水肿，还会促进肾功能的恶化。罗仁教授认为尿蛋白源于血浆，是水谷精微，为至阴之精，应固藏于肾，并且有赖于肺之宣发、脾之升清、肝之疏泄的共同作用，创立了肾病1号方从肺、脾、肝、肾四方面减少尿蛋白，使患者更早进入缓解期，延缓疾病进展，调节免疫，防止复发，尤其对激素抵抗、激素依赖患者具有更重要的意义，并随证或随症加减，对于病情复杂的复合病或复合证患者可用单双日疗法调整阴阳，单日用肾病1号方减少蛋白尿，双日用小生六汤调和脏腑，还从心理、运动、饮食三方面指导患者积极面对疾病。     

青年学生性健康知信行的自我分类偏差对相关问题求助意愿的影响

目的 探讨青年学生性健康知信行自我分类偏差对相关问题求助意愿的影响，为精准实施青年学生性健康促进提供科学依据。方法 2019年3-4月性健康和HIV感染风险评估干预微信小程序（"熊探"）测试期间的青年学生使用者纳入为研究对象。根据研究对象性健康知信行的自我分类和系统分类结果差异划分为3组，包括分类一致组、自我分类偏低组（自评比实际性资讯获取更少、性态度更传统、性经历更少）和自我分类偏高组（自评比实际性资讯获取更多、性态度更开放、性经历更多）。采用logistic回归分析3组研究对象的性健康相关问题求助意愿差异。结果 2 009名研究对象的年龄（19.2±1.1）岁，女性占54.7%（1 099/2 009），大专及以上者占98.4%（1 976/2 009）。性健康知信行自我分类一致、偏低和偏高者分别占49.0%（984/2 009）、10.9%（219/2 009）和40.1%（806/2 009）。与分类一致者相比，自我分类偏低青年学生的HIV自愿咨询检测服务接受意愿更低（aOR=0.65，95%CI：0.43~0.99），自我分类偏高青年学生的性相关疾病求助意愿更低（aOR=0.76，95%CI：0.59~0.98）。结论 性健康知信行自我分类偏差会降低青年学生对相关问题的求助意愿，尤其自我分类偏低会使青年学生低估HIV感染风险，接受咨询检测意愿下降，引起青年学生艾滋病疫情加速扩散。在性健康教育中需加强引导，提高青年学生群体自我评估能力、客观感知和应对风险。     

Clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis: A protocol for systematic review and meta-analysis

Background:Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis is the most common cause of dental pain and arise from an inflamed or necrotic dental pulp. There is growing evidence to support the effectiveness of probiotics in combination with antibiotics on periodontitis. We therefor will conduct this study to evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis.Methods:We will systematically search the following databases: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), and WanFang database. A grey literature search will be conducted using ZETOC Conference Proceedings and Open Grey. Only randomized controlled trials (RCTs) related to research on probiotics in combination with antibiotics to treatment patients with periodontitis will be included. All sources have to be searched from their inception to October 2020. Two authors will independently select studies, extract study data, and evaluate the quality of the included studies. We will use Review Manager Software (RevMan 5.3) to analyze data.Results:This study will systematically evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis.Conclusions:This study will generate evidence for a better clinical decision of patients with periodontitis.Registration number:DOI 10.17605/OSF.IO/QZ6SB (https://osf.io/qz6sb/).     

Significance of pepsinogen in screening for gastric intestinal metaplasia in Guangdong,China

ObjectiveDiagnosis of gastric intestinal metaplasia (GIM) relies on gastroscopy and histopathologic biopsy, but their application in screening for GIM is limited. We aimed to identify serological biomarkers of GIM via screening in Guangdong, China.MethodsCross-sectional field and questionnaire data, demographic information, past medical history, and other relevant data were collected. Blood samples were collected for pepsinogen (PG)I, PGII, gastrin-17, and Helicobacter pylori antibody testing, and gastroscopy and histopathologic biopsy were performed. Single factor and logistic regression analyses were used to evaluate the correlation between these indicators and GIM, and decision tree models were used to determine the cut-off points between indicators.ResultsOf 443 participants enrolled, 87 (19.6%) were diagnosed with GIM. Single factor analysis showed that pepsin indicators (PGI, PGII, and PGI/PGII ratio) and the factors Mandarin as native language, urban residency, hyperlipidemia, and age were associated with GIM. Logistic regression analysis showed that PGI and age were associated with GIM.ConclusionsAge is an important factor for predicting GIM progression; age >60 years increased its risk. Detection of GIM was higher in individuals with PGI levels >127.20 ng/mL, which could be used as a threshold indicating the need to perform gastroscopy and histopathologic biopsy.     

eCASH理念结合早期活动在ICU机械通气患者的应用研究

目的探讨eCASH理念结合早期活动在ICU机械通气患者中的应用效果。方法将96例ICU机械通气患者按入院时间分为对照组和观察组各48例,对照组给予常规镇痛镇静及护理,观察组实施基于eCASH理念的舒适化浅镇静管理结合早期活动。结果观察组谵妄发生率和ICU获得性衰弱发生率显著低于对照组,MRC肌力评分显著高于对照组,机械通气时间和ICU住院天数显著短于对照组(P0.05,P0.01)。结论 eCASH理念结合早期活动应用于ICU机械通气患者,可降低患者谵妄和ICU获得性衰弱,缩短机械通气和ICU入住时间,促进患者康复。     

中美护理硕士研究生教育质量评价的研究进展

护理硕士研究生教育质量评价是护理高等教育质量保障机制的重要环节,是督导和提升护理高等质量的关键。归纳分析中美两国护理硕士研究生教育质量评价现状,包括评价机构、评价标准、评价指标体系以及评价结果的应用等内容,旨在为我国护理硕士研究生教育质量评价体系的构建提供参考。     

呼吸专科护士慢性呼吸疾病管理现状调查

目的调查呼吸专科护士慢性呼吸疾病管理现状,为提高慢性呼吸疾病的管理水平提供参考。方法依据《中国成人慢性呼吸疾病患者护理管理指南》设计调查问卷,对重庆、四川、贵州、陕西、河北、湖北、海南7省市的205名呼吸专科护士进行问卷调查。结果呼吸专科护士慢性呼吸疾病管理总分为(140.72±23.90)分。慢性呼吸疾病管理得分最低的3个条目有评估工具应用、个性化管理计划的实施、慢阻肺随访的次数及指导哮喘患者使用峰流速仪;呼吸专科护士所在单位慢性呼吸疾病管理平台建设均低于50%。结论呼吸专科护士慢性呼吸疾病管理处于中等偏下水平,评估是慢性呼吸疾病管理的薄弱点。需加强呼吸专科护士专业能力培养,规范慢性呼吸疾病全程管理,强化医院平台建设等,提高慢性呼吸疾病的管理水平。