Deep learning with biopsy whole slide images for pretreatment prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer：A multicenter study

IntroductionPredicting pathological complete response (pCR) for patients receiving neoadjuvant chemotherapy (NAC) is crucial in establishing individualized treatment. Whole-slide images (WSIs) of tumor tissues reflect the histopathologic information of the tumor, which is important for therapeutic response effectiveness. In this study, we aimed to investigate whether predictive information for pCR could be detected from WSIs.Materials and methodsWe retrospectively collected data from four cohorts of 874 patients diagnosed with biopsy-proven breast cancer. A deep learning pathological model (DLPM) was constructed to predict pCR using biopsy WSIs in the primary cohort, and it was then validated in three external cohorts. The DLPM could generate a deep learning pathological score (DLPs) for each patient; stromal tumor-infiltrating lymphocytes (TILs) were selected for comparison with DLPs.ResultsThe WSI feature-based DLPM showed good predictive performance with the highest area under the curve (AUC) of 0.72 among the cohorts. Alternatively, the combination of the DLPM and clinical characteristics offered a better prediction performance (AUC >0.70) in all cohorts. We also evaluated the performance of DLPM in three different breast subtypes with the best prediction for the triple-negative breast cancer (TNBC) subtype (AUC: 0.73). Moreover, DLPM combined with clinical characteristics and stromal TILs achieved the highest AUC in the primary cohort (AUC: 0.82) and validation cohort 1 (AUC: 0.80).ConclusionOur study suggested that WSIs integrated with deep learning could potentially predict pCR to NAC in breast cancer. The predictive performance will be improved by combining clinical characteristics. DLPs from DLPM can provide more information compared to stromal TILs for pCR prediction.     

2016—2021年灌云县手足口病流行病学特征分析

目的 分析灌云县2016—2021年手足口病流行特征,为手足口病的防控提供参考依据。方法 采用描述性统计方法,分析灌云县手足口病的流行特征以及病原学变化等。结果 2016 —2021年灌云县手足口病 4 205例,呈现出“隔年高发”特征,年平均发病率为67.50/10万;4 —6月和10 —12月为高发期;男性占比明显高于女性;0～4岁散居儿童居多;伊山镇、侍庄街道和东王集镇发病率位居前三。2016 —2017年确诊患儿病原以EV71为主,2018—2021年以Cox A6为主。8例重症病例集中在1～5岁,确诊的重症患者以EV71感染为主。结论 灌云县手足口病疫情具有“隔年高发”和季节性“双峰流行”特征,以0～4岁散居儿童为高发人群和灌云县县城及周边镇(街)为高发区域。EV71灭活疫苗接种能有效预防EV71病毒引发的手足口病。     

Locally advanced cervical carcinoma patients treated with chemoradiation followed by radical surgery: clinical response and oncological outcomes according to histotype after propensity score analysis

IntroductionThe aims of this study were to analyze the pathological response, and survival outcomes of adenocarcinoma/adenosquamous (AC/ASC) versus squamous cell carcinoma (SCC) in patients with locally advanced cervical cancer (LACC) managed by chemoradiotherapy followed by radical surgery.MethodsRetrospective, multicenter, observational study, including patients with SCC and AC/ACS LACC patients treated with preoperative CT/RT followed by tailored radical surgery (RS) between 06/2002 and 05/2017. Clinical-pathological characteristics were compared between patients with SCC versus AC/ASC. A 1:3 ratio propensity score (PS) matching was applied to remove the variables imbalance between the two groups.ResultsAfter PS, 320 patients were included, of which 240 (75.0%) in the SCC group, and 80 (25.0%) in the AC/ASC group. Clinico-pathological and surgical baseline characteristics were balanced between the two study groups. Percentage of pathologic complete response was 47.5% in SCC patients versus 22.4% of AC/ASC ones (p < 0.001). With a median follow-up of 51 months (range:1–199), there were 54/240 (22.5%) recurrences in SCC versus 28/80 (35.0%) in AC/ASC patients (p = 0.027). AC/ASC patients experienced worse disease free (DFS), and overall survival (OS) compared to SCC patients (p = 0.019, and p = 0.048, respectively). In multivariate analysis, AC/ACS histotype, and FIGO stage were associated with worse DFS and OS.ConclusionIn LACC patients treated with CT/RT followed by RS, AC/ASC histology was associated with lower pathological complete response to CT/RT, and higher risk of recurrence and death compared with SCC patients. This highlights the need for specific therapeutic strategies based on molecular characterization to identify targets and develop novel treatments.     

The impact of circumferential tumour location on the clinical outcome of rectal cancer patients managed with neoadjuvant chemoradiotherapy followed by total mesorectal excision

AimTo investigate the impact of circumferential tumour location on neoadjuvant chemoradiotherapy (CRT) response and its prognostic value for locally advanced rectal cancer (LARC) patients after CRT and surgery.MethodsA retrospective study was performed on 486 patients with LARC who received neoadjuvant CRT and surgical treatment. The rate of pathological complete response (pCR) and survival among patients with anteriorly, laterally, and posteriorly located tumours were compared. Logistic regression was performed to identify pCR predictors.ResultsThe anterior tumours exhibited the highest pCR rate of 26.7%, which was slightly higher than the 20.0% and 12.3% for lateral and posterior tumours, respectively (P = 0.006). The 5-year Overall survival (OS) rates after CRT were similar among the anterior, lateral, and posterior groups (anterior vs lateral vs posterior: 81.1% vs 89.9% vs 84.1%, P = 0.6368). Multivariate analysis revealed that the circumferential tumour location, post-CRT serum CEA and post-CRT tumour thickness measured by MRI were independently correlated with achieving pCR.ConclusionThis study is the first, to the best of our knowledge, to show that anterior LARC exhibited the highest pCR rate after neoadjuvant CRT. Patients with anterior rectal cancers do not have different prognoses from those with non-anterior cancers if they undergo neoadjuvant CRT.     

Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy.     

增强CT评价肝细胞癌凋亡相关蛋白表达的价值探讨

目的:探讨增强CT评价肝细胞癌(hepatocellular carcinoma,HCC)组织中凋亡相关蛋白fas,bax,bc1-2表达的价值。方法:对38例共40个经病理证实且行动、静脉双期CT增强扫描的HCC病灶进行分析,用免疫组化SP法检测癌组织中第Ⅷ因子相关抗原(FactorⅧrelated antigen,FⅧRA),fas,bax,bc1-2和bc1-x1的表达情况,并结合其病理分级将CT增强表现特征与免疫组化的结果进行对照分析。结果:fas,bax,bc1-2和bc1-x1的阳性表达率分别为20%(8/40)、25%(10/40)、27.5%(11/40)和50%(20/40),bax和bc1-2,以及bc1-2和bc1-x1之间分别具有一定的相关性(P<0.05)。bc1-x1的表达与CT显示的病灶大小、以及病理分级具有一定的关系(P<0.05),病理分级与CT显示的边界类型以及瘤内的液化坏死有关(P<0.05)。结论:fas,bax,bc1-2和bc1-x1等蛋白在HCC组织中呈现不同程度的表达,通过CT反映调亡相关蛋白表达的价值有限。     

缺血再灌注脑组织病理形态及脂质过氧化的动态观察

目的:探讨缺血再灌注脑组织病理形态及丙二醛含量变化的关系.方法:阻断双侧颈总动脉和椎动脉结合低血压法复制兔脑完全性缺血再灌注模型,观察心脉龙对脑组织病理形态变化及脂质过氧化的影响.结果:心脉龙能抑制膜脂质过氧化作用,且缺血再灌注脑组织丙二醛含量变化与其病理形态改变具有一致性.结论:动态观察血液丙二醛,可作为评价脑缺血性疾病治疗和预后的检测指标.     

原发性中枢神经系统恶性淋巴瘤27例临床病理分析

目的 :分析和探讨原发性中枢神经系统恶性淋巴瘤 (PCNSML)的临床与病理学特点。　方法 :总结经手术证实的 2 7例PCNSML患者的临床资料 ,并进行病理学及免疫组化研究 ;　结果 :患者以中年男性为多 ,临床表现无特异性 ,术前误诊率高。病理学显示 2 6例为B细胞淋巴瘤 ,绝大多数属弥漫性大B细胞淋巴瘤 ;1例为T细胞淋巴瘤。 81.3%B细胞淋巴瘤bcl 2呈阳性表达。术后行放、化疗者生存期优于单纯手术者。　结论 :PCNSML临床早期诊断困难 ,治疗方案应采取以手术加放化疗的综合治疗措施     

深插胃镜诊断十二指肠乳头以下病变的临床价值

目的 探讨深插胃镜对十二指肠乳头以下病变的诊断价值。方法 回顾性分析行胃镜检查[深插至十二指肠空肠曲(屈氏韧带附近)]的320例患者的临床资料、操作方法及检查结果。结果 320例患者中，深插至十二指肠升部成功率为93．12％，其中最多可以观察到十二指肠空肠以下8～10cm，所用时间约3～15min，发现十二指肠降部及以下病变85例。结论 深插胃镜对十二指肠乳头以下部位病变具有较好的诊断及治疗价值。     

睾丸旁促结缔组织增生性小圆细胞肿瘤1例报告及文献复习

目的:探讨睾丸旁促结缔组织增生性小圆细胞肿瘤的临床、病理特征、诊断及治疗。方法:回顾分析1例睾丸旁促结缔组织增生性小圆细胞肿瘤的诊治及随访资料,并复习相关文献。患者,男,27岁,因阴囊内无痛性肿块4个月就诊。体检于左侧阴囊内可扪及囊性肿块,同侧睾丸不能扪及。行左侧睾丸根治性切除术,术后辅以化疗。结果:术中见左侧睾丸旁多发结节状隆起肿块,质偏硬;术后病理检查肿瘤细胞呈巢状或梁索状结构并埋没在增生的纤维结缔组织中;免疫组化显示瘤细胞具有上皮源性、间质性和神经源性等多向分化的特点。术后已随访3年无瘤生存,预后良好。结论:促结缔组织增生性小圆细胞肿瘤有特异的临床病理特征,好发于年轻男性,手术切除肿瘤联合化疗是治疗的主要方法,睾丸旁促结缔组织增生性小圆细胞肿瘤比腹腔型预后相对好。