高同型半胱氨酸与急性心肌梗死及短期心脏血管不良事件发生的相关性

目的 探讨高同型半胱氨酸(H-Hcy)与急性心肌梗死及短期MACE(心脏血管不良事件)发生的相关性.方法 回顾性研究2013年1月至2019年6月在合肥市第三人民医院心内科住院急性心肌梗死124例,根据Hcy水平分为H-Hcy组(>15umoI/L,n=59例)和Hcy组(≤15umoI/L,n=65例),分析两组病人...     

Bounding box-based 3D AI model for user-guided volumetric segmentation of pancreatic ductal adenocarcinoma on standard-of-care CTs

ObjectivesTo develop a bounding-box-based 3D convolutional neural network (CNN) for user-guided volumetric pancreas ductal adenocarcinoma (PDA) segmentation.MethodsReference segmentations were obtained on CTs (2006–2020) of treatment-naïve PDA. Images were algorithmically cropped using a tumor-centered bounding box for training a 3D nnUNet-based-CNN. Three radiologists independently segmented tumors on test subset, which were combined with reference segmentations using STAPLE to derive composite segmentations. Generalizability was evaluated on Cancer Imaging Archive (TCIA) (n = 41) and Medical Segmentation Decathlon (MSD) (n = 152) datasets.ResultsTotal 1151 patients [667 males; age:65.3 ± 10.2 years; T1:34, T2:477, T3:237, T4:403; mean (range) tumor diameter:4.34 (1.1–12.6)-cm] were randomly divided between training/validation (n = 921) and test subsets (n = 230; 75% from other institutions). Model had a high DSC (mean ± SD) against reference segmentations (0.84 ± 0.06), which was comparable to its DSC against composite segmentations (0.84 ± 0.11, p = 0.52). Model-predicted versus reference tumor volumes were comparable (mean ± SD) (29.1 ± 42.2-cc versus 27.1 ± 32.9-cc, p = 0.69, CCC = 0.93). Inter-reader variability was high (mean DSC 0.69 ± 0.16), especially for smaller and isodense tumors. Conversely, model's high performance was comparable between tumor stages, volumes and densities (p > 0.05). Model was resilient to different tumor locations, status of pancreatic/biliary ducts, pancreatic atrophy, CT vendors and slice thicknesses, as well as to the epicenter and dimensions of the bounding-box (p > 0.05). Performance was generalizable on MSD (DSC:0.82 ± 0.06) and TCIA datasets (DSC:0.84 ± 0.08).ConclusionA computationally efficient bounding box-based AI model developed on a large and diverse dataset shows high accuracy, generalizability, and robustness to clinically encountered variations for user-guided volumetric PDA segmentation including for small and isodense tumors.Clinical relevanceAI-driven bounding box-based user-guided PDA segmentation offers a discovery tool for image-based multi-omics models for applications such as risk-stratification, treatment response assessment, and prognostication, which are urgently needed to customize treatment strategies to the unique biological profile of each patient's tumor.     

基于弥散张量成像技术探讨针刺对脑梗死后吞咽障碍患者神经重塑的研究（英文）

目的:观察针刺对脑梗死后吞咽障碍患者的临床疗效,并应用弥散张量成像技术观察针刺对其的神经重塑。方法:将120例脑梗死后吞咽障碍患者随机分为针刺组及假针刺组,每组60例,2组均接受神经内科常规治疗及吞咽康复训练,针刺组患者采取针刺治疗,穴取四神聪、百会、太阳、风池、舌三针,每次留针30 min,每天治疗1次,每周5次,3周为一疗程,共治疗2个疗程。假针刺组用钝头针放入针套内,用粘性物质将针头固定于皮肤上,实施针刺时使钝头针尖部分刚接触皮肤,不刺入皮肤。钝头针尖分别放置于四神聪、百会、太阳、风池、舌三针上。疗程同针刺组。对所有患者治疗前、后行洼田饮水试验评价临床疗效,使用头颅弥散张量成像技术(DTI)检测神经重塑。结果:临床疗效方面:治疗后,通过饮水功能评定,针刺组吞咽功能正常的为38例高于假针刺组的15例(P<0.05)。神经重塑方面:(1)表观弥散系数(ADC)。治疗前针刺组和假针刺组ADC值分别为(1.76±0.45)mm/s、(1.68±0.51)mm/s;治疗后两组ADC值分别为(0.66±0.15) mm/s、(0.74±0.11) mm/s,治疗后组间比较差异无统计学意...     

运用蛋白质组学技术探讨针刀抗KOA兔软骨细胞凋亡的作用机制（英文）

目的:通过蛋白组学检测筛选与凋亡相关差异表达蛋白,进行分析及验证,阐述针刀抗膝骨关节炎(KOA)兔软骨细胞凋亡的作用机制。方法:30只新西兰大白兔被随机分为正常组,模型组和针刀组,每组10只。模型组与针刀组参照经典Videman法行KOA造模。针刀组:取兔左膝关节髌韧带和内、外侧副韧带中点,作为针刀进针治疗点,每周1次,连续3周。然后对各组兔膝关节软骨蛋白定量,并通过蛋白质组学筛选出差异表达蛋白,再进一步筛选出与凋亡相关差异表达蛋白。将正常组、模型组和针刀组中与凋亡相关差异表达蛋白取交集,获得3组共有与凋亡相关差异表达蛋白,并对其进行聚类分析。使用HE染色检测软骨细胞的病理变化,运用电子显微镜观察软骨细胞凋亡。运用实时定量PCR (rt-PCR)和蛋白质印迹(WB)检测3组共有与凋亡相关差异表达蛋白的mRNA及蛋白质表达。结果:蛋白印迹和rt-PCR结果提示,与模型组相比,针刀组干预后的TXN、CAP1、FABP3的蛋白和mRNA表达较低,差异有统计学意义(all P<0.05);与模型组相比,针刀组干预后的LTF、SCIN、IL-10的蛋白和mRNA表达较高,差异有统计学意义(...     

Camrelizumab Plus Carboplatin and Pemetrexed as First-Line Treatment for Advanced Nonsquamous NSCLC: Extended Follow-Up of CameL Phase 3 Trial

IntroductionIn CameL phase 3 study (ClinicalTrials.gov: NCT03134872), addition of camrelizumab to first-line chemotherapy significantly improved the progression-free survival in patients with stages IIIB to IV nonsquamous NSCLC. Here, we present outcomes after a minimum follow-up of 43.9 months since last patient randomization.MethodsEligible patients were randomized 1:1 to 4 to 6 cycles of camrelizumab plus carboplatin and pemetrexed or chemotherapy alone every 3 weeks, followed by maintenance camrelizumab plus pemetrexed or pemetrexed only (n = 205 and 207, respectively). Total camrelizumab exposure was up to 2 years.ResultsAs of January 31, 2022, camrelizumab plus chemotherapy exhibited substantially improved overall survival over chemotherapy alone (median, 27.1 versus 19.8 mo; hazard ratio = 0.72 [95% confidence interval: 0.57–0.92]). In the chemotherapy-alone group, 95 patients (45.9%) crossed over to camrelizumab monotherapy. After adjustment for crossover, the survival benefit with camrelizumab plus chemotherapy was more pronounced (adjusted hazard ratio = 0.55 [95% confidence interval: 0.42–0.71]). In camrelizumab plus chemotherapy group, 33 patients completed 2 years of camrelizumab. Objective response rate was 97.0%, with ongoing responses in 17 of the 32 responses (53.1%), and 93.9% (31 of 33) of the patients were alive at data cutoff. Safety profiles were consistent with the previous report, and no obvious evidence of cumulative toxicity was found with long exposure to camrelizumab.ConclusionsCamrelizumab plus carboplatin and pemetrexed provides long-term survival benefit over chemotherapy, with manageable toxicity and remarkable and durable response in patients receiving 2 years of camrelizumab, further supporting camrelizumab combination as first-line treatment for advanced nonsquamous NSCLC.