Clinical applications of radiomics in non-small cell lung cancer patients with immune checkpoint inhibitor-related pneumonitis.

Immune checkpoint inhibitors (ICIs) modulate the body's immune function to treat tumors but may also induce pneumonitis. Immune checkpoint inhibitor-related pneumonitis (ICIP) is a serious immune-related adverse event (irAE). Immunotherapy is currently approved as a first-line treatment for non-small cell lung cancer (NSCLC), and the incidence of ICIP in NSCLC patients can be as high as 5%-19% in clinical practice. ICIP can be severe enough to lead to the death of NSCLC patients, but there is a lack of a gold standard for the diagnosis of ICIP. Radiomics is a method that uses computational techniques to analyze medical images (e.g., CT, MRI, PET) and extract important features from them, which can be used to solve classification and regression problems in the clinic. Radiomics has been applied to predict and identify ICIP in NSCLC patients in the hope of transforming clinical qualitative problems into quantitative ones, thus improving the diagnosis and treatment of ICIP. In this review, we summarize the pathogenesis of ICIP and the process of radiomics feature extraction, review the clinical application of radiomics in ICIP of NSCLC patients, and discuss its future application prospects.

Similarities and differences in iron homeostasis strategies between graminaceous and nongraminaceous plants.

Iron (Fe) homeostasis is essential for both plant development and human nutrition. The maintenance of Fe homeostasis involves a complex network in which Fe signaling nodes and circuits coordinate tightly Fe transporters, ferric reductases, H+ -ATPases, low-molecular-mass metal chelators, and transporters of chelators and Fe-chelate complexes. Early-stage studies have revealed different strategies for Fe homeostasis between graminaceous and nongraminaceous plants. Recent progress has refreshed our understanding of previous knowledge, especially on the uptake, phloem transport and systemic signaling of Fe. This review attempts to summarize recent exciting and potentially influential studies on the various routes of Fe uptake and distribution in plants, focusing on breakthroughs that have changed our understanding of plant Fe nutrition.

Efficacy and safety of AnluoHuaxian pills on chronic hepatitis B with normal or minimally elevated alanine transaminase and early liver fibrosis: A randomized controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: The AnluoHuaxian pill (AHP) is a widely used patented medicine for chronic hepatitis B (CHB) patients with advanced fibrosis or cirrhosis that has been used in China for more than 15 years. However, data are lacking on whether monotherapy with AHP can be effective in CHB patients with alanine aminotransferase (ALT) levels less than 2 times the upper limit of normal (ALT<2ULN) and early liver fibrosis (F ≤ 2). AIM OF THE STUDY: We aimed to investigate whether monotherapy with AHP improves liver histology in these patients. MATERIALS AND METHODS: In this double-blind, randomized, placebo-controlled trial, 270 CHB patients with ALT<2ULN and F ≤ 2 were treated in 12 hospitals in China. The patients were randomly assigned to an intervention (AHP) group and a placebo group at a ratio of 2:1. Of these 270 enrolled patients, 147 had paired liver biopsies. The primary end point was histological change after 48 weeks of treatment. RESULTS: Per-protocol analysis revealed that the rate of histologic improvement in liver fibrosis patients in the AHP group was significantly higher than that in the placebo group (37.7% vs. 19.5%, P = 0.035) after 48 weeks of treatment, which was consistent with results from intention-to-treat and sensitivity analyses. Moreover, after adjusting for baseline characteristics, AHP was superior to placebo with respect to improving liver fibrosis (odds ratio [OR] = 2.58, 95% confidence interval [CI]: (1.01, 6.63),P = 0.049) and liver histology (OR = 3.62, 95% CI: (1.42, 9.20),P = 0.007). In noninvasive measurement of liver fibrosis (FibroScan®), the level of liver stiffness measurement (LSM) had decreased significantly at 48 weeks (5.1 kPa) compared with that at baseline (5.7 kPa) (P = 0.008) in the AHP group, whereas it did not decrease significantly in the placebo group. Cirrhosis developed in one patient in the placebo group but in no patients in the AHP group. No serious side effects occurred in the AHP-treated patients. CONCLUSIONS: Treatment of CHB patients who had ALT<2ULN and F ≤ 2 with the traditional Chinese medicine AHP for 48 weeks improves liver fibrosis. However, due to the short duration of treatment and the limited sample size of liver pathology, the long-term benefits of AHP in reducing fibrosis and the risk of cirrhosis and hepatocellular carcinoma in these patients need to be further studied in the future.

NPF transporters in synaptic-like vesicles control delivery of iron and copper to seeds.

Accumulation of iron in seeds is essential for both plant reproduction and human nutrition. Transport of iron to seeds requires the chelator nicotianamine (NA) to prevent its precipitation in the plant vascular tissues. However, how NA is transported to the apoplast for forming metal-NA complexes remains unknown. Here, we report that two members of the nitrate/peptide transporter family, NAET1 and NAET2, function as NA transporters required for translocation of both iron and copper to seeds. We show that NAET1 and NAET2 are predominantly expressed in the shoot and root vascular tissues and mediate secretion of NA out of the cells in resembling the release of neurotransmitters from animal synaptic vesicles. These findings reveal an unusual mechanism of transmembrane transport in plants and uncover a fundamental aspect of plant nutrition that has implications for improving food nutrition and human health.

Repeated Endomorphin Analogue MEL-0614 Reduces Tolerance and Improves Chronic Postoperative Pain without Modulating the P2X7R Signaling Pathway.

The clinical treatment of chronic postoperative pain (CPSP) remains challenging. The side effects of chronic morphine treatment limit its clinical application. MEL-0614, a novel endomorphin analogue that is highly selective and agonistic for µ opioid receptor (MOR), produces a more powerful analgesic effect than that of morphine. In this study, we explored the difference in antinociceptive tolerance and related mechanisms between MEL-0614 and morphine in CPSP induced in a skin/muscle incision and retraction (SMIR) mice model. We found that acute administration of MEL-0614 (1, 3, 5, and 10 nmol, i.t.) produced a dose-dependent analgesic effect that was superior to that of morphine in the SMIR mice model. Long-term MEL-0614 treatment (10 nmol, i.t.) did not induce tolerance compared with morphine. Notably, tolerance induced by morphine could be greatly prevented and/or inhibited via cross-administration or coadministration between MEL-0614 and morphine. In addition, MEL-0614 accelerated the recovery of postoperative pain, whereas morphine aggravated postoperative pain and prolonged its recovery time regardless of preoperative or postoperative treatment. In addition, MEL-0614 did not activate microglia and the P2X7R signaling pathway and showed reduced expression iba1 and P2X7R compared with that observed after morphine administration. Release of inflammatory factors was induced by continued administration of morphine during SMIR surgery, but MEL-0614 did not promote the activation of inflammatory factors. Our results showed that MEL-0614 has superior analgesic effects in CPSP and leads to tolerance to a lesser degree than morphine. Further, MEL-0614 may be used as a promising treatment option for the long-term treatment in CPSP.

Differences in MicroRNA Expression in Chronic Hepatitis B Patients with Early Liver Fibrosis Based on Traditional Chinese Medicine Syndromes.

The aim of this study was to determine if microRNA (miRNA) expression is different among chronic hepatitis B (CHB) patients with early liver fibrosis classified according to traditional Chinese medicine (TCM) syndromes. Eighteen CHB-fibrosis patients and 12 CHB patients without fibrosis were enrolled. The CHB-fibrosis group included 9 patients with the TCM syndrome of Ganyu Pixu Xueyu (GYPXXY), characterized by liver stagnation, spleen deficiency, and blood stasis, and 9 patients with the TCM syndrome of Qixu Xueyu (QXXY), characterized by deficiency of qi, blood, and blood stasis. Agilent miRNA microarray was performed first in liver specimens to determine whether miRNA expression is different in patients with these two TCM syndromes of CHB-fibrosis. Gene Ontology (GO) analysis and KEGG analysis were applied to determine the roles of the differentially expressed miRNAs. QRT-PCR was performed to validate the Agilent miRNA microarray results. Compared with GYPXXY patients, 6 differentially expressed miRNAs were upregulated (miR-144-5p, miR-18a-5p, miR-148b-3p, miR-654-3p, miR-139-3p, and miR-24-1-5p) and 1 was downregulated (miR-6834-3p) in QXXY patients. According to qRT-PCR data, miR-144-5p and miR-654-3p were confirmed as upregulated in CHB-liver fibrosis patients compared to CHB patients without fibrosis, whereas the other 4 miRNAs were not significantly different. More importantly, miR-654-3p was confirmed to be significantly upregulated in QXXY patients compared with values in GYPXXY patients, whereas no significant difference was found in miR-144-5p. Moreover, the pathways of central carbon metabolism in cancer and cell cycle related to miR-654-3p and the target genes of PTEN and ATM were found to be different between QXXY patients and GYPXXY patients. These results indicate that there are different miRNAs, pathways, and target genes between QXXY patients and GYPXXY patients. However, due to the limited sample, whether miR-654-3p and the target genes PTEN and ATM could be molecular markers to differentiate TCM syndromes could not be established.

Investigation of shutter scan acquisition parameters in a prototype chest digital tomosynthesis system.

A shutter scan acquisition (SSA) method is proposed to reduce patient exposure dose in a chest digital tomosynthesis system. Projections obtained using the SSA constitute a combination of truncated and non-truncated projections. The truncated projections are images in which the lung field is set within a region-of-interest (ROI), and the non-truncated projections are full images in which the ROI is not set at all. We proposed a shutter weighting factor (SWF) as an acquisition parameter for SSA. We call the number of truncated projections divided by the number of non-truncated projections as SWF. We used a prototype CDT system and the LUNGMAN phantom with 8 and 10 mm lung nodules. 81 projections were obtained using SSA in five sets according to the SWFs. The image quality was quantified based on the contrast-to-noise ratio (CNR). We also calculated the figure of merit (FOM) to determine the proper acquisition parameters of the five sets. Both the CNR and FOM values of the 8 mm lung nodule in the selected ROI increased with increases of the SWF. However, the CNR value of the 10 mm lung nodule outside the ROI decreased with increases of the SWF, while the FOM value was maximized when the SWF was 3.05. We investigated the effect of the composition ratio of the truncated and non-truncated projections on the reconstructed images of the SSA based on the FOM values. In conclusion, we determined the proper SSA parameters in a prototype CDT system.

Feasibility study of shutter scan acquisition for region of interest (ROI) digital tomosynthesis.

Dose reduction techniques have been studied in medical imaging. We propose shutter scan acquisition for region of interest (ROI) imaging to reduce the patient exposure dose received from a digital tomosynthesis system. A prototype chest digital tomosynthesis (CDT) system (LISTEM, Wonju, Korea) and the LUNGMAN phantom (Kyoto Kagaku, Japan) with lung nodules 8, 10, and 12 mm in size were used for this study. A total of 41 projections with shutter scan acquisition consisted of 21 truncated projections and 20 non-truncated projections. For comparison, 41 projections using conventional full view scan acquisition were also acquired. Truncated projections obtained by shutter scan acquisition were corrected by proposed image processing procedure to remove the truncation artifacts. The image quality was evaluated using the contrast to noise ratio (CNR), coefficient of variation (COV), and figure of merit (FOM). We measured the dose area product (DAP) value to verify the dose reduction using shutter scan acquisition. The ROI of the reconstructed image from shutter scan acquisition showed enhanced contrast. The results showed that CNR values of 8 and 12 mm lung nodules increased by 6.38% and 21.21%, respectively, and the CNR value of 10 mm lung nodule decreased by 3.63%. COV values of the lung nodules were lower in a shutter scan image than in a full view scan image. FOM values of 8, 10, and 12 mm lung nodules increased by 3.06, 2.25, and 2.33 times, respectively. This study compared the proposed shutter scan and conventional full view scan acquisition. In conclusion, using a shutter scan acquisition method resulted in enhanced contrast images within the ROI and higher FOM values. The patient exposure dose of the proposed shutter scan acquisition method can be reduced by limiting the field of view (FOV) to focus on the ROI.

Glucose-regulated protein 78 and heparanase expression in oral squamous cell carcinoma: correlations and prognostic significance.

BACKGROUND: The aim of the present study was to investigate the expression of glucose-related protein 78 (GRP78) and heparanase (HPA) in oral squamous cell carcinoma (OSCC) and their relationship with clinicopathological parameters and potential implications for survival. METHODS: A total of 46 patients with OSCC and 10 normal individuals were recruited for the study. GRP78 and HPA expression were determined in the lesion tissues using immunohistochemical analysis. The correlation between GRP78 and HPA was assessed using the Spearman correlation analysis. The associations of GRP78 and HPA with clinicopathological characteristics and survival were examined using the x2-test, Kaplan-Meier, or Cox regression. RESULTS: Patients with OSCC showed a statistically significant higher prevalence of GRP78 and HPA expression than normal oral tissues. GRP78 and HPA expression was positively correlated with size, TNM stage, histological grade, lymphatic metastasis, and distant metastasis in OSCC patients. GRP78 expression was also positively correlated with HPA expression. Positive GRP78 and HPA expression was inversely correlated with survival in OSCC patients. CONCLUSIONS: HPA expression was found to be positively correlated with GRP78 expression. GRP78 and HPA are biomarkers that may have the potential to guide the treatment of oral cancer patients.

Epithelial-mesenchymal transition is necessary for acquired resistance to cisplatin and increases the metastatic potential of nasopharyngeal carcinoma cells.

Radiotherapy and adjuvant cisplatin (DDP) chemotherapy are standard approaches used in the treatment of nasopharyngeal carcinoma (NPC). However, resistance to chemotherapy has recently become more common, resulting in the failure of this combination therapy for NPC. The aim of the present study was to assess the cellular morphology, motility and molecular changes in DDP-resistant NPC cells in relation to epithelial-mesenchymal transition (EMT). CNE2 cells were continuously exposed to increasing doses of DDP to establish a stable cell line resistant to DDP (CNE2/DDP cells). The human NPC cell lines, HNE1, CNE2, HNE1/DDP and CNE2/DDP, were used to examine the association between chemoresistance and the acquisition of an EMT-like phenotype of cancer cells. The DDP-resistant cells were less sensitive than the HNE1 cells to treatment with DDP, and were shown by a cell viability assay, western blot analysis and qRT-PCR to have acquired chemoresistance. The HNE1/DDP cells examined by wound healing and Transwell Boyden chamber assays exhibited an increased migration and invasion potential. The DDP-resistant cells exhibited morphological and molecular changes consistent with EMT, as observed by western blot analysis and qRT-PCR. These changes included becoming more spindle-like in shape, a loss of polarity and formation of pseudopodia, the downregulation of E-cadherin and ß-catenin and the upregulation of vimentin, fibronectin and matrix metalloproteinase (MMP)-9. Moreover, the levels of the EMT-related transcription factors, Snail, Slug, Twist and zinc finger E-box binding homeobox 1 (ZEB1), were higher in the DDP­resistant NPC cells. These data suggest that the development of DDP resistance of NPC cells is accompanied by inducible EMT-like changes with an increased metastatic potential in vitro. Further elucidation of the association between resistance to DDP and EMT may facilitate the future development of novel therapeutic approaches for the treatment of chemoresistant tumors.

[Clinical observation on argon green laser in the treatment of diabetic macular edema].

OBJECTIVE: To assess the clinical effect of argon green laser photocoagulation on diabetic macular edema. METHODS: Grid macular photocoagulation with argon green laser (lambda = 514 nm), 100-200 microns spot diameter and 0.1-0.2 s duration, was applied to 23 eyes of diabetic macular edema. Panretinal scatter photocoagulations, if needed, were carried out in the later therapy. The mean of the follow-up period was (9.3 +/- 4.1) months. Changes in macular edema and visual acuity as well were observed. RESULTS: Complete and partial resolution of macular edema occurred in 21 out of the 23 eyes and visual acuity improved or remained unchanged in 19 out of the 23 eyes. CONCLUSION: Grid macular photocoagulation with argon green laser is effective and relatively safe in the treatment of diabetic macular edema.