Preliminary analysis of immunotherapy combined with second-line treatment for esophageal squamous cell carcinoma patients / 中华放射肿瘤学杂志

Objective:To investigate the efficacy of camrelizumab combined with second-line therapy in patients with recurrent or metastatic esophageal squamous cell carcinoma (ESCC) in the real-world settings.Methods:Clinical data of 48 patients with esophageal cancer who met the inclusion criteria were retrospectively analyzed. The types of failure after first-line treatment, clinical efficacy, side effects and prognostic factors of second-line treatment were analyzed. SPSS 25.0 software was used for statistical analysis. Count data were expressed by composition ratio and analyzed by Chi-square test or Fisher's exact test. Survival analysis was conducted by Kaplan-Meier curve and log-rank test. Non-normally distributed data were recorded with the median, range and quartile. Results:There were 26, 14, and 4 cases of combined chemoradiotherapy, chemotherapy and radiotherapy in the treatment of second-line camrelizumab, and 4 cases received immunotherapy alone. The median duration of immunotherapy was 6 cycles (range, 2-39 cycles). After second-line treatment, the short-term efficacy of 17, 27 and 4 cases was partial remission (PR), stable disease (SD) and progressive disease (PD), respectively. The overall response rate (ORR) was 35.4% and disease control rate (DCR) was 91.7%. The 1- and 2-year OS rates were 42.9% and 22.5%, and 1- and 2-year PFS rates were 29.0% and 5.8%. The median OS and PFS were 9.0 months (95% CI=6.4-11.7) and 8.5 months (95% CI=1.5-5.6), respectively. Multivariate analysis showed that combined immunotherapy mode, number of cycles of immunotherapy and short-term efficacy were the independent prognostic indicators affecting OS in this group of patients ( HR=2.598, 0.222, 8.330, P=0.044, <0.001, <0.001). Lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), combined immunotherapy mode and short-term efficacy were the independent prognostic indicators affecting PFS in this group ( HR=3.704, 3.598, 6.855, 2.159, 2.747, P=0.009, 0.008, <0.001, 0.049, 0.012). Conclusions:Camrelizumab combined with second-line therapy can bring survival benefit to patients with recurrent or metastatic ESCC after first-line therapy, especially immunotherapy combined with chemoradiotherapy can significantly provide survival benefit. Peripheral blood inflammatory biomarkers are independent indicators affecting clinical prognosis of patients. Patients with better short-term efficacy also achieve better prognosis. The final conclusion remains to be validated by a large number of randomized controlled studies.

Advances in pathophysiology, diagnosis and treatment of adult severe-associated thrombotic microangiopathy / 中华危重病急救医学

Thrombotic microangiopathy (TMA) is a group of highly heterogeneous, acute and severe clinicopathological syndromes, characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia and ischemic injury of end organs. TMA has the characteristics of dangerous condition, multiple organ involvement and high mortality. Patients with severe TMA need to be admitted to intensive care unit (ICU) for organ function support therapy. Early and rapid evaluation, differential diagnosis, and timely and effective treatment are the key to improve the prognosis of TMA patients. Here, we review the pathophysiological changes, diagnosis differential diagnosis, and treatment of the severe TMA in adult.

Comparison of four early warning scores in predicting the prognosis of critically ill patients in secondary hospitals / 中华危重病急救医学

OBJECTIVE@#To explore the predictive value of acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA) and modified early warning score (MEWS) in evaluating the prognosis of patients in intensive care unit (ICU) of secondary hospitals, and to provide guidance for clinical application.@*METHODS@#The clinical data of adult critical patients admitted to the ICU of Wanzhou District First People's Hospital from October 2022 to April 2023 were retrospectively analyzed. According to the clinical outcome of ICU, the patients were divided into improvement group and death group. The general information, blood routine, heart, liver and kidney function indicators, coagulation indicators, blood gas analysis, APACHE II score, SOFA score, qSOFA score, MEWS score at the time of admission to the ICU, the number of cases of invasive mechanical ventilation (IMV) and continuous blood purification (CBP) were compared between the two groups. Univariate analysis was performed, and multivariate Logistic regression analysis was used to analyze the related factors of death. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of the four scores in ICU patients.@*RESULTS@#A total of 126 patients were included, of which 45 patients died in the ICU and 81 patients improved and transferred out. Univariate analysis of death-related critically ill patients showed that procalcitonin (PCT), serum creatinine (SCr), blood urea nitrogen (BUN), albumin (ALB), prothrombin time (PT), activated partial prothrombin time (APTT), D-dimer, pH value, HCO3-, blood lactic acid (Lac), number of patients treated with IMV and CBP, APACHE II score, SOFA score, qSOFA score and MEWS score were significantly different between the two groups (all P < 0.05). Multivariate Logistic regression analysis showed that the APACHE II score [odds ratio (OR) = 1.115, 95% confidence interval (95%CI) was 1.025-1.213, P = 0.011], SOFA score (OR = 1.204, 95%CI was 1.037-1.398, P = 0.015), MEWS score (OR = 1.464, 95%CI was 1.102-1.946, P = 0.009), and APTT (OR = 1.081, 95%CI was 1.015-1.152, P = 0.016) were independent risk factors affecting the mortality of critically ill patients in the ICU. ROC curve analysis showed that APACHE II, SOFA, qSOFA, and MEWS scores could predict the prognosis of critically ill ICU patients, among which SOFA score had the strongest predictive effect, and the area under the curve (AUC) was 0.808. There was a statistically significant difference in the time required for the four scores (F = 117.333, P < 0.001), among which the MEWS scoring required the shortest time [(1.03±0.39) minutes], and the APACHE II scoring required the longest time [(2.81±1.04) minutes].@*CONCLUSIONS@#APACHE II, SOFA, qSOFA, and MEWS scores can be used to assess the severity of critically ill patients and predict in-hospital mortality. The SOFA score is superior to other scores in predicting severity. The MEWS is preferred because its assessment time is shortest. Early warning score can help secondary hospitals to detect potentially critical patients early and provide help for clinical rapid urgent emergency decision-making.

Analysis of clinical characteristics of patients with different vaccines and underlying diseases infected with novel coronavirus Omicron variant / 中华危重病急救医学

Objective:To analyze the clinical characteristics of patients inoculated with different vaccines and underlying diseases, infected with the novel coronavirus Omicron variant.Methods:The data of 430 patients infected with the novel coronavirus Omicron variant who were admitted to Tianjin First Center Hospital from January 21, 2022 to March 7, 2022 were collected. A total of 108 patients with Omicron variant infection with underlying diseases were selected and enrolled. The gender, age, body mass index (BMI), history of underlying diseases, vaccination status (vaccination times, vaccination type), clinical symptoms, laboratory test indicators, imaging data, hospitalization time, nucleic acid negative conversion time, re-positivity and antibody titer from the two groups of the patients were collected and analyzed.Results:In the 108 patients, 93 cases received inactivated vaccine and 15 cases received adenovirus vaccine. There was no statistically significant difference between the two groups in terms of gender, age, BMI, disease types, whether completed the fully vaccinated, whether had prime boost and underlying diseases. Both groups had fever, dry cough, sore throat, runny nose and other clinical symptoms, but there were no statistical difference between the two groups. There were no statistically significant differences in laboratory blood routine tests, biochemical indexes, C-reactive protein (CRP) level and the results of chest computed tomography (CT) imaging between the two groups. There were no statistically significant differences in hospitalization days, nucleic acid negative conversion time, whether admission to intensive care unit (ICU), turn re-positive on nucleic acid tests and immunoglobulin M (IgM) antibody titer expression between the two groups, but immunoglobulin G (IgG) antibody titer in adenovirus group was higher than that in inactivated group (g/L: 229.67±26.13 vs. 194.33±61.56, P = 0.020). There were also no significant differences in laboratory examinations, hospitalization days, nucleic acid negative conversion time, turn re-positive on nucleic acid tests and Novel coronavirus antibody titers expression of the patients with booster shots between the inactivated vaccine group and the adenovirus vaccine group. Conclusions:The protection of inactivated virus vaccine is equivalent to adenovirus vaccine in patients with underlying disease Omicron variant infection, and the titer of IgG antibody in patients with adenovirus vaccine is higher than that in patients with inactivated virus vaccine after one week of recovery.

Preliminary analysis of recurrence-free survival after radical intensity-modulated radiotherapy combined with/without chemotherapy for upper cervical and thoracic esophageal cancer / 中华放射肿瘤学杂志

Objective:To investigate the recurrence-free survival (RFS) and influencing factors of intensity-modulated radiotherapy±chemotherapy (IMRT±C) for the upper thoracic esophageal cancer.Methods:The medical records of 168 patients with cervical and upper thoracic esophageal cancer who met the inclusion criteria from January 2011 to December 2015 were retrospectively analyzed. The RFS was calculated by the Kaplan-Meier method. Multivariate prognostic analysis was performed by Cox models. The recurrence factors were identified by the Logistics model. Results:The 1-, 3-, and 5-year RFS rates were 67.8%, 38.0%, and 20.4%, respectively, and the median RFS was 21.9 months. The locoregional recurrence rate was 47.6%(80/168). The recurrence sites were local esophagus ( n=63), regional lymph nodes ( n=7), and local esophagus+ regional lymph node recurrence ( n=10). Multivariate analysis showed that hoarseness, cTstaging, combined with chemotherapy, 95%PTV 1 exposure dose and GTV average exposure dose were the influencing factors of RFS ( P=0.029, <0.001, 0.031, 0.038, 0.020). Logistics model showed that cTstaging, cNstaging, short-term efficacy, irradiationmethod, GTV maximum transverse diameter and PTV average exposure dose were the influencing factors of recurrence ( P=0.046, 0.022, 0.001, <0.001, 0.012, 0.001). Conclusions:Patients with cervical and upper thoracic esophageal cancer treated with radical IMRT combined with/without chemotherapy have a higher locoregional recurrence rate, and the recurrence rate is mainly the esophagus. The independent factors that affect RFS are different from the risk factors of recurrence.

Epidemiological investigation of a foodborne disease outbreak caused by Vibro parahaemolyticus / 上海预防医学

ObjectiveTo investigate a foodborne disease outbreak and identify the pathogenic factors in order to prevent the occurrence of similar incidents. MethodsEpidemiological study， on-site food hygiene investigation， and laboratory testing were used to analyze the cause of outbreak in Company A. ResultsA total of 24 confirmed cases were screened out. The major clinical symptoms were diarrhea （100.0%）， stomachache （100.0%）， and vomiting （41.7%）. Samples from 24 patients were tested positive for Vibrio parahaemolyticus， and were homologous by Pulsed field gel electrophoresis （PFGE） phylogenetic study. According to the result of case-control study， eating glass noodles salad at the dinner and supper on July 16th， 2019 was the risk factor （OR=15.71，95%CI：1.90‒129.71）. ConclusionThis foodborne disease outbreak was caused by glass noodles salad cross contaminated with Vibrio parahaemolyticus.

Optimization of processing technology of Portulaca oleracea charcoal and its improvement effect on the symptom of hemorrhoid model rats / 中国药房

OBJECTIVE To optimize th e p rocessing technology of Portulaca oleracea charcoal，and to investigate its improvement effect on the symptom of hemorrhoid model rats. METHODS The effects of roasting temperature ，dosage and roasting time on the processing technology of P. oleracea charcoal were investigated with Box-Behnken response surface methodology using comprehensive score of tannin content ，water-soluble extract content and appearance properties as the index. The optimal process parameters are selected and verified. The hemorrhoid model rats were treated with P. oleracea charcoal（0.8 g/mL）prepared by the optimal processing technology ，once a day ，for 11 days. After last medication ，the perianal pathological score of hemorrhoid model rats were performed ；serum levels of tumor necrosis factor α（TNF-α），interleukin 6（IL-6）and IL- 1β were detected. RESULTS The optimal processing technology of P. oleracea charcoal included roasting temperature of 200 ℃， dosage of 150 g and roasting time of 14 min. Results of validation test showed that the comprehensive score of P. oleracea charcoal was 92.57，and relative error of it with predicted value （96.59）was －4.13％. External use of P. oleracea charcoal 0.8 g/mL prepared by the optimal processing technology could significantly promote the wound healing of hemorrhoid model rats ，reduced the amount of exudate ，and decreased the levels of TNF-α，IL-6 and IL-β in serum. CONCLUSIONS The optimized processing technology of P. oleracea charcoal is feasible. P. oleracea charcoal prepared by the optimized processing technology has good curative effect on the symptom of hemorrhoid model rats.

Myeloid cell-driven nonregenerative pulmonary scarring is conserved in multiple nonhuman primate species regardless of SARS-CoV-2 infection modality

The novel coronavirus SARS-CoV-2 has caused a worldwide pandemic resulting in widespread efforts in development of animal models that recapitulate human disease for evaluation of medical countermeasures, and to dissect COVID-19 immunopathogenesis. We tested whether route of experimental infection substantially changes COVID-19 disease characteristics in two species (Macaca mulatta; rhesus macaques; RM, Chlorocebus atheiops; African green monkeys; AGM) of nonhuman primates. Species-specific cohorts of RM and AGM Rhesus macaques (Macaca mulatta, RMs) and African green monkeys (Chlorocebus aethiops, AGMs) were experimentally infected with homologous SARS-CoV-2 by either direct mucosal instillation or small particle aerosol in route-discrete subcohorts. Both species demonstrated equivalent infection initially by either exposure route although the magnitude and duration of viral loading was greater in AGMs than that of the RM. Clinical onset was nearly immediate (+1dpi) in mucosally-exposed cohorts whereas aerosol-infected animals began to show signs +7dpi. Myeloid cell responses indicative of the development of pulmonary scarring and extended lack of regenerative capacity in the pulmonary compartment was a conserved pathologic response in both species by either exposure modality. This pathological commonality may be useful in future anti-fibrosis therapeutic evaluations and expands our understanding of how SARS-CoV-2 infection leads to ARDS and functional lung damage.

The pigtail macaque (Macaca nemestrina) model of COVID-19 reproduces diverse clinical outcomes and reveals new and complex signatures of disease

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19 disease, has killed over four million people worldwide as of July 2021 with infections rising again due to the emergence of highly transmissible variants. Animal models that faithfully recapitulate human disease are critical for assessing SARS-CoV-2 viral and immune dynamics, for understanding mechanisms of disease, and for testing vaccines and therapeutics. Pigtail macaques (PTM, Macaca nemestrina) demonstrate a rapid and severe disease course when infected with simian immunodeficiency virus (SIV), including the development of severe cardiovascular symptoms that are pertinent to COVID-19 manifestations in humans. We thus proposed this species may likewise exhibit severe COVID-19 disease upon infection with SARS-CoV-2. Here, we extensively studied a cohort of SARS-CoV-2-infected PTM euthanized either 6- or 21-days after respiratory viral challenge. We show that PTM demonstrate largely mild-to-moderate COVID-19 disease. Pulmonary infiltrates were dominated by T cells, including CD4+ T cells that upregulate CD8 and express cytotoxic molecules, as well as virus-targeting T cells that were predominantly CD4+. We also noted increases in inflammatory and coagulation markers in blood, pulmonary pathologic lesions, and the development of neutralizing antibodies. Together, our data demonstrate that SARS-CoV-2 infection of PTM recapitulates important features of COVID-19 and reveals new immune and viral dynamics and thus may serve as a useful animal model for studying pathogenesis and testing vaccines and therapeutics.

Effective prophylaxis of COVID-19 in rhesus macaques using a combination of two parentally-administered SARS-CoV-2 neutralizing antibodies

SARS-CoV-2 is a respiratory borne pathogenic beta coronavirus that is the source of a worldwide pandemic and the cause of multiple pathologies in man. The rhesus macaque model of COVID-19 was utilized to test the added benefit of combinatory parenteral administration of two high-affinity anti-SARS-CoV-2 monoclonal antibodies (mAbs; C144-LS and C135-LS) expressly developed to neutralize the virus and modified to extend their pharmacokinetics. After completion of kinetics study of mAbs in the primate, combination treatment was administered prophylactically to mucosal viral challenge. Results showed near complete virus neutralization evidenced by no measurable titer in mucosal tissue swabs, muting of cytokine/chemokine response, and lack of any discernable pathologic sequalae. Blocking infection was a dose-related effect, cohorts receiving lower doses (6, 2 mg/kg) resulted in low grade viral infection in various mucosal sites compared to that of a fully protective dose (20 mg/kg). A subset of animals within this cohort whose infectious challenge was delayed 75 days later after mAb administration were still protected from disease. Results indicate this combination mAb effectively blocks development of COVID-19 in the rhesus disease model and accelerates the prospect of clinical studies with this effective antibody combination.

SARS-CoV-2 Vaccines Elicit Durable Immune Responses in Infant Rhesus Macaques

Early life SARS-CoV-2 vaccination has the potential to provide lifelong protection and achieve herd immunity. To evaluate SARS-CoV-2 infant vaccination, we immunized two groups of 8 infant rhesus macaques (RMs) at weeks 0 and 4 with stabilized prefusion SARS-CoV-2 S-2P spike (S) protein, either encoded by mRNA encapsulated in lipid nanoparticles (mRNA-LNP) or mixed with 3M-052-SE, a TLR7/8 agonist in a squalene emulsion (Protein+3M-052-SE). Neither vaccine induced adverse effects. High magnitude S-binding IgG and neutralizing infectious dose 50 (ID50) >103 were elicited by both vaccines. S-specific T cell responses were dominated by IL-17, IFN-{gamma}, or TNF-. Antibody and cellular responses were stable through week 22. The S-2P mRNA-LNP and Protein-3M-052-SE vaccines are promising pediatric SARS-CoV-2 vaccine candidates to achieve durable protective immunity. One-Sentence SummarySARS-CoV-2 vaccines are well-tolerated and highly immunogenic in infant rhesus macaques

Preliminary analysis of the benefit groups of patients with locoregional recurrence of esophageal squamous cell carcinoma who received different patterns of irradiation / 中华放射肿瘤学杂志

Objective:To explore the benefit groups of patients with locoregional recurrence of esophageal thoracic squamous cell carcinoma who received radiotherapy or chemoradiotherapy with different patterns of irradiation.Methods:Clinical data of 344 esophageal thoracic squamous cell carcinoma patients with postoperative recurrence who received intensity conformal radiotherapy or concurrent chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2009 to 2014 were retrospectively analyzed. The distribution of recurrence sites and prognostic factors were analyzed. A stratified analysis was carried out on the benefit groups of patients receiving the elective nodal irradiation (ENI) and involved field irradiation (IFI).Results:276 cases (80.2%) recurred at a single site and 68 cases (19.8%) recurred at more than two sites. The follow-up rate was 96.2%. The 1-, 3-and 5-year overall survival rates were 53.6%, 22.6% and 16.4%, respectively, with a median of 12.8 months (95% CI: 11.3-14.3 months). The 1-, 3-and 5-year local recurrence-free survival rates were 46.5%, 16.9% and 12.0%, respectively, with a median of 11.0 months (95% CI: 9.6-12.4 months). The 1-, 3-and 5-year progression-free survival rates were 39.8%, 11.3% and 6.7%, respectively, with a median of 7.9 months (95% CI: 5.8-10.0 months). Multivariate analysis showed that gender, the log odds of metastatic lymph nodes (LODDS) and the number of chemotherapy cycles were the independent prognostic factors ( P=0.003, <0.001, <0.001). Subgroup univariate analysis demonstrated that patients with an esophageal lesion length<5.0 cm, N 0 stage, the number of surgically-dissected lymph nodes of ≤9, the number of postoperative positive lymph node metastasis site of 0, and LODDS≤0.030 obtained benefits from ENI ( P=0.032, 0.012, 0.001, 0.012 and 0.014). Patients with the number of surgically-dissected lymph nodes of ≥16 achieved benefits from IFI ( P=0.035). Conclusions:Radiotherapy is an effective treatment mode for patients with local recurrence after esophageal cancer surgery. For patients with preoperative esophagography showing shorter esophageal lesions, earlier postoperative pathological N stage, lower LODDS score, and fewer surgically-dissected lymph nodes probably obtain more benefits from ENI than IFI. However, patients with more surgically-dissected lymph nodes may obtain more benefit from IFI compared with ENI.

Expression and clinical significance of miR-501-5p and LPAR1 mRNA in esophageal cancer / 中国医师杂志

Objective:To study the expression levels of microRNA-501-5p (miR-501-5p) and lysophosphatidic acid receptor 1 (LPAR1) mRNA in esophageal cancer, and to analyze their relationship with clinical pathological data.Methods:From January 2015 to August 2017, 130 patients with esophageal cancer who were hospitalized in Southern Yunnan Central Hospital were selected. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the relative expression of miR-501-5p and LPAR1 mRNA in esophageal cancer tissues and adjacent normal tissues; the relationship between miR-501-5p and LPAR1 mRNA and clinical pathological data and the correlation between the two indexes were analyzed. Kaplan Meier test was used to analyze the relation between prognosis and survival of patients.Results:The relative expression of miR-501-5p in esophageal cancer tissues was higher than that in adjacent tissues, and the relative expression of LPAR1 mRNA was lower than in adjacent tissues ( P<0.05). The relative expression of miR-501-5p and LPAR1 mRNA in esophageal cancer tissues were related to tumor tumor node metastasis (TNM) stage, differentiation degree, and lymph node metastasis ( P<0.05), and were not related to patient age, gender, and tumor diameter ( P>0.05). Correlation analysis showed that the expression of miR-501-5p and LPAR1 mRNA in esophageal cancer tissues was negatively correlated ( r=-0.632, P<0.05). Kaplan Meier test showed that the 3-year overall survival rate of patients in high miR-501-5p expression group was lower than that of low expression group, and the 3-year overall survival rate of patients in high LPAR1 mRNA expression group was higher than that of low expression group ( P<0.05). Conclusions:The expression level of miR-501-5p in esophageal cancer is higher than that in adjacent tissues, and the expression level of LPAR1 mRNA is lower than in adjacent tissues. They are related to tumor TNM stage, differentiation degree, and lymph node metastasis and expected to become new biomarkers in the diagnosis and treatment of esophageal cancer.

Effect of Different Compatibility Ratio of Gardenia jasminoides to Fermented Soybean on the Content of Flavo- noids in Zhizichi Decoction / 中国药房

OBJECTIVE：To investigate t he effects of different compatibility ratio of Gardenia jasminoides to fermented soybean on the content of genistein and total flavonoids ，and to investigate the compatibility regularity of Zhizichi decoction. METHODS：The decoction method was used to prepare the mixed decoction with different compatibility ratio of G. jasminoides to fermented soybean （2∶1，1∶1，1∶2，1∶4，m/m，the same hereinafter ）. UPLC-MS/MS method was used to determine the content of genistein in Zhizichi decoction with different compatibility ratio and corresponding fermented soybean single decoction. UV method was used to determine the content of total flavonoids in Zhizichi decoction with different compatibility ratio and corresponding gardenia single decoction and fermented soybean single decoction. RESULTS ：The established method had good linearity ， precision，repeatability，stability and accuracy. Compared with single decoction ，the content of genistein in the mixed decoction with different compatibility ratio of G. jasminoides to fermented soybean （2∶1，1∶1，1∶2，1∶4）was decreased to different extents ， while the content of total flavonoids was increased to different extents. With the increase of fermented soybean ，the content of genistein in the decoction increased at first and then decreased. When the compatibility ratios of G. jasminoides to fermented soybean were 1 ∶ 1 and 1 ∶ 2，the content of genistein in the decoction was the highest （all 0.071 μg/mL）. With the increase of fermented soybean ，the content of total flavonoids in the decoction did not change regularly ；when the ratio of G. jasminoides to fermented soybean was 1 ∶ 1，the content of total flavonoids in the decoction was the highest （1.861 μg/mL）. CONCLUSIONS ： When the compatibility ratio of G. jasminoides to fermented soybean was 1 ∶ 1，the content of flavonoids in the decoction is the highest.

Effect of locoregional risk factors on long-term prognosis of patients with N0 stage esophageal cancer receiving intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective@#To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with N0 esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.@*Methods@#Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed. Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients. Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients. The survival analysis was carried out by Kaplan-Meier method. The prognosis analysis was performed by multivariate Cox’s regression model.@*Results@#A total of 143 patients (38.2%) had recurrence in GTV. The maximum transverse diameter (GTV-D), GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008, 0.043, 0.001). ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D, GTV-L, GTV-V and GTV-V/L for GTV recurrence were 3.5 cm, 5.5 cm, 24.0 cm3 and 4.6 cm2, respectively (P=0.000, 0.003, 0.000 and 0.000), and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000, 0.002, 0.001 and 0.000). GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009). The 3-, 5-and 10-year survival rates of all patients in the whole group were 42.9%, 23.2% and 7.9%, respectively. Multivariate analysis demonstrated that age, T stage, concurrent radiochemotherapy, GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027, 0.000, 0.018, 0.009 and 0.034). The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.@*Conclusions@#The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with N0 esophageal squamous cell carcinoma undergoing radical radiochemotherapy, which can be utilized as the predicting markers. Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.

Prognosis of different irradiation methods in patients with T2-3N0M0 esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective@#To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients.@*Methods@#A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups.@*Results@#The median overall survival (OS) time was 35.5 months (95%CI : 30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI: 19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038), and T stage and radiotherapy were the independent factors affecting DFS (P=0.002, 0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819, 0.756). However, patients with combined chemotherapy experienced more adverse events.@*Conclusion@#ENI can prolong the OS and DFS of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma, and does not increase the incidence of severe adverse events.

Effect of locoregional risk factors on long-term prognosis of patients with N0 stage esophageal cancer receiving intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with No esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients.Methods Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed.Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients.Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients.The survival analysis was carried out by Kaplan-Meier method.The prognosis analysis was performed by multivariate Cox's regression model.Results A total of 143 patients (38.2％) had recurrence in GTV.The maximum transverse diameter (GTV-D),GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008,0.043,0.001).ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D,GTV-L,GTV-V and GTV-V/L for GTV recurrence were 3.5 cm,5.5 cm,24.0 cm3 and 4.6 cm2,respectively (P=0.000,0.003,0.000 and 0.000),and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000,0.002,0.001 and 0.000).GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009).The 3-,5-and 10-year survival rates of all patients in the whole group were 42.9％,23.2％ and 7.9％,respectively.Multivariate analysis demonstrated that age,T stage,concurrent radiochemotherapy,GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027,0.000,0.018,0.009 and 0.034).The main cause of death in patients with a survival time of more than 5 years was still associated with cancer.Conclusions The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with No esophageal squamous cell carcinoma undergoing radical radiochemotherapy,which can be utilized as the predicting markers.Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients.

Prognosis of different irradiation methods in patients with T2-3N0M0 esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T2-3N0M0 esophageal squamous cell carcinoma,aiming to select the optimal treatment for these patients.Methods A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study.All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups.The composition ratio,prognostic factors and adverse events were analyzed between two groups.Results The median overall survival (OS) time was 35.5 months (95％CI:30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95％CI:19.00-28.00).According to the multivariate analysis results,all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group).Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038),and T stage and radiotherapy were the independent factors affecting DFS (P=0.002,0.032).The incidence of ≥ grade Ⅱ adverse events did not significantly differ between two groups (P=0.819,0.756).However,patients with combined chemotherapy experienced more adverse events.Conclusion ENI can prolong the OS and DFS of patients with clinical T2-3NoMo esophageal squamous cell carcinoma,and does not increase the incidence of severe adverse events.

Prognosis and failure patterns of esophageal squamous cell carcinoma patients undergoing selective lymph node irradiation / 中华放射医学与防护杂志

Objective:To investigate the prognosis and failure mode of patients with esophageal squamous cell carcinoma receiving selective lymph node irradiation (ENI).Methods:A total of 179 eligible patients with esophageal squamous cell carcinoma were retrospectively analyzed. The prognostic value of tumor-related factors, the influencing factors of short-term curative effect and prognosis of patients, and the single and multi factor indexes of affecting the overall survival rate (OS), progression free survival rate (PFS) and recurrence of patients were analyzed.SPSS 19.0 software was used for statistical analysis.Results:The 1, 3- and 5-year OS of the whole group were 77.1%, 40.1% and 26.0%, respectively, and 1-, 3- and 5-year PFS were 62.6%, 30.6%, and 20.3%, respectively. Multivariate analysis showed that hoarseness, cN stage, cTNM stage, GTV-transverse diameter (GTV-D) and GTV-volume/length (GTV-V/L) were independent factors affecting OS ( P<0.05). The sonar, cTNM staging, and short-term efficacy were independent factors affecting PFS ( P<0.05). Recurrence occurred in 75 patients (41.9%) in the whole group, and 61 patients (34.1%) had distant metastases. Among them, 9 patients (10.6%) had both recurrence and distant metastasis. Of the 75 patients with recurrence, 64(85.3%) had simple esophageal recurrence, 4(5.3%) had lymph node recurrence, and 7 (9.3%) had both. Recurrence occurred in 18 of the 63 patients who achieved CR after treatment. Only 2 patients had lymph node recurrence. Logistic multivariate analysis showed that the surrounding tissue/organ invasion, GTV-D and short-term were independent factors affecting the recurrence rate ( P<0.05). Conclusions:ENI is feasible in patients with esophageal squamous cell carcinoma, and the main mode of failure is esophageal recurrence. Pre-treatment sonar, larger GTV-D and GTV-V/L, more advanced clinical stage and poorer short-term efficacy are indicators of poor prognosis, while the peripheral tissue involvement, GTV-D and short-term efficacy are the independent factors that influence failure.

The early diagnostic value of IAP combined with IFABP for patients with mechanical ventilation complicated with AGI / 中华急诊医学杂志

Objective To investigate the early diagnostic value of intra-abdominal pressure (IAP) combined with intestinal fatty acid binding protein (IFABP) for patients with mechanical ventilation complicated with acute gastrointestinal injury (AGI).Methods From August 2015 to December 2015,1 19 patients with mechanical ventilation were admitted to ICU in our hospital,with 78 cases of AGI patients and 41 cases of non-AGI patients.Multiple physiological indexes and laboratory indexes of the two groups were recorded and compared.Results There was no statistical difference in sex,age,APACHE Ⅱ score,BMI index,Lac and mean arterial pressure (MAP) between the two groups (P ＞0.05);the OR values of mechanical ventilation time,oxygenation index,end-expiratory positive pressure (PEEP),CIT,IFABP and IAP were more than 1,so these indicators were all risk factors for AGI in patients with mechanical ventilation.The area under the curve of IAP,IFABP,mechanical ventilation and PEEP were more than 0.5,indicating that these indicators have a certain predictive value for AGI patients with mechanical ventilation.The sensitivity and specificity of IAP were 95％ and 80％ respectively,and the sensitivity and specificity of IFABP were 87.5％ and 50％,respectively.IAP was correlated with IFABP (r =0.621,P =0.031).Conclusions Mechanical ventilation time,oxygenation index,PEEP,CIT,IFABP,and IAP are risk factors for AGI patients with mechanical ventilation.IAP,IFABP,mechanical ventilation time and PEEP have a certain predictive value for AGI patients with mechanical ventilation.The diagnostic value of IAP and IFABP is high,and the two are closely related.Combined application can provide a certain objective basis for clinical AGI diagnosis.