Patients with advanced esophageal cancer（T3-4, N） have a poor prognosis. Chemoradiation or chemotherapy before esophagectomy with adequate lymphadenectomy is the standard treatment for patients with resectable advan...Patients with advanced esophageal cancer（T3-4, N） have a poor prognosis. Chemoradiation or chemotherapy before esophagectomy with adequate lymphadenectomy is the standard treatment for patients with resectable advanced esophageal carcinoma. However, only patients with major histopathologic response（regression to less than 10% of the primary tumor） after preoperative treatment will have a prognostic benefit of preoperative chemoradiation. Using current therapy regimens about 40% to 50% of the patients show major histopathological response. The remaining cohort does not benefit from this neoadjuvant approach but might benefit from earlier surgical resection. Therefore, it is an aim to develop tools for response prediction before starting the treatment and for early response assessment identifying responders. The current review discusses the different imaging techniques and the most recent studies about molecular markers for early response prediction. The results show that [^18F]-fluorodeoxyglucose-positron emission tomography（FDGPET） has a good sensitivity but the specificity is not robust enough for routine clinical use. Newer positron emission tomography detector technology, the combination of FDG-PET with computed tomography, additional evaluation criteria and standardization of evaluation may improve the predictive value. There exist a great number of retrospective studies using molecular markers for prediction of response. Until now the clinical use is missing. But the results of first prospective studies are promising. A future perspective may be the combination of imaging technics and special molecular markers for individualized therapy. Another aspect is the response assessment after finishing neoadjuvant treatment protocol. The different clinical methods are discussed. The results show that until now no non-invasive method is valid enough to assess complete histopathological response.展开更多
To report early imaging assessment of ablated area post electrochemotherapy (ECT) in patients with locally advanced pancreatic cancer (LAPC). METHODSECT was performed in 19 LAPC patients enrolled in an approved ongoin...To report early imaging assessment of ablated area post electrochemotherapy (ECT) in patients with locally advanced pancreatic cancer (LAPC). METHODSECT was performed in 19 LAPC patients enrolled in an approved ongoing clinical phase I/II study. Before and after ECT, 18 patients underwent computed tomography (CT) scan, 11 patients underwent morphological and functional magnetic resonance (MR) scan (dynamic contrast enhanced-MRI) calculating wash-in slope (WIS) and wash-out slope (WOS); diffusion weighted imaging calculating pseudo-diffusivity (Dp), perfusion fraction (fp) and tissue diffusivity (Dt); 10 patients underwent positron emission tomography (PET). Response evaluation criteria in solid tumour (RECIST) on MR and CT were used to assess tumour therapy response. Choi on CT, PET response criteria in solid tumors (PERCIST) on PET and functional parameters on MR were used to evaluate treatment response. RESULTSFor each patient no significant reduction was measurable by CT and MR using RECIST. According Choi criteria a partial response was obtained in 18/18 (100.0%) patients. According PERCIST criteria 6/10 (60.0%) patients showed a partial response, 3/10 (30.0%) stable disease and 1/10 (10.0%) progression disease. Moreover, using functional MR parameters, a significant reduction of viable tumour after ECT can be observed. According ΔWIS and ΔWOS 9/11 (81.8%) patients exhibited a partial response and 2/11 (18.2%) stable disease; 8/11 (72.7%) patients were considered in partial response by ΔDp evaluation and 3/11 (27.3%) in stable disease; according ΔDt 7/11 (63.6%) patients showed a partial response, 1/11 (9.1%) showed progression of disease and 3/11 (27.3%) were stable. Perfusion fraction fp showed a significant reduction after ECT only in four patients. No significant difference was observed after ECT in signal intensity of T1-weighted images and T2-weighted images, and in equilibrium-phase of contrast study, according to χ<sup>2</sup> test was observed. A good correlation was reported between ΔHounsfield unit and Δmaximum standardized uptake value and between Δfp and ΔWOS, with a significant statistically difference (P < 0.05) using Spearman correlation coefficient. CONCLUSIONPerfusion and diffusion MR derived parameters, Choi, PERCIST criteria are more performant than morphological MR and CT criteria to assess ECT treatment response.展开更多
Objective This study used the Distress Assessment and Response Tool(DART)to screen,evaluate,and explore physical symptoms,psychological problems,and social support in patients with cancer pain,with an aim to provide d...Objective This study used the Distress Assessment and Response Tool(DART)to screen,evaluate,and explore physical symptoms,psychological problems,and social support in patients with cancer pain,with an aim to provide data for the comprehensive care of these patients to improve their quality of life.Methods The DART was used to survey 497 patients with cancer pain who were admitted to the Cancer Center of the First Hospital of Jilin University from June 2014 to March 2017.All patients were diagnosed with malignant tumors by clinical,radiological and/or cytological examinations,and were experiencing tumor-related pain.This study recorded the patient’s somatic symptoms,psychological problems and social support in detail.After the data were collected,the SPSS 21.0 software was used to perform the statistical analysis,with the significance level set at P<0.05.Results In total,82.7%of patients were experiencing mild pain(NRS≤3);of these,29.7%and 15.8%reported depression and anxiety,respectively.In addition,17.3%of patients were experiencing moderate or severe pain(NRS≥4);of these,53.5%and 40.7%reported depression and anxiety,respectively.There was a statistically significant difference in the incidence of anxiety and depression between the two groups.Conclusion Patients with cancer pain,particularly those with moderate-to-severe pain,showed a high incidence of distress.In addition,they were likely to report physical symptoms,were conscious of poor health conditions,and were prone to have anxiety and depression.In terms of social support,patients with moderate-to-severe cancer pain should receive substantial support,as they experience work-related and economic concerns and report difficulties in family life and social activities.展开更多
Background: This study assessed the effect of standardized efficacy markers on prognosis in patients with newly diagnosed multiple myeloma(MM)during the induction phase of treatment with bortezomib,cyclophosphamide,an...Background: This study assessed the effect of standardized efficacy markers on prognosis in patients with newly diagnosed multiple myeloma(MM)during the induction phase of treatment with bortezomib,cyclophosphamide,and dexamethasone(BCD).Methods :We retrospectively analyzed clinical data in 197 newly diagnosed MM patients treated with BCD as front-line regimen at Peking Union Medical College Hospital from January 1,2013 to December 31,2018.Results: There were 107 patients with International Staging System(ISS)III and 51 with paraprotein of light chain.Of these,77 completed nine cycles of the BCD regimen.As the number of treatment cycles increased,the proportions of serum and urine immunofixation electrophoresis(IFE)tests elevated from 40.39%to 62.22%and 16.75%to 37.78%,respectively.More than 90%of intact immunoglobulin chain MM patients were evaluated for blood M protein per cycle,but that of urinary M protein was less than 60%.The detection rate of urinary M protein in light chain MM was more than 70%per cycle.Patients with a very good partial response(VGPR)had longer progression-free survival(PFS)than those with uncertain VGPR(32 vs.26 months,p=0.0336).Of the 141 patients who completed at least four cycles without undergoing autologous hematopoietic stem cell transplantation,those who were regularly assessed at every other cycle showed more favorable PFS than those who visited irregularly(27 vs.22 months,p=0.059).Conclusion: Urinary M protein detection rate is significantly lower than that in serum,leading to an overestimation of efficacy,premature reduction of treatment intensity,and shortened PFS.Precise response assessments are critical to treatment decisions and clinical diagnoses.展开更多
Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors s...Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.展开更多
Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular ca...Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.展开更多
BACKGROUND Artificial intelligence in radiology has the potential to assist with the diagnosis,prognostication and therapeutic response prediction of various cancers.A few studies have reported that texture analysis c...BACKGROUND Artificial intelligence in radiology has the potential to assist with the diagnosis,prognostication and therapeutic response prediction of various cancers.A few studies have reported that texture analysis can be helpful in predicting the response to chemotherapy for colorectal liver metastases,however,the results have varied.Necrotic metastases were not clearly excluded in these studies and in most studies the full range of texture analysis features were not evaluated.This study was designed to determine if the computed tomography(CT)texture analysis results of non-necrotic colorectal liver metastases differ from previous reports.A larger range of texture features were also evaluated to identify potential new biomarkers.AIM To identify potential new imaging biomarkers with CT texture analysis which can predict the response to first-line cytotoxic chemotherapy in non-necrotic colorectal liver metastases(CRLMs).METHODS Patients who presented with CRLMs from 2012 to 2020 were retrospectively selected on the institutional radiology information system of our private radiology practice.The inclusion criteria were non-necrotic CRLMs with a minimum size of 10 mm(diagnosed on archived 1.25 mm portal venous phase CT(FOLFOX,FOLFIRI,FOLFOXIRI,CAPE-OX,CAPE-IRI or capecitabine).The final study cohort consisted of 29 patients.The treatment response of the CRLMs was classified according to the RECIST 1.1 criteria.By means of CT texture analysis,various first and second order texture features were extracted from a single nonnecrotic target CRLM in each responding and non-responding patient.Associations between features and response to chemotherapy were assessed by logistic regression models.The prognostic accuracy of selected features was evaluated by using the area under the curve.RESULTS There were 15 responders(partial response)and 14 non-responders(7 stable and 7 with progressive disease).The responders presented with a higher number of CRLMs(P=0.05).In univariable analysis,eight texture features of the responding CRLMs were associated with treatment response,but due to strong correlations among some of the features,only two features,namely minimum histogram gradient intensity and long run low grey level emphasis,were included in the multiple analysis.The area under the receiver operating characteristic curve of the multiple model was 0.80(95%CI:0.64 to 0.96),with a sensitivity of 0.73(95%CI:0.48 to 0.89)and a specificity of 0.79(95%CI:0.52 to 0.92).CONCLUSION Eight first and second order texture features,but particularly minimum histogram gradient intensity and long run low grey level emphasis are significantly correlated with treatment response in non-necrotic CRLMs.展开更多
This article describes the development and application of a streamlined air control and response modeling system with a novel response surface modeling-linear coupled fitting method and a new module to provide streaml...This article describes the development and application of a streamlined air control and response modeling system with a novel response surface modeling-linear coupled fitting method and a new module to provide streamlined model data for PM_（2.5） attainment assessment in China.This method is capable of significantly reducing the dimensions required to establish a response surface model,as well as capturing more realistic response of PM_（2.5） to emission changes with a limited number of model simulations.The newly developed module establishes a data link between the system and the Software for Model Attainment Test—Community Edition（SMAT-CE）,and has the ability to rapidly provide model responses to emission control scenarios for SMAT-CE using a simple interface.The performance of this streamlined system is demonstrated through a case study of the Yangtze River Delta（YRD） in China.Our results show that this system is capable of reproducing the Community Multi-Scale Air Quality（CMAQ） model simulation results with maximum mean normalized error 〈 3.5%.It is also demonstrated that primary emissions make a major contribution to ambient levels of PM_（2.5） in January and August（e.g.,more than50%contributed by primary emissions in Shanghai）,and Shanghai needs to have regional emission control both locally and in its neighboring provinces to meet China＇s annual PM_（2.5）National Ambient Air Quality Standard.The streamlined system provides a real-time control/response assessment to identify the contributions of major emission sources to ambient PM_（2.5）（and potentially O_3 as well） and streamline air quality data for SMAT-CE to perform attainment assessments.展开更多
Radiological imaging has a critical role in the diagnosis of sarcomas and in evaluating therapy response assessment.The current gold standard for response assessment in solid tumors is the Response Evaluation Criteria...Radiological imaging has a critical role in the diagnosis of sarcomas and in evaluating therapy response assessment.The current gold standard for response assessment in solid tumors is the Response Evaluation Criteria in Solid Tumors,which evaluates changes in tumor size as a surrogate endpoint for therapeutic efficacy.However,tumors may undergo necrosis,changes in vascularization or become cystic in response to therapy,with no significant volume changes;thus,size assessments alone may not be adequate.Such morphological changes may give rise to radiographic phenotypes that are not easily detected by human operators.Fortunately,recent advances in high-performance computing and machine learning algorithms have enabled deep analysis of radiological images to extract features that can provide richer information about intensity,shape,size or volume,and texture of tumor phenotypes.There is growing evidence to suggest that these image-derived or“radiomic features”are sensitive to biological processes such as necrosis and glucose metabolism.Thus,radiomics could prove to be a critical tool for assessing treatment response and may present an integral complement to existing response criteria,opening new avenues for patient assessment in sarcoma trials.展开更多
Background Recently, the combination of sevoflurane and remifentanil has been widely used in general anesthesia. In this study, we investigated the sevoflurane-remifentanil pharmacodynamic interactions at clinical con...Background Recently, the combination of sevoflurane and remifentanil has been widely used in general anesthesia. In this study, we investigated the sevoflurane-remifentanil pharmacodynamic interactions at clinical concentrations using the observer＇s assessment of alertness/sedation （OAA/S） and the bispectral index （BIS） by response surface analysis. Methods Totally 65 American Society of Anesthesiologists （ASA） I patients age 20 to 50 years old were included in this study. Patients were randomly assigned to be anesthetized with different target end-tidal sevoflurane concentrations that ranged from 0.2% to 3.4% in increments of 0.2%. The end-tidal sevoflurane concentration was maintained constant throughout the study. Remifentanil was infused with a target controlled infusion （TCI） system at increasing step-wise concentrations from 1 ng/ml to 10 ng/ml. The values of OAA/S and BIS at different sevoflurane-remifentanil concentration combinations were measured. The pharmacodynamic interactions between sevoflurane and remifentanil were analyzed by a response surface method. The three-dimensional response surfaces were constructed with Minitab Software. Model parameters were estimated with NONMEM program. Results Sevoflurane and remifentanil acted synergistically on OANS. Sevoflurane alone could produce OANS 〈1 at a minimal alveolar concentration （MAC） of 0.93%. When used in combination with remifentanil at 1, 3, 6, and 10 ng/ml, the corresponding sevoflurane MACs were reduced to 0.79%, 0.58%, 0.48%, and 0.38%, with reductions of 17.2%, 37.6%, 48.4%, and 62.0% from baseline, respectively. In patients administered remifentanil alone, the OANS score was 〉3 even when the remifentanil concentration reached 10 ng/ml. BIS was closely associated with the sevoflurane concentration and the remifentanil concentration did not noticeably influence the relationship between the sevoflurane concentration and BIS. A sevoflurane concentration of （1.04＋0.19）% to （1.81＋0.21）% could maintain a BIS between 60 and 40. Conclusions The response surface method can analyze the pharmacodynamic interactions between remifentanil and sevoflurane qualitatively and quantitatively. Within the range of our study （remifentanil 〈10 ng/ml, sevoflurane 〈3.4%）, the two drugs produced synergistic effects on OAA/S but had no interactive effect on BIS. A guideline of BIS between 40 and 60 may cause excessive anesthesia when opioids are used to maintain anesthesia.展开更多
Positron emission tomography(PET)represents molecular imaging for non-invasive phenotyping of physiological and biochemical processes in various oncological diseases.PET imaging with 18F-fluorodeoxyglucose(18F-FDG)for...Positron emission tomography(PET)represents molecular imaging for non-invasive phenotyping of physiological and biochemical processes in various oncological diseases.PET imaging with 18F-fluorodeoxyglucose(18F-FDG)for glucose metabolism evaluation is the standard imaging modality for the clinical management of lymphoma.One of the 18F-FDG PET applications is the detection and pre-treatment staging of lymphoma,which is highly sensitive.18F-FDG PET is also applied during treatment to evaluate the individual chemo-sensitivity and accordingly guide the response-adapted therapy.At the end of the therapy regiment,a negative PET scan is indicative of a good prognosis in patients with advanced Hodgkin’s lymphoma and diffuse large B-cell lymphoma.Thus,adjuvant radiotherapy may be alleviated.Future PET studies using non-18F-FDG radiotracers,such as 68Ga-labeled pentixafor(a cyclic pentapeptide that enables sensitive and high-contrast imaging of C-X-C motif chemokine receptor 4),68Ga-labeled fibroblast activation protein inhibitor(FAPI)that reflects the tumor microenvironment,and 89Zr-labeled atezolizumab that targets the programmed cell death-ligand 1(PD-L1),may complement 18F-FDG and offer essential tools to decode lymphoma phenotypes further and identify the mechanisms of lymphoma therapy.展开更多
文摘Patients with advanced esophageal cancer（T3-4, N） have a poor prognosis. Chemoradiation or chemotherapy before esophagectomy with adequate lymphadenectomy is the standard treatment for patients with resectable advanced esophageal carcinoma. However, only patients with major histopathologic response（regression to less than 10% of the primary tumor） after preoperative treatment will have a prognostic benefit of preoperative chemoradiation. Using current therapy regimens about 40% to 50% of the patients show major histopathological response. The remaining cohort does not benefit from this neoadjuvant approach but might benefit from earlier surgical resection. Therefore, it is an aim to develop tools for response prediction before starting the treatment and for early response assessment identifying responders. The current review discusses the different imaging techniques and the most recent studies about molecular markers for early response prediction. The results show that [^18F]-fluorodeoxyglucose-positron emission tomography（FDGPET） has a good sensitivity but the specificity is not robust enough for routine clinical use. Newer positron emission tomography detector technology, the combination of FDG-PET with computed tomography, additional evaluation criteria and standardization of evaluation may improve the predictive value. There exist a great number of retrospective studies using molecular markers for prediction of response. Until now the clinical use is missing. But the results of first prospective studies are promising. A future perspective may be the combination of imaging technics and special molecular markers for individualized therapy. Another aspect is the response assessment after finishing neoadjuvant treatment protocol. The different clinical methods are discussed. The results show that until now no non-invasive method is valid enough to assess complete histopathological response.
文摘To report early imaging assessment of ablated area post electrochemotherapy (ECT) in patients with locally advanced pancreatic cancer (LAPC). METHODSECT was performed in 19 LAPC patients enrolled in an approved ongoing clinical phase I/II study. Before and after ECT, 18 patients underwent computed tomography (CT) scan, 11 patients underwent morphological and functional magnetic resonance (MR) scan (dynamic contrast enhanced-MRI) calculating wash-in slope (WIS) and wash-out slope (WOS); diffusion weighted imaging calculating pseudo-diffusivity (Dp), perfusion fraction (fp) and tissue diffusivity (Dt); 10 patients underwent positron emission tomography (PET). Response evaluation criteria in solid tumour (RECIST) on MR and CT were used to assess tumour therapy response. Choi on CT, PET response criteria in solid tumors (PERCIST) on PET and functional parameters on MR were used to evaluate treatment response. RESULTSFor each patient no significant reduction was measurable by CT and MR using RECIST. According Choi criteria a partial response was obtained in 18/18 (100.0%) patients. According PERCIST criteria 6/10 (60.0%) patients showed a partial response, 3/10 (30.0%) stable disease and 1/10 (10.0%) progression disease. Moreover, using functional MR parameters, a significant reduction of viable tumour after ECT can be observed. According ΔWIS and ΔWOS 9/11 (81.8%) patients exhibited a partial response and 2/11 (18.2%) stable disease; 8/11 (72.7%) patients were considered in partial response by ΔDp evaluation and 3/11 (27.3%) in stable disease; according ΔDt 7/11 (63.6%) patients showed a partial response, 1/11 (9.1%) showed progression of disease and 3/11 (27.3%) were stable. Perfusion fraction fp showed a significant reduction after ECT only in four patients. No significant difference was observed after ECT in signal intensity of T1-weighted images and T2-weighted images, and in equilibrium-phase of contrast study, according to χ<sup>2</sup> test was observed. A good correlation was reported between ΔHounsfield unit and Δmaximum standardized uptake value and between Δfp and ΔWOS, with a significant statistically difference (P < 0.05) using Spearman correlation coefficient. CONCLUSIONPerfusion and diffusion MR derived parameters, Choi, PERCIST criteria are more performant than morphological MR and CT criteria to assess ECT treatment response.
文摘Objective This study used the Distress Assessment and Response Tool(DART)to screen,evaluate,and explore physical symptoms,psychological problems,and social support in patients with cancer pain,with an aim to provide data for the comprehensive care of these patients to improve their quality of life.Methods The DART was used to survey 497 patients with cancer pain who were admitted to the Cancer Center of the First Hospital of Jilin University from June 2014 to March 2017.All patients were diagnosed with malignant tumors by clinical,radiological and/or cytological examinations,and were experiencing tumor-related pain.This study recorded the patient’s somatic symptoms,psychological problems and social support in detail.After the data were collected,the SPSS 21.0 software was used to perform the statistical analysis,with the significance level set at P<0.05.Results In total,82.7%of patients were experiencing mild pain(NRS≤3);of these,29.7%and 15.8%reported depression and anxiety,respectively.In addition,17.3%of patients were experiencing moderate or severe pain(NRS≥4);of these,53.5%and 40.7%reported depression and anxiety,respectively.There was a statistically significant difference in the incidence of anxiety and depression between the two groups.Conclusion Patients with cancer pain,particularly those with moderate-to-severe pain,showed a high incidence of distress.In addition,they were likely to report physical symptoms,were conscious of poor health conditions,and were prone to have anxiety and depression.In terms of social support,patients with moderate-to-severe cancer pain should receive substantial support,as they experience work-related and economic concerns and report difficulties in family life and social activities.
基金National High Level Hospital Clinical Research Funding(Grant/Award Number:2022-PUMCH-B-048)Capital Health Development Scientific Research Fund(Grant/Award Number:2022-2-4013).
文摘Background: This study assessed the effect of standardized efficacy markers on prognosis in patients with newly diagnosed multiple myeloma(MM)during the induction phase of treatment with bortezomib,cyclophosphamide,and dexamethasone(BCD).Methods :We retrospectively analyzed clinical data in 197 newly diagnosed MM patients treated with BCD as front-line regimen at Peking Union Medical College Hospital from January 1,2013 to December 31,2018.Results: There were 107 patients with International Staging System(ISS)III and 51 with paraprotein of light chain.Of these,77 completed nine cycles of the BCD regimen.As the number of treatment cycles increased,the proportions of serum and urine immunofixation electrophoresis(IFE)tests elevated from 40.39%to 62.22%and 16.75%to 37.78%,respectively.More than 90%of intact immunoglobulin chain MM patients were evaluated for blood M protein per cycle,but that of urinary M protein was less than 60%.The detection rate of urinary M protein in light chain MM was more than 70%per cycle.Patients with a very good partial response(VGPR)had longer progression-free survival(PFS)than those with uncertain VGPR(32 vs.26 months,p=0.0336).Of the 141 patients who completed at least four cycles without undergoing autologous hematopoietic stem cell transplantation,those who were regularly assessed at every other cycle showed more favorable PFS than those who visited irregularly(27 vs.22 months,p=0.059).Conclusion: Urinary M protein detection rate is significantly lower than that in serum,leading to an overestimation of efficacy,premature reduction of treatment intensity,and shortened PFS.Precise response assessments are critical to treatment decisions and clinical diagnoses.
文摘Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.
文摘Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.
文摘BACKGROUND Artificial intelligence in radiology has the potential to assist with the diagnosis,prognostication and therapeutic response prediction of various cancers.A few studies have reported that texture analysis can be helpful in predicting the response to chemotherapy for colorectal liver metastases,however,the results have varied.Necrotic metastases were not clearly excluded in these studies and in most studies the full range of texture analysis features were not evaluated.This study was designed to determine if the computed tomography(CT)texture analysis results of non-necrotic colorectal liver metastases differ from previous reports.A larger range of texture features were also evaluated to identify potential new biomarkers.AIM To identify potential new imaging biomarkers with CT texture analysis which can predict the response to first-line cytotoxic chemotherapy in non-necrotic colorectal liver metastases(CRLMs).METHODS Patients who presented with CRLMs from 2012 to 2020 were retrospectively selected on the institutional radiology information system of our private radiology practice.The inclusion criteria were non-necrotic CRLMs with a minimum size of 10 mm(diagnosed on archived 1.25 mm portal venous phase CT(FOLFOX,FOLFIRI,FOLFOXIRI,CAPE-OX,CAPE-IRI or capecitabine).The final study cohort consisted of 29 patients.The treatment response of the CRLMs was classified according to the RECIST 1.1 criteria.By means of CT texture analysis,various first and second order texture features were extracted from a single nonnecrotic target CRLM in each responding and non-responding patient.Associations between features and response to chemotherapy were assessed by logistic regression models.The prognostic accuracy of selected features was evaluated by using the area under the curve.RESULTS There were 15 responders(partial response)and 14 non-responders(7 stable and 7 with progressive disease).The responders presented with a higher number of CRLMs(P=0.05).In univariable analysis,eight texture features of the responding CRLMs were associated with treatment response,but due to strong correlations among some of the features,only two features,namely minimum histogram gradient intensity and long run low grey level emphasis,were included in the multiple analysis.The area under the receiver operating characteristic curve of the multiple model was 0.80(95%CI:0.64 to 0.96),with a sensitivity of 0.73(95%CI:0.48 to 0.89)and a specificity of 0.79(95%CI:0.52 to 0.92).CONCLUSION Eight first and second order texture features,but particularly minimum histogram gradient intensity and long run low grey level emphasis are significantly correlated with treatment response in non-necrotic CRLMs.
基金Financial support and data source for this work is provided by the US Environmental Protection Agency(No.OR13810-001.04 A10-0223-S001-A02)Guangzhou Environmental Protection Bureau(No.x2hj B2150020)+4 种基金the project of an integrated modeling and filed observational verification on the deposition of typical industrial point-source mercury emissions in the Pearl River Deltapartly supported by the funding of Guangdong Provincial Key Laboratory of Atmospheric Environment and Pollution Control(No.2011A060901011)the project of Atmospheric Haze Collaboration Control Technology Design(No.XDB05030400)from the Chinese Academy of Sciencesthe Ministry of Environmental Protection's Special Funds for Research on Public Welfare(No.201409002)Partly financial support is also provided by the Guangdong Provincial Department of Science and Technology,the project of demonstration research of air quality management cost-benefit analysis and attainment assessments technology(No.2014A050503019)
文摘This article describes the development and application of a streamlined air control and response modeling system with a novel response surface modeling-linear coupled fitting method and a new module to provide streamlined model data for PM_（2.5） attainment assessment in China.This method is capable of significantly reducing the dimensions required to establish a response surface model,as well as capturing more realistic response of PM_（2.5） to emission changes with a limited number of model simulations.The newly developed module establishes a data link between the system and the Software for Model Attainment Test—Community Edition（SMAT-CE）,and has the ability to rapidly provide model responses to emission control scenarios for SMAT-CE using a simple interface.The performance of this streamlined system is demonstrated through a case study of the Yangtze River Delta（YRD） in China.Our results show that this system is capable of reproducing the Community Multi-Scale Air Quality（CMAQ） model simulation results with maximum mean normalized error 〈 3.5%.It is also demonstrated that primary emissions make a major contribution to ambient levels of PM_（2.5） in January and August（e.g.,more than50%contributed by primary emissions in Shanghai）,and Shanghai needs to have regional emission control both locally and in its neighboring provinces to meet China＇s annual PM_（2.5）National Ambient Air Quality Standard.The streamlined system provides a real-time control/response assessment to identify the contributions of major emission sources to ambient PM_（2.5）（and potentially O_3 as well） and streamline air quality data for SMAT-CE to perform attainment assessments.
基金This research was supported by the Sarcoma Alliance for Research through Collaboration LMSARC research fundthe philanthropic LMS360 research fund from the University of Michigan LMS360.
文摘Radiological imaging has a critical role in the diagnosis of sarcomas and in evaluating therapy response assessment.The current gold standard for response assessment in solid tumors is the Response Evaluation Criteria in Solid Tumors,which evaluates changes in tumor size as a surrogate endpoint for therapeutic efficacy.However,tumors may undergo necrosis,changes in vascularization or become cystic in response to therapy,with no significant volume changes;thus,size assessments alone may not be adequate.Such morphological changes may give rise to radiographic phenotypes that are not easily detected by human operators.Fortunately,recent advances in high-performance computing and machine learning algorithms have enabled deep analysis of radiological images to extract features that can provide richer information about intensity,shape,size or volume,and texture of tumor phenotypes.There is growing evidence to suggest that these image-derived or“radiomic features”are sensitive to biological processes such as necrosis and glucose metabolism.Thus,radiomics could prove to be a critical tool for assessing treatment response and may present an integral complement to existing response criteria,opening new avenues for patient assessment in sarcoma trials.
基金The National Natural Science Foundation Youth Fund of China
文摘Background Recently, the combination of sevoflurane and remifentanil has been widely used in general anesthesia. In this study, we investigated the sevoflurane-remifentanil pharmacodynamic interactions at clinical concentrations using the observer＇s assessment of alertness/sedation （OAA/S） and the bispectral index （BIS） by response surface analysis. Methods Totally 65 American Society of Anesthesiologists （ASA） I patients age 20 to 50 years old were included in this study. Patients were randomly assigned to be anesthetized with different target end-tidal sevoflurane concentrations that ranged from 0.2% to 3.4% in increments of 0.2%. The end-tidal sevoflurane concentration was maintained constant throughout the study. Remifentanil was infused with a target controlled infusion （TCI） system at increasing step-wise concentrations from 1 ng/ml to 10 ng/ml. The values of OAA/S and BIS at different sevoflurane-remifentanil concentration combinations were measured. The pharmacodynamic interactions between sevoflurane and remifentanil were analyzed by a response surface method. The three-dimensional response surfaces were constructed with Minitab Software. Model parameters were estimated with NONMEM program. Results Sevoflurane and remifentanil acted synergistically on OANS. Sevoflurane alone could produce OANS 〈1 at a minimal alveolar concentration （MAC） of 0.93%. When used in combination with remifentanil at 1, 3, 6, and 10 ng/ml, the corresponding sevoflurane MACs were reduced to 0.79%, 0.58%, 0.48%, and 0.38%, with reductions of 17.2%, 37.6%, 48.4%, and 62.0% from baseline, respectively. In patients administered remifentanil alone, the OANS score was 〉3 even when the remifentanil concentration reached 10 ng/ml. BIS was closely associated with the sevoflurane concentration and the remifentanil concentration did not noticeably influence the relationship between the sevoflurane concentration and BIS. A sevoflurane concentration of （1.04＋0.19）% to （1.81＋0.21）% could maintain a BIS between 60 and 40. Conclusions The response surface method can analyze the pharmacodynamic interactions between remifentanil and sevoflurane qualitatively and quantitatively. Within the range of our study （remifentanil 〈10 ng/ml, sevoflurane 〈3.4%）, the two drugs produced synergistic effects on OAA/S but had no interactive effect on BIS. A guideline of BIS between 40 and 60 may cause excessive anesthesia when opioids are used to maintain anesthesia.
基金supported by National Natural Science Foundation of China(81761148029,81725009,82030049,32027802)National Key R&D Program of China(2021YFA110004500,2021YFE0108300)Fundamental Research Funds for the Central Universities(2021FZZX002-05).
文摘Positron emission tomography(PET)represents molecular imaging for non-invasive phenotyping of physiological and biochemical processes in various oncological diseases.PET imaging with 18F-fluorodeoxyglucose(18F-FDG)for glucose metabolism evaluation is the standard imaging modality for the clinical management of lymphoma.One of the 18F-FDG PET applications is the detection and pre-treatment staging of lymphoma,which is highly sensitive.18F-FDG PET is also applied during treatment to evaluate the individual chemo-sensitivity and accordingly guide the response-adapted therapy.At the end of the therapy regiment,a negative PET scan is indicative of a good prognosis in patients with advanced Hodgkin’s lymphoma and diffuse large B-cell lymphoma.Thus,adjuvant radiotherapy may be alleviated.Future PET studies using non-18F-FDG radiotracers,such as 68Ga-labeled pentixafor(a cyclic pentapeptide that enables sensitive and high-contrast imaging of C-X-C motif chemokine receptor 4),68Ga-labeled fibroblast activation protein inhibitor(FAPI)that reflects the tumor microenvironment,and 89Zr-labeled atezolizumab that targets the programmed cell death-ligand 1(PD-L1),may complement 18F-FDG and offer essential tools to decode lymphoma phenotypes further and identify the mechanisms of lymphoma therapy.
