ObjectiveTo explore the accuracy of machine learning algorithms based on SHOX2 and RASSF1A methylation levels in predicting early-stage lung adenocarcinoma pathological types. MethodsA retrospective analysis was conducted on formalin-fixed paraffin-embedded (FFPE) specimens from patients who underwent lung tumor resection surgery at Affiliated Hospital of Nantong University from January 2021 to January 2023. Based on the pathological classification of the tumors, patients were divided into three groups: a benign tumor/adenocarcinoma in situ (BT/AIS) group, a minimally invasive adenocarcinoma (MIA) group, and an invasive adenocarcinoma (IA) group. The methylation levels of SHOX2 and RASSF1A in FFPE specimens were measured using the LungMe kit through methylation-specific PCR (MS-PCR). Using the methylation levels of SHOX2 and RASSF1A as predictive variables, various machine learning algorithms (including logistic regression, XGBoost, random forest, and naive Bayes) were employed to predict different lung adenocarcinoma pathological types. ResultsA total of 272 patients were included. The average ages of patients in the BT/AIS, MIA, and IA groups were 57.97, 61.31, and 63.84 years, respectively. The proportions of female patients were 55.38%, 61.11%, and 61.36%, respectively. In the early-stage lung adenocarcinoma prediction model established based on SHOX2 and RASSF1A methylation levels, the random forest and XGBoost models performed well in predicting each pathological type. The C-statistics of the random forest model for the BT/AIS, MIA, and IA groups were 0.71, 0.72, and 0.78, respectively. The C-statistics of the XGBoost model for the BT/AIS, MIA, and IA groups were 0.70, 0.75, and 0.77, respectively. The naive Bayes model only showed robust performance in the IA group, with a C-statistic of 0.73, indicating some predictive ability. The logistic regression model performed the worst among all groups, showing no predictive ability for any group. Through decision curve analysis, the random forest model demonstrated higher net benefit in predicting BT/AIS and MIA pathological types, indicating its potential value in clinical application. ConclusionMachine learning algorithms based on SHOX2 and RASSF1A methylation levels have high accuracy in predicting early-stage lung adenocarcinoma pathological types.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
目的：探讨慢性非侵袭性真菌性鼻窦炎(NIFS)的治疗要点。方法：分析11 例NIFS 患者，全部施行鼻内镜手术，术后定期随访。结果：术后随访2年，全部治愈。结论：以鼻内镜手术治疗为主的综合治疗，疗效好，复发率低。
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
Stage T1 lung cancer refers to the tumor with maximum diameter≤3 cm, surrounded by the pleural membrane of the lung or viscera, and does not exceed the lobar bronchus under the bronchoscope. The prognosis is generally good, but some of them are more invasive, and more aggressive treatments are needed to achieve the best prognosis. This article reviews which T1 lung cancers are susceptible to metastasis and their risk factors. It is hoped that such patients will receive the attention of relevant scholars, and when they are encountered clinically, a more aggressive approach will be taken to extend their life expectancy．
Objective The aim of this article is to analyze the clinical characteristics of intra-abdominal aggressive fibromatosis and discuss its treatment methods. Methods Retrospective analysis of the clinical data in 8 cases of intra-abdominal aggressive fibromatosis who were confirmed by surgery and pathological diagnosis between Feb. 2011 and Mar. 2017 in Shengjing hospital was performed. Results Of the 8 cases (3 males and 5 females), there were 4 cases of simple abdominal pain (2 cases of repeated intermittent abdominal pain and 2 cases of acute abdominal pain), 3 cases of abdominal mass, and 1 case of relapses after surgery in outside hospital (others 7 cases were the first visit). The course of disease was 4 to 720 d, with median of 130 d. All cases underwent radical surgery, and the operative time was 92 to 493 min, with an average of 246 min. Intraoperative blood loss was 20 to 1 000 mL, with an average of 321 mL. The drainage tube placement time in all patients was 5 to 9 d, with an average of 6 d. The hospital stay was 11 to 75 d, with an average of 25 d. Two cases suffered from postoperatively appeared abdominal pain symptoms. All cases were followed-up for 6 to 40 months, with median of 23 months. During the follow-up period, 1 case relapsed on 212 dafter surgery, and the remaining 7 cases had no recurrence. Conclusion For intra-abdominal aggressive fibromatosis, it is difficult to make clear diagnosis before operation and surgery is the primary choice of treatment when symptom appeared.
目的 观察非侵袭性真菌性鼻窦炎鼻内镜手术治疗效果及围手术期治疗对疗效的影响。 方法 回顾性分析2008年6月－2010年12月诊治的86例非侵袭性真菌性鼻窦炎患者的临床特征，总结鼻内镜手术治疗效果及围手术期抗生素、黏液促排剂、鼻喷激素、鼻冲洗等综合治疗的作用。 结果 86例患者均一次治愈，随访1～3年，无复发；围手术期综合治疗有利于减少术中出血，减轻术后黏膜水肿、减少分泌物，缩短病程。 结论 鼻内镜下彻底清除病灶是非侵袭性真菌性鼻窦炎安全、有效的一种治疗方法；合理的围手术期综合治疗具有其积极的作用。
Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive pulmonary fungal infection( IPFI) . Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases( 62. 2% ) , Cryptococcus in 18 cases( 20. 0% ) , Mucormycosis in 6 cases( 6. 7% ) , and Histoplasma in 6 cases( 6. 7% ) , etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients ( 54. 4% ) received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases( 27. 8%) , nodule lesions type in 15 cases( 16. 7% ) , lung consolidation type in 22 cases( 24. 4% ) , cavity type in 22 cases( 24. 4% ) , aspergilloma type in 6 cases( 6. 7% ) . 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2% . 31 cases ( 34. 4% ) underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases ( 62. 2% ) received systemic anti-fugal therapy, and 43 cases( 76. 8% ) were cured or significantly improved. 3 cases ( 3. 3% ) refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-termand broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.