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Background Immunotherapy is becoming a standard of care for non-small cell lung cancer (NSCLC). Checkpoint inhibitor-associated pneumonia (CIP) is a rare and potentially life-threatening event that can occur at any time during tumor immunotherapy. However, there may be differences in the radiological patterns and prognosis of CIP during different periods. This study aimed to investigate the radiographic features and prognosis of early- and late-onset immune-related pneumonitis. Methods We retrospectively analyzed the clinical data of 677 NSCLC patients receiving immunotherapy to identify 32 patients with CIP, analyzed the clinical and radiographic data, and summarized the radiological features and prognosis of early- and late-onset CIP. Results CIP had an incidence of 4.7%, a median onset time of 10 weeks, and a mortality of 28.1%. Among these, CIP included 14 early-onset cases, where grade ≥ 3 CIP accounted for 92.9%, main radiographic pattern was organizing pneumonia (OP)-like pattern, and mortality was 50.0%. We also identified 18 late-onset CIPs, where grade ≥ 3 CIP accounted for 50.0%, main radiographic pattern was nonspecific interstitial pneumonia (NSIP)-like pattern, and mortality was 11.1%. The overall survival rate of the early-onset group was significantly lower than that of the late-onset group (P Conclusion Early-onset CIP cases were higher in the Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade and mainly presented with an OP-like radiographic pattern; whereas, late-onset CIP cases were lower in CTCAE grade and mainly presented with an NSIP-like radiographic pattern. Finally, the prognosis of the early-onset CIP group was poorer than that of the late-onset CIP group. We believe that this study will be helpful for clinicians for making early diagnosis and deciding treatment modalities for patients with CIP.

In clinic, perioperative neurocognitive disorder is becoming a common complication of surgery in old patients. Neuroinflammation and blood-brain barrier (BBB) disruption are important contributors for cognitive impairment. Atorvastatin, as a strong HMG-CoA reductase inhibitor, has been widely used in clinic. However, it remains unclear whether atorvastatin could prevent anesthesia and surgery-induced BBB disruption and cognitive injury by its anti-inflammatory property. In this study, aged C57BL/6J mice were used to address this question. Initially, the mice were subject to atorvastatin treatment for 7 days (10 mg/kg). After a simple laparotomy under 1.5% isoflurane anesthesia, Morris water maze was performed to assess spatial learning and memory. Western blot analysis, immunohistochemistry, and enzyme-linked immunosorbent assay were used to examine the inflammatory response, BBB integrity, and cell apoptosis. Terminal-deoxynucleotidyl transferase mediated nick end labeling assay was used to assess cell apoptosis. The fluorescein sodium and transmission electron microscopy were used to detect the permeability and structure of BBB. The results showed that anesthesia and surgery significantly injured hippocampal-dependent learning and memory, which was ameliorated by atorvastatin. Atorvastatin could also reverse the surgery-induced increase of systemic and hippocampal cytokines, including IL-1β, TNF-α, and IL-6, accompanied by inhibiting the nuclear factor kappa-B (NF-κB) pathway and Nucleotide-Binding Oligomerization Domain, or Leucine Rich Repeat and Pyrin Domain Containing 3 (NLRP3) inflammasome activation, as well as hippocampal neuronal apoptosis. In addition, surgery triggered an increase of BBB permeability, paralleled by a decrease of the ZO-1, occludin, and Claudin 5 proteins in the hippocampus. However, atorvastatin treatment could protect the BBB integrity from the impact of surgery, by up-regulating the expressions of ZO-1, occludin, and Claudin 5. These findings suggest that atorvastatin exhibits neuroprotective effects on cognition in aged mice undergoing surgery.

Yuanyong Wang,1,* Naixin Liang,2,* Zhiqiang Xue,1 Xinying Xue3,4 1Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Department of Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 4Department of Respiratory Disease, School of Clinical Medicine, Weifang Medical University, Weifang, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinying XueDepartment of Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of ChinaEmail xinyingxue2010@163.comZhiqiang XueDepartment of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of ChinaEmail xuezhiqiang301@126.comBackground and Aims: Esophageal adenocarcinoma (EAC) patients usually have a poor prognosis without early diagnosis. In this study, we aimed to identify a novel signature to improve the prediction of overall survival (OS) in EAC.Methods: Eighty-one and 68 samples from The Cancer Genome Atlas (TCGA) and GSE19417 dataset were included for discovery and survival validation, respectively. In the TCGA cohort, a total of 1,811 DEmRNAs, 1,096 DElncRNAs, and 31 DEmiRNAs were identified between EAC and normal esophagus tissues. A mRNA–miRNA–lncRNA ceRNA network of EAC was established, which consisted of 94 DEmRNAs, 13 DEmiRNAs, and 46 DElncRNAs.Results: In this study, we identified eight genes (UBE2B, LAMP2, B3GNT2, TAF9B, EFNA1, PHF8, PIGA, and NEURL1) which were related to survival in EAC. The independent external microarray data from the Gene Expression Omnibus (GEO) was used to validate these candidate genes. The prognostic ability of the signature was also validated in EAC patients in our hospital. Patients assigned to the high-risk group had a poor overall survival rate compared with the low-risk.Conclusion: The current study provides novel insights into the mRNA-related ceRNA network in EAC and the eight mRNA biomarkers may be independent prognostic signatures in predicting the survival of EAC patients.Keywords: esophageal adenocarcinoma, signature, competing endogenous RNA, overall survival, TCGA

In this paper, we focus on the research of matching a computer-generated composite face sketch to a photograph. This is of great importance in the field of criminal investigation. To blend the different facial representation modalities, we propose a robust feature model by combining pixel-level features extracted from multi-scale key face patches and high-level features learned from a pre-trained deep learning-based model. At first, texture features are captured by a two-level histogram of oriented gradient descriptor, considering both the overall structure and local details. The semantic-level facial characteristics are analyzed through the high-level features of the Visual Geometry Group-Face (VGG-Face) network. Next, feature similarities between each sketch/photograph pair are measured by feature distance. Then, adaptive weights are assigned to each feature similarity, and score level fused according to their visual saliency contribution. Finally, the fused feature similarity is evaluated for matching purposes. After experimenting on the Pattern Recognition and Image Processing-Viewed Software-Generated Composite (PRIP-VSGC) database and the expanded University of Malta Composite Face Sketch (UoM-SGFS) database, it is found that this framework could achieve more satisfying results compared to the existing methods.

this study attempts to identify the independent risk factors that can predict lymph node metastasis for the patients with non-small cell lung cancer (NSCLC), and guide doctor adoption of individualized treatment for such patients.This study was approved by the Hospital's Ethics Committee and all patients had signed informed consent forms. We retrospectively reviewed NSCLC patients who had undergone surgical resection from December 2008 to December 2013.The statistical significance of evaluation variables and lymph node metastasis was determined with Pearson's Chi-square test. The risk factors of lymph node metastasis were determined through univariate and multivariate logistic regression analysis. And for the age and tumor diameter factors, optimal cutoff points were determined with a receiver operating characteristic analysis.In the present study, a total of 2623 patients were included in the study, and 779 patients with lymph node metastasis. Three independent risk factors were identified: age, tumor diameter and Ki-67 index. We found that65 years of age (Adjusted-OR:1.921), ≥2.85 cm of tumor diameter (Adjusted-OR:3.141), and 5%~25% in Ki-67 group (Adjusted-OR:2.137),≥25% (Adjusted-OR:3.341) were significant. Also we found that 307 patients with lymph node metastasis and the lymph node metastasis rate was 51.0%, when the age65 years, Ki-67 index≥25%, and the tumor diameter≥2.85 cm. On the contrary, there were only 2 patients with lymph node metastasis, and the rate of lymph node metastasis was 5.1%.Identifying three independent risk factors that predict lymph node metastasis in non-small cell patients, Among NSCLC patients in whom all three predictors were identified, and over a half of the patients showed lymph node metastasis.

Identifying early-stage cancer patients at risk for progression is a major goal of biomarker research. This report describes a novel 19-gene signature (19-GCS) that predicts stage I lung adenocarcinoma (LAC) recurrence and response to therapy and performs comparably in pancreatic adenocarcinoma (PAC), which shares LAC molecular traits. Kaplan-Meier, Cox regression, and cross-validation analyses were used to build the signature from training, test, and validation sets comprising 831 stage I LAC transcriptomes from multiple independent data sets. A statistical analysis was performed using the R language. Pathway and gene set enrichment were used to identify underlying mechanisms. 19-GCS strongly predicts overall survival and recurrence-free survival in stage I LAC (P=0.002 and P

Background: As a life-threatening fungus, Cryptococcus gattii (C gattii) species complex is emerging worldwide. However, the geographical distribution, molecular traits, and virulence difference are poorly characterized in China.Results: From 2011 to 2017, we collected 32 strains of C gattii from 18 hospitals across China, of which 27 [84·4%] strains molecular traits were profiled by whole-genome sequencing (WGS) and multi-locus sequence typing (MLST) and compared with strains previously described in China from 2006 to 2020. Totally 119 clinical cases caused by C gattii strains (87 in previous reports and 32 in our study) distributed widely in 20 provincial-level administrative regions of China, of which 114 strains molecular types were obtained. The majority molecular type was VGI (81/114, 71·1%) and the other was VGII (33/114, 28·9%). Four major subtypes of VGI (VGIa, VGIb, VGIc, and VGId) were revealed from global C gattii VGI (n=308), respectively accounting for 52·9% (163/308), 36·0% (111/308), 3·9% (12/308), and 4·2% (13/308). The other nine strains could not be assigned to these four subtypes clearly. Our clinical data suggested that VGIb cases had a worse clinical outcome than VGIa, which was consistent with in vitro and in vivo experiments. In addition, a candidate virulence SNP on SOD2 in VGIa was initially identified by comparing high-quality de novo reference genome.Conclusions: The geographical distribution of C gattii species complex was first described in China. C gattii VGI could be clearly segregated into four major subtypes based on genomics profiles and VGIb was more virulent than VGIa in China. Our study suggests the molecular type of C gattii is necessary for personalized treatment in clinic.

There are increasing reports of a type of lung cancer that manifests as solitary cystic airspaces. The purpose of this case series was to identify the CT features and possible mechanisms of solitary cystic lung cancer, on the basis of CT observations and pathologic characteristics. The clinical, imaging, and pathologic data of 106 patients with solitary cystic lung cancer were collected and analyzed between January 2011 and December 2017. CT images were reviewed independently by three radiologists who were blinded to pathologic findings. Demographic data and clinical and smoking status were extracted from the medical records. The mean age was 58.8 years 6 10.6 (standard deviation) (range, 30–82 years). CT features in the 106 patients included nonuniform cystic walls in 96 (90.6%) patients, cyst septations in 62 (58.5%) patients, nodular walls in 58 (54.7%) patients, ground-glass opacity around the cyst in 53 patients (50.0%), and irregular margins in 42 (39.6%) patients. At histologic examination, the majority of cases (81 [87.1%] of 93) were adenocarcinoma.

BACKGROUND This multiple-center retrospective study aimed to investigate computed tomography (CT) imaging findings in 72 patients with airway-invasive pulmonary aspergillosis. MATERIAL AND METHODS Seventy-two patients with airway-invasive pulmonary aspergillosis confirmed by pathology results were divided into 3 types according to image characteristics. Type I involved the trachea or the main bronchus. Type II involved the lobular and segmental bronchi, which manifested early as bronchial wall thickening, and later development was divided into types IIa and IIb. Type IIa manifested as bronchiectasis, and type IIb manifested as consolidation around the bronchus. Type III involved the bronchioles and pulmonary parenchyma, with tree-in-bud sign and acinar nodules around. CT signs of the various types and their differentiation were investigated. RESULTS The main clinical manifestations of the 72 patients with airway-invasive pulmonary aspergillosis were shortness of breath (55/72, 76.4%), cough (40/72, 55.6%), expectoration (35/72, 48.6%), dyspnea (8/72, 11.1%), weight loss (2/72, 2.8%), and fever (30/72, 41.7%). CT typing identified 3 types: 2 patients (2.8%) had type I, presenting as thickening of trachea or main bronchial walls; 3 patients (4.2%) had early type II, manifesting as thickening of lobular or segmental bronchial walls; 27 patients (37.5%) developed type IIa, manifesting as bronchiectasis; 22 patients (30.6%) had type IIb, manifesting as consolidation around the bronchus; and 18 patients (25.0%) had type III, presenting as nodules and patchy shadows with small cavities in the periphery of the lung. CONCLUSIONS Airway pulmonary aspergillosis has characteristic imaging findings, which can help early clinical diagnosis through classification according to CT imaging characteristics.

Objective This study aimed to compare the clinical features of pulmonary cryptococcosis (PC) in patients with and without central nervous system (CNS) involvement. Methods We retrospectively reviewed demographics, presenting symptoms, radiographic features, and laboratory findings of patients diagnosed with PC in 28 hospitals from 2010 to 2019. Risk factors for CNS involvement were analyzed using logistic regression models. Result A total of 440 patients were included, and 36 (8.2%) had CNS involvement. Significant differences in fever, headache, and chills occurred between the two groups (overall and with/without CNS involvement) for fever (17.8% [78/440]; 52.8% vs. 14.6% of patients, respectively), headache (4.5% [20/440]; 55.6% vs. 0% of patients, respectively), and chills (4.3% [19/440]; 13.9% vs. 3.5% of patients, respectively). The common imaging manifestation was nodules (66.4%). Multivariate analysis showed that cavitation (adjusted odds ratio [AOR] = 3.552), fever (AOR = 4.182), and headache were risk factors for CNS involvement. Routine blood tests showed no differences between the groups, whereas in cerebrospinal fluid the white blood cell count increased significantly and glucose decreased significantly. Conclusion In patients with PC, the risk of CNS involvement increases in patients with headache, fever, and cavitation; these unique clinical features may be helpful in the diagnosis.

Small cell lung cancer (SCLC) is highly invasive and lethal. Genomic studies are beginning to characterize its genetic determinants and heterogeneity. Here we performed RNA-Seq and whoe exome sequencing (WES) in 19 Chinese SCLC clinical tumor specimens. Integration with other two public cohorts (n = 129 for RNA-seq, n = 171 for WES), we carried out gene co-expression network analysis and classified into four subgroups: ASCL1-high, NEUROD1-high, a novel variant subtype with CCSP/CC10-high, and a fourth subtype with high expression of NOTCH family and inflammatory genes. We further found that this fourth subtype was characterized by overexpression of immune-related pathways and immunosuppressive factors, referred to as immune subtype. In addition to transcriptomic signatures, specific genomic alterations were also significantly enriched in each subtype. We successfully built a machine learning model to predict the subtypes of newly coming specimens based on transcriptomic data. In particular, we found that POU2F3 protein was effective in distinguishing immunotherapy patients, i.e. the immune subtype, which was further validated by an independent data of chemo-resistant patients received 2nd -line immunotherapy. Collectively, our work systematically studied the transcriptomic and genomic heterogeneity of SCLC, and characterized an immune subtype that displayed features of sensitivity to immune checkpoint-based therapies.

Isoflurane, a widely used volatile anesthetic, induces neuronal apoptosis and memory impairments in various animal models. However, the potential mechanisms and effective pharmacologic agents are still not fully understood. The p38MAPK/ATF-2 pathway has been proved to regulate neuronal cell survival and inflammation. Besides, atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, exerts neuroprotective effects. Thus, this study aimed to explore the influence of atorvastatin on isoflurane-induced neurodegeneration and underlying mechanisms. Aged C57BL/6 mice (20 months old) were exposed to isoflurane (1.5%) anesthesia for 6 h. Atorvastatin (5, 10, or 20 mg/kg body weight) was administered to the mice for 7 days. Atorvastatin attenuated the isoflurane-induced generation of ROS and apoptosis. Western blotting revealed a decrease in cleaved caspase-9 and caspase-3 expression in line with ROS levels. Furthermore, atorvastatin ameliorated the isoflurane-induced activation of p38MAPK/ATF-2 signaling. In a cellular study, we proved that isoflurane could induce oxidative stress and inflammation by activating the p38MAPK/ATF-2 pathway in BV-2 microglia cells. In addition, SB203580, a selected p38MAPK inhibitor, inhibited the isoflurane-induced inflammation, oxidative stress, and apoptosis. The results implied that p38MAPK/ATF-2 was a potential target for the treatment of postoperative cognitive dysfunction.

Background Pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) is the most frequent subset of primary pulmonary lymphoma. This study aimed to identify radiologic characteristics of pulmonary MALToma based on computed tomography (CT) observations and pathologic features, and further investigate its prognosis. Methods Sixty-six patients (55.4 ± 10.9 years; 51.5% male) diagnosed as pulmonary MALToma by pathology were retrospectively enrolled. According to distributions and features of lesions shown on CT, patients were divided into three patterns, including single nodular/mass, multiple nodular/mass, and pneumonia-like consolidative. Results Variety of the location and extent of the lymphomatous infiltration accounted for different characteristics demonstrated at CT. The pneumonia-like consolidative pattern was the most frequent pattern observed in 42 patients (63.6%), followed by single nodular/mass (21.2%) and multiple nodular/mass (15.2%). CT features included air bronchogram (72.7%), well-marginated halo sign (53.0%), coarse spiculate with different lengths (72.7%), angiogram sign (77.1% of 35 patients), peribronchovascular thickening (48.5%), irregular cavitation (16.7%) and pulmonary cyst (7.6%). The estimated 5-year cumulative overall survival rate of pulmonary MALToma was 100.0%. Conclusions Pulmonary MALToma demonstrates several characteristics at CT. Identification of the significant pulmonary abnormalities of this indolent disease entity might be helpful for early diagnosis and optimal treatment.

Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.

Patients with pneumonia-type lung cancer (PTLC) do not exhibit specific clinical features, which makes imaging diagnosis difficult. Therefore, the aetiology of the pathological changes occurring during PTLC remains unclear. The current study aimed to explore the possible mechanism of PTLC formation by CT scans and pathological analysis of the lungs. A retrospective analysis was conducted on the CT and pathological data of 17 cases of PTLC. The diagnosis of lung cancer was confirmed by pathology. The CT scans of nine patients indicated diffuse distribution of lesions in the lungs, whereas those of three patients indicated single-lung multi-leaf distribution, and those of the remaining five patients included single-leaf distribution. All patients demonstrated increased plaque or patchy density in the majority of the lesions located near the heart. The pathological types of the identified tumours were mucinous adenocarcinoma with adherent growth as the main sub-type. A large number of mucus lakes were observed, containing floating tumour cells, as determined by optical microscopy. In addition, a number of tumour cells were located in the residual alveolar wall of the observed mucus lakes. The results of the present study suggested that the mucinous adenocarcinoma tumour cells produced substantial quantities of mucus, and that the cells were scattered and planted along with the mucus through the airway, which led to possible development of pneumonia-type mucinous adenocarcinoma.

Immune-related adverse events (irAEs), caused by anti-PD-1/PD-L1 antibodies, can lead to fulminant and even fatal consequences and thus require early detection and aggressive management. However, a comprehensive approach to identify biomarkers of irAE is lacking. Here, we utilize a strategy that combines pharmacovigilance data and omics data, and evaluate associations between multi-omics factors and irAE reporting odds ratio across different cancer types. We identify a bivariate regression model of LCP1 and ADPGK that can accurately predict irAE. We further validate LCP1 and ADPGK as biomarkers in an independent patient-level cohort. Our approach provides a method for identifying potential biomarkers of irAE in cancer immunotherapy using both pharmacovigilance data and multi-omics data., Immunotherapy, the reactivation of the immune system to recognize cancer cells, can be accompanied by severe adverse effects. Here, the authors use pharmacovigilance and genomic data to be able to predict which patients might be susceptible to such severe events.

Background: Detailed catalog of lung cancer-associated gene mutations provides valuable information for lung cancer diagnosis and treatment. In China, there has never been a wide-ranging study cataloging lung cancer-associated gene mutations. This study aims to reveal a comprehensive catalog of lung cancer gene mutations in china, focusing on EGFR, ALK, KRAS, HER2, PIK3CA, MET, BRAF, HRAS, and CTNNB1 as major targets. Additionally, we also aim to correlate smoking history, gender, and age distribution and pathological types with various types of gene mutations. Patients and Methods: A retrospective data acquisition was conducted spanning 6 years (2013-2018) among all patients who underwent lung cancer surgeries not bronchial or percutaneous lung biopsy at three major tertiary hospitals. Finally, we identified 1,729 patients who matched our inclusion criteria. Results: 1081 patients (62.49%) harbored EGFR mutation. ALK (n = 42, 2.43%), KRAS (n = 201, 11.62%), CTNNB1 (n = 28, 1.62%), BRAF (n = 31, 1.79%), PIK3CA (n = 51, 2.95%), MET (n = 14, 0.81%), HER2 (n = 47, 2.72%), HRAS (n = 3, 0.17%), and other genes(n = 232, 13.4%). Females expressed 55.38% vs. males 44.62% mutations. Among subjects with known smoking histories, 32.82% smokers, 67.15% non-smokers were observed. Generally, 51.80% patients were above 60 years vs. 48.20% in younger patients. Pathological types found includes LUADs 71.11%, SQCCs 1.68%, ASC 0.75%, LCC 0.58%, SCC 0.35%, ACC 0.17%, and SC 0.06%, unclear 25.19%. Conclusion: We offer a detailed catalog of the distribution of lung cancer mutations. Showing how gender, smoking history, age, and pathological types are significantly related to the prevalence of lung cancer in China.

Objective This study was performed to compare the radiologic characteristics and pathological presentations of primary pulmonary lymphoma (PPL), explore the possible mechanism underlying its development, summarize its radiologic characteristics, and improve the accuracy of its diagnosis. Methods The medical records of 22 patients pathologically diagnosed with PPL were retrospectively analyzed. Results Chest computed tomography (CT) demonstrated single or multiple nodules and masses in the lungs, patchy opacities or consolidation along the bronchovascular bundle, and no significantly enlarged mediastinal or hilar lymph nodes. All 22 cases of PPL were classified as non-Hodgkin’s lymphoma (NHL) by transbronchial biopsy, CT-guided needle biopsy, and postoperative pathology. Most (16 cases) were marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). Twelve patients had air bronchograms within the lesion, and 13 showed ill-defined lesions with ground-glass brush-like changes. Conclusion PPL is a rare lung tumor, and most are classified as MALT lymphoma, a subtype of NHL. Chest CT can help to diagnose this disease. Positron emission tomography (PET)/CT is of great clinical value for evaluation of the lesion and patient’s general condition. The possibility of PPL should be considered in patients with characteristic CT and PET/CT findings and mild clinical symptoms, and early treatment should be administered.

Exosome is a crucial manner for cancer cell to cell communication and circulating exosomes sever as promising diagnostic and prognostic markers for various types of diseases. A predominant type of cargo of exosome is small RNAs, especially miRNAs. Here, we profiled plasma exosomal miRNAs of six lung adenocarcinoma patients before and after surgery, as well as six healthy individuals as normal control. Our profiling revealed 38 upregulated and 37 downregulated exosomal miRNAs in the plasma of lung adenocarcinoma patients. Additionally, we found that most upregulated miRNAs were increased in the lung adenocarcinoma samples of TCGA database. We further evaluated the correlation between the upregulated exosomal miRNAs and overall survival with Kaplan-Meier survival analysis using online databases. Our results suggested that exosomal miR-151a-5p, miR-10b-5p, miR-192-5p, miR-106b-3p, and miR-484 are potential prognostic markers for lung adenocarcinoma. Importantly, we validated candidate miRNAs in lung adenocarcinoma patients before and after surgery as well as in healthy controls and found that miR-484 was significantly increased in the plasma of lung adenocarcinoma patients and strikingly decreased post-surgery. Hence, we provided novel information on lung adenocarcinoma-derived exosomal miRNA and potential non-invasive diagnostic and prognostic markers for lung adenocarcinoma.

Composite sketch recognition belongs to heterogeneous face recognition research, which is of great important in the field of criminal investigation. Because composite face sketch and photo belong to different modalities, robust representation of face feature cross different modalities is the key to recognition. Considering that composite sketch lacks texture details in some area, using texture features only may result in low recognition accuracy, this paper proposes a composite sketch recognition algorithm based on multi-scale Hog features and semantic attributes. Firstly, the global Hog features of the face and the local Hog features of each face component are extracted to represent the contour and detail features. Then the global and detail features are fused according to their importance at score level. Finally, semantic attributes are employed to reorder the matching results. The proposed algorithm is validated on PRIP-VSGC database and UoM-SGFS database, and achieves rank 10 identification accuracy of 88.6% and 96.7% respectively, which demonstrates that the proposed method outperforms other state-of-the-art methods.

Cholangiocarcinoma (CCA) and gallbladder carcinoma (GBC) are biliary tract cancers with poor five-year survival and high recurrence rates. Both CCA and GBC patients suffer from lack of circulating diagnostic biomarkers at the early stage. Extracellular vesicles, especially exosomes, have been emerged as promising diagnostic sources for cancers due to easy and quick accessibility. Hence, identification of exosomal biomarkers provides a novel strategy for CCA and GBC diagnosis. Here, five CCA patients and four GBC patients were enrolled for exosomal small RNA sequencing. Our data showed that exosomal piwi-interacting RNA (piRNA) populations were altered in the plasma of CCA and GBC patients. In comparison to healthy individuals, 694 and 323 piRNAs were upregulated in CCA and GBC, respectively, while 36 and 191 piRNAs were downregulated. Interestingly, sequencing results predicted that piR-2660989, piR-10506469, piR-20548188, piR-10822895, piR-hsa-23209, and piR-18044111 were upregulated in both CCA and GBC plasma. Importantly, we further included blood samples from 50 health individuals, 40 CCA patients, and 25 GBC patients and found that piR-10506469 were significantly increased in the exosomes of plasma from both CCA and GBC patients. Moreover, we analyzed the expression levels of differentially expressed exosomal piRNAs in the plasma of CCA and GBC patient before and after surgeries and found that piR-10506469 and piR-20548188 were significantly decreased in patients underwent surgeries. Taken together, our data revealed that exosomal piRNAs those are differentially expressed in CCA and GBC plasma may serve as potential biomarkers for the diagnosis of CCA and GBC.

// Xinying Xue 1, 2 , Yuxia Liu 3 , Yong Wang 1 , Mingming Meng 4 , Kaifei Wang 2 , Xuefeng Zang 5 , Sheng Zhao 6 , Xiaohua Sun 7 , Lei Cui 8 , Lei Pan 1 , Sanhong Liu 9 1 Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing, China 2 Department of Respiratory Diseases of Chinese PLA General Hospital, Beijing, China 3 Department of Research, Peking Union Medical Collage Hospital, Beijing, China 4 Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China 5 Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China 6 Department of Cardiology, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Beijing, China 7 Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China 8 Department of Central Laboratory, Beijing Shijitan Hospital, Capital Medical University, Beijing, China 9 Shanghai Institute of Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, China Correspondence to: Lei Pan, email: leipan2010@163.com Sanhong Liu, email: liush@shanghaitech.edu.cn Lei Cui, email: cuileite@aliyun.com Keywords: non-small cell lung carcinoma, miR-21, miR-155, SOCS1, SOCS6 Received: July 11, 2016 Accepted: October 25, 2016 Published: November 02, 2016 ABSTRACT Lung cancer remains the leading cause of cancer-associated death worldwide. MiR-21 and miR-155 are the most amplified miRNAs in non-small cell lung carcinoma (NSCLC), and are critical promoters of NSCLC progression. However, it remains unclear how miR-21 and miR-155 induce cancer progression, and whether these miRNAs share common targets, such as tumor suppressor genes required to prevent NSCLC. Here we report that miR-21 and miR-155 levels are elevated in NSCLC and are proportional to the progression of the disease. In addition, miR-21 and miR-155 share nearly 30% of their predicted target genes, including SOCS1 , SOCS6 , and PTEN , three tumor suppressor genes often silenced in NSCLC. Consequently, antagonizing miR-21, miR-155 or both potently inhibited tumor progression in xenografted animal models of NSCLC. Treatment with miR-21 and miR-155 inhibitors in combination was always more effective against NSCLC than treatment with a single inhibitor. Furthermore, levels of miR-21 and miR-155 expression correlated inversely with overall and disease-free survival of NSCLC patients. Our findings reveal that miR-21 and miR-155 promote the development of NSCLC, in part by downregulating SOCS1 , SOCS6 , and PTEN . Combined inhibition of miR-21 and miR-155 could improve the treatment of NSCLC.

Recent studies reported negative predictors for immune checkpoint inhibitors (ICI) in non–small cell lung cancer (NSCLC), including STK11, KEAP1 , and PTEN ([1–3][1]). Aggarwal and colleagues' study showed that patients with NSCLC with high blood-based tumor mutation burden (bTMB) and absence of

The manifestations of pulmonary cryptococcosis with multiple nodules or masses on computed tomography (CT) are diverse and difficult to differentiate from those of lung cancer and pulmonary tuberculosis. The present study compared the multislice spiral CT signs with pathological results and used the pathological results to explain the CT signs with the aim of improving the accuracy of the diagnosis of this disease. A retrospective analysis of 20 patients with primary pulmonary cryptococcosis with multiple nodules or masses was performed. Based on the CT signs, eight patients had been misdiagnosed with lung cancer accompanied by intrapulmonary metastasis andthree patients had been misdiagnosed with tuberculosis. The major CT manifestations were a cluster of nodules or masses located within 2 cm below the pleura and distributed along the bronchi. A total of nine patients had primary lesions with diameters of 1.1–2.0 cm and 12 patients had satellite lesions with diameters of 0.1–1.0 cm. Regarding treatment, 5 patients underwent surgical monotherapy, 12 patients underwent antifungal monotherapy and three patients received surgery in combination with antifungal therapy. HE staining indicated that Cryptococcus neoformans was engulfed by macrophages, which were surrounded by massive infiltrating lymphocytes and a large amount of fibrous tissue, which formed multinucleated macrophages or granulomas. Periodic acid-Schiff staining was positive and acid fast staining was negative. In conclusion, comparison of CT signs with the pathological manifestation of pulmonary cryptococcosis with multiple nodules or masses indicated that the pathological results may explain certain imaging signs. Combination of CT and pathological examination may provide a deeper understanding of this disease and improve the accuracy of its diagnosis.

Objective Diagnosis of pulmonary cryptococcosis is difficult. In this study, we examined the clinical and radiological features that increase the diagnostic accuracy for pulmonary cryptococcosis. Methods This retrospective study included clinical data from 68 patients with pulmonary cryptococcosis from 2012 to 2016 in 3 tertiary hospitals. Results Among the 68 patients, 39 (57.35%) had no complications, 39 (57.35%) had clinical symptoms, 6 (8.82%) had a history of occupational exposure, 27 (39.71%) had a single nodule/mass (the most common type of pulmonary cryptococcosis) on chest computed tomography images, 21 (30.88%) had multiple nodules/masses, 16 (23.53%) had ground glass opacity with or without nodules, 2 (2.94%) had miliary nodules, and 2 (2.94%) had enlarged mediastinal lymph nodes. Fifty-three (77.94%) patients had lesions with irregular margins, 33 (48.53%) had spiculated lesions, 32 (47.06%) had air bronchograms, 9 (13.24%) had cavities, and 4 (5.88%) had calcifications. Twenty-four patients underwent surgery, 35 received antifungal treatment, and 9 received both treatments. Conclusion The clinical features and computed tomography signs found in this study are not specific for a diagnosis of pulmonary cryptococcosis. Therefore, an increased awareness of pulmonary cryptococcosis is needed among clinicians.

IgG4-related disease (IgG4-RD) is recognized as an immune-mediated condition with pathology features of lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis, accompanied with or without elevated serum IgG4 concentrations. However, few of pulmonary artery IgG4-RD causing pulmonary hypertension (PH) was reported. The medical records of 3 patients with pulmonary artery IgG4-RD inducing PH were analyzed retrospectively. Imaging findings demonstrated that the lesions of 3 patients located in pulmonary artery, which were initially diagnosed as pulmonary thrombus or malignant tumor. Computed tomography pulmonary angiography (CTPA), ultrasonic cardiogram, and positron emission tomography/computed tomography (PET/CT) didn’t support the diagnosis of pulmonary thrombus or malignant tumor. Right heart catheterization (RHC) showed definite PH. Biopsy by right heart catheterization in 2 patients or pneumonectomy in 1 patient confirmed the diagnosis as IgG4-RD. Treated with glucocorticoids and cyclophosphamide or rituximab, 2 patients’ IgG4 concentrations declined sharply and the lesions shrunk gradually. Another patient treated with glucocorticoids died of heart failure. IgG4-RD involved pulmonary artery causing PH was rare. A high index of awareness of this disease is required for early diagnosis and treatment. PET/CT might be a valuable approach to distinguish pulmonary artery IgG4-RD from pulmonary thrombus and malignant tumor.

Purpose: Triple-negative breast cancer (TNBC) has attracted more attention both clinically and experimentally because of its high-risk biological characteristics and lacking of effective treatment method. The purpose of this retrospective study was to find out the incidence of triple-negative breast cancer (TNBC) in all kinds of breast cancers and to compare and analyze the clinicopathological features, recurrence, metastasis and prognosis of patients with TNBC and non-triple negative breast cancer (non-TNBC). Methods: A total of 1578 female patients with primary breast cancer were diagnosed and treated at the department of General Surgery, the Chinese PLA General Hospital, China, from Jan. 2004 to Jun. 2009. The 1578 breast cancer patients were divided into two groups: the TNBC group and the non-TNBC group. The clinical features and prognosis of the two groups were compared. Results: The incidence of TNBC was 20.41%. Compared with the non-TNBC, the TNBC were characterized as younger age, higher histological grade, higher rate of positive lymph node, bigger tumor size, higher clinical stage at diagnosis, higher histological grade, quicker and easier recurrence and metastasis and lower 5-year DFS rate and 5-year OS rate. The metastasis of TNBC had obvious organic tendency. The lungs, liver and brain were the first three most common sites of metastases. The information of age, the tumor size, lymph node status, clinical stage, histological grade, pathological types and operation method, especially the age and lymph node status play the important roles in judging the prognosis of TNBC. Conclusions: According to this study we found that TNBC was a distinct subgroup of breast cancer with particular clinicopathologic behavior. Compared with the non-TNBC, TNBC was characterized by more aggressive behavior, and lower DFS and OS rate. The metastasis of TNBC had obvious organic tendency. The information of age, the maximum diameter of the tumor, lymph node status, clinical stage, histological grade, pathological types and operation method, especially the age and lymph node status played the important roles in judging the prognosis of TNBC patients.

With the rapid development of Internet technology, images on the Internet are used in various aspects of people’s lives. The security and authorization of images are strongly dependent on image quality. Some potential problems have also emerged, among which the quality assessment and denoising of images are particularly evident. This paper proposes a novel NR-IQA method based on the dual convolutional neural network structure, which combines saliency detection with the human visual system (HSV), used as a weighting function to reflect the important distortion caused by the local area. The model is trained using gray and color features in the HSV space. It is applied to the parameter selection of an image denoising algorithm. The experiment proves that our proposed method can accurately evaluate image quality in the process of denoising. It provides great help in parameter optimization iteration and improves the performance of the algorithm. Through experiments, we obtain both improved image quality and a reasonable result of subject assessment when the cascaded algorithm is applied in image security and authorization.

Background and Aim Lung cancer is the most commonly diagnosed neoplasm and the leading cause of cancer-related death worldwide. Despite the high incidence of lung cancer, the diagnosis of solitary thin-walled cavity lung cancer is rare. The aim of this review is to explore the potentials of computed tomography (CT) as diagnostic tool for solitary thin-walled cavity lung cancer. Method The literature search was made in electronic databases including PudMed, Ovid SP, Embase, Web of Sciences, EBSCO and Wiley online by using relevant key terms. Because of the rarity of the subject, no precise exclusion or inclusion criteria were used for article selection and the outcome dissemination was decided to be more descriptive rather than quantitative. Results The detection of cavitation in lungs is frequently done utilizing chest radiographs CT scans. However, the diagnostic challenge remains the accurate detection of solitary thin-walled cavity lung cancer among the prevalence of cavitary lung lesions in multiple thoracic disorders including benign disorders, infectious disease and malignant tumors. Moreover, an accurate diagnosis of solitary thin-walled cavity lung cancer is further complicated by its subjective classification within the literature. In order to facilitate early diagnosis of this disease and circumvent the need for more invasive tests that may not be warranted, the overarching goal is to establish definitive radiological features of lung cavities that are indicative of malignancy. Herein, we describe the benefits of using CT to identify and diagnose solitary thin-walled cavity lung cancer, as well as explore the underlying mechanisms that contribute to thin-walled cavity formation in oncology patients. Conclusion CT is the best modality for the noninvasive differentiation between malignant and nonmalignant cavities as it provides reliable information regarding the morphology and density of lesions. Besides, CT densitometry can efficiently detect the calcifications in lesions.

Objective To perform a retrospective comparison of the clinical and radiological features of Klebsiella pneumoniae (KP)-associated and non-KP-associated pyogenic liver abscesses (PLA) in Chinese patients. Methods Patients with confirmed diagnoses of bacterial liver abscess at three Beijing hospitals were enrolled. Clinical isolates from liver abscesses were used to determine serology and expression of hypermucoviscosity genes. Basic clinical, ultrasonographic (US) and computed tomography (CT) data were recorded and compared between patients with KP- and non-KP-associated PLA. Results A total of 101 (77.10%) and 30 (22.90%) cases were due to KP and non-KP pathogens, respectively. Compared with the non-KP cohort, the KP cohort demonstrated a significantly higher incidence of underlying diabetes mellitus, and more gas-forming abscesses, as demonstrated by US and CT examinations. Prior abdominal surgery or chemoradiation therapy was significantly associated with non-KP cases. The non-KP group had a higher chance of a clear edge, compared with the KP group, on pre-contrast CT images. Conclusion KP and non-KP-associated PLA have distinctive risk factors and unique US and CT features, in Chinese patients.

The role of C-X-C motif chemokine 10 (CXCL10), a pro-inflammatory factor, in the development of acute respiratory distress syndrome (ARDS) remains unclear. In this study, we explored the role of CXCL10 and the effect of CXCL10 neutralization in lipopolysaccharide (LPS)-induced ARDS in rats. The expression of CXCL10 and its receptor chemokine receptor 3(CXCR3) increased after LPS induction. Moreover, neutralization of CXCL10 ameliorated the severity of ARDS by reducing pulmonary edema, inhibiting the release of inflammatory mediators (IFN-γ, IL-6 and ICAM-1) and limiting inflammatory cells (neutrophils, macrophages, CD8+ T cells) influx into the lung, with a reduction in CXCR3 expression in neutrophils and macrophages. Therefore, CXCL10 could be a potential therapeutic target in LPS-induced ARDS.

Acute respiratory distress syndrome (ARDS) is often characterized by reduced lung compliance, which suggests dysfunction of the endogenous surfactant system. The effectiveness of exogenous surfactants as replacements for the endogenous system in the treatment of ARDS in adults was assessed. Randomized controlled trials from Medline (1950-2011), Embase (1989-2011), the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (1994-2011) were analyzed. Two reviewers identified trials for inclusion and the results of included trials were quantitatively pooled with a fixed-effects model. Seven trials (2,144 patients) with good methodological quality were included in the analysis. Pulmonary surfactant treatment was not associated with reduced mortality [relative risk (RR), 1.00; 95% confidence interval (CI) 0.89-1.12]. Subgroup analysis revealed no reduced mortality for various surfactant types. Heterogeneity was not significant in the primary outcome analysis (I(2)=0%). There was no evidence of publication bias. Oxygenation, ventilation-free days, duration of ventilation and APACHE II scores did not undergo pooled analysis due to insufficient data. Exogenous surfactant did not reduce mortality in adults with ARDS in our meta-analysis, and we cannot accurately define whether exogenous surfactant has an effect on oxygenation from the included studies.

A substantial percentage (8%) of all newly diagnosed cancer cases are in patients with previous tumours, with a similar trend in lung cancer. Cases of multiple primary lung cancer (MPLC) are increasing worldwide, due to improved diagnostic and surveillance mechanisms and the ageing population. Diagnosis of MPLC is complicated by difficulties in distinguishing it from lung cancer metastasis. Clinicopathological assessment, diagnosis and management have evolved, but remain severely limited by the lack of robust and dependable molecular markers for the differential diagnosis of metastasis and MPLC. This systematic review evaluates diagnostic criteria for MPLC, and the subsequent management and success rates. The incorporation of molecular biology techniques into the diagnostic process for MPLC is also discussed.

The present study aimed to investigate polypoid colonic metastases from gastric stump carcinoma by performing a retrospective analysis of the clinical data of a patient with such a diagnosis, and by discussing other previous case studies from the literature. The patient of the present study was an 80-year-old male who had undergone a gastrectomy 48 years previously for a benign perforated gastric ulcer. A colonoscopy revealed >10 multiple polypoid lesions of 6–10 mm in diameter distributed throughout the entire colon, except in the rectum. Each lesion had either erosion or a depression at the top and several were covered with a white fur-like substance. Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma. The patient was referred to the Oncology unit (Beijing Shijitan Hospital, Beijing, China) for assessment and chemotherapy treatment, which was initiated with 1,000 mg Xeloda orally administered twice a day for two-week courses every three weeks. The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months. Gastric or gastric stump carcinoma may metastasize to the colon presenting as solitary or multiple colonic polyps. Thus, it is important to consider this diagnosis as such colon metastases may mimic solitary or multiple colonic polyps, which are commonly observed. A differential diagnosis is required in this complicated situation.

Pulmonary arterial hypertension (PAH) is a debilitating condition with progressive remodeling of the pulmonary resistance vessels. PAH is characterized by multifocal, polyclonal lesions inhabited by cells that underwent phenotypic transition, resulting in altered cell proliferation and contractility, ultimately resulting in increased vascular resistance. Diagnosis of PAH is confounded by the fact that it is largely asymptomatic in the initial stages. In fact, idiopathic PAH patients >65 years of age cannot be diagnosed hemodynamically due to high pulmonary capillary wedge pressure. This highlights the need for defining more robust molecular biomarkers for PAH diagnosis and progression. Recent studies have indicated that microRNAs (miRNAs), a class of small noncoding RNAs that regulate gene expression, play a discrete role in vascular inflammation and in the etiology of cardiovascular pathologies inclusive of PAH and can potentially serve as diagnostic biomarkers. However, a cohesive understanding of global miRNA-mediated molecular events that control pulmonary vasculature plasticity is lacking which, if addressed systematically, can lead to detailed elucidation of the downstream cellular pathways that are affected by activation/silencing of silenced cognate transcripts. In turn, this can lead to not only robust biomarkers, but also to novel therapeutic strategies targeting more upstream regulators than the existing ones targeting more downstream effectors. The current review aims to provide a summary understanding of PAH, its associated pathophysiology, current knowledge of the role of miRNAs in PAH, and identifies grey areas that need further research for successful bench-to-bedside transition of these exciting new discoveries.

Quinolones are a group of antimicrobial agents that were serendipitously discovered as byproducts of the synthesis of chloroquine. Chemical modifications, such as the addition of fluorine or piperazine, resulted in the synthesis of third- and fourth-generation fluoroquinolones, with broad-spectrum antimicrobial actions against aerobic or anaerobic, Gram-positive or Gram-negative bacteria. The efficacy and consequent widespread use of quinolones and fluoroquinolones has led to a steady global increase in resistance, mediated via gene mutations, alterations in efflux or cell membranes and plasmid-conferred resistance. The first plasmid-mediated quinolone resistance gene, qnrA1, was detected in 1998. Since then, many other genes have been identified and the underlying mechanisms of resistance have been elucidated. This review provides an overview of quinolone resistance, with particular emphasis on plasmid-mediated resistance.

Background Solitary thin-walled cavity lung cancer is a specific form of lung cancer, the diagnosis of which remains a formidable challenge. Objective By comparing the computed tomography (CT) presentations and pathological findings, the purpose of present study was to explain the possible mechanism of thin-walled cavity formation and to improve the diagnostic accuracy for this disease. Methods The medical records of eighteen patients with solitary thin-walled cavity lung cancer were analyzed retrospectively. Results Chest CT demonstrated that solitary thin-walled cavities located at pulmonary periphery, and all these cavity lesions displayed suspected malignant signs. Pathological findings after surgery confirmed these lesions were adenocarcinoma, most of which were moderately or well differentiated. Microscopic findings showed tumor cells proliferated in the surface of thin-wall cavity in nine patients and infringed bronchiolar wall in five patients. No obvious necrotic tumor cell was observed in each patient. Conclusion It was suggested some thin-walled cavities may be formed as a result of unidirectional check-valve mechanism. Together, a high index of awareness of this suspected CT signs is required for early diagnosis of this disease.

The diagnosis of synchronous multiple primary lung cancer (SMPLC) remains a formidable challenge. The aim of the present study was to identify useful clues for the clinical diagnosis of SMPLC, in particular for the early stages. The medical records of 10 patients diagnosed with SMPLC with different histological types were analyzed retrospectively. Chest computed tomography (CT) findings showed two pulmonary lesions in all patients. The two lesions displayed malignant characteristics of primary lung cancer. The levels of a number of tumor markers, including carcinoembryonic antigen, neuron-specific enolase, cytokeratin fragment 21-1, squamous cell carcinoma and CA125 increased in 2 patients. Auxiliary examinations of other physical sites in these patients did not show signs of neoplasm metastasis. Two tumors were separately staged and appropriate treatment was carried out based on the revised stage, which provided more benefits for SMPLC patients. The diagnosis of SMPLC might be delayed or mistaken owing to its similarity to neoplasm metastasis. A high index of awareness is required for the early diagnosis of this disease. The malignant characteristics of primary lung cancer in various lesions may be valuable clues for the diagnosis of SMPLC. Alterations in the levels of tumor markers may be a poor diagnostic tool for the detection of SMPLC. Separate biopsies for different pulmonary masses should be performed for clinical staging as soon as possible and reasonable treatment based on the stage should also be selected.

Endobronchial tuberculosis (EBTB), of which the incidence has been increasing in recent years, is a special type of pulmonary tuberculosis. The endobronchial tuberculose focuses often injure the tracheobronchial wall and lead to tracheobronchial stenosis. The tracheobronchial stenosis may cause intractable tuberculosis and make patients become chronic infection sources of tuberculosis, or may even cause pulmonary complications and result in death. The etiological confirmation of Mycobacterium tuberculosis is most substantial for diagnosis. However, because the positive rate of acid-fast bacillus staining for sputum smears is low and the clinical and radiological findings are usually nondistinctive, the diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of awareness of this disease is required and the bronchoscopy should be performed as soon as possible in suspected patients. The eradication of Mycobacterium tuberculosis and the prevention of tracheobronchial stenosis are two most substantial treatment goals. To get treatment goals, the diagnosis must be established early and aggressive treatments must be performed before the disease progresses too far.

Gefitinib-induced interstitial lung disease (ILD) is a rare but lethal drug adverse event, which usually leads to the withdrawal of gefitinib and causes complications with anticancer treatment. In this study, gefitinib administration combined with prednisolone in a female with stage IIIb non-small cell lung cancer (NSCLC) produced a good outcome without inducing ILD. The results suggested that combined administration of gefitinib with glucocorticoids may be an efficient method to treat NSCLC while avoiding complications with ILD.

A new class of multifunctional nanobubble using poly(lactic-co-glycolic acid) (PLGA) has been developed as ultrasound imaging contrast agents, doxorubicin carriers, and enhancers of ultrasound-mediated drug delivery. The doxorubicin nanobubble (DOX-NB) wrapping carbon tetrafluoride gas was prepared with double emulsion method. We evaluated the enhanced ultrasonic function of the DOX-NB in vivo; its antitumor function was confirmed. The diameter of the prepared bubble was 500 nm, and the potential was −23 mV. The drug loading and encapsulation efficiency of the bubble were 78.6 and 7.4 %, respectively. Therefore, the DOX-NB greatly enhanced ultrasound imaging in vivo. Ultrasound combined with DOX-NB had significant antitumor effect. Compared with other groups, the tumor growth rate and the proliferation index were the lowest while the survival rate and apoptosis index were the highest.