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Automatic segmentation of lung nodules on computed tomography (CT) images is challenging owing to the variability of morphology, location, and intensity. In addition, few segmentation methods can capture intra-nodular heterogeneity to assist lung nodule diagnosis. In this study, we propose an end-to-end architecture to perform fully automated segmentation of multiple types of lung nodules and generate intra-nodular heterogeneity images for clinical use. To this end, a hybrid loss is considered by introducing a Faster R-CNN model based on generalized intersection over union loss in generative adversarial network. The Lung Image Database Consortium image collection dataset, comprising 2,635 lung nodules, was combined with 3,200 lung nodules from five hospitals for this study. Compared with manual segmentation by radiologists, the proposed model obtained an average dice coefficient (DC) of 82.05% on the test dataset. Compared with U-net, NoduleNet, nnU-net, and other three models, the proposed method achieved comparable performance on lung nodule segmentation and generated more vivid and valid intra-nodular heterogeneity images, which are beneficial in radiological diagnosis. In an external test of 91 patients from another hospital, the proposed model achieved an average DC of 81.61%. The proposed method effectively addresses the challenges of inevitable human interaction and additional pre-processing procedures in the existing solutions for lung nodule segmentation. In addition, the results show that the intra-nodular heterogeneity images generated by the proposed model are suitable to facilitate lung nodule diagnosis in radiology.

Purpose: We established a CT-derived approach to achieve accurate progression-free survival (PFS) prediction to EGFR tyrosine kinase inhibitors (TKI) therapy in multicenter, stage IV EGFR-mutated non–small cell lung cancer (NSCLC) patients.Experimental Design: A total of 1,032 CT-based phenotypic characteristics were extracted according to the intensity, shape, and texture of NSCLC pretherapy images. On the basis of these CT features extracted from 117 stage IV EGFR-mutant NSCLC patients, a CT-based phenotypic signature was proposed using a Cox regression model with LASSO penalty for the survival risk stratification of EGFR-TKI therapy. The signature was validated using two independent cohorts (101 and 96 patients, respectively). The benefit of EGFR-TKIs in stratified patients was then compared with another stage-IV EGFR-mutant NSCLC cohort only treated with standard chemotherapy (56 patients). Furthermore, an individualized prediction model incorporating the phenotypic signature and clinicopathologic risk characteristics was proposed for PFS prediction, and also validated by multicenter cohorts.Results: The signature consisted of 12 CT features demonstrated good accuracy for discriminating patients with rapid and slow progression to EGFR-TKI therapy in three cohorts (HR: 3.61, 3.77, and 3.67, respectively). Rapid progression patients received EGFR TKIs did not show significant difference with patients underwent chemotherapy for progression-free survival benefit (P = 0.682). Decision curve analysis revealed that the proposed model significantly improved the clinical benefit compared with the clinicopathologic-based characteristics model (P < 0.0001).Conclusions: The proposed CT-based predictive strategy can achieve individualized prediction of PFS probability to EGFR-TKI therapy in NSCLCs, which holds promise of improving the pretherapy personalized management of TKIs. Clin Cancer Res; 24(15); 3583–92. ©2018 AACR.

Supplementary Table S1. Multivariable Cox regression analysis of various clinicopathologic characteristics and the twelve-feature-based signature with progression-free survival; Supplementary Table S2. Detail of treatment of all the patients. Including the administration of TKIs, mean time of TKI therapy and chemotherapy of each department; Supplementary Table S3. Univariate association of twelve features and progression-free survival in the training dataset; Supplementary Table S4. Comparison of clinical variables between the rapid-progression subgroup and slow-progression subgroup in EGFR-TKI cases; Supplementary Figure S1. X-tile plots of the twelve selected key features; Supplementary Figure S2. Turning parameter (λ) selection in the LASSO model; Supplementary Figure S3. Stratified analysis of the signature; Supplementary Figure S4. Time-dependent ROC curves of the risk characteristics; Supplementary Figure S5. Progression probability of three different patient cohorts.

Public access algorithms and source code in this study.

This research paper elucidates the clinical effect of an integrated nursing model of medical care and patient in the diagnosis and treatment of congenital esophageal atresia (CEA). For this purpose, a total of 120 children with CEA were selected as study subjects who were admitted to our hospital (January 2017 to April 2020). They were randomly divided into the control group and observation group. Each group had 60 cases. The control group was given routine nursing, while the observation group adopted the integrated nursing model of medical care. The integrated nursing model had the characteristics of recognizing and managing the CEA quickly and efficiently. Thus, it can help increase the survival rate of infants. This model works along with the parents to provide specialized services to the child. They were tasked to carefully observe the infants as well as calm the parents. They were also given the additional task of keeping track of patients who were currently admitted in the hospital and those who were already discharged. The tracking and communication were done with the help of a communication platform which is WeChat. The rehospitalization rate, 1-hour visit rate, accuracy rate of children with suspected postoperative complications, psychological status of children’s parents, medical compliance, and satisfaction were compared between the two groups. The rehospitalization rate in the observation group was lower than that in the control group ( P < 0.05 ). The 1-hour visit rate and accuracy of children with suspected postoperative complications in the observation group were higher than those in the control group ( P < 0.05 ). The anxiety and depression scores of the parents in the observation group were lower than those in the control group ( P < 0.05 ). The compliance and satisfaction of parents in the observation group were higher than those in the control group ( P < 0.05 ). The clinical effect of the integrated nursing model of medical care and patient in CEA was highly satisfactory. It reduces the rehospitalization rate and enables timely diagnosis and treatment of suspicious complications effectively. It also improved parents’ negative psychological emotions, compliance, and satisfaction.

This report describes a 68-year-old woman with non-cystic fibrosis bronchiectasis (“bronchiectasis”) associated with nontuberculous mycobacteria (NTM) infection. She presented with cough, expectoration, bronchiectasis, and a negative QuantiFERON tuberculosis (QFT) test. But her sputum and bronchoalveolar lavage fluid (BALF) tested acid-fast bacilli (AFB) positive. The patient had a nine-year history of autoimmune liver disease and was diagnosed with liver cirrhosis for 1 year. Metagenomics next generation sequencing (mNGS) of her BALF sample reported positive for NTM and Pseudomonas aeruginosa (PA). According to the patient's clinical features and consultations with respiratory and tuberculosis specialists, the patient was not prescribed anti-tuberculosis treatment. Rather, her symptoms improved with anti-PA treatment. This case report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.report also emphasizes the importance of avoiding anti-tuberculosis treatment immediately after an initial diagnosis of non-tuberculous mycobacterial pneumonia.

Juvenile xanthogranuloma is rare in children and there are limited data on its imaging features.To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of juvenile xanthogranuloma in children.A retrospective review was performed of clinical and radiographic data of histologically confirmed juvenile xanthogranuloma between January 2009 and June 2020.Fourteen children (4 girls, 10 boys; age range: 1 day to 13 years, mean age: 73 months) were included in the study: 4/14 had CT only, 5/14 had MRI only and 5/14 had CT and MRI. Sites of extracutaneous juvenile xanthogranuloma involvement included subcutaneous soft tissue (8/14), liver (2/14), lungs (2/14), kidney (2/14), nose (2/14), pancreas (1/14), central nervous system (1/14) and greater omentum (1/14), mainly manifested as single or multiple nodules or masses in different organs. On CT, the lesions mainly manifested as an iso-hypo density mass with mild or marked enhancement. On MRI, the lesions mainly manifested as slightly hyperintense on T1 and slightly hypointense on T2, with decreased diffusivity and homogeneous enhancement. Juvenile xanthogranuloma was not included in the imaging differential diagnosis in any case.Juvenile xanthogranuloma mainly manifests as single or multiple nodules or masses in different organs. Slight hyperintensity on T1 and slight hypointensity on T2 with decreased diffusivity and homogeneous enhancement are relatively characteristic imaging findings of juvenile xanthogranuloma. Combined with its typical skin lesions and imaging features, radiologists should include juvenile xanthogranuloma in the differential diagnosis when confronted with similar cases.

The metabolic parameters which included mean standardised uptake value (SUVmean), metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardised uptake lean body mass (SULmax), and maximum standardised uptake body surface area (SUVbsa) have rarely been investigated in pulmonary carcinoid (PC). This study aimed to retrospectively compare theWe performed a retrospective review in 60 patients with PC, from January 2016 to November 2021, who underwent theSixty patients with PC were consecutively identified, including 39 patients (65.0%) with typical carcinoids (TCs) and 21 (35.0%) with atypical carcinoids (ACs). One (1/21) patient had mutation in BRAF. The ACs have a larger size (

Moderate to severe corona virusinfected patients are usually managed by systemic steroids and immunosuppressant drugs, increasing the risk of opportunistic fungal infections. Pulmonary mucormycosis is a rare but fatal invasive fungal disease that mainly affects people with compromised immune systems and is associated with several diagnostic difficulties. This study sheds light on the diagnostic challenges and benefits of chest computed tomography in the early detection of mucormycosis lesions, which will help physicians and surgeons manage the disease more effectively. Methods: Our study reports a single-center experience with pulmonary mucormycosis in recovered/active COVID-19 patients. We reviewed all medical records of COVID-19 positive patients diagnosed with pulmonary mucormycosis histopathologically. Chest CT images were extracted from the Picture Archiving and Communication System (PACS) and evaluated. Results: Our study demonstrated reverse halo sign in the majority (75%) of patients during the early disease course. In addition to RHS, several other lesions like GGOs, peri-lesional halo, multiple nodular lesions, consolidative/cavitary lesions are also found during some disease stages. About 75% of patients harbor lesions exhibiting peripheral predominance with unilateral lung involvement. More than half of our study population (64%) lost their lives within a month despite aggressive medical and surgical treatment, reflecting the aggressiveness of the disease.

Quercetin is a kind of distinctive bioactive flavonoid that has potent anti-oxidant, anti-inflammatory and anti-diabetic properties. The present article was designed to check the effect of quercetin on diabetic retinopathy. Adult retinal pigment epithelial cell line (ARPE)-19 cells were pre-treated with quercetin and then stimulated by high glucose. Cell damage was evaluated by CCK-8 assay, flow cytometer, quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), enzyme-linked immunosorbent assay, 2,7-dichlorofluorescein diacetate probe and western blot. The association between quercetin and miR-29b expression as well as the downstream pathways was studied by qRT-PCR and western blot. Pre-treating ARPE-19 cells with quercetin clearly attenuated high glucose-induced viability loss, apoptosis, MCP-1 and IL-6 overproduction and reactive oxygen species (ROS) generation. Quercetin down-regulated p53, Bax and cleaved-caspase-3 expression, while up-regulated CyclinD1, CDK4 and Bcl-2. miR-29b was low expressed in high glucose-treated cell, but quercetin elevated its expression. Moreover, the protective action of quercetin towards ARPE-19 cells was attenuated when miR-29b was suppressed. Also, quercetin promoted PTEN/AKT pathway, while inhibited NF-κB pathway via a miR-29b-dependent way. These data illustrated quercetin possibly possess the anti-diabetic retinopathy potential, as quercetin clearly attenuated high glucose-evoked damage in ARPE-19 cells. The protective action of quercetin may due to its regulation on miR-29b expression as well as PTEN/AKT and NF-κB pathways.

Objective The echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene is a key oncogenic driver in non-small cell lung cancer (NSCLC). This study analyzed the clinicopathological characteristics and prognostic significance of EML4-ALK fusion gene in patients with surgically resected adenocarcinoma. Methods The clinicopathological characteristics of 1056 consecutive patients with surgically resected stage I-IIIA adenocarcinoma were collected from February 2014 to October 2014, and EML4-ALK rearrangement was detected using real-time polymerase chain reaction (RT-PCR) technology. To compare the imaging and pathological features, a propensity score matching (PSM) method was performed. The follow-up information was collected to evaluate the long-term outcomes of patients with EML4-ALK rearrangement. Results The prevalence of EML4-ALK rearrangement was 6.6% in 1056 consecutive patients. A total of 70 EML4-ALK-positive and 210 EML4-ALK-negative patients were identified after PSM. Imaging and pathological analyses showed that EML4-ALK rearrangement was significantly associated with less ground-glass opacity (GGO) (adjusted OR=1.38, 95% CI=1.03-1.85, Ptrend =0.029) and higher prevalence of non-invasive mucinous adenocarcinoma mucin-laden adenocarcinomas (non-IMA MLA, adjusted OR=6.79, 95% CI=2.69-17.17, P

Objectives. The metabolic parameters which included mean standardised uptake value (SUVmean), metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardised uptake lean body mass (SULmax), and maximum standardised uptake body surface area (SUVbsa) have rarely been investigated in pulmonary carcinoid (PC). This study aimed to retrospectively compare the 18F-FDG PET/CT features of PC subtypes and observe clinicopathological and oncogenic characteristics of PC. Methods. We performed a retrospective review in 60 patients with PC, from January 2016 to November 2021, who underwent the 18F-FDG PET/CT scan. All the PC diagnoses were histopathologic confirmed by surgical samples. The metabolic and morphological features were obtained from 18F-FDG PET/CT images. The ratio of metabolic to morphological lesion volumes (MMVR) was calculated. Results. Sixty patients with PC were consecutively identified, including 39 patients (65.0%) with typical carcinoids (TCs) and 21 (35.0%) with atypical carcinoids (ACs). One (1/21) patient had mutation in BRAF. The ACs have a larger size ( P P = 0.011), higher Ki-67 expression ( P P = 0.003), higher SUVmean values ( P = 0.006), higher SULmax values ( P = 0.005), higher SUVbsa values ( P = 0.001), higher MTV values ( P = 0.033), and higher TLG values ( P = 0.002). The multivariate analysis showed that MMVR ( P = 0.020) was significantly associated with AC. For predicting AC, the optimal cut-off value of SUVmax, SUVmean, SULmax, SUVbsa, MTV, TLG, and the maximum diameter was 5.19, 3.18, 2.65, 1.47, 4.36, 18.44, and 3.0, respectively. The AUC values of above mentioned parameters was 0.756 (95%CI, 0.631–881; P = 0.001), 0.735 (95%CI, 0.602–868; P = 0.003), 0.736 (95%CI, 0.607–865; P = 0.003), 0.742 (95%CI, 0.612–873; P = 0.002), 0.593 (95%CI, 0.430–755; P = 0.239), 0.680 (95%CI, 0.531–829; P = 0.022), and 0.733 (95%CI, 0.598–868; P = 0.003), respectively. For predicting TC, the optimal cut-off value of the MMVR was 0.92, and the AUC value was 0.780 (95%CI, 0.647–0.913; P

BACKGROUND: Percutaneous transthoracic lung biopsy is customarily conducted under computed tomography (CT) guidance, which primarily depends on the conductors’ experience and inevitably contributes to long procedural duration and radiation exposure. Novel technique facilitating lung biopsy is currently demanded. METHODS: Based on the reconstructed anatomical information of CT scans, a three-dimensionally printed navigational template was customized to guide fine-needle aspiration (FNA). The needle insertion site and angle could be indicated by the template after proper placement according to the reference landmarks. From June 2020 to August 2020, patients with peripheral indeterminate lung lesions ≥30 mm in diameter were enrolled in a pilot trial. Cases were considered successful when the virtual line indicated by the template in the first CT scan was pointing at the target, and the rate of success was recorded. The insertion deviation, procedural duration, radiation exposure, biopsy-related complications, and diagnostic yield were documented as well. RESULTS: A total of 20 patients consented to participate, and 2 withdrew. The remaining 18 participants consisting of 11 men and 7 women with a median age of 63 [inter-quartile range (IQR), 50–68] years and a median body mass index (BMI) of 23.5 (IQR, 20.8–25.8) kg/m(2) received template-guided FNA. The median nodule size of the patients was 41.2 (IQR, 36.2–51.9) mm and 17 lesions were successfully targeted (success rate, 94.4%). One lesion was not reached through the designed trajectory due to an unpredictable alteration of the lesion’s location resulting from pleural effusion. The median deviation between the actual position of the needle tip and the designed route was 9.4 (IQR, 6.8–11.7) mm. The median procedural duration was 10.7 (IQR, 9.7–11.8) min, and the median radiation exposure was 220.9 (IQR, 198.6–249.5) mGy×cm. No major biopsy-related complication was encountered. Definitive diagnosis of malignancy was reached in 13 of the 17 (76.5%) participants. CONCLUSIONS: The feasibility and safety of navigational template-guided FNA were preliminarily validated in lung biopsy cohort. Nonetheless, patients with pleural effusion were not recommended to undergo FNA guided by such technique. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (identifier: NCT03325907).

Background Preoperative mediastinal staging is crucial for the optimal management of clinical stage I non-small cell lung cancer (NSCLC). Purpose To develop a deep learning signature for N2 metastasis prediction and prognosis stratification in clinical stage I NSCLC. Materials and Methods In this retrospective study conducted from May 2020 to October 2020 in a population with clinical stage I NSCLC, an internal cohort was adopted to establish a deep learning signature. Subsequently, the predictive efficacy and biologic basis of the proposed signature were investigated in an external cohort. A multicenter diagnostic trial (registration number: ChiCTR2000041310) was also performed to evaluate its clinical utility. Finally, on the basis of the N2 risk scores, the instructive significance of the signature in prognostic stratification was explored. The diagnostic efficiency was quantified with the area under the receiver operating characteristic curve (AUC), and the survival outcomes were assessed using the Cox proportional hazards model. Results A total of 3096 patients (mean age ± standard deviation, 60 years ± 9; 1703 men) were included in the study. The proposed signature achieved AUCs of 0.82, 0.81, and 0.81 in an internal test set (

Background: The exacerbation of non-cystic fibrosis bronchiectasis (NCFB) may lead to poor prognosis. The objective of this study was to retrospectively analyze the clinical efficacy and safety of endobronchial therapy with gentamicin and dexamethasone after airway clearance by bronchoscopy in the exacerbation of NCFB.Methods: We retrospectively reviewed 2,156 patients with NCFB between January 2015 and June 2016 and 367 consecutive patients with exacerbation of bronchiectasis who had complete data and underwent airway clearance (AC) by bronchoscopy. The final cohort included 181 cases of intratracheal instillation with gentamicin and dexamethasone after AC (a group with airway drugs named the drug group) and 186 cases of AC only (a group without airway drugs named the control group). The last follow-up was on June 30, 2017.Results: The total cough score and the total symptom score in the drug group were improved compared to those in the control group during 3 months after discharge (p < 0.001). Re-examination of chest HRCT within 4–6 months after discharge revealed that the improvements of peribronchial thickening, the extent of mucous plugging, and the Bhalla score were all significantly improved in the drug group. Moreover, the re-exacerbations in the drug group were significantly decreased within 1 year after discharge. Univariate analysis showed a highly significant prolongation of the time to first re-exacerbation in bronchiectasis due to treatment with airway drugs compared with that of the control group. Multivariate Cox regression analysis showed that the risk of first re-exacerbation in the drug group decreased by 29.7% compared with that of the control group.Conclusion: Endobronchial therapy with gentamicin and dexamethasone after AC by bronchoscopy is a safe and effective method for treating NCFB.

Purpose The purpose of this study was to elucidate the clinicopathologic and lymph node metastatic characteristics in patients with adenocarcinoma manifested as persistent ground glass mass (GGM, ground glass opacity [GGO] exceeding 3 cm in diameter). Materials and Methods 304 patients with adenocarcinoma manifested as persistent GGM > 3 cm, who underwent complete surgical resection between November 2013 and December 2017 were included in this study. We elucidated the lymph node metastatic incidence and characteristics according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with lymph node involvement. Results All of the GGMs were invasive adenocarcinoma in histopathology. The total incidence of lymph node metastasis was 2.0% (6/304). All of the 6 cases with hilar or mediastinal lymph node metastasis were manifested as solid-predominant GGM > 3 cm and no cases with lymph node metastasis were identified in GGO-predominant GGM > 3 cm. Lymph node metastases were more likely to present in younger patients (p = 0.032), tumors with solid size >2.0 cm (p = 0.000), more advanced clinical T stage (p = 0.000), radiological solid-predominant tumors (p = 0.002) and acinar-predominant or papillary-predominant adenocarcinoma (p = 0.002). As for solid-predominant GGMs >3 cm, lymph node metastases were more likely to be found in tumors with solid size >2.0 cm (p = 0.026), more advanced clinical T stage(p = 0.026), acinar-predominant or papillary-predominant adenocarcinoma (p = 0.029). Whole tumor size was not associated with the presence of lymph node metastases. There were 2 right upper-lobe cases with upper mediastinal lymph nodes skip metastasis without intrapulmonary, interlobar, and hilar lymph node metastasis. Conclusion All of the GGMs >3 cm were invasive adenocarcinoma. The incidence of lymph node metastasis in GGO-predominant GGMs >3 cm was extremely low. Solid size would be a better predictor of lymph node metastasis than whole tumor size in sold-predominant GGMs >3 cm.

In recent years, antibiotics and microplastics have both received increasing attention. However, the contamination and correlation between the two pollutants in the groundwater of drinking-water source areas has not yet been considered. In this study, eight antibiotics were detected in 81 groundwater samples from a drinking-water source area. These were trimethoprim (TMP), sulfadimidine (SDD), sulfadiazine (SDZ), sulfamethoxazole (SMX), sulfachloropyridazine (SCP), norfloxacin (NOR), ciprofloxacin (CIP) and enrofloxacin (ENRO). Detection rates ranged from 1.23% to 95.06% and the maximum concentration ranged from 0.44 ng/L to 45.40 ng/L. Antibiotics in the groundwater pose no threat to human health, while only ENRO, CIP, NOR, SMX, and SDZ posed medium to low risks to the aquatic ecosystem. In contrast, the detection rate of microplastics was 100% with abundance values ranging from 4 n/L to 72 n/L, with an average of 29 n/L. Microplastic polymers were identified as polyamide, polyethylene, polypropylene, polyvinyl chloride and polystyrene. These also occurred in surface water but the particle sizes in groundwater were lower than those in the surface water. Through correlation analysis, it was found that NOR, ENRO and total antibiotic concentrations were significantly correlated with microplastic abundances. This study revealed the contamination and potential risks of antibiotics and microplastics in the groundwater of a drinking-water source area and found a correlation between them, indicating that risk management of antibiotics and microplastics in groundwater should be highly concerned.

Rationale: No approved pharmacotherapies are available for patients with interstitial pneumonia with autoimmune features (IPAF). Objective: In the present work, we aimed to evaluate the efficacy and safety of pirfenidone for the treatment of IPAF.Methods: A retrospective cohort study consisting of patients who met diagnostic criteria for IPAF was performed after a multidisciplinary review, and the patients receiving pirfenidone were compared with those in the non-pirfenidone group. The baseline data and diagnostic characteristics of patients were assessed. Pulmonary function and prednisone dose were analyzed by a mix-effects model.Results: A total of 184 patients, who met the diagnostic criteria of IPAF, were divided into two groups: pirfenidone group (n=81) and non-pirfenidone group (n=103). Patients in the pirfenidone group had a lower forced vital capacity (FVC%, P< 0.001) and a lower diffusion capacity for carbon monoxide (DLCO%, P=0.003). The pirfenidone group exhibited a greater increase of FVC% at 6 (P=0.003), 12 (P=0.013), and 24 (P=0.003) months. After adjustment for sex, age, UIP pattern, baseline FVC% and DLCO%, patients in the pirfenidone group continued to show a greater improvement in FVC% (χ2 (1) =4.59, P=0.032). Subgroup analysis identified superior therapeutic effects of pirfenidone in patients with dosage > 600 mg/day (P = 0.010) and medication course > 12 months (P = 0.007). Besides, the pirfenidone group had a lower prednisone dose than the non-pirfenidone group after 12 months of treatment (P=0.002). Moreover, 17 patients (19.32%) experienced side effects after taking pirfenidone, including one case of anaphylactic shock.Conclusions: Pirfenidone (600-1,800 mg/day) might help improve FVC, with an acceptable safety and tolerability profile in IPAF patients.

OBJECTIVE: This study sought to investigate the association between (18)F-fludeoxyglucose ((18)F-FDG) uptake in positron emission tomography/CT (PET/CT) scans and different programmed death ligand-1 (PD-L1) expression conditions in non-small cell lung cancer (NSCLC). METHODS: From October 2017 to December 2019, NSCLC was retrospectively identified in 419 consecutive patients who underwent (18)F-FDG PET/CT scans and PD-L1 expression tests using the PD-L1 22C3 assay. The association between clinicopathological characteristics and PD-L1 expression was assessed. RESULTS: The frequency of PD-L1-positive tumours was 38.2% (160/419) in NSCLC. In NSCLC, the multivariate analysis showed a high maximum standardised uptake value (SUVmax) (p < 0.0001) and an EGFR wild type genotype (p = 0.027) was significantly associated with PD-L1-positivity. In adenocarcinoma (ADC), the multivariate analysis showed that a high SUVmax (p < 0.0001) was significantly associated with PD-L1-positivity. In NSCLC and ADC, a Mann–Whitney U test showed significant differences between groups with PD-L1 high expression and PD-L1 low expression levels in terms of SUVmax (p = 0.011 and p = 0.013, respectively). The results of the receiver operating characteristic curve analysis showed that the area under the curve of the SUVmax was 0.767 (95% CI, 0.720–0.814; p < 0.0001) and 0.712 (95% CI, 0.651–0.774; p < 0.0001) in NSCLC and ADC, respectively. CONCLUSION: The study demonstrates that the SUVmax was significantly associated with PD-L1 expression in NSCLC and ADC. The SUVmax was significantly different between the PD-L1 high and low expression conditions, as quantified using a PD-L1 22C3 assay. ADVANCES IN KNOWLEDGE: This study provides direct evidence that SUVmax as a metabolic biomarker may help select patients with NSCLC likely to benefit from pembrolizumab.

Purpose: This study aimed to evaluate the effect of continuous clustered care on the physical growth of preterm infants and on the satisfaction with the nursing care. Methods: 120 preterm infants who were admitted to our hospital from Jan 2018 to Dec 2018 were recruited as the study cohort. These infants were randomly divided into a control group (n=60, routine care) and an experimental group (n=60, continuous clustered nursing care). The study compared the parenting skills in the two groups, the infant development at 6 and 12 months, the prevalence of diseases within one year after discharge, and the parents’ satisfaction with the nursing care. Results: There was no significant difference in the parenting skill levels between the two groups. The body masses, heights, and head circumferences of the infants at 6-months and 12-months in the experimental group were better than they were in the control group. The experimental group’s physical and intellectual development were significantly better than the physical and intellectual development in the control group (P

Background To investigate the impact of ALK variants on the features of brain metastases (BM), the outcome of chemotherapy and targeted therapy using crizotinib, as well as the progression pattern in patients with ALK fusion. Methods Patients with ALK fusion were retrospectively collected from January 2013 to July 2017 in Shanghai Pulmonary Hospital. ALK rearrangements were identified via ARMS-PCR. ALK variants were identified via Sanger Sequencing. Results A total of 135 patients and 41 with brain metastasis were identified. Radiological features showed that the patients with ALK variant 1 had a larger BM size compared with patients with ALK non-variant 1 (median tumor size: 16.89 vs. 11.01 mm, P=0.031). Similar time to treatment failure (TTF) was observed in patients with ALK variant 1 and non-variant 1 who received first-line crizotinib (median TTF: 15.7 vs. 13.8 months, HR =0.75, P=0.34). Patients with ALK variant 1 who had baseline BM had significantly shorter TTF than non-variant 1 with baseline BM when treated with first-line crizotinib (median TTF: 9.1 vs. 14.9 months, HR =2.68, P=0.037). In patients treated with chemotherapy, ALK variant 1 was associated with inferior TTF (median TTF: 5.6 vs. 8.1 months, HR =1.66, P=0.039). Progression pattern was similar between ALK variant 1 and non-variant 1. Conclusions Patients with ALK variant 1 and baseline BM had inferior TTF on first-line crizotinib treatment and presented with more aggressive radiological features. Patients with ALK non-variant 1 had better clinical outcome on first-line chemotherapy.

Background: How to accurately assess IPF severity and predict prognosis remains a problem. This study aimed to develop a new method, which can be easily used to assess pulmonary fibrosis severity.Method:1. Development of a HRCT combined pulmonary function & physiological parameter (CTPF) assessment method: The method included two parts. 1) CT-based fibrosis staging: Four representative lung CT sections were selected and evenly divided into 100 small areas. The percentage of honeycomb lesion area in the four sections was determined fibrosis stage,2) PF-based severity grade: FVC%pred,DLco%pred,SpO2% age and gender were used to assess PF severity grade. 2. Validation of the new method: The method was used to assess 192 patients with IPF. Two radiologists used the CT-based fibrosis staging method to determine the fibrosis stage. Pulmonologist determined the PF severity grade. 3. Statistical analyses: By Intra-group correlation coefficient and Spearman correlation coefficient to estimate the consistency between the CT scores from the two radiologists and the correlation between CT scores and lung function parameters. Using the competitive risk Fine–Gray model to analyze the relationship between CT-based stage/PF-based grade and prognosis. CT-based stage, PF-based grade, and GAP stage were used as predictor models to predicted the death risk. Results: 1. The intra-group correlation coefficient of the CT scores of the two radiologists was 0.95, PConclusion: Combined CT-based staging and PF-based grading methods CTPF can be adopted easily in clinical practice, and can assess IPF severity and predict death risk more accurately.