History Of Malignant Tumors Research Articles

Clinical and biochemical factors associated with amygdalar metabolic activity

We investigated clinical factors and biochemical markers associated with amygdalar metabolic activity evaluated by [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) in 346 subjects without a history of malignant neoplasms. Univariate regression analysis revealed significant relationships between amygdalar metabolic activity and fasting plasma glucose (FPG), glycated hemoglobin, coronary artery disease (CAD) history, aspirin use, oral hypoglycemic agents (OHAs) use, and asymmetric dimethylarginine (ADMA). In multiple stepwise regression analysis, FPG and CAD history were independently associated with amygdalar metabolic activity. Moreover, in 36 patients with type 2 diabetes mellitus (T2DM), additional OHAs treatment significantly improved glycemic and metabolic parameters, and decreased ADMA concentrations. Baseline and Δpigment epithelium-derived factor (PEDF), a marker of insulin resistance, was a significant associate with Δamygdalar metabolic activity. Our study demonstrates that FPG and CAD history were independently associated with amygdalar metabolic activity in subjects without a history of malignant neoplasms. In T2DM patients, PEDF might regulate amygdala metabolic activity.

Development and assessment of a mortality risk prediction nomogram model for pneumocystis disease in ICU within 28 days

To develop and assess a nomogram predictive model for evaluating the 28-day mortality risk in patients diagnosed with Pneumocystis who have been admitted to the intensive care unit (ICU). From 2008 to 2022, clinical data on patients with Pneumocystis were collected using the American Critical Care Medical Information Database IV (MIMIC-IV). Initially, 63 significant predictive indicators were included, with ICU admission as the time node and all-cause mortality within 28 days as the outcome. Using complete data modeling, the variable selection approach combines two methods: Lasso regression (glmnet package) and collinearity screening (car package). Use the bootstrap method 1000 times for internal validation. Calculate the AUC, mean sensitivity, and specificity of 1000 resamplings, as well as the 95% confidence interval, and then plot the ROC, calibration, and DCA curves. The patients were split into two groups based on their 28-day survival status: 83 cases (67.48%) in the survival group and 40 instances (32.52%) in the death group. Five variables—the history of malignant tumors, Lods scores, Oasis scores, and complications of shock and severe renal injury—were eventually included in the entire sample after screening. According to Receiver Operating Characteristic (ROC) analysis, the model’s sensitivity was 0.600 (95% CI 0.448–0.752), specificity was 0.904 (95% CI 0.840–0.967), and AUC was 0.814 (95% CI 0.732–0.897). The DCA curve indicates that the model application has high accuracy, which leads to a net benefit for population prediction, and the model calibration curve demonstrates good calibration accuracy. The bootstrap model’s 1000 internal validation results demonstrate that the model’s calibration performance is good and that its accuracy is highest when the probability of patient outcome events falls between 35 and 60%, which yields the highest net benefit for population prediction. This study developed a nomogram utilizing MIMIC-IV clinical big data to predict the 28-day mortality risk in patients with Pneumocystis disease. Incorporating five critical factors, the nomogram offers a user-friendly, visual method for calculating personalized risk scores based on patient-specific information, including medical history, laboratory results, and clinical scores. Demonstrating robust discrimination and calibration, this tool provides clinicians with a valuable resource for assessing prognosis and making evidence-based treatment decisions.

Interpretable prediction of 30-day mortality in patients with acute pancreatitis based on machine learning and SHAP.

Severe acute pancreatitis (SAP) can be fatal if left unrecognized and untreated. The purpose was to develop a machine learning (ML) model for predicting the 30-day all-cause mortality risk in SAP patients and to explain the most important predictors. This research utilized six ML methods, including logistic regression (LR), k-nearest neighbors(KNN), support vector machines (SVM), naive Bayes (NB), random forests(RF), and extreme gradient boosting(XGBoost), to construct six predictive models for SAP. An extensive evaluation was conducted to determine the most effective model and then the Shapley Additive exPlanations (SHAP) method was applied to visualize key variables. Utilizing the optimized model, stratified predictions were made for patients with SAP. Further, the study employed multivariable Cox regression analysis and Kaplan-Meier survival curves, along with subgroup analysis, to explore the relationship between the machine learning-based score and 30-day mortality. Through LASSO regression and recursive feature elimination (RFE), 25 optimal feature variables are selected. The XGBoost model performed best, with an area under the curve (AUC) of 0.881, a sensitivity of 0.5714, a specificity of 0.9651 and an F1 score of 0.64. The first six most important feature variables were the use of vasopressor, high Charlson comorbidity index, low blood oxygen saturation, history of malignant tumor, hyperglycemia and high APSIII score. Based on the optimal threshold of 0.62, patients were divided into high and low-risk groups, and the 30-day survival rate in the high-risk group decreased significantly. COX regression analysis further confirmed the positive correlation between high-risk scores and 30-day mortality. In the subgroup analysis, the model showed good risk stratification ability in patients with different gender, renal replacement therapy and with or without a history of malignant tumor, but it was not effective in predicting peripheral vascular disease. the XGBoost model effectively predicts the severity of SAP, serving as a valuable tool for clinicians to identify SAP early.

Cardiometabolic characteristics of weight cycling: results from a mid-South regional comprehensive health care system.

The objective of this study was to determine the unique clinical and cardiometabolic risk characteristics of weight-cyclers and identify differences between weight-cyclers and individuals with other weight-change trajectories. A deidentified database of 1,428,204 Vanderbilt University Medical Center patients from 1997 to 2020 was included based on having ≥5 years of recorded weights. Patients with a history of malignant neoplasm, bariatric surgery, implausible BMI (e.g., <15 or >80 kg/m2), or missing documented height were excluded, yielding 83,261 participants categorized by weight trajectory, i.e., weight-stable, weight-gainer, weight-loser, or weight-cycler, based on criteria of ≥5% weight-change thresholds. Additionally, quartiles of average successive weight variability were evaluated to determine the effect of absolute differences among successive weight values. Over half (55%) of participants were weight-cyclers, 23% were weight-gainers, 12% were weight-losers, and 10% were weight-stable over 5 years. Although baseline BMI did not differ among groups, weight-cyclers were more likely to have lower high-density lipoprotein cholesterol and higher blood glucose and triglyceride levels and to have been prescribed antihypertensive, dyslipidemia, and/or antidiabetic therapies. They were also younger and more likely to be smokers. Participants with the greatest weight variability (i.e., highest quartile of average successive weight variability) had higher cardiometabolic risk scores. Weight cycling was highly prevalent but yielded no meaningful overall change in body weight after 5 years. These findings support a paradigm shift in weight management in individuals with overweight/obesity toward reducing cardiometabolic risk with or without weight loss.

Comprehensive risk factor analysis for sick sinus syndrome: an analysis of genetic, sociodemographic, clinical and laboratory data from the UK Biobank

Abstract Background Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and interact bidirectionally, often to initiate and perpetuate each other. The polygenic risk score (PRS) assesses the cumulative risk of disease onset based on variations at multiple genetic loci. To date, no specific PRS has been established for SSS. This study investigates the impact of clinical, sociodemographic, laboratory, and genetic factors, which were represented by PRS for AF due to the absence of a specific PRS for SSS on predicting the incidence of SSS. Methods The UK biobank enrolled 502,421 individuals, aged 38 to 73, across 22 centres in the UK locations, from 2006 to 2010. After excluding cases with incomplete data, prior history of AF, and valvular heart disease, 405,869 participants without AF (median age, 58.0 [interquartile range (IQR), 50.0–64.0] years; 213,684 [45.2%] male) were analyzed. Participants were categorized into three groups according to a validated PRS for AF: the first quintile the middle three quintiles, and the fifth quintile. Throughout the observation period, the incidence of SSS event was documented. Results During a follow-up period of 11.9 (IQR 11.1-12.6) years, a total of 769 cases of Sick sinus syndrome were identified. The Kaplan-Meier analysis demonstrated a progressive increase in the incidence of SSS as the quintiles of AF-related PRS increased. (Log-rank: P &amp;lt;0.001) Among 24 variables, statistically significant hazard ratios were observed with age, male sex, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), previous myocardial infarction (MI), history of malignant neoplasm, hypertension, diabetes mellitus, cystatin C, and AF PRS. In the prediction model for Sick Sinus Syndrome, the C-index for the sociodemographic model was 0.753. This increased to 0.764 with the addition of clinical factors, to 0.765 with the inclusion of biomarkers, and further to 0.769 upon adding genetic factors. Conclusion Our study found significant associations between the incidence of SSS and a range of sociodemographic, clinical, laboratory, and genetic factors, including age, male sex, BMI, blood pressure, and medical history. Notably, the AF PRS also showed relevance, suggesting its potential utility in developing one for SSS in the absence of a dedicated PRS for SSS.

The diagnostic value of CT-based radiomics nomogram for solitary indeterminate smoothly marginated solid pulmonary nodules.

This study aimed to explore the value of radiomics nomogram based on computed tomography (CT) on the diagnosis of benign and malignant solitary indeterminate smoothly marginated solid pulmonary nodules (SMSPNs). This study retrospectively reviewed 205 cases with solitary indeterminate SMSPNs on CT, including 112 cases of benign nodules and 93 cases of malignant nodules. They were divided into training (n=143) and validation (n=62) cohorts based on different CT scanners. Radiomics features of the nodules were extracted from the lung window CT images. The variance threshold method, SelectKBest, and least absolute shrinkage and selection operator were used to select the key radiomics features to construct the rad-score. Through multivariate logistic regression analysis, a nomogram was built by combining rad-score, clinical factors, and CT features. The nomogram performance was evaluated by the area under the receiver operating characteristic curve (AUC). A total of 19 radiomics features were selected to construct the rad-score, and the nomogram was constructed by the rad-score, one clinical factor (history of malignant tumor), and three CT features (including calcification, pleural retraction, and lobulation). The nomogram performed better than the radiomics model, clinical model, and experienced radiologists who specialized in thoracic radiology for nodule diagnosis. The AUC values of the nomogram were 0.942 in the training cohort and 0.933 in the validation cohort. The calibration curve and decision curve showed that the nomogram demonstrated good consistency and clinical applicability. The CT-based radiomics nomogram achieved high efficiency in the preoperative diagnosis of solitary indeterminate SMSPNs, and it is of great significance in guiding clinical decision-making.

Endoscopic ultrasound-guided tissue acquisition for focal liver lesions in patients with a history of multiple primary malignant neoplasms.

This study aimed to investigate the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing focal liver lesions in patients with a history of multiple primary malignant neoplasms. Among patients who underwent EUS-TA for focal liver lesions between 2016 and 2022, those with a history of multiple malignant neoplasms were included. A histologically confirmed malignant tumor within the past 5 years before EUS-TA was defined as a history of malignant neoplasm. The primary outcomes were diagnostic ability and adverse events of EUS-TA. This study included 16 patients (median age, 73 [33-90] years), the median tumor size was 32 (6-51) mm, 14 had a history of double malignant neoplasms, whereas two had triple malignant neoplasms. Malignant neoplasms were detected histologically or cytologically in all cases. Immunohistochemistry was performed in 75% (12/16), and the final diagnosis of EUS-TA was metastatic liver tumor in 12 patients, and primary malignant liver tumor in four patients. The primary site could be identified in 11 of 12 metastatic tumor cases. The diagnostic yield of EUS-TA was 100% (16/16) for differentiating benign and malignant tumors and 94% (15/16) for confirming the histological type including the primary site of metastatic lesions. No adverse events were associated with the procedure. EUS-TA is a useful diagnostic modality for focal liver lesions in patients with a history of multiple malignant neoplasms, allowing for the differential diagnosis of primary and metastatic tumors and identification of the primary site of metastatic lesions.

Sellar metastasis: A rare intraoperative finding – surgical treatment, strategies and outcome

ObjectiveThe sellar region, though uncommon for metastatic spread, may become more prevalent due to longer survival of patients with metastatic malignancies. Compression of adjacent vital anatomy can cause disabling symptoms and endocrine disturbances, leading to significant morbidity MethodsThis study analyzed sellar pathologies treated via endonasal approach from January 2011 to December 2021 to assess the incidence of sellar metastases. Patient demographics, presenting symptoms, radiological and histological findings, management, and outcomes were evaluated ResultsAmong 334 patients treated during the study period, eight (2.3 %) had metastases confirmed histopathologically, with one having a known malignant tumor history. Preoperative imaging suspected malignancy or metastasis in two cases. Diagnosis was unexpectedly confirmed in 57 % of cases. Subtotal resection was achieved in three cases, near-total resection in one. Mean follow-up was 2.4 years, with 71 % mortality ConclusionsThe sellar region can manifest metastatic disease, with sellar symptoms potentially indicating neoplastic disease onset. Rapid hormonal dysfunction or ophthalmoplegia suggests metastasis, even without a known primary. Further meta analysis of reported cases is necessary to determine the incidence and optimal treatment of these rare metastases.

Mucin-producing tumors of the ovary——preoperative differentiation between metastatic ovarian mucinous carcinoma and primary mucinous malignant tumors

ObjectiveTo investigate the clinical and magnetic resonance imaging (MRI) features for preoperatively discriminating primary ovarian mucinous malignant tumors (POMTs) and metastatic mucinous carcinomas involving the ovary (MOMCs).MethodsThis retrospective multicenter study enrolled 61 patients with 22 POMTs and 49 MOMCs, which were pathologically proved between November 2014 to Jane 2023. The clinical and MRI features were evaluated and compared between POMTs and MOMCs. Univariate and multivariate analyses were performed to identify the significant variables between the two groups, which were then incorporated into a predictive nomogram, and ROC curve analysis was subsequently carried out to evaluate diagnostic performance.Results35.9% patients with MOMCs were discovered synchronously with the primary carcinomas; 25.6% patients with MOMCs were bilateral, and all of the patients with POMTs were unilateral. The biomarker CEA was significantly different between the two groups (p = 0.002). There were significant differences in the following MRI features: tumor size, configuration, enhanced pattern, the number of cysts, honeycomb sign, stained-glass appearance, ascites, size diversity ratio, signal diversity ratio. The locular size diversity ratio (p = 0.005, OR = 1.31), and signal intensity diversity ratio (p = 0.10, OR = 4.01) were independent predictors for MOMCs. The combination of above independent criteria yielded the largest area under curve of 0.922 with a sensitivity of 82.3% and specificity of 88.9%.ConclusionsPatients with MOMCs were more commonly bilaterally and having higher levels of CEA, but did not always had a malignant tumor history. For ovarian mucin-producing tumors, the uniform locular sizes and signal intensities were more predict MOMCs.

Opportunistic lung cancer screening with low-dose computed tomography in National Cancer Center of China: The first 14 years' experience.

In China, over 50% of lung cancer cases occur in nonsmokers. Thus, identifying high-risk individuals for targeted lung cancer screening is crucial. Beyond age and smoking, determining other risk factors for lung cancer in the Asian population has become a focal point of research. Using 30,000 participants in the prospectively enrolled cohort at China's National Cancer Center (NCC) over the past 14 years, we categorized participants by risk, with an emphasis on nonsmoking females. Between November 2005 and December 2019, 31,431 individuals voluntarily underwent low-dose computed tomography (LDCT) scans for lung cancer screening at the NCC. We recorded details like smoking history, exposure to hazards, and family history of malignant tumors. Using the 2019 NCCN criteria, participants were categorized into high-, moderate-, and low-risk groups. Additionally, we separated non-high-risk groups into female never smokers (aged over 40) exposed to second-hand smoke (SHS) and others. Any positive results from initial scans were monitored per the I-ELCAP protocol (2006), and suspected malignancies were addressed through collaborative decisions between patients and physicians. We analyzed and compared the detection rates of positive results, confirmed lung cancers, and cancer stages across risk, age, and gender groups. Out of 31,431 participants (55.9% male, 44.1% female), 3695 (11.8%) showed positive baseline LDCT scans with 197 (0.6%; 106 females, 91 males) confirmed as lung cancer cases pathologically. Malignancy rate by age was 0.1% among those aged under 40 years, 0.4% among those aged 40-49 years, 0.8% among those aged 50-59 years, and 1.2% among those aged 60 years and older. From the 25,763 participants (56.9% male, 43.1% female) who completed questionnaires, 1877 (7.3%) were categorized as high risk, 6500 (25.2%) as moderate risk, and 17,386 (67.5%) as low risk. Of the 23,886 in the non-high-risk category, 8041 (33.7%) were females over 40 years old exposed to SHS. The high-risk group showed the highest lung cancer detection rate at 1.4%. However, females exposed to SHS had a notably higher detection rate than the rest of the non-high-risk group (1.1% vs. 0.5%; p < 0.0001). In this cohort, 84.8% of the detected lung cancers were at an early stage. In our study, using LDCT for lung cancer screening proved significant for high-risk individuals. For non-high-risk populations, LDCT screening could be considered for nonsmoking women with exposure to SHS.

Predicting subsolid pulmonary nodules before percutaneous needle biopsy: a comparison of artificial neural network and biopsy results

To establish an artificial neural network (ANN) model to predict subsolid nodules (SSNs) before percutaneous core-needle biopsy (PCNB). The results of the two methods were compared to provide guidance on the treatment of SSNs. This was a single-centre retrospective study using data from 1,459 SSNs between 2013 and 2021. The ANN was developed using data from patients who underwent surgery following computed tomography (CT) (SFC) and validated using data from patients who underwent surgery following biopsy (SFB). The prediction results of the ANN for the PCNB group and the histopathological results obtained after biopsy were compared with the histopathological results of lung nodules in the same group after surgery. Additionally, the choice of predictors for PCNB was analysed using multivariate analysis. There was no significant difference between the accuracies of the ANN and PCNB in the SFB group (p=0.086). The sensitivity of PCNB was lower than that of the ANN (p=0.000), but the specificity was higher (p=0.001). PCNB had better diagnostic ability than the ANN. The incidence of precursor lesions and non-neoplastic lesions in the SFB group was lower than that in the SFC group (p=0.000). A history of malignant tumours, size (2-3 cm), volume (>400 cm3) and mean CT value (≥-450 HU) are important factors for selecting PCNB. Both ANN and PCNB have comparable accuracy in diagnosing SSNs; however, PCNB has a slightly higher diagnostic ability than ANN. Selecting appropriate patients for PCNB is important for maximising the benefit to SSN patients.

Secretory breast carcinoma: clinicopathological features and prognosis of 52 patients.

Secretory breast carcinoma is a rare histological subtype of invasive breast cancer and considered with an indolent clinical behavior. This study was conducted to analyze the clinicopathological features of patients with secretory breast carcinoma (SBC), explore the outcome, and compare the prognostic difference with invasive ductal breast carcinoma (IDC). METHODSAND MATERIALS: Patients with SBC diagnosed between 2006 and 2017 from Fudan University Shanghai Cancer Center were included in the study, excluding patients with previous malignant tumor history and incomplete clinical data or follow-up records. Peculiar clinicopathological and immunohistochemical features of the cases were fully described. Clinical data of 4979 cases of IDC were also evaluated during this period. After propensity score matching, prognostic analysis of SBCs and IDCs was calculated by Kaplan-Meier method and landmark analysis method. The data of 52 patients diagnosed with SBC were identified from the pathological files. Among them, 47 patients were women, and 5 were men. The median age of the 52 SBCs was 46years (mean, 48.1years; range, 10-80years). The tumor sizes ranged from 0.3 to 6.8cm, with a mean of 3.5cm. Eight patients (15.4%) had positive axillary lymph node involvement. The molecular classification was mostly triple-negative breast cancer (65.4%). Fluorescence in situ hybridization confirmed the presence of ETV6::NTRK3 rearrangement in 16 of 18 cases (88.9%). Furthermore, Kaplan-Meier survival analysis and landmark analysis demonstrated that there were no statistically significant differences in DFS and OS between SBC and IDC patients. Although SBCs are generally associated with a favorable prognosis, our work exhibited that the clinicopathological features of SBC were partly different from former understandings, indicating that therapeutic procedure should be prudent. Further studies are necessary to fully identify the clinical behavior and predictive markers to improvediagnosis and management in this unique subtype of breast cancer.

Routine left atrial appendage closure: a retrospective analysis of mid-term outcomes

Background: There is strong evidence that stroke associated with atrial fibrillation (AF) has a cardioembolic origin. Given that the main source of thrombi in such patients is the left atrial appendage (LAA), there is a prospect of its closure becoming an adjunct or alternative to lifelong anticoagulant therapy.Objective: To evaluate the long-term effectiveness of routine LAA closure for ischemic stroke (IS) prevention in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).Methods: Our retrospective single-center study included patients who underwent cardiac surgery with CPB within 3 years. All participants were older than 18 years. The exclusion criteria: lack of information on the long-term outcomes; hemodynamically significant lesion of brachiocephalic vessels; porcelain aorta; infective endocarditis; history of malignant neoplasms, autoimmune diseases, and systemic vasculitis; acute coronary syndrome, repeated open heart surgery, and minimally invasive procedures. The selected patients were divided into 2 groups. Group 1 included patients who underwent concomitant LAA closure. Group 2 consisted of patients with intact LAA. We further divided patients based on whether they had preoperative AF or not. The primary end point was IS. The secondary end points were survival, perioperative myocardial infarction and AF, CPB and aortic cross-clamp time, number of resternotomies for bleeding, length of stay in the intensive care and cardiac surgery units.Results: After the primary analysis and use of exclusion criteria, we formed an LAA closure group (216 patients) and a group with intact LAA (179 patients). Among 129 patients with preoperative AF, concomitant LAA closure was performed in 69 patients and was not performed in 60 patients. Among 266 patients with no history of AF, this procedure was performed in 147 patients and was not performed in 119 patients. Multivariable Cox regression analysis included all the patients and showed that LAA closure was an independent predictor of decrease in IS incidence (hazard ratio, 0.20; 95% CI, 0.06-0.62; P = .006). At the same time, the procedure lost its benefits when patients with AF were excluded from the analysis. There were no differences in the secondary end points.Conclusion: LAA closure is an effective and safe method for long-term IS prevention in patients with AF operated on using CPB. The use of this procedure as a routine addition to the main cardiac surgery is not viable. Received 12 December 2022. Revised 4 September 2023. Accepted 5 September 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Selectively Irradiation of the Supraclavicular Area in Nasopharyngeal Carcinoma Treated with Intensity Modulated Radiotherapy

The application of intensity-modulated radiotherapy (IMRT) has significantly improved the locoregional control and overall survival of patients with nasopharyngeal carcinoma (NPC), but how to deescalate the intensity of treatment to further reduce the side effects while ensuring the efficacy is the main concern of clinicians. Decreasing radiation volume is one of the hot research topics. Whole-neck irradiation is recommended for patients with cervical lymph node involvement, which includes levels IVb and Vc. Since the implementation of IMRT in our clinic, patients with only upper cervical lymph node invasion have not been irradiated in the levels IVb and Vc, and the regional control rate is comparable to that of other centers. This study intends to retrospectively analyze the feasibility of omitting levels IVb and Vc in patients with only upper cervical lymph node invasion, and provide a basis for the revision of international guideline for the delineation of the clinical target volume (CTV). Patients with histologically confirmed NPC who completed IMRT successfully at our attending group between January 2014 to March 2018 were candidates for this study. Other eligibility criteria for analysis were as follows: (1) The first patient without distant metastasis; (2) Only patients with upper cervical lymph node invasion (only N1, N2, because the maximum diameter of the upper neck 6cm diagnosed as N3 patients were not included) (AJCC staging system, 8th edition); (3) Having complete baseline imaging data; (4) Over 3 months of follow-up; (5) Patients without previous history of malignant tumor and secondary cancer. According to the delineation of CTV in our protocol for patients with stage N1 and N2, levels IVb and Vc are not irradiated (i.e., retaining the original supraclavicular area). The main endpoints of the study were regional recurrence-free survival (RRFS) and recurrence rates in levels IVb and Vc. In all, 363 patients with NPC and median follow-up of 61.9 months (range, 3.67-93.3) met the study inclusion criteria and comprise the dataset for the analysis. The overall survival, survival without local recurrence, survival without regional recurrence, and survival without distant metastasis at 3 and 5 years were 94.6% and 91.1%, 97.7% and 96.5%, 98.6% and 98.0%, 93.5% and 91.1%. At the final follow-up, 11 cases showed regional recurrence, and only one case (0.28%) showed recurrence in regions IVb and Vc, which were field recurrences, while the rest were intra-field recurrences. Omitting levels Ⅳb and Ⅴc IMRT should be safe and feasible for patients who only had involvement of upper neck LNs. Further well-designed multicenter prospective trials should be conducted to confirm our results and further optimize the recommendation of the International Guideline.

Usefulness of attenuation value on computed tomography plain scan for diagnosing enlarged mediastinal lymph nodes metastases.

To evaluate the diagnostic value of computed tomography (CT) attenuation in mediastinal lymph node metastases of malignant tumors. A retrospective review was conducted of a Chinese institutional database of consecutive patients with a history of malignant tumors. Those who had enlarged, necrotic, or hypermetabolic lymph nodes detected in the mediastinum during routine CT examination or positron emission tomography (PET)/CT imaging from January 2019 to December 2021 were collected for investigation. All patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and were followed up for at least 6 months to diagnose lymph node metastases. One-to-one correlation was attempted between the CT images of the lymph nodes and EBUS-TBNA area of the same lymph node groups and similar size. Radiologists measured size, as well as plain CT and contrast-enhanced CT (CECT) attenuation values of mediastinal lymph nodes, and evaluated the effectiveness of these variables in diagnosing lymph node metastasis. A total of 135 lymph nodes of 114 patients were included in the study. In the univariate analysis, the long-axis diameter, short-axis diameter, short-axis/long-axis ratio, and plain CT attenuation values of lymph nodes were found to be statistically significantly different between the metastatic and non-metastatic lymph nodes. The areas under receiver operator characteristic (ROC) curves (AUCs) of long-axis diameter, short-axis diameter, short-axis/long-axis ratio, and plain CT attenuation value for diagnosing metastases were 0.711, 0.788, 0.671, and 0.827, respectively. The best value of the AUC for diagnosing lymph node metastases was 0.827 [95% confidence interval (CI): 0.749-0.890] using plain CT attenuation value ≤45 Hounsfield units (HU). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 92.8%, 69.2%, 86.5%, and 81.8%, respectively. Similar results were obtained from the 68 cases of lung cancer. Plain CT attenuation values reached the best AUC (0.860) for diagnosing lymph node metastases. Plain CT attenuation of lymph nodes is an effective method for diagnosing enlarged mediastinal lymph nodes with a history of multiple malignancies or lung cancer. Plain CT could be used as an additional test where there is no PET/CT available in cases of diagnostic dilemma.

Gliosarcoma in a patient with triple-negative breast cancer: A case report

Abstract Gliosarcoma is a rare subtype of glioblastoma with the histological features of both glioblastoma and soft-tissue sarcoma. Triple-negative breast cancer (TNBC) is a special type of breast cancer that is different from other breast cancers. It is characterized by strong invasiveness, high recurrence rate, and poor prognosis. The concurrent occurrence of gliosarcoma and TNBC was rarely seen and reported. A 63-year-old woman with a history of TNBC was found to have an intracranial mass due to headache. Intracranial tumor resection surgery was undergone, and histopathological examination postoperation revealed gliosarcoma. After craniotomy, the patient underwent standard radiotherapy and chemotherapy. Postoperative follow-up observation showed no obvious recurrence of either tumor. In conclusion, gliosarcoma and TNBC are tumors with poor prognosis. It is rare to encounter two types of malignant tumors in the same patient. When we encounter intracranial space-occupying patients with a history of malignant tumors, we should first consider tumor metastasis. When excluding the possibility of cancer metastasis, the possibility of two primary tumors should be considered.

Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors.

In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.

First case of endometrial cancer after yolk sac tumor in a patient with Li-Fraumeni syndrome

BackgroundLi-Fraumeni syndrome (LFS) is a rare autosomal dominant disease with high penetrance caused by a germline variant of TP53 gene. We report the first case of endometrial cancer after yolk sac tumor with LFS.Case presentationThe presented female patient underwent right adnexectomy at age 23 because of a yolk sac tumor of the ovary. At the age of 27, the patient was diagnosed with endometrial adenocarcinoma, received cytoreductive surgery and chemotherapy. Given that her personal cancer history along with a strong family history of cancer, her father passing away from lung cancer at age 48 and her grandmother dying of ovarian cancer at age 50, the patient was referred for genetic counseling and testing. Genetic screening revealed a heterozygous pathogenic TP53 c.844C > T, p.( R282 W) with NM_000546.5 variant, a class 5 (C5) variant. This is the first reported case of a yolk sac tumor accompanied by subsequent endometrial cancer that is associated with LFS.ConclusionsWe reported a first case of an endometrial cancer after yolk sac tumor patient with a tumor family history of harboring the germline TP53 pathogenic variation which expanded types of tumor that can be presented in patients with LFS. This case highlights the importance of genetic testing for patients with malignant tumors, as well as patients with a family history of malignant tumors. And our case highlights the necessity of screening for gynecologic tumor in LFS patients.

Efficacy of Warfarin Therapy Guided by Pharmacogenetics: A Real-world Investigation Among Han Taiwanese

The anticoagulation activity of warfarin in populations with CYP2C9, VKORC1, and CYP4F2 variants differs between individuals and is correlated with poor international normalized ratio (INR) control. Pharmacogenetics-guided warfarin dosing has been successfully developed for patients with genetic variations in recent years. However, few real-world data have been used to investigate the INR and warfarin dosage and the time to target INR. This study examined the largest collection of genetic and clinical real-world data related to warfarin to provide further evidence supporting the benefits of pharmacogenetics in clinical outcomes. We retrieved a total of 69,610 INR-warfarin records after the index date from 2,613 patients in the China Medical University Hospital database between January 2003 and December 2019. Each INR reading was obtained from the latest laboratory data after the hospital visit date. Patients with a history of malignant neoplasms or pregnancy before the index date were excluded, as were patients without data on INR measurements after the fifth day of prescription, genetic information, or gender variables. The primary outcomes were the INR and warfarin dosage during days 7, 14, 28, 56, and 84 after prescription. The secondary outcome was the time required to reach the INR ranges of 1.5 to 3.0 and >4.0. A total of 59,643 INR-warfarin records from 2188 patients were retrieved. The average INR was higher for homozygous carriers of the minor allele at CYP2C9 and VKORC1 during the first 7 days (1.83 [1.03] [CYP2C9*1] and 2.46 [1.44] [CYP2C9*3], P < 0.001; 1.39 [0.36] [rs9923231 G/G], 1.55 [0.79] [rs9923231 G/A], and 1.96 [1.13] [rs9923231 A/A], P < 0.001) than for the wild-type allele. These patients with variants required lower warfarin doses than those with the wild-type allele during the first 28 days. CYP4F2 variant patients seemed to require higher doses of warfarin than those in the wild-type group; however, no significant difference in the average INR was observed (1.95 [1.14] [homozygous V433 carriers], 1.78 [0.98] [heterozygous V433M carriers], and 1.66 [0.91] [homozygous M433 carriers], P=0.016). Our study indicates that genetic variants in the Han population may enhance warfarin responsiveness, which holds clinical relevance. An increased warfarin dosage was not linked to a shorter time to therapeutic INR between CYP4F2 variant patients and those with a wild-type allele. Assessing CYP2C9 and VKORC1 genetic polymorphisms before initiating warfarin treatment in real-world practice is essential for potentially vulnerable patients and is likely to optimize therapeutic dosing.

First case of bloodstream infection caused by NDM-positive Escherichia hermannii

BackgroundEscherichia hermannii (E. hermanni) is always accompanied by other bacterial infections in humans. In previous reports, most E. hermannii-related infections were caused by sensitive strains. Here, for the first time, we report the case of a patient with New Delhi metallo-β-lactamase (NDM)-positive E. hermannii bloodstream infection.Case presentationThe patient was a 70-year-old male admitted to our hospital due to a 4-day fever, with a history of malignant tumor, liver cirrhosis, and chronic obstructive pulmonary disease. After admission, his blood culture tested positive for E. hermannii. The drug resistance analysis showed positive for NDM resistance, with susceptibility to aztreonam, levofloxacin, and amikacin. The blood culture turned negative after 8 days of aztreonam treatment. The patient’s symptoms improved, and he was discharged after 14 days of hospitalization.ConclusionsThis is the first report of a bloodstream infection caused by an NDM-positive E. hermannii strain. The anti-infection regimen used in this case provides a new reference regimen for clinical practice.