Objective:To analyze the correlation of epidermal growth factor receptor (EGFR) expression in esophageal cancer tissues with sensitivity of radical radiotherapy and prognosis of patients.Methods:A total of 98 esophageal cancer patients admitted to the Affiliated Hospital of Jiangnan University from January 2017 to July 2019 were selected, and all patients received radical radiotherapy. The efficacy was assessed after 4 weeks of radiotherapy, partial remission (PR) + complete remission (CR) was treated as the sensitive group and disease progression (PD) + stable disease (SD) was treated as the tolerated group. The expression of EGFR in cancer tissues and paraneoplastic tissues (more than 5cm from the margin of cancer tissues) was measured by using immunohistochemistry. The expression of EGFR in cancer tissues and paraneoplastic tissues and the clinicopathological characteristics of the sensitive and tolerant groups were compared. Cox proportional risk model was used to analyze the factors influencing the prognosis of esophageal cancer patients; the Kaplan-Meier method was used to analyze the relationship between EGFR expression in cancer tissues and prognosis of patients.Results:The positive expression rate of EGFR in esophageal cancer tissues (66.3%, 65/98) was higher than that in paraneoplastic tissues (29.6%, 29/98), and the difference between the two groups was statistically significant (χ 2=26.49, P < 0.001). All 98 patients successfully completed radical radiotherapy, including 4 cases of CR, 60 cases of PR, 26 cases of SD and 8 cases of PD. The proportion of patients with highly differentiated and tumor length ≤1.5 cm in the sensitive group was higher than that in the tolerant group, and the differences were statistically significant (all P < 0.05). The positive expression rate of EGFR in cancer tissues in the sensitive group (56.3%, 36/64) was lower than that in the tolerant group (85.3%, 29/34), and the difference between the two groups was statistically significant ( χ2=8.39, P < 0.001). Multifactorial Cox regression analysis showed that poor differentiation, tumor long diameter >1.5 cm, and positive EGFR expression were independent risk factors for overall survival in patients with esophageal cancer (all P < 0.05). The difference in overall survival between patients with positive and negative EGFR expression was statistically significant ( χ2=9.70, P = 0.002). Conclusions:Highly-expressed EGFR in esophageal cancer tissues may suggest low sensitivity of radical radiotherapy and poor prognosis of patients.

Objective:To evaluate the effectiveness and safety of concurrent chemoradiotherapy combined with nimotuzumab in the treatment of patients with inoperable esophageal squamous cell carcinoma (ESCC).Methods:A retrospective analysis was conducted on the clinical data of 503 patients with inoperable ESCC who underwent concurrent chemoradiotherapy in the Department of Radiation Oncology, Changzhou No. 2 People′s Hospital Affiliated to Nanjing Medical University and Department of Radiation Oncology, Affiliated Hospital of Jiangnan University from 2014 to 2020. Among these patients, 69 received concurrent chemoradiotherapy combined with nimotuzumab (the combined therapy group) and 434 received concurrent chemoradiotherapy alone (the concurrent chemoradiotherapy group). Patients of both groups were matched at a ratio of 1∶2 using the propensity score matching (PSM) method. As a result, 168 patients were determined for clinical analysis, including 61 in the combined therapy group and 107 in the concurrent chemoradiotherapy group. The short-term efficacy and adverse reactions of both groups were compared. The overall survival (OS) curves and progression-free survival (PFS) curves were plotted using the Kaplan-Meier method for the Log-rank test.Results:The two groups showed no statistical difference ( P > 0.05) in clinical baseline characteristics after the PSM. The objective response rate (ORR) of the combined therapy group was significantly higher than that of the concurrent chemoradiotherapy group with statistically significant differences (85.2% vs. 71.0%, χ2 = 4.33, P = 0.037). There was no statistical difference (98.4% vs. 91.6%, P > 0.05) in the disease control rate (DCR) between the two groups. The combined therapy group had median PFS of 28.07 months and 1-, 3-, and 5-year PFS ratios of 78.2%, 37.5% and 29.1%, respectively. The concurrent chemoradiotherapy group had mPFS of 19.54 months and 1-, 3-, and 5-year PFS ratios of 72.9%, 28.3% and 21.3%, respectively. Both groups showed statistically significant differences in PFS ( χ2 = 4.49, P = 0.034). The combined group had median OS of 34.93 months and 1-, 3-, and 5-year OS ratios of 88.5%, 46.8% and 37.4%, respectively. The concurrent chemoradiotherapy group had mOS of 24.30 months and 1-, 3-, and 5-year OS ratios of 81.3%, 35.2% and 28.0%, respectively. Both groups showed statistically significant differences in OS (χ 2= 5.11, P = 0.024), but did not show statistical differences ( P > 0.05) in the severity degree of each adverse effect during the treatment. Conclusions:Concurrent chemoradiotherapy combined with nimotuzumab can improve the ORR and prolong the PFS and OS of patients with inoperable ESCC compared with concurrent chemoradiotherapy alone. Furthermore, combining with nimotuzumab does not increase adverse effects and can be tolerated by patients with high safety.

目的 针对急诊护理路径对急诊性心肌梗死患者急救效果进行研究.方法 选取我院在2021年7月至2022年5月收治的120例急诊性心梗死患者作为研究对象.随机将患者分为观察组和对照组,每组各60例.对照组采用常规护理方法;观察组则在对照组的基础上采取急诊护理路径.分析对比两组的救治情况、心理状态、不良反应及护理满意度.结果 观察组急诊分诊时间、急救时间、救治方案时间、缓解疼痛时间、住院时间、卧床时间明显短于对照组(P<0.05).护理后观察组SAS评分、SDS评分均显著低于对照组(P<0.05).观察组不良反

目的 研究增加肿瘤区单次剂量对接受根治性放疗的食管鳞癌患者的预后影响.方法 回顾性分析2014年09月—2019年07月在江南大学附属医院接受根治性放疗的食管鳞癌患者88例,依据给予肿瘤区的单次剂量不同将患者分为单次剂量≤2 Gy组(n=48)和单次剂量>2 Gy组(n=40),比较两组患者的1年生存率、3年生存率、中位生存期(OS)和中位无进展生存期(PFS),并采用Cox比例风险模型分析食管癌患者预后的影响因素.结果 单次剂量>2 Gy组和≤2 Gy组中位OS均为25个月,中位PFS分别为15个月和12个月,1年OS率、3年OS率分别为87.5％和81.3％、40％和22.9％,前者相比后者生存率有改善趋势,但两者差异均无统计学意义(P>0.05).两组患者血液毒性、放射性食管炎、放射性肺损伤的发生率差异均无统计学意义(P>0.05).多因素分析显示病变长度、TNM分期、放射性食管炎程度、放射性肺损伤程度是不可手术食管癌患者的预后的独立影响因素.结论 对于接受根治性放疗的食管癌患者,增加PTV单次剂量具有可行性和安全性.

Objective:To explore the healing mechanism of porcine small intestinal submucosa decorated with nano-silver (NS-PSIS) in the treatment of a model of fistula-in-ano.Methods:NS-PSIS was constructed. Animal models of fistula-in-ano were established using New Zealand rabbits and randomly divided into two groups according to random number table ( n=12 in each group). Rabbits in the experimental group were treated with NS-PSIS for anal fistulas, and those in the control group were treated with PSIS. The treated anal fistula tissue samples were obtained at 12, 24, 48 h and 14 d after surgery ( n=3 in each group). Hematoxylin-eosin staining was performed to observe the pathomorphological changes of the marginal tissues of the anal fistula. Masson staining was performed to assess collagen deposition in the marginal tissue of the anal fistula and quantitative analysis was performed. Immunohistochemical staining was performed to detect the expression of CD34 in the marginal tissue of the anal fistula and calculate the microvessel density (MVD). The expression of transforming growth factor (TGF)-β1, Smad2, collagen type Ⅰ (COL Ⅰ) and collagen type Ⅲ (COL Ⅲ) was detected. Real-time polymerase chain reaction (RT-qPCR) was performed to detect the mRNA expression of TGF-β1, Smad2, COL Ⅰ and COL Ⅲ. For measurement data meeting normal distribution, independent sample t-test was used for comparison between two groups; otherwise, Wilcoxon rank sum test was used. Results:NS-PSIS was successfully constructed. A New Zealand rabbit model of fistula-in-ano was successfully established. In the early stage of treatment (12-48 h after surgery), significant inflammatory cell infiltration, fibroblast proliferation, collagen synthesis and neovascularization were observed around the fistula tract in both groups. Masson staining showed that collagen synthesis in the NS-PSIS group was significantly more than that in the PSIS group at 48 h after surgery [(29.40±2.80)% vs. (20.97±1.68)%, t=-7.752, P<0.01]. Immunohistochemistry showed that at 48 h after surgery, the MVD in NS-PSIS group was significantly higher than that in PSIS group [6.8 (5.2, 7.8) vs. 5 (4, 6.8), Z=-2.969, P<0.01]. At 24 h after surgery, the expression levels of COL Ⅰ [(22.06±2.83)% vs. (13.5±2.88)%, t=-6.342, P<0.01] and COL Ⅲ [(25.70±3.44)% vs. (20.02±2.45)%, t=-4.038, P<0.001] in NS-PSIS group were significantly higher than those in PSIS group. At 48 h after surgery, the expression levels of COL Ⅰ [(28.71±3.81)% vs. (20.09±3.07)%, t=-5.284, P<0.01] and COL Ⅲ [(30.59±1.41)% vs. (24.01±1.77)%, t=-710, P<0.01] in NS-PSIS group were significantly higher than those in PSIS group. In addition, the expression levels of TGF-β1 [19.71 (18.56, 20.90)% vs. (18.56±2.57)%, Z=-3.621, P<0.01] and Smad2 [(18.56±2.57)% vs. (12.22±2.55)%, t=-5.249, P<0.01] in the NS-PSIS group were significantly higher than those in the PSIS group at 48 h after surgery. RT-qPCR showed that the mRNA expression levels of TGF-β1 [8.62 (8.57, 9.05) vs. 6.87 (6.51, 7.14), Z=-3.621, P<0.01], Smad2 [13.44 (11.25, 13.59) vs. 10.05 (9.05, 10.37), Z=-3.616, P<0.01], COL Ⅰ [4.02 (3.84, 5.82) vs. 2.58 (2.08, 4.08), Z=-2.012, P<0.01] and COL Ⅲ [12.12 (11.60, 14.60) vs. 9.24 (7.25, 9.52), Z=-3.064, P<0.01] in the NS-PSIS group were significantly higher than those in the PSIS group at 48 h after surgery. Conclusion:The ability of NS-PSIS to promote neovascularization and collagen synthesis might be superior to PSIS in the early stage of therapy (48 h after surgery), and the mechanism might be related to the activation of TGF-β1/Smad2/COL Ⅰ/COL Ⅲ signaling pathway.

目的 探讨烟酰胺N甲基转移酶(NNMT)在食管癌中的表达及机制.方法 采用免疫组化法检测84例食管癌及癌旁正常组织中NNMT的表达,将siRNA NC(对照组)、siRNA NNMT(siRNA组)转染到EC9706食管癌细胞,Realtime PCR检测NNMT mRNA表达,CCK-8实验检测细胞活力,Hoechst染色检测细胞凋亡,Transwell实验检测细胞侵袭能力,Western blot检测NNMT、Wnt1a、β-catenin、CyclinD1、MMP-9蛋白表达.结果 NNMT在食管癌组织(59/84,70.23％)中的阳性表达显著高于癌旁正常组织(4/84,4.69％)(χ2=76.825,P<0.05).与对照组比较,siRNA组NNMT mRNA[(0.56±0.05)vs(1.00±0.10),t=5.903,P<0.05]及蛋白表达量[(0.74±0.07)vs(1.56±0.16),t=7.321,P<0.05]均下调,细胞活力[(0.39±0.04)vs(0.62±0.06),t=5.832,P<0.05]降低,细胞凋亡率[(32.46±3.24)％vs(3.31±0.32)％,t=6.431,P<0.05]提高,细胞侵袭数目[(32.47±3.25)vs(189.32±18.90),t=6.321,P<0.05]减少,Wnt1a[(0.41±0.04)vs(0.15±0.01),t=5.842,P<0.05]、β-catenin[(0.34±0.03)vs(0.17±0.02),t=5.216,P<0.05]、CyclinD1[(1.12±013)vs(0.39±0.04),t=6.438,P<0.05]、MMP-9[(0.87±0.09)vs(0.31±0.03),t=5.128,P<0.05]表达量均下调.结论 NNMT在食管癌组织中高表达,下调NNMT可以抑制EC9706食管癌细胞增殖与侵袭,与阻断Wnt/β-catenin信号通路有关.

Objective:To assess the role of Glasgow prognostic score (GPS) in the prognostic evaluation of nasopharyngeal carcinoma patients.Methods:Clinical data of 129 nasopharyngeal carcinoma patients who received radical radiotherapy in Affiliated Hospital of Jiangnan University from January 2012 to December 2013 were retrospectively analyzed. Clinicopathological characteristics of the patients were collected, including gender, age, TNM staging, pathological type and treatment regimen, etc. The GPS before and at 3 months after radiotherapy were calculated. The survival curve was drawn by the Kaplan- Meier method. Cox regression model was used for analysis of prognostic factors. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to evaluate the predictive capability of clinical parameters on prognosis. Results:With a median follow-up of 89.0 months (range: 5.1-104.6 months), the 5-year progression-free survival (PFS) of 129 patients was 79.8% and 84.5% for the 5-year overall survival (OS). At 3 months after radiotherapy, the 5-year PFS were 85.6%, 61.1% and 33.3% in the GPS 0, 1 and 2 groups, and 90.4%, 66.7% and 33.3% for the 5-year OS, respectively (all P<0.01). At 3 months after radiotherapy, the GPS, clinical staging (Ⅰ-Ⅲ vs. Ⅳ A) and concurrent chemotherapy were significantly correlated with PFS and OS (all P<0.01). ROC curve showed that at 3 months after radiotherapy, the AUC values of GPS, clinical staging and two combined in predicting OS were 0.694, 0.815 and 0.860, respectively. Conclusions:At 3 months after radiotherapy, higher GPS is an independent poor prognostic factor for nasopharyngeal carcinoma patients. The combination of GPS and clinical staging yields high accuracy in the prognostic evaluation of nasopharyngeal carcinoma patients.

The anti-epidermal growth factor receptor (EGFR) monoclonal antibody cetuximab in combination with chemotherapy is the standard of care in the first-line treatment for RAS wild-type metastatic colorectal cancer (mCRC), and it may also be effective in further lines of therapy. After the first-line cetuximab combined with chemotherapy, it is controversial that cetuximab can be used as maintenance treatment. Progressive disease (PD) occurs when tumors develop resistance to a therapy. Progression after chemotherapy and targeted therapy does not mean that the tumor is resistant to both treatments at the same time. Evidence from multiple studies suggests that patients who experience progression on cetuximab plus chemotherapy have probably developed resistance to the chemotherapeutic agents rather than the biologic component of the regimen and others may regain sensitivity to cetuximab following a chemotherapy switch. It is still inconclusive whether the patients treated with the continuation treatment and rechallenge treatment with cetuximab after having PD on regimens including cetuximab in an earlier treatment line can gain additional clinical benefit. Multiple studies have attempted to identify patients suitable for such a strategy. With this approach, treatment benefit can be extended, adding to established continuum-of-care strategies in patients with mCRC.

Objective:To explore the construction of early warning system for non-small cell lung cancer (NSCLC) by whole genome sequencing.Methods:The experiment was divided into two groups: normal tissue and NSCLC tissue. The expression of excision repair cross-complementation group 1 (ERCC1), tubb3 and RRM1 mRNA in NSCLC cells was detected by real-time quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR). The distribution of methylation in NSCLC cells was detected by whole genome sequencing. CpG methylation analysis was performed using sequencing data. Histone modification data were used to analyze the relationship between histone modification and DNA methylation. The expression of histone methylated eggs and methylated related enzymes in normal and NSCLC tissues were detected by protein immunoassay.Results:Compared with the control cells, ERCC1 mRNA [(0.78±0.14) vs. (0.12±0.04), χ2=6.370, P<0.05] and RRM1 mRNA [(0.52±0.07) vs. (0.05±0.01), χ2=5.360, P<0.05] expression in NSCLC cells was down-regulated compared with control cells. Methylation level in NSCLC group increased at transcription start site and decreased in intergene region ( χ2=3.140, P<0.05). Nine CpG methylation sensitive sites were found in the NSCLC group (RUNX3, MIR196A1, HOXA11, OTP, GATA4, PTPRU, SLC15A3, ZIC1 and TFAP2B). NSCLC group compared with control group, the lower histone acetylation [(H3K9ac [(43.57±8.84) vs. (10.64±4.35), χ2=8.730, P<0.05] and H3K27ac [(40.52±8.64) vs. (9.67±3.58), χ2=5.470, P<0.05) ] and histone methylation [(H2az [(42.56±9.74) vs. (12.47±6.05), χ2=7.420, P<0.05]. H3K4me1 [(37.47±6.42) vs. (15.46±7.34), χ2=5.380, P<0.05], H3K4me2 [(50.37±10.24) vs. (9.47±6.54), χ2=9.270, P<0.05]. H3K4me3 [(52.37±6.49) vs. (10.58±5.88), χ2=1.690, P<0.05] and H3K79me2 [(34.55±6.42) vs. (11.23±6.94), χ2=3.450, P<0.05]. Compared to the control group, NSCLC group DNMT1 express cut [(1.88±0.24) vs. (0.12±0.01), χ2=5.430, P<0.05], DNMT3a expression cut [(1.75±0.36) vs. (0.49±0.11), χ2=7.890, P<0.05], expression of DNMT3b cut [(0.88±0.14) vs. (0.13±0.05), χ2=1.360, P<0.05], expression of H3K4me3 cut [(2.53±0.35) vs. (0.35±0.08), χ2=5.440, P<0.05), H3K9me2 expression cut (0.55±0.07) vs. (0.05±0.01), χ2=3.270, P<0.05]. Conclusion:Histone modification is closely related to DNA methylation, and the expression of histone methylation and methylation-related enzymes is also affected. Methylation sensitive sites can be used as biomarkers for early detection of NSCLC.

目的 探讨选择替吉奥+顺铂对Ⅲ、Ⅳa期鼻咽癌患者实施同期I M RT放化疗治疗后获得的近期疗效以及表现出的不良反应.方法 选择我院2017年04月～2019年03月收治的82例Ⅲ、Ⅳa期鼻咽癌患者作为实验对象;数字奇偶法分组后探究每组拟定的放化疗方案;比照组(41例):拟定5-FU+顺铂方案展开同期IMRT放化疗;实验组(41例):拟定替吉奥+顺铂方案展开同期IMRT放化疗;最终就组间病症近期疗效以及不良反应总占比展开对比.结果 实验组Ⅲ、Ⅳa期鼻咽癌患者病症近期治疗总有效率(90.24％)高于比照组(70.73％)明显(P<0.05);实验组Ⅲ、Ⅳa期鼻咽癌患者不良反应总占比(21.95％)低于比照组(60.98％)明显(P<0.05).结论 Ⅲ、Ⅳa期鼻咽癌患者于临床接受替吉奥+顺铂方案完成同期IMRT放化疗治疗后,利于病症近期疗效提升以及不良反应总占比的降低,最终促进Ⅲ、Ⅳa期鼻咽癌患者的耐受性提升以及综合状态改善.

目的 探讨放疗前中性粒细胞与淋巴细胞比值(NLR)对食管癌患者预后的影响.方法 回顾性分析86例食管癌放疗患者的临床资料.根据放疗前外周血NLR分为低NLR组(NLR ＜2.56)和高NLR组(NLR≥2.56),比较2组患者的3、5年总生存率和1、3年无病生存率.结果 放疗前,低NLR组患者的3、5年生存率分别为52.8％、33.2％,显著高于放疗前高NLR组的32.3％、14.0％(P＜0.05);放疗前低NLR组患者的1、3年无病生存率分别为72.8％、44.9％,显著高于放疗前高NLR组的45.0％、18.3％ (P ＜0.05).多因素分析表明,NLR、肿瘤分化程度及TNM分期是食管癌患者放疗后总生存和无病生存的独立预后因素.结论 食管癌患者放疗前NLR升高是影响预后的不利因素.