Table of Content

21 August 2024, Volume 45 Issue 4

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A pioneer promotes integration of medicine and information technology, shedding light on medical imaging—Professor Wang Zhenchang, academician of Chinese Academy of Engineering

Wang Hao, Zhao Pengfei, Lyu Han, Zhang Peng

2024, 45(4):  561-565.  doi:10.3969/j.issn.1006-7795.2024.04.001

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Professor Wang Zhenchang is the first academician of the Information and Electronic Engineering Division of the Chinese Academy of Engineering in the health field. As a leading figure in the field of image perception and analysis of auditory and visual systems, He has long been engaged in scientific research of physiological and pathological information detection, perception technology, and instruments. His major academic achievements include: ①Breaking through the limitations of traditional imaging relying on single-structure information diagnosis, he established a new paradigm for a multi-modal and multi-dimensional coordinated diagnostic system for complex human system images and a physiological-pathological multi-element information correlation diagnosis system. Further, he created a multi-element coordinated perception method for auditory conduction pathways to clarify the mechanism and causes of pulsatile tinnitus, which led international frontier research in this direction. ②Overcoming the difficulty of accurately identifying tiny human structures, he was in charge of the development of the world's first bone-specific computed tomography (CT) instrument with a resolution of 50 μm, promoting information acquisition capability from sub-millimeter to tens of micrometers. This successfully explored a new high-performance development path for specialized and refined domestic CT instruments. ③ Based on the integration of information technology and medicine, he significantly improved the detection efficiency of small lesions in the auditory and visual systems and advanced the reconstruction of medical imaging. Many of his research results have been included in international consensus, textbooks, and national unified teaching materials, and it has also been widely applied in the clinical practice, beneficial to hundreds of millions of patients.





The application of artificial intelligence in the reproductive endocrinology

Pei Youjuan, Ruan Xiangyan, Ju Rui, Wang Yuejiao, Jiang Lingling, Ma Jun

2024, 45(4):  566-572.  doi:10.3969/j.issn.1006-7795.2024.04.002

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As artificial intelligence (AI) is widely used and rapidly developed in the medical field, more and more AI technology are applied to solve the problems of diagnosis, treatment, health management, supervision and prevention of reproductive endocrinology diseases.This article review briefly the history of AI development and the application of AI in the field of reproductive endocrinology, and summarized the current situation, feasibility, and limitations of the application of AI in the field of reproductive endocrinology so as to provide broader ideas for the research of AI in reproductive endocrinology.

Protective effect of N-Acetyl-L-Cysteine on cryopreserved-thawed human ovarian tissue

Li Yanglu, Ruan Xiangyan, Li Yanqiu, Gu Muqing, Du Juan, Wang Zecheng, Cheng Jiaojiao, Jin Fengyu, Jiang Lingling, Yang Yu, Alfred O. Mueck

2024, 45(4):  573-582.  doi:10.3969/j.issn.1006-7795.2024.04.003

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Objective  To investigate the protective effect of antioxidant N-Acetyl-L-Cysteine (NAC) on human ovarian tissue by human ovarian tissue xenotransplantation based on the current human ovarian tissue cryopreservation and thawing protocol in Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University.  Methods  The ovarian tissues from 4 patients were cryopreserved and thawed according to the currently-used protocol or the modified protocol (adding with 5 mm NAC). the fresh ovarian tissues underwent Calcein acetoxymethyl ester （Calcein-AM ）staining and hematoxylin-eosin (HE) staining to evaluate follicle activity and follicle counting. Thirty-six female nude mice who underwent ovariectomy were randomly divided into 4 groups. The thawing ovarian tissues were transplanted under the bilateral renal capsules of the nude mice. According to the different freezing-thawing protocol, the four group were divided as current freezing-thawing protocol group (control group), the modified protocol group (NAC group), ovariectomy group and normal group (no surgery). The nude mice were killed on day 3, day 7 and day 21 respectively, and serum and ovarian tissue grafts were taken. Serum samples were detected by enzyme-linked immunosorbent assay (ELISA) for estradiol (E2), follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH). One ovarian graft was taken for HE staining to observe follicle development and one graft for total antioxidant capability (TAC).  Results  There was no significant difference in follicle development stages between the two transplantation groups at each time point after transplantation (P>0.05). The TAC level of NAC group was significantly higher than that of control group (P<0.05), but no difference was found between NAC group and fresh ovarian tissue (P>0.05). The level of serum E2 in control group was significantly higher than that in ovariectomy group on the 3rd day of transplantation (P<0.05), and there was no significant difference between the two transplantation groups and ovariectomy group at other time points (P>0.05). The level of FSH at day 3 and 21 after transplantation was lower than that in ovariectomy group (P<0.05), and had no significant difference from that in normal group (P>0.05). On the 3rd day after transplantation, AMH in the control group was significantly higher than that in the ovarian ovariectomy group (P<0.05), but no significant difference was found between the control group and the other groups (P>0.05). On 7th day after transplantation, AMH level in the two transplantation groups decreased, and was significantly lower than that in the normal group (P<0.05). On the 21st day after transplantation, AMH levels in both transplantation groups were significantly higher than those in ovariectomy group (P<0.05), but had no significant difference with normal group (P>0.05).  Conclusions  Both the currently-use protocol and the modified protocol can effectively restore the endocrine function of ovarian tissue. Compared with the currently-use cryopreservation regimen, the modified regimen can improve the antioxidant capacity of transplanted ovarian tissue, reduce the primordial follicle activation at the initial stage of transplantation, and preserve more primordial follicles.

Changes in sexual hormone levels of iatrogenic premature ovarian insufficiency and its impact on glucose metabolism

Wang Zecheng, Ruan Xiangyan, Yang Yu, Li Jing, Alfred O. Mueck

2024, 45(4):  583-588.  doi:10.3969/j.issn.1006-7795.2024.04.004

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Objective  To investigate the changes in sex hormone levels and their effects on glucose metabolism in patients with iatrogenic premature ovarian insufficiency (POI). Methods  This study recruited 60 patients aged 20-40 years with iatrogenic POI due to hematopoietic stem cell transplantation (HSCT) and 60 patients with idiopathic POI who visited the Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2022 to April 2024. General information collected included height, weight, age, and body mass index (BMI). Laboratory measurements included follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), cortisol (F), total testosterone (TT), free testosterone (FT), fasting plasma glucose (FPG), and fasting insulin (FINS). Results  Body weight, BMI, E₂, TT and FT levels were significantly lower in iatrogenic POI patients compared to idiopathic POI patients (all P<0.05). FSH, LH, FINS, and FPG levels were significantly higher in iatrogenic POI patients compared to idiopathic POI patients (all P<0.05). There were no significant differences in age, height, and cortisol levels between iatrogenic and idiopathic POI patients (all P>0.05). The proportion of iatrogenic POI patients with hyperinsulinemia was significantly higher than that of idiopathic POI patients (P=0.025).Conclusions  Patients with iatrogenic POI exhibited more severe decreases in sex hormone levels and abnormalities in glucose metabolism compared to those with idiopathic POI, possibly due to greater damage to ovarian function from disease treatment. However, iatrogenic POI can be prevented by ovarian tissue cryopreservation (OTC) which can simultaneously preserve fertility and ovarian endocrine function. Therefore, it is highly necessary for patients undergoing OTC before receiving radiotherapy and chemotherapy.

The impact of testosterone levels on female sexual function in menopausal transitional and postmenopausal women

Wang Zhikun, Ruan Xiangyan, Liu Lili, Yang Yu, Jiang Lingling, Wang Zecheng, Alfred O.Mueck

2024, 45(4):  589-595.  doi:10.3969/j.issn.1006-7795.2024.04.005

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Objective  To explore the impact of testosterone levels on female sexual function in menopausal transitional and postmenopausal women.  Methods  A total of 450 menopausal transitional and postmenopausal women who visited Beijing Obstetrics and Gynecology Hospital for the first time from January to December 2023 were recruited, including 201 menopausal transitional and 249 postmenopausal women. Demographic data and medical history were collected, female sexual function and climacteric symptoms were evaluated by using female sexual function index (FSFI) scale and modified Kupperman index (KMI). The sex hormone levels were tested for all women, including total testosterone(TT), free testosterone(FT), bioactive testosterone(BioT), 4-androstenedione(A4) and estrogen. Multiple linear regression is used to explore the impact of testosterone levels on female sexual function.  Results  Compared with menopausal transitional women, the FSFI scores in postmenopausal women decreased significantly (P<0.05). Multiple linear regression analysis showed that BioT level was positively correlated with arousal score (β=0.190, P<0.05) and FSFI total score (β=0.178, P<0.05), FT level was positively correlated with desire (β=0.166, P<0.05), satisfaction (β=0.176, P<0.05), and FSFI total score (β=0.126, P<0.05), while TT level was not associated with FSFI scores. The KMI score is negatively correlated with the FSFI scores (P<0.05).  Conclusions  Female sexual dysfunction (FSD) was associated with reduced FT and BioT levels, while not associated with TT level.





Correlation analysis between body composition and lumbar bone mineral density in perimenopausal and postmenopausal women

Liu Lili, Ruan Xiangyan, Yang Yu, Jiang Lingling, Wang Zecheng, Zhang Mingzhen, Alfred O.Mueck

2024, 45(4):  596-601.  doi:10.3969/j.issn.1006-7795.2024.04.006

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Objective  To explore the relationship between body composition and lumbar bone mineral density (BMD) in perimenopausal and postmenopausal women, and to further analyze the influencing factors of bone loss in this population. Methods  A total of 300 perimenopausal and postmenopausal women who were admitted to the Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from October 2021 to March 2024 were recruited as subjects. The age, menopausal status, and activity type of all subjects were collected with the menopausal symptom comprehensive assessment scale. The bone density of the lumbar spine was measured with quantitative computed tomography (QCT) and the subjects were divided into normal bone mass group and low bone mass group, according to the measurement results. The body composition of all subjects, such as body weight, fat, lower limb muscle, and knee joint activity was measured with muscle function analyzer. One-Way analysis of variance was used to compare the differences in body composition between the normal bone mass group and the osteopenia group. Multivariate Logistic regression analysis was used to explore the risk factors of osteopenia.Results  Among the 300 subjects, there were 148 (49%) perimenopausal women, with an average age of (51.40±5.03) years and 152 postmenopausal women (51 %), with an average age of (53.59±6.04) years. The BMD of postmenopausal women was significantly lower than that of perimenopausal women (P<0.05 ). There were 118 cases (39%) in the low bone mass group and 182 cases (61%) in the normal bone mass group. The age, percentage of fat, proportion of postmenopausal women and proportion of women without exercise in low bone mass group were significantly higher than those in normal bone mass group (P<0.05 ). The lower limb muscle distribution coefficient, lower limb muscle strength, and the proportion of exercise were significantly lower than those in the normal bone mass group (P<0.05 ),respectively. Spearman correlation analysis showed that BMD in perimenopausal and postmenopausal women was significantly negatively correlated with age, fat percentage, and proportion of postmenopausal women (r=-0.492, -0.125, -0.287, P < 0.05 ), while it was significantly positively correlated with lower limb muscle distribution coefficient, lower limb muscle strength, and proportion of exercise (r=0.143,0.180,0.193, P < 0.05 ). Binary Logistic regression analysis showed that older age, higher percentage of fat, less muscle distribution of lower limbs, and less exercise were risk factors for bone loss (P<0.05 ).Conclusions  Compared with perimenopausal women, the BMD of lumbar vertebrae in postmenopausal women was significantly lower. The BMD of lumbar vertebrae in perimenopausal and postmenopausal women was closely related to body composition and activity type. Older age, higher percentage of fat, less muscle distribution of lower limbs and less exercise were risk factors for bone loss (P<0.05 ). It is suggested that clinicians should pay attention to the changes of lumbar BMD and body composition of women in this period, so as to improve their quality of life and prevent the occurrence of osteoporosis through timely and reasonable intervention measures.

Diagnostic value of multiple androgen indexes measured by LC-MS/MS for polycystic ovary syndrome

Zhao Yue, Ruan Xiangyan, Wang Yuejiao, Ma Jun, Jin Jing

2024, 45(4):  602-608.  doi:10.3969/j.issn.1006-7795.2024.04.007

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Objective  To explore the clinical significance of steroid hormones in the diagnosis of polycystic ovary syndrome (PCOS) and to improve the detection rate of hyperandrogenemia (HA) through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). Methods  The study included 100 PCOS patients with clinical HA and 100 controls were recruited at the Department of Gynecology and Endocrinology of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January to December 2023. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the diagnostic efficacy of various androgen levels including total testosterone (TT), free testosterone (FT), bioavailable testosterone (BIO-T), androstenedione (A2), 17-Hydroxyprogesterone, dihydrotestosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin for PCOS . The diagnostic value of chemiluminescence immunoassay (CLIA) and LC-MS/MS in detecting serum TT levels was compared with each other. The HA detection rate screened by LC-MS/MS and CLIA method was also compared. Results  Compared to the control group, patients with PCOS had a higher TT (P<0.05), luteal hormone (LH, P<0.05), LH/［follicle stimulating hormone, (FSH)］ (P<0.05), anti-Müllerian hormone (P<0.05), fasting insulin (P<0.05) and homeostasis models assessment-insulin resistance index (P<0.05)  measured by CLIA. The FT showed the highest diagnostic value with the AUC 86.4%（P<0.05, 95%CI: 0.815-0.912）, followed by TT with AUC 84.4% (P<0.05, 95%CI: 0.812-0.909), BIO-T with AUC 82.2% (P<0.05, 95%CI: 0.792-0.896) and A2 with AUC 84.2% (P<0.05, 95%CI: 0.790-0.895) in women with PCOS measured by LC-MS/MS. The TT detection by LC-MS/MS had the higher diagnostic sensitivity for PCOS than that by CLIA (AUC was 0.891 to 0.841). The HA detection rate by LC-MS/MS was significantly higher than that by CLIA in patients with PCOS (P<0.05). Conclusions LC-MS/MS is more sensitive and accurate than CLIA in the detection of various androgen indicators. The diagnosis value of FT is most effective for the diagnosis and early screening for HA of PCOS with the clinical manifestations of high androgen, which make it more suitable for clinical application . 

The effect of HI-TOPK-032 on the proliferation of ovarian cancer based on a nude mouse model

Tang Fan, Deng Mengqi, Miao Jinwei

2024, 45(4):  609-615.  doi:10.3969/j.issn.1006-7795.2024.04.008

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Objective  To investigate the expression of T-LAK cell-originated protein kinase/PDZ-binding-kinase (TOPK/PBK) in ovarian cancer and the effect of HI-TOPK-032, an inhibitor of TOPK/PBK, on ovarian cancer cells. Methods  The expression of TOPK/PBK in ovarian cancer tissue and normal samples were analyzed by gene expression profiling interactive analysis (GEPIA) software. The effect of HI-TOPK-032 on the proliferative activity of ovarian cancer cells was analyzed by methyl thiazolyl tetrazolium (MTT) assay and colony formation assay. The effect of HI-TOPK-032 was also assessed on subcutaneous ovarian tumor in nude mice. Results  The expression of TOPK/PBK in ovarian cancer was significantly higher than that in normal ovarian tissue (P<0.05). With the treatment of HI-TOPK-032, the expression of TOPK/PBK was inhibited, and the proliferation capacity of OVCAR3 and SKOV3 cells decreased (P<0.0001). The mass ［(1.514±0.358)g vs (0.670±0.450)g］ and volume ［(0.418±0.171)cm3 vs (0.973±0.262)cm3］ of subcutaneous tumors in the HI-TOPK-032 treatment group were significantly lower than that in the control group. Conclusions TOPK/PBK is highly expressed in ovarian cancer, contributing to the growth of ovarian cancer. HI-TOPK-032 exerts an inhibiting effect on the growth of ovarian cancer. 

Analysis of sexual function of patients with polycystic ovary syndrome with different clinical phenotypes

Tian Xuanxuan, Ruan Xiangyan, Jin Jing, Ju Rui, Du Juan, Cheng Jiaojiao, Yang Yu

2024, 45(4):  616-622.  doi:10.3969/j.issn.1006-7795.2024.04.009

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Objective  To investigate the sexual function of different clinical phenotypes in patients with polycystic ovarian syndrome (PCOS) and its correlation with clinical and sex hormonal characteristics. Methods  The study evaluated sexual function on PCOS patients and control women in the Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from October 2020 to December 2021, via the Chinese version of Female Sexual Function Index (FSFI). PCOS were divided into four clinical phenotype groups according to the Rotterdam criteria, A: oligo-ovulation or anovulation (OA) + hyperandrogenism (HA) + polycystic ovaries (PCO); B: OA + HA; C: HA+ PCO; D: OA +PCO. The clinical data that may affect sexual function were collected and sex hormone levels were measured, including anthropometric markers, serum follicle-stimulating hormone, luteinizing hormone, prolactin and total testosterone. Results  A total of 910 PCOS women and 402 control women with complete parameters were included in the study. Phenotype A had the lowest total FSFI mean score (23.69±3.20) (P <0.05); phenotype B, C and D showed a trend of sequential increase. Control group had the highest total FSFI mean score (24.96±3.79) (P <0.05).  Compared with the control group, Group A had the highest risk percentage of female sexual dysfunction (FSD) at 87.5% (P <0.05), followed by Group B, Group C, and Group D. The control group had the lowest FSD risk percentage, which was 62.19% (P <0.05). The FSD risk in Group A was higher than that in Group C and Group D (P <0.05), while the FSD risk in Group B was higher than that in Group D (P <0.05). Multivariate linear regression analysis demonstrated that total testosterone (TT), age, waist circumference, and body fat distribution were negatively correlated with female sexual function. Conclusions Compared with the control group, PCOS patients have a higher risk of FSD and are associated with the clinical phenotype of PCOS. The classic phenotype that simultaneously meets the three diagnostic characteristics of PCOS has the highest risk of FSD. TT, age, waist circumference, and body fat distribution are associated with FSD risk in PCOS women.





The impact of body composition on liver and kidney function and blood lipids in patients with polycystic ovary syndrome

Jiang Lingling, Ruan Xiangyan, Li Yanqiu, Zhang Mingzhen, Wang Zecheng, Yang Yu , Liu Lili, Alfred O. Mueck

2024, 45(4):  623-628.  doi:10.3969/j.issn.1006-7795.2024.04.010

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Objective  To analyze the impact of body composition on liver and kidney function and blood lipids in women with polycystic ovary syndrome (PCOS).Methods  This cross-sectional case-control study recruited 678 women aged 20-40 years from the Department of Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, between October 2020 and December 2023. According to the 2004 international Rotterdam criteria, participants were divided into a PCOS group (n=578) and a control group (n=100). Height, weight, waist circumference, and hip circumference were measured, and body mass index (BMI) was calculated. Body fat percentage (BFP) was measured. Alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (Cre), uric acid (UA), blood urea nitrogen (BUN), total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and lipoprotein(a) ［LP(a)］ levels were detected. The impact of body composition on liver function in PCOS was analyzed.Results  PCOS group had significantly higher body weight, waist circumference, and BMI than the control group (all P<0.05). ALT, AST, and UA levels in the PCOS group were significantly higher than those in the control group (all P<0.05). There were no statistically significant differences in BUN, Cre, and HDL-C between the PCOS and control groups. The body fat percentage in the PCOS group was significantly higher than that in the control group (P<0.05), with 64.07% of PCOS patients being overweight or obese. The abnormal transaminase rate in the PCOS group was 12.8%, while that in overweight and obese PCOS patients was 17.86%. The abnormal transaminase rate in overweight and obese PCOS patients was significantly higher than that in lean PCOS patients and the control group (both P<0.05). Regarding blood lipids, PCOS patients had significantly higher TC, TG, LDL-C, and LP(a) levels than the control group.Conclusions  Patients with PCOS, especially those who are overweight or obese, face higher risk of liver dysfunction and dyslipidemia. Therefore, the management of PCOS patients should pay special attention to the impact of body composition on liver and kidney function as well as lipid levels. The overall health and long-term quality of life of PCOS patients can be improved, through controlling weight, improving insulin resistance, regulating diet, and increasing physical activity.

New progresses in ovarian tissue cryopreservation and transplantation

Du Juan, Ruan Xiangyan

2024, 45(4):  629-635.  doi:10.3969/j.issn.1006-7795.2024.04.011

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Ovarian tissue cryopreservation and transplantation not only protect female fertility but also preserve ovarian endocrine function. It is effective in the prevention and treatment of iatrogenic premature ovarian insufficiency, especially in prepubertal girls and women in urgent need of disease treatment. The efficacy and safety of ovarian tissue cryopreservation have proved, and the current clinical gold standard is slow freezing, while vitrification is only for research. Despite the rapid development of this technique in recent years, it still faces problems such as cryoinjury, toxicity of cryoprotectants, assessment of follicular reserve, and safety of cryopreservation and transplantation. This article summarizes the progresses of research on these issues.

Analysis of the efficacy and safety of PD-1 inhibitors combined with chemotherapy in neoadjuvant treatment of locally advanced non-small cell lung cancer

Li Tiezheng, Xu Kaikai, Deng Yuqing, Wang Peihao, Qin Qi, Guo Kangshun, Wang Bingren, Chang Dong, Cui Yong

2024, 45(4):  636-641.  doi:10.3969/j.issn.1006-7795.2024.04.012

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Objective  To investigate the efficacy and safety of programmed cell death protein 1 (PD-1) inhibitors combined with chemotherapy in neoadjuvant treatment for locally advanced non-small cell lung cancer (NSCLC). Methods  A retrospective analysis was conducted on clinical data of 43 patients with locally advanced (ⅡB～ⅢB) non-small cell lung cancer who received neoadjuvant immunotherapy combined with chemotherapy in the Department of Thoracic Surgery, Beijing Friendship Hospital from June 2021 to June 2023. The radiological and pathological efficacy were evaluated, meanwhile immune-related adverse events were observed. Results  The evaluation of radiological efficacy showed an objective response rate of 76.7% and a disease control rate of 93.0%. Among the 34 patients (79.1%) who underwent surgery, the R0 resection rate was 97.1%, the complete pathological response rate was 29.4%, and the major pathological response rate was 55.9%. The incidence rate of grade 1-2 immune-related adverse events was 67.4%, and the incidence rate of grade 3 or above adverse events was 7.0%. Conclusions Neoadjuvant PD-1 inhibitor combined with chemotherapy for non-small cell lung cancer has significant efficacy, with high rates of pathological response and R0 resection. The immune-related adverse events and surgical complications are within an acceptable range, indicating high safety.

Observation on the preliminary efficacy of neoadjuvant immunotherapy combined with chemotherapy in non-small cell lung cancer

Wu Zhaozhen, Zheng Hua, Sheng Shuyan, Zhang Quan, Zhang Hui, Li Jie, Lyu Jialin, Qian Zhe, Wang Shouzheng, Li Xi , Hu Ying

2024, 45(4):  642-648.  doi:10.3969/j.issn.1006-7795.2024.04.013

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Objective  To evaluate the efficacy of neoadjuvant programmed receptor 1 (PD-1) monoclonal antibody immunotherapy combined with chemotherapy for non-small cell lung cancer（NSCLC）. Methods  This study included 176 patients with stage ⅠB~Ⅲ resectable NSCLC who received neoadjuvant   immunotherapy combined with chemotherapy  at our research center from January 2021 to December 2023. Totally, 159 patients (90.34%) received surgical treatment, including 42 cases of adenocarcinoma and 115 cases of squamous cell carcinoma. Results  The median number of neoadjuvant treatment cycles was 2, with 4 patients (2.5%) achieving complete response (CR), 115 patients (72.3%) achieving partial response (PR), and 40 patients (25.2%) assessed as stable disease (SD) with only 2 cases of tumor enlargement; After surgery, 96 patients (60.4%, 95% CI: 52.7%-68.1%) achieved major pathological response (MPR), and 74 patients (46.5%, 95% CI: 38.7%-54.4%) achieved pathological complete  response (pCR); Multivariate analysis showed that gender and programmed ligand 1 (PD-L1) significantly influenced the rates of MPR and pCR. Conclusion  Neoadjuvant immunotherapy combined with chemotherapy showed initial efficacy in resectable stage ⅠB~Ⅲ NSCLC, and the expression level of PD-L1 may be a predictive factor for MPR and pCR.





Prognostic factors in neoadjuvant immunotherapy for non-small cell lung cancer：pathologic lymph node metastasis and primary tumor response

Xu Yuan, Liang Naixin, Liu Hongsheng

2024, 45(4):  649-653.  doi:10.3969/j.issn.1006-7795.2024.04.014

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Objective  To investigate the prognostic impact of pathologic lymph node metastasis and primary tumor response after neoadjuvant immunotherapy in patients with non-small cell lung cancer (NSCLC). Methods  Clinicopathological data of 40 NSCLC patients who underwent surgical resection after neoadjuvant immunotherapy were retrospectively analyzed. The relationships of pathologic nodal stage (N1/N2) and primary tumor response ［pathological complete response (pCR)/major pathological response (MPR)/non-objective response (non-OR)］with progression-free survival (PFS) were evaluated, and a prognostic risk stratification model was established. Results  Pathologic nodal stage and primary tumor response were not significantly associated with PFS when considered separately. However, their interaction had a significant impact on prognosis： for N1 patients, the ones with pCR/MPR had better PFS than those with non-OR (P =0.038); for N2 patients, primary tumor response was not significantly associated with PFS. Based on the interaction, patients were stratified into low-risk (N1+pCR/MPR) and high-risk (N1+non-OR/N2) groups, with significant differences in PFS (P =0.003). Conclusions The interaction between pathologic lymph node metastasis and primary tumor response is a key prognostic factor in NSCLC after neoadjuvant immunotherapy. The prognostic risk stratification model based on their interaction may help guide individualized treatment decisions, but prospective validation is needed.

The predictive value of folate receptor-positive circulating tumor cells in patients with resectable stage Ⅲ squamous cell carcinoma after neoadjuvant chemotherapy combined with immunotherapy

Liu Yang, Yang Lei, Han Yi

2024, 45(4):  654-659.  doi:10.3969/j.issn.1006-7795.2024.04.015

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Objective  To investigate the predictive value of folate receptor-positive circulating tumor cells (FR+-CTCs) in determining the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stage Ⅲ squamous cell carcinoma. Methods  A total of patients diagnosed with resectable stage Ⅲ squamous cell carcinoma and admitted to Beijing Chest Hospital from June 2021 to June 2023 were included in this study. After receiving 2 cycles of neoadjuvant chemotherapy combined with immunotherapy, the following parameters were recorded: ① general clinical data including age, gender, clinical stage, tumor location，pre-and post-treatment white blood cell count; ② levels of tumor markers such as serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1), squamous cell carcinoma antigen (SCC), and FR+-CTCs before and after treatment; ③ postoperative pathological results, based on which the patients were divided into two groups: group E (<10% residual tumor cells) and NE group (>10% residual tumor cells). Binary Logistic regression analysis was performed using general clinical data, white blood cell count, tumor marker data, and FR+-CTCs data before and after treatment to statistically analyze factors influencing the efficacy of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable stage Ⅲ squamous cell carcinoma. The predictive value of FR+-CTCs was assessed using receiver operating characteristics (ROC) curve analysis. Results  A total of 24 patients were included in this study, with 15 patients in group E and 9 patients in the NE group. There were no significant differences observed between the two groups regarding general clinical data or pre-treatment levels of CEA, CYFRA 21-1, SCC or FR+-CTCs(P >0.05). Additionally,no statistically significant differences were found for CEA,CYFRA21-1,and SCC levels after treatment.FR+-CTCs in group E was significantly lower than that in group NE (P<0.05). Binary Logistic regression analysis showed that FR+-CTCs after treatment (OR=1.28, 95%CI： 1.00-1.63, P=0.047) was the influencing factor of neoadjuvant chemotherapy combined with immunotherapy. ROC analysis showed that the cut-off value of FR+-CTCs after treatment was 10.10, with a specificity of 0.87, a sensitivity of 0.89, and an area under the curve of 0.837. Conclusion  For patients with resectable Ⅲ squamous cell carcinoma, FR+-CTCs after treatment lower than 10.10 FU/3 mL can predict the remission effect of neoadjuvant chemotherapy combined with immunotherapy.

Efficacy of neoadjuvant chemotherapy combined with immunotherapy in the treatment of stage Ⅲ non-small cell lung cancer 

Wang Jusi, Song Weian, Di Shouyin, Liu Junqiang, Fan Boshi, Zhou Shaohua, Yue Caiying, Zhao Jiahua, Chen Siyu, Gong Taiqian

2024, 45(4):  660-665.  doi:10.3969/j.issn.1006-7795.2024.04.016

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Objective  To investigate the short-term efficacy and safety of neoadjuvant chemotherapy combined with immunosuppressants in the treatment of stage non-small cell lung cancer. Methods  Totally 53 patients with stage Ⅲ non-small cell lung cancer in the Sixth Medical Center of the General Hospital from January 2021 to February 2024 were selected to assess the safety during treatment and the efficacy at the end of treatment. Results  The imaging evaluation showed that 8 patients had complete response,34 patients had partial response, 8 patients had stable disease, and 3 patients had progressive disease. The objective remission rate was 79.2%, and the disease control rate was 94.3%. After neoadjuvant therapy, all 53 patients underwent minimally invasive thoracoscopic tumor resection after imaging and department discussion, and no patients converted to thoracotomy, 10 patients had postoperative complications, with the incidence of 18.7%, and only 1 patient died of respiratory failure caused by severe pulmonary infection after surgery. Histopathological evaluation showed that there were 15 cases of complete response, 32 cases of partial response, 5 cases of stable disease, 1 case of disease progression, and 33 cases (62.3%) of the major pathological response, with the objective response rate of 88.7% and the disease control rate of 98.1%. The adverse reactions were mainly grade 1 and 2, and only 3 patients of grade 3 adverse events, and no grade 4 adverse reactions occurred.   Conclusion  Neoadjuvant immunotherapy combined with chemotherapy has good efficacy and safety in the treatment of locally advanced non-small cell lung cancer, and is worthy of further promotion and application.

Advances in research of perioperative immunotherapy for non-small cell lung cancer—advances in neoadjuvant immunotherapy

Hao Zhuohong, Yun Duo, Zhang Ying, Li Huihui, Lin Haishan, Cui Yong, Zhao Lei

2024, 45(4):  666-677.  doi:10.3969/j.issn.1006-7795.2024.04.017

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The treatment  of non-small cell lung cancer (NSCLC) with a considerably high occurrence and lethality represents a significant global health challenge, which urgently needs to be addressed. With the introduction of immune checkpoint inhibitors (ICIs), new treatment avenues for NSCLC have emerged, showing significant survival benefits in patients with advanced NSCLC. In recent years, researchers have begun to explore the feasibility of incorporating ICIs into neoadjuvant therapy, finding that they also offer therapeutic benefits in this context. This article aims to review recent research progress on ICIs in the neoadjuvant treatment of NSCLC, focusing on their impact on patient survival, pathological response, and other aspects. These research findings shed light on new strategies and insights for improving the neoadjuvant treatment outcomes of NSCLC patients.

Application value of GhostNet lightweight network in diagnosis of diabetic retinopathy

Zhu Xiaohong, Zhang Yun, Liu Meiling, Cao Kai

2024, 45(4):  678-687.  doi:10.3969/j.issn.1006-7795.2024.04.018

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Objective  To evaluate the value of GhostNet lightweight network based on fundus color imaging in the diagnosis of diabetic retinopathy (DR), and the value of differential diagnosis between DR and other fundus diseases compared with classical convolutional neural network DenseNet121.Methods  Totally 29 535 color fundus photographs (including 9 883 DR, 2 000 normal fundus and 17 652 other blinding fundus diseases for differential diagnosis) were collected from large samples. Classical convolutional neural network (DenseNet121) and lightweight network (GhostNet) were used to train the model by transfer learning. Receiver operating characteristic (ROC)curve, sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were used to evaluate the performance of the two models. Results  Compared with model based on DenseNet121, the diagnostic time of single fundus photo by GhostNet model was shortened by 60.3%. In the diagnosis of DR, AUC value, sensitivity and specificity, accuracy reached 0.911, 0.888, 0.934, and 91.3% respectively. It is slightly lower than 0.954, 0.921, 0.986, and 95.5% of model based on DenseNet121. In the differential diagnosis of DR and other fundus diseases, the AUC value, sensitivity, specificity, accuracy of model based on GhostNet were 0.862, 0.856, 0.901, and 87.8% respectively. For model based on DenseNet121, the values were 0.899, 0.871, 0.935, and 90.2%, respectively. Conclusions  The operation speed of DR diagnosis model and differential diagnosis model based on GhostNet lightweight neural network is significantly faster than that of classical model DenseNet121, and the accuracy is satisfying. For primary medical institutions with lack of ophthalmologists and low equipment performance, such as community hospitals, we can consider using this technology to carry out primary screening of DR.

Preference of preconception health care service models for women of childbearing age based on discrete choice experiment

Yang Xi, Li Xiang, Lü Jing, Ma Ruhuan, Wu Binqiang, Xu Tingting

2024, 45(4):  686-692.  doi:10.3969/j.issn.1006-7795.2024.04.019

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Objective  To analyze the preferences of women of childbearing age for preconception health care services and provide insights for optimizing the reproductive health system and enhancing their willingness to have children. Methods  A discrete choice experiment questionnaire was developed based on a literature review and semi-structured interviews. It identified five key factors influencing preconception health care preferences: hospital level, examination content, offer form, integrated service form, and distance to the examination location. Using convenient sampling, women of childbearing age in Beijing were surveyed. The sample‘s measurement information was analyzed using mean (standard deviation) and count information with frequency (composition ratio). Preferences and their interaction with demographic information were analyzed using a mixed logistic model. Results  Out of 356 questionnaires, 329 were valid (92.4% effective rate). The survey showed 84.8% of respondents were under 35, and 74.8% lived in the city. Women preferred services close to their location (β=-0.636, P<0.01), including 19 basic examinations with education on diet, exercise, and psychology (β=0.611, P <0.01), home guidance (β=0.410, P<0.01), combined with premarital examinations (β=0.225, P <0.01), and offered by level-three hospitals (β=0.104, P=0.089). Women in rural areas preferred home guidance and proximity, while those with previous pregnancies preferred genetic testing. Conclusions Women of childbearing age in Beijing prioritize the distance to the examination location and the examination content when choosing preconception health care services. Preferences vary with demographic characteristics. Recommendations include increasing publicity, strengthening policy guidance, planning services tailored to contemporary women, reducing the distance to examination sites, and promoting guidance on diet, exercise, and psychology during pregnancy.

Diagnostic value of artificial intelligence assisted diagnostic system for acute leukemia: a Meta-analysis

Zhang Daqian, Zhang Xiaoxin, Ye Zichen, Xie Zhilan, Yang Jichun, Jiang Yu

2024, 45(4):  693-700.  doi:10.3969/j.issn.1006-7795.2024.04.020

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Objective  Using Meta-analysis to comprehensively evaluate the potential  of artificial intelligence(AI) in assisting the diagnosis of acute leukemia. Methods  We delved into databases including Ovid-Medline, Embase, IEEE and Cochrane Library, meticulously hunting for trials that hamessed AI for diagnosing acute leukemia .Our search spanned from inception until May 1st, 2023. After sifting through literature and data extraction by two independent reviewers, and subsequent evaluation of the potential bias in the selected studies, we conducted Meta-analysis using Stata 17.0, RevMan 5.4 and Meta-Disc 1.4 software to obtain the results.  Results  Analysis a total of 15 studies, involving a whopping 20 214 images. The Meta-analysis results that the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio(NLR), diagnostic odds ratio (DOR), for AI-assisted acute leukemia screening stood at 0.96 （95% CI: 0.92-0.97), 0.97 （95% CI: 0.94-0.98), 29.9 （95% CI: 17.2-51.9), 0.05 （95% CI: 0.03-0.08), 652 （95% CI: 290-1 464), and a staggering 97%, respectively. The area under the curve (AUC) on the summary receiver operating characteristic (SROC) graph clocked in at 0.99 （95% CI: 0.98-1.0).  Conclusions  AI technology has high sensitivity, specificity and higher AUC value in screening and early diagnosis of acute leukemia，It has potential clinical application value, however, Due to limitations in the quantity and quality of included studies causing significant heterogeneity between studies, further analysis is needed on the potential sources of this heterogeneity, provide more accurate and reliable basis for the standardization of AI assisted diagnosis in acute leukemia. This study has been registered with PROSPERO registration number CRD42023480455.





Neuromuscular blocking effects of rocuronium in patients with Parkinson’s disease 

Xie Sining, Xiong Wei, Li Xiangjiahui, Chen Liang, Fan Yifang, Han Ruquan

2024, 45(4):  701-705.  doi:10.3969/j.issn.1006-7795.2024.04.021

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Objective  To observe the neuromuscular blocking effects of rocuronium in patients with Parkinson's disease (PD) compared to non-PD patients. Methods  This study included 31 American Society of Anesthesiologists (ASA)Ⅰ-Ⅲ PD patients (PD group) aged 18-65 years undergoing subthalamic nucleus-deep brain stimulation (STN-DBS) surgery and 24 non-PD patients (non-PD group) undergoing facial nerve decompression. Anesthesia was induced with a bolus of rocuronium (0.6 mg/kg) intravenously, and neuromuscular block was monitored with  train-of-four (TOF). The duration of 90% recovery of TOF (DURTOF 90%), onset time, clinical duration, recovery index, and occurrence of severe respiratory complications within 2 hours after surgery were recorded. Results  Compared to the non-PD group, both DURTOF 90% and clinical duration were significantly prolonged in the PD group (P<0.05). There was no significant difference in the onset time of rocuronium between the two groups (P>0.05). In PD patients, the DURTOF 90% of rocuronium was positively correlated with the course of the disease, with a longer course associated with delayed DURTOF 90% (P<0.05). There were no severe respiratory complications in both groups after surgery. Conclusions The DURTOF 90%and clinical duration of rocuronium are significantly prolonged in patients with PD, and the DURTOF 90% is positively correlated with the course of the disease.





Clinical features and prognosis of pulmonary mucormycosis

Bai Yu, Li Xueqing, Guo Yiqun, Yang Chunxia, Gu Li

2024, 45(4):  706-714.  doi:10.3969/j.issn.1006-7795.2024.04.022

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Objective  To improve the understanding of the clinical characteristics of pulmonary mucormycosis and analyze the risk factors of death in patients with pulmonary mucormycosis. Methods  Twenty-five cases of pulmonary mucormycosis hospitalized in Beijing Chaoyang Hospital, Capital Medical University from January 2017 to June 2023 were retrospectively collected including the risk factors, clinical manifestations, laboratory test, radiological features, treatment prognosis, etc. Among them, the risk factors, clinical manifestations, radiological features and prognosis data were analyzed by Fisher precise test. Independent sample t test or Mann-Whitney U test were used for laboratory test data. Univariate regression analysis was performed for statistically significant parameters to find risk factors for the death of pulmonary mucormycosis. Results  Among the 25 patients, male accounted for 15/25, aged (52.64±13.74) （32-76) years, and the length of hospitalization was 15 (10.5, 21.5) days. The most common risk factors for pulmonary mucormycosis were diabetes (20/25), glucocorticoid exposure (13/25),  insensitive antifungal drug use (10/25), and solid organ transplantation (5/25). The most common clinical symptoms were fever (21/25) and cough (21/25), followed by dyspnea (10/25), hemoptysis or bloody sputum (9/25). Among them, 8 patients died. Compared with the surviving patients, the patients in the death group had a shorter hospital stay (P=0.003) and a higher proportion of solid organ transplantation history (P=0.023). There was no difference in other general conditions and risk factors between the two groups. Platelet levels in the death group were lower than those in the survival group ［174 (78,227)×10⁹/L vs 310 (229,347)×10⁹/L］, and the difference was statistically significant (P=0.030). Among the 25 patients, the most common mucor fungi were Rhizopus  （including Rhizopus arrhizus, Rhizopus microsporus, etc.） and Rhizomucors (mainly Rhizomucor pusillus). Multiple pulmonary nodules were the most common imaging change in the survival group, and the difference between the two groups was statistically significant (P=0.042). Mucor pulmonary treatment included sensitive antifungal agents and surgical or interventional therapy, and there was no significant difference in treatment between surviving and dying patients. Solid organ transplantation increased the risk of death in patients with pulmonary mucormycosis (OR=16.000, 95% CI: 1.381-185.405, P=0.027). Conclusions Diabetes mellitus, glucocorticoid exposure, the use of immunosuppressive agents and solid organ transplantation are common risk factors for pulmonary mucormycosis. Most of its clinical manifestations and laboratory tests are nonspecific, and the common imaging features include multi-lobed lesions, pleural effusion, tracheal stenosis or occlusion, cuneate compactness, and multiple pulmonary nodules. Among the above clinical features, patients with lower platelet levels and solid organ transplant recipients had a higher mortality rate, and solid organ transplantation increased the risk of death in patients with pulmonary mucormycosis.

Efficacy of dapagliflozin in treatment of coronary heart disease and heart failure with preserved ejection fraction patients

Hou Dongyan, Feng Dan, Li Na

2024, 45(4):  715-720.  doi:10.3969/j.issn.1006-7795.2024.04.023

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Objective  To observe the improvement effect of dapagliflozin on cardiac function in patients with heart failure with preserved ejection fraction (HFpEF) complicated with coronary heart disease. Methods  Patients with coronary heart disease and HFpEF who were hospitalized in the Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University from January 2021 to September 2022 were selected as the research objects. Among them, 69 patients who took dapagliflozin were selected as the dapagliflozin group, and 81 patients who did not take dapagliflozin were selected as the control group. Patients in both groups were treated with standard secondary prevention of coronary heart disease. If there were no contraindications, both groups were given standardized treatment for heart failure. The basic patients’ information were collected by the hospital information system, as well as outpatient follow-up data for 12 months of hospitalization and discharge, including blood glucose, blood lipids, N-terminal pro B-type natriuretic peptide (NT-proBNP) and other laboratory indicators, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), left ventricular posterior wall thickness (LVPWT), stroke volume (SV), left ventricular diastolic function E/e'avg et al. And record the cardiac death, acute left heart failure, re-hospitalization for heart failure, re-hospitalization for angina, and adverse drug reactions during hospitalization. Results  The degree of blood lipid and blood glucose control and the improvement of NT-proBNP, LVEF and E/e 'avg in the dapagliflozin group were better than those in control group, the differences were statistically significant (P<0.05). During the follow-up period, the incidence of acute left heart failure and rehospitalization due to heart failure in the dapagliflozin group was significantly lower than those in control group, the differences were statistically significant (P<0.05). Conclusions Dapagliflozin can improve cardiac diastolic function, reduce NT-proBNP levels, improve quality of life, and readmission rate for heart failure in patients with coronary heart disease complicated with HFpEF. Simultaneously, it has good security.

Predictive value of neutrophil to lymphocyte ratio and platelet count combined with D-dimer in the prognosis of children with severe pneumonia complicated with sepsis

Huang Xiaohui, Wang Xinwei, Wu Jie

2024, 45(4):  721-726.  doi:10.3969/j.issn.1006-7795.2024.04.024

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Objective  To investigate the prognosticative value of neutrophil to lymphocyte ratio (NLR) and platelet (PLT) combined with D-dimer (D-D) in children with severe pneumonia complicated with sepsis.  Methods  The clinical data of 310 children with severe pneumonia complicated with sepsis admitted to the emergency intensive care unit (EICU) of Beijing Children's Hospital, Capital Medical University from January 2018 to January 2023 were reviewed. All the children were followed up by outpatient review or telephone after discharge, and the prognosis of the children was evaluated according to relevant criteria. They were divided into good prognosis group (n=198) and bad prognosis group (n=112). The hospital electronic medical record information system was used to collect the basic clinical data such as age and gender of all the children, record the early warning score ［chronic health status score Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) ］ of the children at admission, and collect the laboratory indicators within 24 h of diagnosis of sepsis. Logistic regression was used to analyze the related influencing factors of poor prognosis in children with pneumonia complicated with sepsis, and receiver operating curve (ROC) was used to analyze the sensitivity, specificity and accuracy of NLR, PLT count and D-D in predicting the prognosis of children with severe pneumonia complicated with sepsis.  Results  There was no significant difference in age and gender between the two groups  (P<0.05). APACHEII and SOFA scores in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05). The levels of NLR and D-D in the good prognosis group were significantly lower than those in the poor prognosis group, and the expression level of PLT was higher than that in the poor prognosis group (P<0.05). The variables with P ≤0.05 in univariate analysis were included in multivariate Logistic regression to determine the independent risk factors for prognosis. Adjusted for confounding factors such as age, sex, APACHE II score, and continuous variables, NLR and d-dimer levels were protective factors for prognosis （OR<1，P<0.05）, the expression level of PLT was a risk factor for prognosis（OR>1，P<0.05）. The results of ROC curve analysis showed that the area under the curve (AUC), sensitivity, specificity and accuracy were 0.949, 94.95%, 82.14% and 90.32%, respectively.  Conclusions  The NLR, PLT count and D-D in peripheral blood of children with severe pneumonia complicated with sepsis are significantly increased, and the three combined tests are of great value in predicting the prognosis of children.

Study on the prevention system of research misconduct in medical science journals

Gao Jian, Li Qiuping, Yan Hong

2024, 45(4):  727-732.  doi:10.3969/j.issn.1006-7795.2024.04.025

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Objective   To establish a system to prevent research misconduct from the perspective of editorial office of medical sci-tech journals, so as to reduce the phenomenon of research misconduct in medical disciplines and improve the journal reputation. Methods  Editors, faculty, administrators, and students were deeply interviewed, and questionnaires were also conducted. SPSS 22 software was used to process the data and t test was adopted for comparison. Cronbach's α coefficient of this survey is 0.736, indicating a high internal consistency. It means the questionnaire is reliable. The preliminary framework was verified and improved based on the survey result of the cognition and current situation of research misconduct education and prevention. Results  Most of the respondents (> 91%) had a clear understanding of academic misconduct, and most of the respondents (> 85%) had a correct attitude towards academic misconduct. Among the research misconducts frequently encountered by editors, the most popular choice appeared to be “no ethical approval or unproven” for editors who had worked for 11 to 15 years (P=0.039), and the difference was statistically significant. The junior and intermediate editors were more prone to the establishment of the system of changing author signature, order and retraction(P=0.025). The proportion of editors with junior and intermediate titles who chose publishing announcement in the punishment measures for research misconduct was significantly higher than that of editors with senior titles (P=0.001), and the difference was statistically significant. Conclusion  There are many causes for research misconduct. Therefore, it is particularly important not only to strengthen the moral self-discipline of the authors, but also to strengthen the supervision of the society, improve the relevant legal system and build a scientific and perfect research misconduct prevention system. This paper discussed the prevention system of research misconduct in the editorial office of medical journals from five levels: moral education, legal basis, system construction, technical control and recognition and punishment, which is conducive to preventing the production of research misconduct papers.

Preliminary exploration on peer review processes of university sci-tech journals in an open science era

Sun Chaoyuan, Zhang Jianjun, Chen Ruifang, Sun Lina

2024, 45(4):  733-736.  doi:10.3969/j.issn.1006-7795.2024.04.026

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Peer review is an important part of the scientific publishing process. However, traditional peer review appears to have some bias. To improve peer review in accordance with the open science, several models of open peer review (OPR) have been proposed,  main OPR models include open identities, open reports, open participation, open interaction; open pre-review manuscripts, open final-version commenting, and open platforms. OPR is growing rapidly which brings greater transparency and participation to peer review processes. Open reports,open participation and open final-version commenting seems to have great potential for improvement of peer review processes of university sci-tech journals.