Ultra-high dose rate flash radiotherapy(FLASH-RT)has attracted wide attention in the field of radiotherapy in recent years.For FLASH-RT,radiation is delivered at a very high dose rate[usually thousands of times compar...Ultra-high dose rate flash radiotherapy(FLASH-RT)has attracted wide attention in the field of radiotherapy in recent years.For FLASH-RT,radiation is delivered at a very high dose rate[usually thousands of times compared with conventional radiotherapy(CONV-RT)]in an extremely short time.This novel irradiation technique shows a protective effect on normal tissues,also known as the flash effect.At the same time,FLASH-RT is comparable to CONV-RT in terms of tumorkilling efficacy.As basic research dedicates to uncover the mechanisms by which FLASH-RT reduces radiation-induced normal tissue damage,clinical trials of FLASH-RT have been gradually conducted worldwide.This article systematically reviews the evidence of the feasibility and safety of FLASH-RT in clinical practice and offers insights into the future translation of this technology in clinic.展开更多
Crystal structure prediction(CSP)is a foundational computational technique for determining the atomic arrangements of crystalline materials,especially under high-pressure conditions.While CSP plays a critical role in ...Crystal structure prediction(CSP)is a foundational computational technique for determining the atomic arrangements of crystalline materials,especially under high-pressure conditions.While CSP plays a critical role in materials science,traditional approaches often encounter significant challenges related to computational efficiency and scalability,particularly when applied to complex systems.Recent advances in machine learning(ML)have shown tremendous promise in addressing these limitations,enabling the rapid and accurate prediction of crystal structures across a wide range of chemical compositions and external conditions.This review provides a concise overview of recent progress in ML-assisted CSP methodologies,with a particular focus on machine learning potentials and generative models.By critically analyzing these advances,we highlight the transformative impact of ML in accelerating materials discovery,enhancing computational efficiency,and broadening the applicability of CSP.Additionally,we discuss emerging opportunities and challenges in this rapidly evolving field.展开更多
BACKGROUND The optimal sequencing of immune checkpoint inhibitor(ICI)and brain radiotherapy in the management of brain metastasis from non-small cell lung cancer(NSCLC)is unclear.AIM To evaluate the survival of concur...BACKGROUND The optimal sequencing of immune checkpoint inhibitor(ICI)and brain radiotherapy in the management of brain metastasis from non-small cell lung cancer(NSCLC)is unclear.AIM To evaluate the survival of concurrent ICI and consolidation ICI in NSCLC patients treated with brain radiotherapy.METHODS We retrospectively analyzed NSCLC patients treated with brain radiotherapy and ICI.Treatment response and survival were estimated.The cox proportional hazards regression model was utilized to investigate the association between overall survival and clinical variables.RESULTS There were 54 patients in concurrent ICI and radiotherapy group,and 62 individuals treated with radiotherapy followed by consolidation ICI.The objective response rates were similar between the two group.The median progression free survival was significantly high in the concurrent ICI group compared with consolidation ICI group(9.56 months vs 8.15 months,P=0.038).In addition,the median overall survival was 22.08 months in the concurrent ICI group,clearly longer than that in the consolidation group(13.24 months,P=0.009).CONCLUSION In NSCLC patients with brain metastases,our analyses suggested that radio therapy concurrent with ICI was associated with significant benefit compared with radiotherapy followed by consolidation ICI.展开更多
Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatmen...Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.展开更多
Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients[mean age(53.5±7.1...Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients[mean age(53.5±7.1)years]who underwent normal hemodialysis more than 6 months were randomly classified into two groups,Levocarnitine supplemented group(LS-G)(n=20;Levocarnitine supplementation after each normal hemodialysis session,at a dose of 1.0 g/day by intravenous administration)and control group(C-G)(n=20;normal hemodialysis).Before treatment,one month and three months after treatment we respectively measured or observed the following items,the tolerance to hemodialysis,carnitine level in plasma,C-reactive protein,IL-6,TNF-α,percentage of neutrophil,and some relevant nutritional parameters,such as lipid profile,transferrin,total protein,albumin and prealbumin levels.Comparative analysis was conducted between the two groups.Results In LS-G three months after treatment,the levels of carnitine,hemoglobin,and prealbumin in plasma were significantly increased(P<0.05),but C-reactive protein,neutrophil percentage,low-density lipoprotein and triglyceride were significantly decreased(P<0.05)in contrast to those in C-G and before treatment.Transferrin,total protein,and albumin were elevated in LS-G,with no statistical significance.Conclusion There was a significant improvement of lipid metabolism and nutritional status for the long-term maintenance hemodialysis patients with Levocarnitine supplementation.And this improvement is related to the decrease of inflammatory factors.展开更多
ST-elevation myocardial infarction(STEMI)remains a leading cause of cardiovascular morbidity and mortality worldwide,and accurate early risk stratification is critical for implementing precision therapies in clinical ...ST-elevation myocardial infarction(STEMI)remains a leading cause of cardiovascular morbidity and mortality worldwide,and accurate early risk stratification is critical for implementing precision therapies in clinical practice.However,existing clinical risk scores and manually derived imaging biomarkers have limited accuracy in predicting post-STEMI outcomes.To address this gap,we developed DeepSTEMI,an end-to-end deep learning system that integrates multi-sequence cardiac magnetic resonance(CMR)images with clinical parameters for predicting 2-year major adverse cardiovascular events(MACE).The system comprised two key algorithmic modules:a U-Net module that automatically segments heart regions from raw CMR images and a Transformer-based module that predicted future cardiovascular events.DeepSTEMI was developed using a multicenter dataset(n=610;20,618 images)from STEMI patients enrolled in the EARLY-MYO-CMR registry(NCT03768453),with external validation performed in 334 patients(9944 images)from three independent cardiac centers.In external validation,DeepSTEMI demonstrated superior predictive performance compared to conventional clinical risk scores and manual CMR parameters(AUC 0.894,95%CI:0.823-0.965;overall accuracy 94.3%).The model identified high-risk patients who exhibited a 20-fold MACE risk compared to low-risk counterparts(HR 20.43,log-rank P<0.001).SHapley Additive exPlanations(SHAP)analysis revealed that DeepSTEMI's predictive power stems from clinical-imaging synergy,enabling it to capture complex pathological patterns.DeepSTEMI achieved consistently superior performance over the Eitel score across all subgroups,with the greatest benefit observed in women(NRI 1.597)and in patients imaged 4-7 d post-STEMI(NRI 1.442).Overall,DeepSTEMI serves as an automated,scalable,and interpretable clinical copilot,which advances postSTEMI risk stratification beyond the limitations of current paradigms.展开更多
文摘Ultra-high dose rate flash radiotherapy(FLASH-RT)has attracted wide attention in the field of radiotherapy in recent years.For FLASH-RT,radiation is delivered at a very high dose rate[usually thousands of times compared with conventional radiotherapy(CONV-RT)]in an extremely short time.This novel irradiation technique shows a protective effect on normal tissues,also known as the flash effect.At the same time,FLASH-RT is comparable to CONV-RT in terms of tumorkilling efficacy.As basic research dedicates to uncover the mechanisms by which FLASH-RT reduces radiation-induced normal tissue damage,clinical trials of FLASH-RT have been gradually conducted worldwide.This article systematically reviews the evidence of the feasibility and safety of FLASH-RT in clinical practice and offers insights into the future translation of this technology in clinic.
基金supported by the National Key Research and Development Program of China(Grant No.2022YFA1402304)the National Natural Science Foundation of China(Grant Nos.12034009,12374005,52288102,52090024,and T2225013)+1 种基金the Fundamental Research Funds for the Central Universitiesthe Program for JLU Science and Technology Innovative Research Team.
文摘Crystal structure prediction(CSP)is a foundational computational technique for determining the atomic arrangements of crystalline materials,especially under high-pressure conditions.While CSP plays a critical role in materials science,traditional approaches often encounter significant challenges related to computational efficiency and scalability,particularly when applied to complex systems.Recent advances in machine learning(ML)have shown tremendous promise in addressing these limitations,enabling the rapid and accurate prediction of crystal structures across a wide range of chemical compositions and external conditions.This review provides a concise overview of recent progress in ML-assisted CSP methodologies,with a particular focus on machine learning potentials and generative models.By critically analyzing these advances,we highlight the transformative impact of ML in accelerating materials discovery,enhancing computational efficiency,and broadening the applicability of CSP.Additionally,we discuss emerging opportunities and challenges in this rapidly evolving field.
文摘BACKGROUND The optimal sequencing of immune checkpoint inhibitor(ICI)and brain radiotherapy in the management of brain metastasis from non-small cell lung cancer(NSCLC)is unclear.AIM To evaluate the survival of concurrent ICI and consolidation ICI in NSCLC patients treated with brain radiotherapy.METHODS We retrospectively analyzed NSCLC patients treated with brain radiotherapy and ICI.Treatment response and survival were estimated.The cox proportional hazards regression model was utilized to investigate the association between overall survival and clinical variables.RESULTS There were 54 patients in concurrent ICI and radiotherapy group,and 62 individuals treated with radiotherapy followed by consolidation ICI.The objective response rates were similar between the two group.The median progression free survival was significantly high in the concurrent ICI group compared with consolidation ICI group(9.56 months vs 8.15 months,P=0.038).In addition,the median overall survival was 22.08 months in the concurrent ICI group,clearly longer than that in the consolidation group(13.24 months,P=0.009).CONCLUSION In NSCLC patients with brain metastases,our analyses suggested that radio therapy concurrent with ICI was associated with significant benefit compared with radiotherapy followed by consolidation ICI.
基金Project (No.08XD14026) supported by the Program of Shanghai Subject Chief Scientist,China
文摘Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.
基金supported by the Science and Technology Fund of Xi'an(No.SF08002)
文摘Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients[mean age(53.5±7.1)years]who underwent normal hemodialysis more than 6 months were randomly classified into two groups,Levocarnitine supplemented group(LS-G)(n=20;Levocarnitine supplementation after each normal hemodialysis session,at a dose of 1.0 g/day by intravenous administration)and control group(C-G)(n=20;normal hemodialysis).Before treatment,one month and three months after treatment we respectively measured or observed the following items,the tolerance to hemodialysis,carnitine level in plasma,C-reactive protein,IL-6,TNF-α,percentage of neutrophil,and some relevant nutritional parameters,such as lipid profile,transferrin,total protein,albumin and prealbumin levels.Comparative analysis was conducted between the two groups.Results In LS-G three months after treatment,the levels of carnitine,hemoglobin,and prealbumin in plasma were significantly increased(P<0.05),but C-reactive protein,neutrophil percentage,low-density lipoprotein and triglyceride were significantly decreased(P<0.05)in contrast to those in C-G and before treatment.Transferrin,total protein,and albumin were elevated in LS-G,with no statistical significance.Conclusion There was a significant improvement of lipid metabolism and nutritional status for the long-term maintenance hemodialysis patients with Levocarnitine supplementation.And this improvement is related to the decrease of inflammatory factors.
基金supported by the Innovative Research Group Project of China’s National Natural Science Foundation(82421001)the National Natural Science Foundation of China(823B2005,824B1015,U21A20341,T2525004,82470394,82230014,82202159,81930007,81971570,and 32100426)+13 种基金the National Key Research and Development Program of China(2021YFC2502300 and 2022YFE0103500)the National Science Fund for Distinguished Young Scholars(81625002)the Shanghai Municipal Health Commission(2022JC013,2023ZZ02021,GWVI11.1-26,and 2022ZZ01008)the Science and Technology Commission of Shanghai Municipality(24DZ2202700,22DZ2292400,22JC1402100,and 20YF1426100)the Program of Shanghai Academic Research Leader(21XD1432100)the Shanghai Municipal Education Commission(SHSMU-ZDCX20210700)the Shanghai Municipal Health Commission(202440156)the Shanghai Institutions of Higher Learning,Innovative Research Team of High-Level Local Universities in Shanghai(SHSMU-ZDCX20210700)(Project 2021-01-07-00-02-E00083)the National High Level Hospital Clinical Research Funding(2022-PUMCH-C-023)the MedicalEngineering Joint Funds of Shanghai Jiao Tong University(YG2022QN107 and 2025ZYB-007)the Shanghai Clinical Cohort Program(Reserve Clinical Cohort)by the Shanghai Hospital Deveopment Center(SHDC2025CCS037)the Shanghai Professional Technical Service Platform for Cardio-Cerebral Disease Biobank and Database(22DZ2292400)the Pudong New District Health Commission(PW2023E-02)support from the innovative research team of high-level local universities in Shanghai。
文摘ST-elevation myocardial infarction(STEMI)remains a leading cause of cardiovascular morbidity and mortality worldwide,and accurate early risk stratification is critical for implementing precision therapies in clinical practice.However,existing clinical risk scores and manually derived imaging biomarkers have limited accuracy in predicting post-STEMI outcomes.To address this gap,we developed DeepSTEMI,an end-to-end deep learning system that integrates multi-sequence cardiac magnetic resonance(CMR)images with clinical parameters for predicting 2-year major adverse cardiovascular events(MACE).The system comprised two key algorithmic modules:a U-Net module that automatically segments heart regions from raw CMR images and a Transformer-based module that predicted future cardiovascular events.DeepSTEMI was developed using a multicenter dataset(n=610;20,618 images)from STEMI patients enrolled in the EARLY-MYO-CMR registry(NCT03768453),with external validation performed in 334 patients(9944 images)from three independent cardiac centers.In external validation,DeepSTEMI demonstrated superior predictive performance compared to conventional clinical risk scores and manual CMR parameters(AUC 0.894,95%CI:0.823-0.965;overall accuracy 94.3%).The model identified high-risk patients who exhibited a 20-fold MACE risk compared to low-risk counterparts(HR 20.43,log-rank P<0.001).SHapley Additive exPlanations(SHAP)analysis revealed that DeepSTEMI's predictive power stems from clinical-imaging synergy,enabling it to capture complex pathological patterns.DeepSTEMI achieved consistently superior performance over the Eitel score across all subgroups,with the greatest benefit observed in women(NRI 1.597)and in patients imaged 4-7 d post-STEMI(NRI 1.442).Overall,DeepSTEMI serves as an automated,scalable,and interpretable clinical copilot,which advances postSTEMI risk stratification beyond the limitations of current paradigms.
