Objective:To explore the relationship between the longitudinal change trajectory of white blood cell (WBC) and new-onset type 2 diabetes mellitus(T2DM).Methods:It was a prospective cohort study. A total of 2 792 people who underwent health examinations at the Health Management Center of the Affiliated Hospital of Qingdao University from January 2019 to December 2023 for five consecutive years and met the research standards were selected as the study subjects. Group-based trajectory modeling (GBTM) was established. The target population was divided into three groups based on the longitudinal change trajectory of WBC: low-stable group, medium-stable group and high-stable group. The cumulative incidence of T2DM in the three groups were analyzed. Multivariate Cox proportional risk regression models were used to analyze the correlation between different WBC trajectory groups and the risk of T2DM in total population, males and females. A restricted cubic spline regression (RCS) model was used to analyze the dose-response relationship between baseline WBC and risk of T2DM.Results:The cumulative incidence rate of T2DM in low-stable group, medium-stable group and high-stable group increased gradually, which was 2.5%, 5.3% and 6.9%, respectively ( χ2=19.024, P<0.001). After adjusting for multiple confounding factors in the Cox proportional hazards regression model, no significant difference in the incidence risk of T2DM among the three WBC trajectory groups in males; While the hazard ratios in the high-stable and medium-stable group in women was 2.852(95% CI: 1.067-7.628) and 2.588 (95% CI: 1.133-5.912), respectively, when compared with that in the low-stable group (both P<0.05). RCS curve analysis showed a linear relationship between WBC and the risk of T2DM in female ( Pnon-linear=0.956), when the WBC count was>5.53×10 9/L, the risk of T2DM increased with the rise of WBC. Conclusion:Higher WBC trajectory is positively correlated with the risk of new-onset T2DM in female health examination population.

Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and modified-endoscopic mucosal resection (M-EMR) for G1 rectal neuroendocrine tumors (RNETs) .Methods:Data of 121 patients with pathologically confirmed G1 RNETs treated with ESD ( n=105) or M-EMR ( n=16) in Nanjing Drum Tower Hospital from January 2017 to September 2020 were retrospectively analyzed. The complete resection rate, complication incidence, hospital stay, treatment cost and other indicators of the two groups were compared by using inverse probability of treatment weighting (IPTW). Results:There were significant differences in tumor number ( χ2=8.76, P=0.003), tumor invasion depth ( χ2=6.96, P=0.008), utilization of metal clips [82.9% (87/105) VS 93.8% (15/16), χ2=8.78, P=0.003], number of metal clips ( χ2=8.41, P=0.016), hemostasis using hot clamp [78.1% (82/105) VS 18.7% (3/16), χ2=20.64, P<0.001], traction procedure [2.9% (3/105) VS 18.7% (3/16), χ2=4.45, P=0.035] and treatment cost (17 568.6 ± 8 911.0 yuan VS 8 120.8±1 528.2 yuan, t=3.65, P<0.001) between the ESD group and the M-EMR group. After verifying the stability of the results using IPTW sensitivity analysis, there was still significant difference in the treatment cost ( t=2.07, P<0.001). Conclusion:Both ESD and M-EMR demonstrate comparable efficacy in treating G1 RNETs; however, M-EMR exhibites lower treatment costs.

As a malignant hematological disease mainly originating from T or B lymphoid progenitor cell, acute lymphocytic leukemia (ALL) is more prevalent in children. With the gradual revelation of the autophagy mechanism, the role of autophagy in ALL has gained increasing attention. Autophagy can not only stimulate the survival of leukemia cells as an adaptive response, but also inhibit cell proliferation in some other cases. Therefore, how to regulate autophagy in promoting death or survival and reduce the drug resistance in ALL has become a hotspot. This article reviews the role of autophagy in ALL.

Objective:To explore the adjustment ranges of auto-segmentation contours for organs at risk (OAR) in patients with nasopharyngeal carcinoma and assess the dosimetric impacts of the contours from varying sources on radiotherapy plans.Methods:Twenty-five patients with early-stage nasopharyngeal carcinoma were investigated. Through expert delineation, deep learning-based automatic delineation, and atlas-based automatic delineation of their spinal cord, brainstem, optic nerves, optic chiasm, parotid glands, oral cavity, hypopharynx, and mandible, as well as expert correction of these automatic delineations, five structure sets were formed. Moreover, the contours delineated by experts (also referred to as the expert contours) of the target volumes and other OARs were copied into the images for subsequent research. The Dice similarity coefficients (DSCs) of the structure sets were calculated. Using the radiotherapy plans optimized based on expert contours as templates, the radiotherapy plans and dose distributions of all the structure sets were established. The expert contours and contours determined using automatic delineation and corrected by experts (also referred to as the corrected contours) were defined as clinical contours. Then, three research objectives were set: the dosimetric effects of inter-observer clinical contour variations, the impacts of contour variations on plan optimization, and the impacts of contour variations on plan evaluation.Results:The average DSC of the visual pathway was 0.62±0.10, lower than that of other OARs (0.86±0.04). After expert correction, the DSCs of contours obtained using deep learning- and atlas-based automatic delineation increased by 7.61% and 10.69%, respectively. For the dosimetric effects of inner-observer contour variations, the Dmax of the optic chiasm was the maximum (3.96±6.02)Gy, while the Dmean of the hypopharynx was the minimum (0.81±0.55 Gy). When the impacts of contour variations on plan optimization were assessed based on expert contours, the dose differences (Δ D) exceeding ±3 Gy accounted for 22%, 14%, 46%, and 42%, respectively for the spinal cord, brainstem, optic nerve, and optic chiasm and accounted for only 2% for other OARs. After expert correction, the Δ D between automatic and expert contours decreased, with Δ D exceeding ±3 Gy decreased by 16% and 14%, respectively for the optic nerves and optic chiasm. When the average distance of the overlap volume histogram (OVH) exceeded 3.5 cm, all Δ Dmax fell within ±3 Gy. When the average distance of OVH was greater than 1.5 cm, all Δ Dmean fell within ±2 Gy. For contours obtained using deep learning and atlas-based automatic delineation, the doses of 50.0%±17.3% and 52.6%±19.3% of patients fell within the dose ranges of clinical contours, respectively. The numbers of patients for whom the Dmax of the spinal cord, optic nerve, optic chiasm and the D1 cm 3 of the mandible in the two types of automatic contours fell within the dose ranges of clinical contours were statistically different ( t = -4.24, -3.99, -3.16, 3.51, P < 0.05). Conclusions:After expert correction, the automatic delineation results from different sources exhibited certain geometric differences. The expert correction reduced the impacts of automatic contours on plan optimization. The average distance of OVH is identified as an important feature used to determine dose differences. For small-volume serial organs close to the target volumes, meticulous corrections are required before applying auto-segmentation to clinical practice.

Objective To investigate the relationships of serum angiopoietin-like protein 4 (ANGPTL4) and fibroblast growth factor-23 (FGF-23) levels with the severity and prognosis of patients with diabetic nephropathy. Methods A total of 120 patients (diabetic nephropathy group) with diabetic nephropathy were selected from July 2018 to July 2020 and divided into mild group (n=62) and severe group (n=58) according to the staging criteria of diabetic nephropathy; based on the prognosis within 3 years, they were also divided into good prognosis group (n=94) and poor prognosis group (n=26). Additionally, 102 diabetic patients were enrolled as diabetic group, and 81 healthy volunteers were selected as control group. The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay (ELISA). Logistic regression analysis was used to analyze the influencing factors of prognosis, and receiver operating characteristic (ROC) curves were drawn to analyze the values of ANGPTL4, FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy. Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group (P < 0.05); compared with the simple diabetic group, the levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group were significantly increased (P < 0.05); the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group (P < 0.05); the ROC curve analysis revealed that the areas under the curve (AUCs) for assessing disease severity of ANGPTL4, FGF-23 and their combination were 0.748, 0.781 and 0.858 respectively, and the combined diagnosis was significantly better than FGF-23 (Z=2.149, P=0.032) and ANGPTL4 (Z=2.886, P=0.004) alone; the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group (P < 0.05); significant differences were observed in diabetes duration, blood urea nitrogen (BUN), serum creatinine (Scr), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), hypertension, ANGPTL4 and FGF-23 levels between diabetic nephropathy patients with different prognoses (P < 0.05); the Scr, ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy (P < 0.05); the ROC curve analysis for prognosis assessment showed that the AUCs of ANGPTL4, FGF-23 and their combination were 0.774, 0.795 and 0.874 respectively; the combined diagnosis was significantly better than FGF-23 (Z=2.385, P=0.171) and ANGPTL4 (Z=2.317, P=0.021) alone. Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients, and they have certain reference value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective:To examine whether the mixed infection rate in pertussis infants is significantly higher than that in non-pertussis infants with respiratory tract infection, to explore the mixed infection pathogen distribution in pertussis infants, and to provide reference for clinical diagnosis and treatment.Methods:A case-control study was conducted on 118 nasopharyngeal swabs collected from infants who applied for clinical pertussis etiological testing (culture and specific nucleic acid detection of Bordetella pertussis) in Beijing Children′s Hospital, Jiaxing Maternity and Child Health Care Hospital and Wuhu No.1 People′s Hospital from August 2018 to January 2021.According to the pertussis etiological testing results, the patients were divided into the pertussis group (65 cases) and non-pertussis group (53 cases). Thirty-three pairs of cases were matched according to age, onset season and city.All nasopharyngeal swabs were tested for infections of other pathogens using FilmArray RP2, which can detect 21 respiratory infection pathogens.The mixed infection rate was compared between groups by Chi- square test. Results:According to the FilmArray RP2 test results, 56.9%(37/65) cases in pertussis group and 15.1%(8/53) cases in the non-pertussis group were positive for multiple pathogens, and the difference was statistically significant ( χ2=21.651, P<0.001). The top 5 mixed infection pathogens in pertussis infants were human rhinovirus/enterovirus (HRV/EV) (38.5%, 25/65), parainfluenza virus (PIV) (18.5%, 12/65), respiratory syncytial virus (RSV) (10.8%, 7/65), coronavirus (Cov) (10.8%, 7/65), and adenovirus (ADV) (7.7%, 5/65). The mixed infection rates of the pertussis group in spring, summer, autumn and winter were 46.2% (6/13), 58.3%(14/24), 55.6%(5/9), and 63.2%(12/19), respectively.Comparison of matched and unmatched cases achieved similar results. Conclusions:Among clinical suspected pertussis infant specimens, the mixed infection rate in confirmed cases is tremendously higher than that in non-pertussis infants.The main mixed infection pathogens in pertussis infants are HRV/EV, PIV, RSV, Cov, and ADV.Mixed infection in pertussis children commonly occurs in four seasons, with the highest incidence in winter.

Objective:To explore the difference in the complexity of different treatment planning systems, multi-leaf collimator (MLC) types and treatment sites of volume-modulated arc therapy (VMAT), and propose a complexity score for plan quality control.Methods:Statistical analysis of 12 complexity metrics including Monaco and Eclipse, Agility, Millennium and High-definition MLC, nasopharyngeal, lung and cervical cancer was performed. Spearman correlation coefficient between complexity metrics was calculated. Principal component analysis was conducted to reduce the dimensionality of the original data set to the first two principal components and explain its physical meaning. Complexity score based on the principal components was calculated to establish warning and action thresholds for plan quality control. The correlation between complexity metrics and γ pass rate was analyzed.Results:Except cervical cancer aperture sub-regions metric, other metrics had significant differences between Monaco and Eclipse. Monaco MLC had a more regular field but higher MU, smaller leaf gap, and longer leaf travel distance. High-definition MLC with smaller leaf width significantly added MLC aperture-related metrics. The first two principal components explained over 80% of the total variance of the original dataset, complexity score was weighted average of first two principal components. The distribution of complexity score for different equipment and sites was different. The warning threshold was expressed as the average plus standard deviation, and the action threshold was expressed as the average plus 2 standard deviations. Complexity metrics and complexity scores had small correlation with γ pass rate, showing weak or irrelevant but statistically significant. Conclusions:Different planning systems, MLC types, and treatment site complexity metrics are significantly different. The complexity score is a useful tool for plan quality control.

Objective:To study the changing characteristics and impact factors of helical tomotherapy (HT)for longitudinal dose fall-off outside the target, in order to guide the plan junction or pretreatment target and implementation efficiency in clinical.Methods:Eight patients with head and neck tumors admitted to the Department of Oncology Radiotherapy of the First Affiliated Hospital of Zhengzhou University in December 2019 were retrospectively selected as the research objects. The planning target area and dose drop structure were outlined in the head and neck images with a thickness of 1 mm obtained by Siemens SOMATOM Definition AS positioning computerized tomography (CT). Different field widths (FW, 5.0 cm/2.5 cm/1.0 cm) and pitches (0.430/0.287/0.215) were assembled for planning with the same modulation factor (1.8), finest does calculation grid (0.195 cm ×0.195 cm) and other planning parameters were consistent. The plans were designed by different parameters, and the result was analyzed by univariate analysis.Results:The that different pitch curves coincided under the same field width by comparative analyzing, so pitchs had no effect on dose drop. The different field width curves were independent of each other, indicating that the field width had an effect on dose drop in the head and foot direction. The relationship between the longitudinal dose drop speed outside the target and the change of the field width was inversely correlated: the larger field widths meant the slower dose fall-off and the larger penumbra, while the smaller field widths meant the faster fall-off and the smaller penumbra. When the dose fall-off to 50% of the prescribed dose, the distance from the target was approximately equal to half the field widths, and the pitchs had not affect the rate of dose-drop, while the dose at different distances from the target boundary could be calculated by the fitting formulas. The field widths and pitchs had little effect on the CI and HI index of the target, relatively, the target area was best when the field width was 2.5 cm. The total beam-on time gradually decreased with the increase of the field widths and pitches.Conclusions:When segment target therapy needs to consider planning junction, execution efficiency, and controlling longitudinal dose fall-off and considered the execution, the optimal planned parameters such as field widths and pitches could be selected or the target at the junction regions could be adducted according to the longitudinal dose drop formula, so as to achieve the ideal dose distribution.

Objective:To evaluate the combined effect of an trajectory log field based(LBF)and two commercial dose reconstruction systems on volume-modulated arc therapy(VMAT)dose verification of lung cancer.Methods:An in-house program was developed to introduce errors in trajectory log of TrueBeam to the origin plan and recalculate the dose of the error plan in treatment planning system(TPS). A total of 18 lung cancer cases treated by two-arc VMAT were selected to perform on LINAC and measured by ArcCheck simultaneously. Then, the reconstructed doses were obtained by 3DVH. The mode of reconstruction was calculated by LFB and Compass. Five of the 18 cases were performed on LINAC two times in four hours and measured by ArcCheck to evaluate the stability of the TrueBeam performance. The 18 plans were recalculated and performed on LINAC with a solid water phantom with 5 cm build-up, 4 cm back scattering thickness and a FC65-G detector in the center. The measured dose by detector was compared with the reconstructed dose by three systems.Results:TheTruebeam performance was stable. For all of the 18 cases, the point dose measured by FC65-G and reconstructed by three systems had a deviation of less than 2% to the TPS calculated. For all of the organs reconstructed by LBF and most organs reconstructed by 3DVH and Compass, the γ pass rate between them and TPS all exceeded 90% under all criteria, as well as the ArcCheck measured results. For all the organ dose difference between reconstructed and TPS, LBF system had the smallest difference, followed by the Compass system except the lung, and the 3DVH had the highest difference.Conclusions:LBF, 3DVH and Compass can reflect the VMAT dose verification results of lung cancer from different perspectives. The combined application of three systems can demonstrate the verification results in an intuitive manner, which is beneficial for subsequent analysis.

Objective:To systematically evaluate the incidence and influencing factors of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) in Chinese parturient women so as to provide a reference for related research and clinical practice.Methods:We searched literature related to the incidence and influencing factors of DOL Ⅱ in Web of Science, PubMed, Embase, Cochrane Library, VIP, China National Knowledge Infrastructure (CNKI) , Wanfang Data and China Biology Medicine Literature Database by computer. Two researchers conducted the quality evaluation and data extraction on literature, as well as the systematic review. Meta-analysis was used for data conforming to quantitative analysis by Stata 12.0.Results:A total of 13 studies were included in the systematic review. Meta-analysis showed that the incidence of DOLⅡ in Chinese parturient women was 24% [95% confidence interval (18%-31%) ]. Among the main influencing factors, parturient women factors include age, parity, delivery method, body mass index, sleep status, exposure of stressful life events during pregnancy, anxiety, depression, postpartum fatigue, pregnancy complications, methods of anesthesia, drug use; infant factors involve premature delivery, birth weight, sucking posture, number of sucking; social factors consist of the time to milk, breastfeeding education during pregnancy.Conclusions:The incidence of DOLⅡ in Chinese parturient women is relatively high, and there are many influencing factors involved. The effects of most factors have different evaluations, and the causal relationship with DOLⅡ needs further verification.