ObjectiveThis paper aims to conduct a secondary analysis of a randomized controlled trial on the treatment of myelodysplastic syndrome （MDS） with deficiency of both the spleen and kidney and blockage of toxin and blood stasis with an arsenic-containing traditional Chinese medicine compound， by applying the mixed model for repeated measure （MMRM） and the method of stratified composite outcome with win ratio. The analysis includes the assessment of hematological efficacy and the composite outcome evaluation of adverse reactions， so as to more comprehensively assess the therapy of this regimen. MethodsThe MMRM and win ratio methods were used to evaluate the efficacy of a prospective，multi-center，double-blind，randomized controlled study. The blood routine （hemoglobin concentration，neutrophil count， and platelet count） and biochemical indexes （aspartate aminotransferase，alanine aminotransferase，serum creatinine，and serum ferritin） of the patients were detected at the time of enrollment and at the end of each course of treatment in the laboratory department of Xiyuan Hospital. The patients' syndromes at the time of enrollment and after treatment were recorded and scored according to the therapy standard of traditional Chinese medicine for diseases and syndromes. MMRM was used to analyze the blood routine indexes of the experimental group and the control group. This method has the advantages of high data reliability and dynamic efficacy under intervention and time. The win ratio method was used to evaluate the composite outcome of traditional Chinese medicine syndrome scores and biochemical indexes according to the priority and to verify the clinical safety of arsenic-containing traditional Chinese medicine compound. ResultsThe results of MMRM analysis showed that the hemoglobin concentration of patients in the group with arsenic-containing traditional Chinese medicine compound increased significantly compared with that before treatment in the group，while that in the placebo group decreased significantly （P<0.01）. When compared with that after treatment in the placebo group，the hemoglobin concentration of patients in the group with arsenic-containing traditional Chinese medicine compound increased significantly，and the mean difference of least squares （LS） was statistically significant （P<0.01）. When compared with those before treatment in the group，there were no statistically significant differences in the neutrophil count and platelet count in both groups. After treatment，there were no statistically significant differences in the neutrophil count， platelet count， and the mean difference of LS between the two groups. The analysis results of win ratio showed that the group with arsenic-containing traditional Chinese medicine compound had a significant advantage in the comparison of composite outcomes，with a win ratio （95% CI） of 2.01 （1.24-3.27） （P<0.01），and that the possibility of "winning" in terms of safety was 2.01 times that of the placebo group. The safety advantage of the group with arsenic-containing traditional Chinese medicine compound mainly came from the traditional Chinese medicine syndrome scores，renal function indexes， and iron reserve capacity indexes，and the number of winning times was less than that of losing times in the comparison of liver function outcomes. ConclusionThe MMRM analysis proves that the arsenic-containing traditional Chinese medicine compound can significantly improve the hemoglobin concentration of patients with myelodysplastic syndrome with refractory cytopenia and multilineage dysplasia （MDS-RCMD） of the type of deficiency of both the spleen and kidney and blockage of toxin and blood stasis. This conclusion is not interfered with by time trends and individual relationships and methodologically improves the credibility of the therapy of the arsenic-containing traditional Chinese medicine compound in treating MDS. Four outcomes are evaluated by the win ratio method，namely traditional Chinese medicine syndromes，liver function，renal function， and iron reserve capacity，proving that the arsenic-containing traditional Chinese medicine compound has the comprehensive advantages of improving the survival quality of the patients and reducing adverse reactions. The win ratio outcome provides clear comparative indexes for the evaluation of adverse reactions，making it easier for regulatory authorities，medical staff， and patients to understand the safety of the arsenic-containing traditional Chinese medicine compound in clinical application.

Objective:To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse.Methods:This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected.Results:A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm2, left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion:The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

Due to advances in treatment methods, the survival rate and quality of life of cancer patients have been improved. Radiation-induced vascular injury (RIVI) is a common adverse reaction following radiotherapy, mainly manifested as capillary injury and atherosclerosis in the irradiated area. Radiotherapy induces RIVI in the cerebral vessels, carotid arteries, coronary arteries, and large arteries through mechanisms such as endothelial cell injury and senescence, oxidative stress and inflammatory responses, angiogenesis, and vascular remodeling. In this review research progress in the pathological features, pathophysiological mechanisms, clinical manifestations, prevention and treatment strategies of RIVI was summarized, aiming to provide insights for future research on RIVI.

Objective To observe the value of enhanced CT radiomics combined with deep learning(DL)algorithm for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 100 patients with single PTC were retrospectively enrolled and divided into training set(n=70)and test set(n=30)at the ratio of 7∶3.The optimal radiomics features and DL features of lesions were extracted and screened based on arterial phase cervical CT,and the radiomics score(Radscore)and DL score(Deepscore)were calculated to construct radiomics model and DL model,respectively.Clinical data,routine CT findings,Radscore and Deepscore were enrolled in multivariate logistic regression analysis to screen the independent predictors of PTC CLNM,and a combined model was then constructed.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting PTC CLNM.Results Thirteen optimal radiomics features and 12 DL features were selected.Radscore(OR=1.698,P=0.002)and Deepscore(OR=1.872,P=0.021)were both independent predictors of PTC CLNM.The AUC of radiomics mode,l DL model and combined model for predicting PTC CLNM was 0.775,0.876 and 0.880 in training set,which in test set was 0.739,0.776 and 0.789,respectively.In training set,the prediction efficacy of combined model was better than that of radiomics model(Z=2.551,P=0.011).Conclusion Combined with DL algorithm could effectively increase the efficacy of enhanced CT radiomics for predict PTC CLNM.

Objective To observe the value of intratumoral and peritumoral CT radiomics combined with clinic for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 338 patients with PTC were retrospectively enrolled and divided into training set(n=236)and validation set(n=102)at a ratio of 7∶3,also further assigned into subgroups according to CLNM or not within sets.The clinical independent risk factors for PTC CLNM were identified using multivariate logistic regression analysis,and a clinical model was then constructed.Intratumoral ROI were delineated on CT images including non-enhanced and three-phase enhancement images,which were then enlarged by 2 mm.Radiomics models of intratumoral,peritumoral and intratumoral+peritumoral ROI were established based on non-enhanced CT,as well as arterial phase,venous phase,delayed phase and multi-phase enhanced CT,respectively,the best one was selected and combined with clinical model to construct a combined model.Receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting PTC CLNM.Results Male patient and aged＜45 years were both clinical independent risk factors for PTC CLNM(both P＜0.05).Multi-phase intratumoral+peritumoral radiomics model was the optimal radiomics model,which was used to construct the combined model combining with clinical model.The AUC of combined model for predicting PTC CLNM in training set was 0.859,superior to that of clinical model and multi-phase intratumoral+peritumoral radiomics model(0.684,0.831,both P＜0.05),which in validation set was 0.832,similar to that of multi-phase intratumoral+peritumoral radiomics model(0.819,P=0.368)but superior to that of clinical model(0.605,P＜0.001).Conclusion Multi-phase intratumoral and peritumoral CT radiomics could be used to predict PTC CLNM.Combining with clinic could further improve its efficacy.

Objective To investigate the characteristics of peripheral blood in the treatment of aplastic anemia(AA)with Bushen Shengxue Method and Yiqi Yangxue Method combined with Western medicine.Methods Totally 492 AA patients who were treated in 19 centers including Xiyuan Hospital China Academy of Chinese Medical Sciences from September 2018 to March 2021 were selected,and were randomized into three groups:161 cases in the Bushen Shengxue group,164 cases in the Yiqi Yangxue group,and 167 cases in the control group.All three groups were orally administered cyclosporine and androgens.Bushen Shengxue group was given Bushen Shengxue Granules,Yiqi Yangxue group was given Yiqi Yangxue Granules,and the control group was given placebo(half dosage of Bushen Shengxue granules).The general data,overall efficacy,and peripheral blood at the 1st month,the 4th month,and 6th month after treatment were analyzed.Results The total effective rate of Bushen Shengxue group was 98.8％(159/161),which was significantly higher than that of Yiqi Yangxue group(79.9％)and the control group(61.7％),with statistical significance(P＜0.001);The total effective rate of Yiqi Yangxue group was significantly higher than that of the control group(P＜0.001).Compared with before treatment,the hemoglobin(HGB)levels of all three groups of patients significantly increased after treatment(P＜0.001,P＜0.01),and the platelet levels of Bushen Shengxue group and the control group significantly increased after treatment(P＜0.001);after treatment,the HGB levels in the three groups were ranked from high to low as the Bushen Shengxue group,Yiqi Yangxue group and the control group(P＜0.01).25％of patients had HGB levels exceeding 20％of baseline values,Bushen Shengxue group took 1 month,while Yiqi Yangxue group and control group took 4 months;25％of patients had an increase in HGB levels exceeding 50％of the baseline value,Bushen Shengxue group took 6 months,while Yiqi Yangxue group and control group took more than 6 months.At 6 months,the number of patients with HGB elevation exceeding 20％and 50％of baseline values in Bushen Shengxue group was higher than that in Yiqi Yangxue group and the control group(P＜0.05,P＜0.001).25％of patients had white blood cell elevation exceeding 50％of the baseline value,Bushen Shengxue group took 4 months,Yiqi Yangxue group took 6 months,and the control group took more than 6 months.25％of patients showed an increase in platelet levels exceeding 100％of the baseline value,Bushen Shengxue group took 4 months,while Yiqi Yangxue group and control group took 6 months;at 6 months,the number of patients in Bushen Shengxue group and Yiqi Yangxue group with platelet elevation exceeding 20％of the baseline value was significantly higher than that in the control group(P＜0.01,P＜0.05).Conclusion Bushen Shengxue method combined with Western medicine intreating AA is better than the method of Yiqi Yangxue method combined with Western medicine.In terms of improving HGB,it is reflected in shortening the recovery time and increasing the number of beneficiaries,and the dosage can affect the recovery time and the number of beneficiaries at the same time;in terms of improving white blood cell and platelet,it is reflected in shortening the recovery time,and the dosage can affect the recovery time.

Acute kidney injury (AKI) is one of the common critical illnesses characterized by a higher incidence, poor prognosis and limited effective therapeutics in clinical practice. Early diagnosis, etiologic differentiation and prognostic evaluation are crucial for improving outcomes and key components of integrated AKI management. However, the lack of ideal markers and intervention targets poses significant challenges in these aspects. Klotho, a protein predominantly synthesizes and secretes by renal tubular epithelial cells, has been shown to exert various protective effects on the kidney. Recent evidence suggests that abnormal Klotho levels are implicated in the pathogenesis and development of AKI, and hold promise for application in early diagnosis, etiologic recognition, and prognostic evaluation of AKI. Additionally, administration of exogenous Klotho protein or upregulation of endogenous Klotho expression has demonstrated preventive and therapeutic efficacy against AKI caused by a variety of etiologies. This paper reviewed the alterations in Klotho levels during AKI and evaluated its potential role in enhancing the integrated diagnosis and treatment of AKI.

Objective To observe the value of enhanced CT radiomics combined with deep learning(DL)algorithm for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 100 patients with single PTC were retrospectively enrolled and divided into training set(n=70)and test set(n=30)at the ratio of 7∶3.The optimal radiomics features and DL features of lesions were extracted and screened based on arterial phase cervical CT,and the radiomics score(Radscore)and DL score(Deepscore)were calculated to construct radiomics model and DL model,respectively.Clinical data,routine CT findings,Radscore and Deepscore were enrolled in multivariate logistic regression analysis to screen the independent predictors of PTC CLNM,and a combined model was then constructed.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting PTC CLNM.Results Thirteen optimal radiomics features and 12 DL features were selected.Radscore(OR=1.698,P=0.002)and Deepscore(OR=1.872,P=0.021)were both independent predictors of PTC CLNM.The AUC of radiomics mode,l DL model and combined model for predicting PTC CLNM was 0.775,0.876 and 0.880 in training set,which in test set was 0.739,0.776 and 0.789,respectively.In training set,the prediction efficacy of combined model was better than that of radiomics model(Z=2.551,P=0.011).Conclusion Combined with DL algorithm could effectively increase the efficacy of enhanced CT radiomics for predict PTC CLNM.

Objective:To evaluate the effectiveness of T-piece resuscitator as a respiratory support strategy during the transport of critically ill premature infants,and to provide a scientific basis for clinical decision-making.Methods:A total of 280 critically ill premature newborns hospitalized in the NICU of Fifth Medical Center of Chinese People's Liberation Army General Hospital from January 2017 to December 2023 were included.Infants were categorized into three groups based on the respiratory support method given during transport: the ventilator group(108 cases),the T-piece group(102 cases),and the resuscitation sac group(70 cases).The transport distance,general condition at birth,prenatal conditions,dyspnea symptoms at admission,blood gas analysis results,clinical diagnosis,clinical intervations,and related treatment among the three groups were retrospectively analyzed.Results:There were no significant differences in the transport distance,the number of endotrached intubations during transport,the main complications during pregnancy,the general condition at birth,and the history of asphyxia among the three groups(all P>0.05).The incidence of triple-concave sign at admission in T-piece group was significantly lower than that in resuscitation sac group (41.7% vs.62.9%, P=0.005),and the arterial carbon dioxide tension(PaCO 2) at admission was also significantly lower in T-piece group than that in resuscitation sac group[(41.194±8.720) mmHg vs.(45.360±13.998) mmHg, P=0.034].Furthermore,the T-piece group had significantly lower rates of type II respiratory failure(0.9% vs.22.9%),respiratory acidosis(9.3% vs.27.1%),hypoxemia(7.4% vs.28.6%),hyperoxygen partial pressure(1.9% vs.28.6%),neonatal respiratory distress syndrome(66.7% vs.87.1%),and intracranial hemorrhage(18.5% vs.38.6%) during hospitalization compared to the resuscitation sac group (all P<0.05).The proportion of tracheal intubations(63.9% vs.87.1%) and the time of using non-invasive ventilator[1.0(1.0,2.0)d vs.1.0(1.0,6.0)d] were also significantly lower in T-piece group compared to the resuscitation sac group(both P<0.05).Compared with the respiratory group,there were no statistically significant differences in the aforementioned indicators for the T-piece group. Conclusion:The T-piece resuscitator can provide stable and adjustable positive end-inspiratory pressure and positive expiratory pressure,as well as a stable inspired oxygen flow rate,without increasing the risk of invasive procedures and severe complications.Its application during the transport and treatment of critically ill premature infants has definite clinical value.

Purpose To evaluate the value of arterial-phase CT-based radiomics and habitat imaging models in predicting programmed death ligand 1(PD-L1)expression levels in non-small cell lung cancer(NSCLC).Materials and Methods Clinical and imaging data from 258 pathologically confirmed NSCLC patients at Yijishan Hospital of Wannan Medical College from April 2022 to May 2024 were retrospectively analyzed.Patients were randomly divided into training(n=207)and validation(n=51)sets at a 4∶1 ratio.Whole-lesion radiomic features were extracted from arterial-phase CT images.Subregional habitats were generated using local feature clustering,and their radiomic features were fused to derive habitat analysis features.Dimensionality reduction identified features for constructing whole-lesion radiomic and habitat analysis models.Logistic regression algorithms were used to build models and develop nomograms.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),and clinical utility was assessed via decision curve analysis.Results Two independent clinical risk factors(tumor location and necrosis presence),14 whole-lesion radiomic features and 16 habitat analysis features were selected.The clinical model achieved AUCs of 0.685(training)and 0.682(validation).The habitat analysis model(AUC:0.776 training,0.761 validation)outperformed the whole-lesion radiomic model(AUC:0.701 training,0.647 validation).The combined model integrating clinical,whole-lesion and habitat analysis features demonstrated superior performance(AUC:0.838 training,0.826 validation)and the highest clinical net benefit on decision curve analysis.Conclusion Habitat imaging features derived from arterial-phase CT effectively predict PD-L1 expression in NSCLC.Combining clinical characteristics with whole-lesion and habitat analysis features further enhances predictive performance.