Objective:To investigate the efficacy of neuromuscular electrical stimulation (NMES) combined with limb rehabilitation therapy in improving limb function of patients with hemiplegia due to stroke.Methods:A randomized controlled study was conducted on 110 patients with hemiplegia due to stroke admitted to the 987 Hospital of the PLA Joint Logistic Support Force from January 2021 to January 2023. These patients were divided into a control group and an observation group, with 55 cases each, using a random number table method. The control group received conventional rehabilitation therapy, while the observation group received NMES combined with limb rehabilitation therapy. All patients were treated for 3 months. The Trunk Impairment Scale, Brunnstrom Motor Function Scale, Surface Electromyography, Brunel Balance Scale, Simple Gait Test Scale, and Modified Ashworth Scale were used to evaluate trunk control function, limb control function, neuromuscular disorders, balance control function (forward-backward inclination angle, left-right inclination angle), gait temporal-spatial parameters, symmetry parameters, and muscle tone recovery in both groups before and after treatment.Results:After treatment, the Total Impairment Scale and Brunnstrom scores for upper and lower limbs in the observation group were higher than those in the control group [(18.31 ± 1.61) vs. (14.38 ± 1.42), (3.78 ± 0.41) vs. (3.01 ± 0.63), (3.75 ± 0.42) vs. (3.28 ± 0.63), t = 13.58, 7.60, 4.60, all P < 0.05]. Additionally, the scores for tibialis anterior, fibularis brevis, fibularis longus, medial gastrocnemius, lateral gastrocnemius muscle control were higher in the observation group compared with the control group. The scores for Berg Balance Scale, forward-backward inclination angle, left-right inclination angle, step frequency, step length, step speed, and step width in the observation group were also superior to those in the control group. All differences were statistically significant ( t = 17.88, 20.15, 24.62, 19.53, 22.80, 3.31, 8.66, 7.88, 6.08, 4.21, 7.43, 3.35, all P < 0.05). Furthermore, the deviations in step length, the ratio of support on the affected side to the unaffected side, and the ratio of swing on the affected side to the unaffected side in the observation group were lower than those in the control group [(3.53 ± 2.55) vs. (5.35 ± 3.21), (1.11 ± 0.04) vs. (1.14 ± 0.03), (1.10 ± 0.06) vs. (1.24 ± 0.09), t = 3.29, 4.45, 9.60, all P < 0.05]. Additionally, the level of muscle tone recovery in the observation group was higher than that in the control group ( Z = 2.53, P = 0.011). Conclusions:In the treatment of hemiplegia due to stroke, NMES combined with limb rehabilitation therapy can effectively improve patients' trunk and limb control, enhance balance function, and greatly promote muscle strength recovery.

Objective:To investigate the efficacy of neuromuscular electrical stimulation (NMES) combined with limb rehabilitation therapy in improving limb function of patients with hemiplegia due to stroke.Methods:A randomized controlled study was conducted on 110 patients with hemiplegia due to stroke admitted to the 987 Hospital of the PLA Joint Logistic Support Force from January 2021 to January 2023. These patients were divided into a control group and an observation group, with 55 cases each, using a random number table method. The control group received conventional rehabilitation therapy, while the observation group received NMES combined with limb rehabilitation therapy. All patients were treated for 3 months. The Trunk Impairment Scale, Brunnstrom Motor Function Scale, Surface Electromyography, Brunel Balance Scale, Simple Gait Test Scale, and Modified Ashworth Scale were used to evaluate trunk control function, limb control function, neuromuscular disorders, balance control function (forward-backward inclination angle, left-right inclination angle), gait temporal-spatial parameters, symmetry parameters, and muscle tone recovery in both groups before and after treatment.Results:After treatment, the Total Impairment Scale and Brunnstrom scores for upper and lower limbs in the observation group were higher than those in the control group [(18.31 ± 1.61) vs. (14.38 ± 1.42), (3.78 ± 0.41) vs. (3.01 ± 0.63), (3.75 ± 0.42) vs. (3.28 ± 0.63), t = 13.58, 7.60, 4.60, all P < 0.05]. Additionally, the scores for tibialis anterior, fibularis brevis, fibularis longus, medial gastrocnemius, lateral gastrocnemius muscle control were higher in the observation group compared with the control group. The scores for Berg Balance Scale, forward-backward inclination angle, left-right inclination angle, step frequency, step length, step speed, and step width in the observation group were also superior to those in the control group. All differences were statistically significant ( t = 17.88, 20.15, 24.62, 19.53, 22.80, 3.31, 8.66, 7.88, 6.08, 4.21, 7.43, 3.35, all P < 0.05). Furthermore, the deviations in step length, the ratio of support on the affected side to the unaffected side, and the ratio of swing on the affected side to the unaffected side in the observation group were lower than those in the control group [(3.53 ± 2.55) vs. (5.35 ± 3.21), (1.11 ± 0.04) vs. (1.14 ± 0.03), (1.10 ± 0.06) vs. (1.24 ± 0.09), t = 3.29, 4.45, 9.60, all P < 0.05]. Additionally, the level of muscle tone recovery in the observation group was higher than that in the control group ( Z = 2.53, P = 0.011). Conclusions:In the treatment of hemiplegia due to stroke, NMES combined with limb rehabilitation therapy can effectively improve patients' trunk and limb control, enhance balance function, and greatly promote muscle strength recovery.

ObjectiveTo investigate the difference in the risk of cardiovascular diseases between patients with different subtypes of non-alcoholic fatty liver disease （NAFLD） from the perspective of metabolism， since cardiovascular events induced by metabolic disorders are the leading cause of death in NAFLD. MethodsThe cluster sampling method was used to conduct a multicenter cross-sectional study among three representative hospitals in Pudong New Area of Shanghai， China. A total of 37 122 sets of physical examination data from July 2022 to June 2023 were collected and stratified according to body mass index （BMI）. The chi-square test was used for comparison of continuous data between groups， and a multivariable Logistic regression analysis was used to investigate the association between NAFLD subtypes and cardiometabolic risk factors. ResultsA total of 9 372 cases of NAFLD were detected， with a detection rate of 25.25%， and more than 97% of these patients were diagnosed with metabolic associated fatty liver disease （MAFLD）. The subgroup analysis showed that the detection rates of lean， overweight， and obese NAFLD were 7.72%， 33.99%， and 63.56%， respectively. Compared with the patients with lean or overweight NAFLD， the patients with obese NAFLD showed a significantly higher proportion of patients with abnormalities in blood pressure， blood glucose， triglyceride （TG）， high-density lipoprotein （HDL） or uric acid （all P<0.001）. Among related risk factors， lean NAFLD was associated with the increase in total cholesterol （TC）（P<0.05）， while overweight NAFLD and obese NAFLD were not associated with TC abnormalities （P>0.05）； obese NAFLD was not associated with TG abnormalities， while lean NAFLD and overweight NAFLD were associated with TG abnormalities （both P<0.05）； all types of NAFLD were associated with the abnormalities of waist-hip ratio， blood pressure， blood glucose， low-density lipoprotein， HDL， and uric acid （all P<0.05）. ConclusionThe detection rates of different subtypes of NAFLD in Shanghai Pudong are close to those reported in China and globally， and the epidemiologic data of NAFLD can be used analogously for MAFLD. There are certain differences in the distribution and association of cardiometabolic risk factors between different subtypes of NAFLD， and targeted interventions should be formulated based on the metabolic characteristics of each type of NAFLD.

Objectives:To investigate the relationship between locations of ventricular septal perforation and 30-day prognosis in patients with acute myocardial infarction complicated by ventricular septal perforation.Methods:Clinical data of 150 acute myocardial infarction patients with ventricular septal perforation admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and People's Hospital of Xinjiang Uygur Autonomous Region from January 2009 to October 2023 were retrospectively analyzed.Kaplan-Meier method was used to compare the difference in 30-day survival rate among patients with different sites of ventricular septal perforation.The impact of locations of ventricular septal perforation on 30-day prognosis of acute myocardial infarction patients was evaluated by multivariate Cox regression analysis(forward stepwise).Results:In acute myocardial infarction patients,the occurrence of anterior ventricular septal perforation was higher than that of posterior ventricular septal perforation(79.5%vs.20.5%,P<0.001).In the anterior ventricular septal perforation patients,females were more common(50.0%vs.22.6%,P=0.006),the blood glucose level was higher([10.51±5.99]mmol/L vs.[8.02±2.81]mmol/L,P=0.026),the left ventricular end-diastolic diameter was smaller([50.7±6.1]mm vs.[55.1±5.0]mm,P<0.001),the ventricular septal aperture was also smaller([9.8±4.6]mm vs.[12.6±5.4]mm,P=0.004),30-day mortality was higher(55.8%vs.35.5%,P=0.043)compared with posterior ventricular septal perforation patients.Multivariate Cox regression analysis(forward stepwise)showed that no transthoracic surgery or transcatheter closure(HR=26.344,95%CI:8.261-84.009,P<0.001)and anterior ventricular septal perforation(HR=2.432,95%CI:1.281-4.619,P=0.007)were associated with increased risk of 30-day all-cause mortality in patients with acute myocardial infarction complicated by ventricular septal perforation.Conclusions:In patients with acute myocardial infarction complicated by ventricular septal perforation,the incidence of anterior ventricular septal perforation is higher than posterior ventricular septal perforation and the 30-day all-cause mortality of anterior ventricular septal perforation patients is also higher.No transthoracic surgery or transcatheter closure and anterior ventricular septal perforation are the independent influential factors of 30-day all-cause mortality in patients with acute myocardial infarction and ventricular septal perforation.

Objective:To compare the dosimetric differences between a 3D-printed non-coplanar multi-channel applicator and traditional single-channel/co-planar multi-channel applicators in postoperative vaginal brachytherapy for early-stage endometrial cancer.Methods:CT scan data of 66 patients with stage I endometrial cancer, encompassing 100 3D brachytherapy CT imaging datasets, admitted to Department of Gynecologic Oncology of the Fourth Hospital of Hebei Medical University from December 2021 to June 2024 were retrospectively analyzed. Based on CT images and delineated structures, offline reconstructions of radiotherapy plans were performed for single-channel, coplanar multi-channel, and 3D-printed non-coplanar multi-channel applicators. These 3 radiotherapy plans were optimized, and the high-risk clinical target volume (HR-CTV) coverage (V 100 ≥90%) and doses to organs at risk (rectum, bladder) were compared. The prescription dose was standardized at 600 cGy, with constraints of rectal D 2 cm3 ≤420 cGy and bladder D 2 cm3 ≤480 cGy. Comparison among multiple groups was conducted by ANOVA. Bonferroni method was used to correct P-values for comparison between two groups. Results:When defined as HR-CTV D 90%≥600 cGy, bladder D 2 cm3 was (398.29±76.13)cGy and rectum D 2 cm3 was (402.10±49.77)cGy of the 3D-printed non-coplanar multi-channel group,which were significantly lower than those in the single-channel group [bladder D 2 cm3 (424.09±131.52) cGy, rectum D 2 cm3 (493.11±115.17) cGy] and coplanar group [bladder D 2 cm3 (461.28±134.84) cGy, rectum D 2 cm3 (508.75±119.02) cGy], respectively. When limiting bladder D 2 cm3≤480 cGy, rectal D 2 cm3 was (446.81±78.53 cGy) of the 3D-printed non-coplanar multi-channel group, which was significantly lower than those in the single-channel group [(589.71±153.91) cGy] and the coplanar group [(545.51±122.00) cGy], respectively. Meanwhile, HR-CTV V 100% (94.53%±3.42%) was higher than (91.19%±7.63%) in the coplanar group. When the rectal D 2 cm3 was ≤ 420 cGy, HR-CTV V 100% was (91.92%±4.04%) of the 3D-printed non-coplanar multi-channel group,which was significantly better than (79.23%±13.95%) in the single-channel group and (85.88%±6.86%) in the coplanar group, respectively. Conclusions:The 3D-printed non-coplanar multi-channel applicator significantly reduces bladder and rectal doses while enhancing target coverage, outperforming traditional single-channel and co-planar multi-channel applicators. This innovation provides an optimized solution for individualized precision radiotherapy.

Objective:To explore the clinical features, genetic traits and prognosis status of acute myeloid leukemia (AML) patients with TP53 mutation.Methods:A retrospective case series study was performed. Clinical data of 42 AML patients with TP53 mutation abundance of at least 10% who were admitted to the First Hospital of Jilin University from April 2018 to August 2023 were collected. Chromosomal karyotypes were detected using fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS) was performed on bone marrow samples from these patients. The Kaplan-Meier method was utilized to analyze the recurrence-free survival (RFS) of 22 patients who achieved complete remission (CR) after induction therapy, as well as the overall survival (OS) of 39 patients who underwent treatment. The Cox proportional hazards model was employed to analyze the factors influencing RFS and OS. Thirty-one patients who underwent induction therapy for ≥ 2 courses were divided into the non-refractory group (22 cases) and the refractory group (9 cases) based on whether CR was achieved after induction therapy, and the clinical and genetic characteristics and prognosis of the two groups were compared.Results:Among the 42 AML patients with TP53 mutation, there were 26 males and 16 females, with a median age [ M( Q1, Q3)] of 57.0 (44.0, 63.5) years. At the initial stage, the median white blood cell count in peripheral blood was 4.06×10 9/L (2.59×10 9/L, 27.36×10 9/L), the median proportion of bone marrow primitive cells was 45.25% (29.00%, 80.63%), the proportion of primitive and immature cells in bone marrow cell immune analysis was 28.70% (12.71%, 61.48%), and the median TP53 mutation abundance was 55.48% (38.72%, 73.31%). Among the 42 patients, 23 cases (54.76%) had complex chromosomal karyotypes, with the most frequent abnormal chromosomes being chromosome 5 (47.62%, 20 cases), chromosome 7 (45.24%, 19 cases) and chromosome 17 (26.19%, 10 cases). The mutant genes with high mutation frequency were DNMT3A (19.05%, 8 cases), N/KRAS (19.05%, 8 cases), ASXL1 (16.67%, 7 cases) and NPM1 (16.67%, 7 cases). Among the 39 patients with detailed TP53 mutation data, 36 had missense mutations and 3 had frameshift mutations. In the non-refractory and refractory groups, the N/KRAS mutation rates were 13.6% (3/22) and 55.6% (5/9), respectively ( P = 0.027). The median RFS time of 22 CR patients after induction therapy was 109 d (95% CI: 57-483 d). The results of multivariate Cox regression analysis showed that complex chromosomal karyotype was an independent risk factor for RFS ( HR = 11.819, 95% CI: 1.345-103.880, P = 0.028). The median RFS time of patients without and with complex chromosomal karyotypes was 842 d (95% CI: 0-1 716 d) and 148 d (95% CI: 88-208 d), respectively, and the difference in RFS between the two groups was statistically significant ( P = 0.001). The median OS time of 39 patients receiving treatment was 151 d (95% CI: 75-227 d). The results of multivariate Cox regression analysis showed that NPM1 gene mutation was an independent protective factor for OS ( HR = 0.289, 95% CI: 0.075-1.114, P = 0.071). The median OS time of patients with and without NPM1 gene mutation was 1 562 d (95% CI: 610- 1 710 d) and 136 d (95% CI: 99-173 d), respectively, and the difference in OS between the two groups was statistically significant ( P = 0.020). Conclusions:TP53-mutant AML patients often have poor chromosomal karyotypes and genetic abnormalities, while refractory AML patients often have N/KRAS mutation. The complex chromosomal karyotype is a risk factor for RFS, while NPM1 gene mutation is a protective factor for OS.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative option for patients with intermediate-high risk and relapsed/refractory acute myeloid leukemia (AML). Relapse remains the primary factor affecting the prognosis of patients after transplantation, with only a small number of patients achieving long-term survival after conventional salvage therapy. Molecular targeted drugs, as a new intervention measure, can significantly reduce the recurrence rate of AML after transplantation, without a significant increase in treatment-related adverse reactions. This article primarily focuses on the targeted drugs that are either in clinical use or in clinical trials, and reviews their role in maintenance therapy for AML after transplantation.

Objective To investigate the corrective effect of phacoemulsification with intraocular lens implantation combined with limbal relaxing incision(LRI)on cataract patients with corneal astigmatism.Methods A total of 39 patients(41 eyes)with cataract complicated by corneal astigmatism(the astigmatism was-2.0 to-0.5 D)who visited Department of Ophthalmology of The First Affiliated Hospital of Naval Medical University from Sep.2023 to May 2024 were enrolled.During phacoemulsification with intraocular lens implantation,LRI was performed to correct corneal astigmatism.Preoperative corneal astigmatism was measured using corneal topography and IOLMaster.Corneal astigmatism was re-examined 1 and 3 months after surgery,and Alpins method was used to analyze the changes of corneal astigmation before surgery and 1 month after surgery.The primary vector parameters,such as target induced astigmatism vector(TIA),surgically induced astigmatism vector(SIA),difference vector(DV),correction index and flattening index(FI),were observed.Results The preoperative corneal astigmatism was(-1.07+0.27)D,which was decreased to(-0.53+0.23)D 1 month postoperatively and(-0.55+0.24)D 3 months postoperatively(both P＜0.05).Vector analysis of corneal astigmatism showed that the TIA was(1.07+0.27)D,SIA was(0.99+0.42)D,DV was(0.53+0.24)D;correction index was 0.93+0.36(the ideal value is 1),suggesting slight undercorrection;the median of the angle of error had an absolute value of 18.15°,and the interquartile range was 15.19°;and the flattening effect was(0.70+0.45)D,the FI was 0.65+0.42,and the success rate was(50.42+19.29)％.Conclusion The combination of LRI with cataract surgery for correcting corneal astigmatism has demonstrated favorable corrective outcomes,especially for the correction of low to moderate corneal astigmatism.

Objective:To investigate the efficacy of cytoreductive radical prostatectomy (CRP) in patients with oligometastatic prostate cancer, and to assess its impact on progression-free survival (PFS), overall survival (OS), as well as the incidence and severity of complications.Methods:A prospective, monocentric non-randomized controlled trial including 80 cases of oligometastatic prostate cancer admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2020 to June 2024 was conducted. There were 40 patients each assigned to CRP group and no local treatment (NLT) group. The study used multivariate analysis to account for potential biases, analyzed the effects of CRP on PFS, OS as well as circulating tumor cell (CTC) and DNA methylation status. Meanwhile, the incidence and severity of complications were recorded. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. Count data and rank data were expressed as number of cases and percentage, and Chi-test was used for comparison between groups. Kaplan-Meier method was used to calculate PFS and OS, and Log-rank test was used to compare differences between groups. Multivariate analysis was performed using Cox proportional hazard regression model. A time-dependent Cox regression model was used to consider the effect of follow-up time on the results. Results:The PFS and OS in the CRP group were significantly better than those in the NLT group. The PFS rates in CRP group and NLT group at 12 months were 60% and 35% ( P=0.030). The OS rates at 12 months in the CRP group reached 80%, compared to 50% in the NLT group ( P=0.040). The level of CTC in the CRP group decreased from 50 cells/mL at first month to 5 cells/mL at 12th month, and the DNA methylation status decreased from 0.75 at first month to 0.30 at 12th month, which were significantly better than those in the NLT group ( P<0.05). The incidence of complications decreased gradually from first month to 12th month, with the CRP group from 30% to 10%, and the NLT group from 25% to 12% ( P=0.080). Although the severity of complications was slightly higher in the CRP group than in the NLT group at the early stage, the difference in severity gradually narrowed and eventually became similar between the two groups by the 12th month of follow-up. Conclusion:CRP significantly prolonged PFS and OS in patients with oligometastatic prostate cancer, reduced tumor burden, and despite a higher incidence of early complications, overall safety was good.

Objectives:To investigate the relationship between locations of ventricular septal perforation and 30-day prognosis in patients with acute myocardial infarction complicated by ventricular septal perforation.Methods:Clinical data of 150 acute myocardial infarction patients with ventricular septal perforation admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and People's Hospital of Xinjiang Uygur Autonomous Region from January 2009 to October 2023 were retrospectively analyzed.Kaplan-Meier method was used to compare the difference in 30-day survival rate among patients with different sites of ventricular septal perforation.The impact of locations of ventricular septal perforation on 30-day prognosis of acute myocardial infarction patients was evaluated by multivariate Cox regression analysis(forward stepwise).Results:In acute myocardial infarction patients,the occurrence of anterior ventricular septal perforation was higher than that of posterior ventricular septal perforation(79.5%vs.20.5%,P<0.001).In the anterior ventricular septal perforation patients,females were more common(50.0%vs.22.6%,P=0.006),the blood glucose level was higher([10.51±5.99]mmol/L vs.[8.02±2.81]mmol/L,P=0.026),the left ventricular end-diastolic diameter was smaller([50.7±6.1]mm vs.[55.1±5.0]mm,P<0.001),the ventricular septal aperture was also smaller([9.8±4.6]mm vs.[12.6±5.4]mm,P=0.004),30-day mortality was higher(55.8%vs.35.5%,P=0.043)compared with posterior ventricular septal perforation patients.Multivariate Cox regression analysis(forward stepwise)showed that no transthoracic surgery or transcatheter closure(HR=26.344,95%CI:8.261-84.009,P<0.001)and anterior ventricular septal perforation(HR=2.432,95%CI:1.281-4.619,P=0.007)were associated with increased risk of 30-day all-cause mortality in patients with acute myocardial infarction complicated by ventricular septal perforation.Conclusions:In patients with acute myocardial infarction complicated by ventricular septal perforation,the incidence of anterior ventricular septal perforation is higher than posterior ventricular septal perforation and the 30-day all-cause mortality of anterior ventricular septal perforation patients is also higher.No transthoracic surgery or transcatheter closure and anterior ventricular septal perforation are the independent influential factors of 30-day all-cause mortality in patients with acute myocardial infarction and ventricular septal perforation.