Objective:To evaluate the safety and efficacy of the probiotic Bifidobacterium longum subsp. longum BL21 (BL21) in preventing radiation-induced diarrhea (RID) in cervical cancer patients during radiotherapy (RT) and to investigate the intestinal microbiota in the patients. Methods:This study was a prospective, single-arm, phase Ⅱ clinical trial, involving cervical cancer patients treated with radical and adjuvant RT. From the first day of RT, participants took one pack of BL21 powder (containing 20 billion colony-forming unit(CFU) of Bifidobacterium longum subsp. longum BL21) orally every day until the end of RT. The occurrence of adverse events and RID during RT were assessed as per Common Terminology Criteria for Adverse Events ( CTCAE) v5.0. In this way, the safety and efficacy of BL21 in preventing RID were evaluated. Additionally, the intestinal microbiota in fecal samples collected from the patients before and after RT were analyzed using 16S rRNA sequencing. Results:A total of 35 cervical cancer patients were enrolled in this study, with 29 cases incorporated for the final analysis. No serious adverse event related to the administration of BL21 was observed. The patients exhibited slight RID, with the majority (22/29) developing no or grade 1 RID during RT. The microbiota in the fecal samples showed decreased alpha diversity after RT, as indicated by the Chao1 ( P = 0.002) and Shannon ( P = 0.005) indices. Furthermore, these samples exhibited a notably higher abundance of genus Clostridium (LDA score = 3.98). The fecal samples from patients with grade 1 RID or no RID post-RT exhibited higher alpha diversity than those from patients with grade 2 RID or above post-RT (Chao1: P = 0.07, Shannon: P = 0.28), as well as a high abundance of genera Gemmiger (LDA score = 4.48) and Dorea (LDA score = 3.83). Conclusions:The administration of BL21 to cervical cancer patients during RT is simple, convenient, safe, and effective in preventing RID, thus warranting further investigation.

Objective:To evaluate the safety and efficacy of the probiotic Bifidobacterium longum subsp. longum BL21 (BL21) in preventing radiation-induced diarrhea (RID) in cervical cancer patients during radiotherapy (RT) and to investigate the intestinal microbiota in the patients. Methods:This study was a prospective, single-arm, phase Ⅱ clinical trial, involving cervical cancer patients treated with radical and adjuvant RT. From the first day of RT, participants took one pack of BL21 powder (containing 20 billion colony-forming unit(CFU) of Bifidobacterium longum subsp. longum BL21) orally every day until the end of RT. The occurrence of adverse events and RID during RT were assessed as per Common Terminology Criteria for Adverse Events ( CTCAE) v5.0. In this way, the safety and efficacy of BL21 in preventing RID were evaluated. Additionally, the intestinal microbiota in fecal samples collected from the patients before and after RT were analyzed using 16S rRNA sequencing. Results:A total of 35 cervical cancer patients were enrolled in this study, with 29 cases incorporated for the final analysis. No serious adverse event related to the administration of BL21 was observed. The patients exhibited slight RID, with the majority (22/29) developing no or grade 1 RID during RT. The microbiota in the fecal samples showed decreased alpha diversity after RT, as indicated by the Chao1 ( P = 0.002) and Shannon ( P = 0.005) indices. Furthermore, these samples exhibited a notably higher abundance of genus Clostridium (LDA score = 3.98). The fecal samples from patients with grade 1 RID or no RID post-RT exhibited higher alpha diversity than those from patients with grade 2 RID or above post-RT (Chao1: P = 0.07, Shannon: P = 0.28), as well as a high abundance of genera Gemmiger (LDA score = 4.48) and Dorea (LDA score = 3.83). Conclusions:The administration of BL21 to cervical cancer patients during RT is simple, convenient, safe, and effective in preventing RID, thus warranting further investigation.

Objective To investigate the risk factors of latent blood loss after internal fixation of intertrochanteric fracture of femur.Methods The clinical data of 112 patients with intertrochanteric fracture of femur treated with internal fixation in our hospital from May 2019 to July 2022 were retrospectively analyzed,and the hidden blood loss after surgery was recorded.SPSS software was used to analyze the influencing factors of hidden blood loss after internal fixation of intertrochanteric fracture of femur.Results None of the 152 patients with intertrochanteric fracture of femur had serious complications or died during perioperative period,and the wound was not infected.The fixation alignment was good.The postoperative dominant blood loss was(236.37±71.52)ml,the recessive blood loss was(709.74±132.36)ml,and the total blood loss was(946.11±205.61)ml.The recessive blood loss was significantly higher than the dominant blood loss(P＜0.05).Multiple linear regression analysis showed that age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation,and operation time were all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur(P＜0.05).Conclusion Age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation and operation time are all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur.According to these factors,medical staff can formulate corresponding prevention and treatment programs to reduce the latent blood loss after internal fixation of intertrochanteric fracture of femur.

Objective To investigate the risk factors of latent blood loss after internal fixation of intertrochanteric fracture of femur.Methods The clinical data of 112 patients with intertrochanteric fracture of femur treated with internal fixation in our hospital from May 2019 to July 2022 were retrospectively analyzed,and the hidden blood loss after surgery was recorded.SPSS software was used to analyze the influencing factors of hidden blood loss after internal fixation of intertrochanteric fracture of femur.Results None of the 152 patients with intertrochanteric fracture of femur had serious complications or died during perioperative period,and the wound was not infected.The fixation alignment was good.The postoperative dominant blood loss was(236.37±71.52)ml,the recessive blood loss was(709.74±132.36)ml,and the total blood loss was(946.11±205.61)ml.The recessive blood loss was significantly higher than the dominant blood loss(P＜0.05).Multiple linear regression analysis showed that age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation,and operation time were all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur(P＜0.05).Conclusion Age,hypertension,diabetes,fracture type,preoperative anticoagulation,time from injury to operation and operation time are all risk factors for latent blood loss after internal fixation of intertrochanteric fracture of femur.According to these factors,medical staff can formulate corresponding prevention and treatment programs to reduce the latent blood loss after internal fixation of intertrochanteric fracture of femur.

Objective:To explore the application effectiveness of multidisciplinary team(MDT)in the diagnosis and treatment of chronic refractory wounds,and to provide new ideas for optimizing the clinical diagnosis and treatment of such diseases.Methods:A retrospective analysis was performed on the clini-cal data of patients with chronic refractory wounds who underwent surgery at Peking University Third Hos-pital from January 2015 to October 2023,and a total of 456 patients,including 290 males and 166 females,with an average age of(49.4±16.9)years.According to whether preoperative MDT discussion was conducted,the patients were divided into MDT discussion group and non-MDT discussion group.The overall implementation process of MDT included:Starting and recording with the medical office,collec-ting data and discussing the initial MDT,informing the patient of the treatment plan and strictly imple-menting it,and the change of the condition needs to be discussed again by MDT.The general clinical da-ta,anesthesia risk grade,complications(hypertension,diabetes,coronary heart disease),and the etiology and location of chronic refractory wounds between the two groups were compared.The main observational measurements and outcome indicators of treatment effectiveness included the number of sur-geries required to achieve wound healing after admission,the recurrence rate after wound healing,the incidence of perioperative complications(pulmonary infection,severe cardiovascular event,vein thrombus embo-lism,cerebral stroke and delirium,etc.),and patient satisfaction score.Results:There were 189 patients in the MDT discussion group and 267 patients in the non-MDT discussion group.There was no significant statistical difference in the clinical data,such as age,gender,body mass index,American Society of Anesthesiologists,comorbidities,etiology,and location of chronic refractory wounds between the two groups(P＞0.05).The average number of surgeries required for wound healing in MDT discussion group and non-MDT discussion group was 2.1±1.1 and 2.8±1.6,respectively,with a sta-tistically significant difference(P＜0.001).This difference was also significant in chronic refractory wounds caused by three etiologies:Diabetic ulcer,infection after trauma or surgery,and non-union after radiotherapy(P＜0.05).The recurrence rate of the patients in the non-MDT discussion group after wound healing was 18.0％,slightly higher than that in the MDT discussion group of 14.3％(P＞0.05).In terms of perioperative complications,the non-MDT discussion group also had a higher incidence(3.7％vs.2.6％),but the difference was not statistically significant(P＞0.05).In terms of patient satisfac-tion,the MDT discussion group scored significantly higher(96.5 vs.91.1,P=0.028).Conclusion:The MDT mode can significantly reduce the number of surgeries for patients with chronic refractory wounds,improve the effectiveness of therapy and increase patient satisfaction.It is a recommended model for optimizing the clinical diagnosis and treatment effectiveness of chronic refractory wounds.

Objective:To investigate the incidence and potential risk factors associated with postopera-tive spinal epidural hematoma(SEH)following anterior cervical spine surgery(ACSS).Methods:A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022.Patients who developed postoperative SEH were categorized as the SEH group,while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator,same gender,same surgery year,and similar age(±5 years)at a ratio of 4:1.The general condition,pre-operative comorbidities,anticoagulant or antiplatelet therapy,preoperative coagulation and platelet counts,American society of Anesthesiologists physical status classification,cervical spondylosis classifi-cation,preoperative modified Japanese Orthopaedic Society score and cervical disability index score,sur-gical modality,surgical segment levels,ossification of the posterior longitudinal ligament among the surgi-cal level,surgery duration,estimated blood loss,postoperative drainage volume,preoperative mean arte-rial pressure,mean arterial pressure during postoperative awakening periods,hospital stay and hospitali-zation cost were compared between the two groups.A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH.Receiver operating characteristic curve and area under the curve(AUC)were used to describe the dis-crimination ability of the indicators.Results:A total of 85 patients were enrolled in the study,including 17 patients in the SEH group and 68 patients in the non-SEH group.Seventeen patients with SEH under-went hematoma evacuation,and all of them were successfully treated and discharged from the hospital.Corpectomy(OR=7.247;95％CI:1.962-26.766;P=0.003)and the highest mean arterial pressure during awakening(OR=1.056;95％CI:1.002-1.113;P=0.043)were independent risk factors for SEH.The AUC values were 0.713(95％CI:0.578-0.848)and 0.665(95％CI:0.51-0.82)re-spectively.The patients with SEH had longer hospital stays(P＜0.001)and greater hospitalization costs(P=0.035).Conclusion:Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS.High-risk patients should be closely monitored during the perioperative period.

Hypothyroidism (HT) can arise as a complication of radiotherapy for breast cancer. Despite having a significant impact on patients′ quality of life, HT had always been overlooked by radiotherapists in the past. In recent years, many studies highlighting the protection of the thyroid in the process of radiotherapy for breast cancer have been conducted, achieving valuable conclusion. These studies can serve as a guide for radiotherapists to limit the dose to the thyroid during radiotherapy, thus reducing the incidence of HT.

Objective:To evaluate the diagnostic performance of non-contrast-enhanced Dixon water-fat separation Compressed SENSE (CS-SENSE) whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T on patients with suspected coronary artery disease (CAD).Method:The study complied with the Declaration of Helsinki. Local ethics committee approved this study and written informed consent was obtained from each patient. In this prospective study, from March 2021 to September 2021, 53 consecutive participants with suspected CAD who were scheduled for X-ray coronary angiography (CAG) were prospectively recruited in Zhongshan Hospital. CMRA was performed with a 3.0 T scanner without contrast agent enhancement during free breathing with Dixon water-fat separation and CS-SENSE methods. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using CAG as the reference method.Results:Acquisition of whole-heart CMRA images was successfully performed in 46 (86.8%) of 53 patients with an average imaging time of (7.8±1.8) min. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of CMRA according to a patient-based analysis were 95.8%(95%CI 78.9%-99.9%), 81.8%(95%CI 59.7%-94.8%), 85.2%(95%CI 66.3%-95.8%), 94.7%(95%CI 74.0%-99.9%), 89.1%(95%CI 76.4%-96.4%), respectively. The areas under the receiver-operator characteristic curve (AUC) from CMRA images according to patient-, vessel-and segment-based analyses were 0.876(95%CI 0.745-0.955), 0.880(95%CI 0.814-0.929), 0.903(95%CI 0.877-0.926), respectively.Conclusion:3.0 T non-contrast-enhanced Dixon water-fat separation CS-SENSE whole-heart CMRA is a promising technique to detect clinically significant coronary stenosis on patients with suspected CAD.

Objective To study the mechanism of RING finger protein 34 ( RNF34 ) involved in innate immunity . Methods Recombinant PCR was used and transient expression of the plasmid was achieved in HEK 293T cells.The cells were stimulated with Sendai virus ( SeV) or N-RIG-Ⅰfor the indicated time while luciferase activity was observed using the dual-luciferase reporter assay kit .Results We constructed the plasmid pcDNA 3-Flag-RNF34 and its three mutations .The study found that when stimulated by SeV , RNF34 could inhibit the activity of NF-κB and IFN-βmore significantly than RNF34-ΔFYVE, RNF34-ΔCID and RNF34-ΔRING.We also found that RNF 34 and its three mutants had similar inhibitory effect when the activation of NF-κB and IFN-βwas stimulated by the N-RIG-Ⅰ.Conclusion RNF34 negatively regulates innate immunity by acting on the RIG-Ⅰ-MAVS signaling pathway .