ObjectiveTo investigate the association between metabolic associated fatty liver disease （MAFLD） and the risk of atherosclerotic cardiovascular disease （ASCVD）， and to provide data support for the prevention and treatment of such metabolic-associated diseases in clinical practice. MethodsAn observation cohort was established for the workers of Kailuan who underwent physical examination for the first time from June 2006 to October 2007 and had complete liver assessment data， without the history of malignant tumor， MAFLD or ASCVD. According to the presence or absence of MAFLD， the patients were divided into non-MAFLD group with 67 565 patients and MAFLD group with 29 004 patients， and according to the presence or absence of ASCVD， the patients were divided into non-ASCVD group with 69 141 patients and ASCVD group with 481 patients. The group t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between the two groups. The χ² test was used for comparison of categorical data between the two groups. The life-table method was used to calculate the cumulative incidence rates of new-onset ASCVD and MAFLD； the Kaplan-Meier method was used to plot the survival curves of the cumulative incidence rates of ASCVD in the MAFLD group and the non-MAFLD group and the cumulative incidence rates of MAFLD in the ASCVD group and the non-ASCVD group， and the log-rank test was used for comparison of cumulative incidence rates between two groups. A multivariate Cox proportional-hazards regression model analysis was used to investigate the impact of MAFLD on the risk of ASCVD and the impact of ASCVD on the risk of MAFLD. ResultsCompared with the non-MAFLD group， the MAFLD group had significantly higher levels of body mass index （BMI）， waist circumference， systolic blood pressure （SBP）， diastolic blood pressure （DBP）， resting heart rate， alanine aminotransferase， uric acid （UA）， fasting blood glucose （FBG）， triglyceride （TG）， total cholesterol， low-density lipoprotein cholesterol， and high sensitivity C-reactive protein （hs-CRP）， as well as significanty lower levels of estimated glomerular filtration rate （eGFR） and high-density lipoprotein cholesterol （all P <0.05）. Compared with the non-ASCVD group， the ASCVD group had significantly higher levels of BMI， waist circumference， SBP， DBP， UA， FBG， TG， and hs-CRP and a significantly lower level of eGFR （all P<0.05）. The incidence rate of new-onset ASCVD continued to increase over time in the MAFLD group and the non-MAFLD group， while the incidence rate of new-onset MAFLD firstly increased and then remained stable over time in the ASCVD group and the non-ASCVD group. There were 4 263 cases （14.70%） of new-osnet ASCVD in the MAFLD group， with an incidence density of 12.90 per 1 000 person-years， while there were 6 529 cases （9.66%） of new-osnet ASCVD in the non-MAFLD group， with an incidence density of 8.24 per 1 000 person-years， and there were significant differences in the incidence density and cumulative incidence rate of ASCVD between the two groups （χ²=519.09 and 531.80， both P<0.05）. There were 148 cases （30.77%） of new-onset MAFLD in the ASCVD group， with an incidence density of 40.10 per 1 000 person-years， while there were 32 194 cases （46.56%） of new-onset MAFLD in the non-ASCVD group， with an incidence density of 57.59 per 1 000 person-years， and there were significant differences in the incidence density and cumulative incidence rate of MAFLD between the two groups （χ²=19.29 and 30.78， both P<0.05）. The corrected multivariate Cox proportional-hazards regression model analysis showed that MAFLD was a risk factor for new-onset ASCVD （hazard ratio ［HR］=1.11， 95% confidence interval ［CI］： 1.06 — 1.16， P<0.001）， while ASCVD was a protective factor against new-onset MAFLD （HR=0.72， 95%CI： 0.61 — 0.85， P<0.001）. ConclusionThere is a significant association between MAFLD and ASCVD， with an increase in the risk of ASCVD in the MAFLD population and a reduction in the risk of MAFLD in the ASCVD population.

Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

OBJECTIVE:To systematically evaluate the efficacy of transcranial direct current stimulation on the motor function of patients with Parkinson's disease,and to compare the efficacy of transcranial direct current stimulation at different targets on the motor function of patients with Parkinson's disease,so as to provide a theoretical basis for the target selection of transcranial direct current stimulation in clinical practice. METHODS:Cochrane Library,PubMed,Web of Science,CNKI,VIP,WanFang Data were retrieved for randomized controlled trials on the improvement of motor function in patients with Parkinson's disease by transcranial direct current stimulation published from the database inception to January 2023.The keywords were"Parkinson,transcranial direct current stimulation"in English and Chinese.The quality of the included studies was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the PEDro scale.Meta-analysis of outcome indicators was performed using RevMan 5.4 and Stata 17.0 software. RESULTS:Fifteen randomized controlled trials were finally included,and the PEDro scale showed that all were high-quality or very high-quality studies.Meta-analysis showed that transcranial direct current stimulation significantly improved Unified-Parkinson Disease Rating Scale part III score[mean difference(MD)=-2.49,95%confidence interval(CI):-4.42 to-0.55,P<0.05),step frequency score(MD=0.07,95%CI:0.03-0.11,P<0.05)and step speed score(MD=0.02,95%CI:0.00-0.05,P<0.05),but not for Berg Balance Scale scores(MD=2.57,95%CI:-0.74 to 5.87,P>0.05).Network Meta-analysis probability ranking:In terms of Unified-Parkinson Disease Rating Scale part III scores,the probability ranking results of target stimulation efficacy were dorsal lateral prefrontal cortex(52.4%)>primary motor cortex(45.8%)>central point of the brain(1.8%)>conventional rehabilitation(0%);in terms of gait frequency scores,the probability probability ranking results of target stimulation efficacy were cerebellum(50.1%)>central point of the brain(45.8%)>dorsal lateral prefrontal cortex(3.9%)>primary motor cortex(0.2%)>conventional rehabilitation(0%);in terms of gait speed scores,the probability ranking results of target stimulation efficacy were cerebellum(64.8%)>dorsal lateral prefrontal cortex(23.8%)>central point of the brain(9.4%)>primary motor cortex(1.7%)>conventional rehabilitation(0.4%);in terms of Berg Balance Scale scores,the probability ranking results of target stimulation efficacy were cerebellum(77.4%)>dorsal lateral prefrontal cortex(20.7%)>central point of the brain(0.7%)>conventional rehabilitation(0.2%). CONCLUSION:Transcranial direct current stimulation significantly improves motor function of patients with Parkinson's disease,with better motor coordination in the dorsolateral prefrontal cortex and better walking and balance in the cerebellum.

BACKGROUND: This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability. METHODS: This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability. RESULTS: STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min. CONCLUSION The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
Reproducibility of Results ; Surveys and Questionnaires ; Practice Guidelines as Topic ; Humans