ObjectiveTo explore the factors influencing home-based rehabilitation exercise and the needs for digital interventions among patients with spinal muscular atrophy (SMA), based on the behavior change wheel (BCW), and to provide evidence for the development of digital home-based rehabilitation interventions. MethodsA two-phase qualitative study was conducted from December, 2024 to March, 2025. Using convenience sampling, 14 participants were recruited, including patients with SMA, primary caregivers, rehabilitation professionals, clinicians, a patient organization representative and a health policy expert. In phase 1, semi-structured individual interviews were conducted with seven participants, including patients, caregivers and a patient organization representative, to identify factors influencing home-based rehabilitation exercise and unmet needs. In phase 2, a focus group involving 12 stakeholders was conducted, including five participants who had participated in phase 1, to explore requirements for the functions, knowledge content and interface design of a digital intervention, five of them had participated in phase 1. Overall, the two phases involved 14 individual participants, accounting for 19 participant-instances. Thematic analysis was performed using both deductive and inductive approaches, guided by the capability-opportunity-motivation-behavior (COM-B) model. ResultsSix themes were identified. phase 1 showed that patients with SMA experienced inadequate continuity of rehabilitation services and limited access to professional rehabilitation resources, with interruptions in institution-based rehabilitation coexisting with declining adherence to home-based exercise. Home-based rehabilitation exercise was jointly influenced by capability-, opportunity- and motivation-related factors, including limited capabilities of patients and caregivers, constraints in time and supportive conditions and insufficient goals, feedback, and incentives. Individualized rehabilitation plans and professional guidance were the major unmet needs. phase 2 showed that the core functions of a digital intervention should include individualized exercise plans, professional guidance and feedback, reminders and incentives, safety monitoring, remote assessment, and privacy and permission management. Core knowledge content should include stratified exercise guidance, caregiving skills, recognition of abnormal conditions, and information on when and how to seek help. The interface should be simple, impose a low user burden and accommodate different types of users. ConclusionHome-based rehabilitation exercise among patients with SMA is jointly influenced by multiple capability-, opportunity- and motivation-related factors. Digital interventions should prioritize individualized rehabilitation plans, professional guidance and sustained behavioral support. These findings may inform the development of a digital home-based rehabilitation intervention prototype for patients with SMA; its feasibility, safety, clinical effectiveness and economic value require further evaluation.

Objective To explore the relationship between serum soluble cell surface differentiation antigen 40 ligand(sCD40L),a disintegrin-like and metalloproteinase with thrombospondin type-1 motif 13(ADAMTS13)levels and postoperative lower extremity deep vein thrombosis(DVT)formation in elderly pa-tients with hip fractures.Methods A total of 192 elderly patients with hip fractures who visited the hospital from June 2022 to June 2023 were selected and separated into non DVT group(120 cases)and DVT group(72 cases)based on whether they experienced lower extremity DVT after surgery.Enzyme-linked immunosorbent assay was applied to detect serum sCD40L and ADAMTS13 levels in each group.Pearson method was applied to analyze the correlation between serum sCD40L and ADAMTS13 levels in patients.Multivariate Logistic re-gression model was applied to analyze the factors affecting postoperative lower extremity DVT in elderly pa-tients with hip fractures.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum sCD40L and ADAMTS13 levels for postoperative lower extremity DVT in elderly patients with hip fractures.Results There were statistically significant differences in the proportion of hyperlipidemia and the time from fracture to surgery between the two groups(P＜0.05).Compared with the non DVT group,the serum sCD40L level in the DVT group increased(P＜0.05)and the ADAMTS13 level decreased(P＜0.05).Pearson method results showed that the serum sCD40L level was negatively correlated with ADAMTS13 level in patients(r=-0.457,P＜0.001).Multivariate Logistic regression model analysis showed that hyperlipi-demia,long time from fracture to surgery,increased level of serum sCD40L were risk factors for postoperative lower extremity DVT in elderly patients with hip fractures(P＜0.05),and the increased level of serum AD-AMTS13 was a protective factor for postoperative lower extremity DVT in patients with hip fractures(P＜0.05).The area under the curve of the combined prediction of serum sCD40L and ADAMTS13 for postopera-tive lower extremity DVT in elderly patients with hip fractures was 0.812,which was larger than that of sCD40L and ADAMTS13 alone(P＜0.05).Conclusion Serum sCD40L level increases and ADAMTS13 level decreases in elderly patients with hip fracture who had lower extremity DVT after surgery,the two could re-flect the risk of DVT and have predictive value for the occurrence of lower extremity DVT in elderly patients with hip fracture.

Recently,the substance P(SP)/neurokinin-1 receptor(NK-1R)system has been found to be involved in various human pathophysiological disorders including the symptoms of coronavirus disease 2019(COVID-19).Besides,studies in the oncological field have demonstrated an intricate correlation between the upregulation of NK-1R and the activation of SP/NK-1R system with the progression of multiple carcinoma types and poor clinical prognosis.These findings indicate that the modulation of SP/NK-1R system with NK-1R antagonists can be a potential broad-spectrum antitumor strategy.This review updates the latest potential and applications of NK-1R antagonists in the treatment of human diseases and cancers,as well as the underlying mechanisms.Furthermore,the strategies to improve the bioavailability and efficacy of NK-1R antagonist drugs are summarized,such as solid dispersion systems,nanonization,and nanoencapsulation.As a radiopharmaceutical therapeutic,the NK-1R antagonist aprepitant was originally developed as radioligand receptor to target NK-1R-overexpressing tumors.However,combining NK-1R antagonists with other drugs can produce a synergistic effect,thereby enhancing the therapeutic effect,alleviating the symptoms,and improving patients'quality of life in several diseases and cancers.

Objective:To investigate the efficacy of XELOX regimen combined with bevacizumab for treatment of patients with advanced colorectal cancer and its clinical significances.Methods:A prospective randomized controlled study was conducted. Seventy-eight patients with advanced colorectal cancer who received treatment at People's Hospital of Suzhou New District and the Second Affiliated Hospital of Soochow University from February 2019 to November 2020 were selected. According to the random number table method, they were divided into the treatment group (40 cases) and the control group (38 cases). The treatment group received bevacizumab combined with XELOX regimen, while the control group only received XELOX regimen chemotherapy. The short-term efficacy, levels of tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199)], levels of cytokines [interleukin-1 (IL-1), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and albumin (ALB)], and incidence of adverse reactions were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival (OS) of the two groups, and log-rank test was performed.Results:In 78 patients with colorectal cancer, there were 47 males and 31 females; the age was (59±16) years old. The overall response rate of the treatment group was higher than that of the control group [55.00% (22/40) vs. 26.31% (10/38)], and the difference was statistically significant ( χ2 = 6.63, P < 0.05). There were no statistically significant differences in the levels of tumor markers and cytokines between the two groups before treatment (all P > 0.05). After treatment, the levels of CA199, CA125, CEA, IL-1, IL-6, and ESR in the treatment group were lower than those in the control group [CA199: (22±4) U/ml vs. (27± 4) U/ml, CA125: (35±3) U/ml vs. (37±4) U/ml, CEA: (4.4±0.7) ng/ml vs. (5.0±1.0) ng/ml, IL-1: (29± 4) pg/ml vs. (34±4) pg/ml, IL-6: (14.0±2.3) ng/L vs. (15.3±2.5) ng/L, ESR: (9.2±2.0) mm/1 h vs. (13.6±2.1) mm/1 h], ALB level was higher than that in the control group [(34.3±1.5) g/L vs. (29.8±1.4) g/L], and the differences were statistically significant (all P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant ( P > 0.05). As of the end of follow-up, the OS of the treatment group was better than that of the control group, and the difference was statistically significant ( P = 0.004). Conclusions:The combination of XELOX regimen and bevacizumab targeted therapy can reduce the levels of tumor markers and inflammatory cytokines in patients with advanced colorectal cancer, and improve their prognosis with high safety.

Objective:To investigate the efficacy of XELOX regimen combined with bevacizumab for treatment of patients with advanced colorectal cancer and its clinical significances.Methods:A prospective randomized controlled study was conducted. Seventy-eight patients with advanced colorectal cancer who received treatment at People's Hospital of Suzhou New District and the Second Affiliated Hospital of Soochow University from February 2019 to November 2020 were selected. According to the random number table method, they were divided into the treatment group (40 cases) and the control group (38 cases). The treatment group received bevacizumab combined with XELOX regimen, while the control group only received XELOX regimen chemotherapy. The short-term efficacy, levels of tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199)], levels of cytokines [interleukin-1 (IL-1), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and albumin (ALB)], and incidence of adverse reactions were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival (OS) of the two groups, and log-rank test was performed.Results:In 78 patients with colorectal cancer, there were 47 males and 31 females; the age was (59±16) years old. The overall response rate of the treatment group was higher than that of the control group [55.00% (22/40) vs. 26.31% (10/38)], and the difference was statistically significant ( χ2 = 6.63, P < 0.05). There were no statistically significant differences in the levels of tumor markers and cytokines between the two groups before treatment (all P > 0.05). After treatment, the levels of CA199, CA125, CEA, IL-1, IL-6, and ESR in the treatment group were lower than those in the control group [CA199: (22±4) U/ml vs. (27± 4) U/ml, CA125: (35±3) U/ml vs. (37±4) U/ml, CEA: (4.4±0.7) ng/ml vs. (5.0±1.0) ng/ml, IL-1: (29± 4) pg/ml vs. (34±4) pg/ml, IL-6: (14.0±2.3) ng/L vs. (15.3±2.5) ng/L, ESR: (9.2±2.0) mm/1 h vs. (13.6±2.1) mm/1 h], ALB level was higher than that in the control group [(34.3±1.5) g/L vs. (29.8±1.4) g/L], and the differences were statistically significant (all P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant ( P > 0.05). As of the end of follow-up, the OS of the treatment group was better than that of the control group, and the difference was statistically significant ( P = 0.004). Conclusions:The combination of XELOX regimen and bevacizumab targeted therapy can reduce the levels of tumor markers and inflammatory cytokines in patients with advanced colorectal cancer, and improve their prognosis with high safety.

Objective To investigate the predictive value of preoperative frailty for pulmonary com-plications(PPCs)after cardiac surgery in elderly patients.Methods A total of 162 elderly patients,109 males and 53 females,aged 65-83 years,BMI 18-36 kg/m2,ASA physical status Ⅱ-Ⅳ,underwent elec-tive open heart surgery from July 2022 to January 2023 were collected.The patients were divided into two groups according to the occurrence of PPCs:the PPCs group(n=57)and the non-PPCs group(n=105).General information,smoking history,alcohol consumption history,EuroSCORE Ⅱ,frailty,chronic comorbidities(hypertension,diabetes mellitus,myocardial infarction,pulmonary hypertension,chronic ob-structive pulmonary disease,sleep apnea syndrome,etc.),Hb,creatinine,albumin,pulmonary function indices,left ventricular ejection fraction,type of surgery,duration of surgery,aortic clamping time,and cardiopulmonary bypass time were collected.Factors with P＜0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis,and the predictive efficacy of the Fried frailty scale and EuroSCORE Ⅱ for PPCs were compared by the area under the ROC curve(AUC).Results PPCs occurred in 57 patients(35.2％).Multifactorial Logistic regression analysis showed that frailty(OR=3.14,95％CI 1.05-9.37,P＜0.05)and EuroSCORE Ⅱ(OR=2.16,95％CI 1.01-4.60,P＜0.05)were risk factors for the development of PPCs.The predictive power of Fried frailty scale(AUC=0.76,95％CI 0.68-0.82)was significantly higher than that of EuroSCORE Ⅱ(AUC=0.65,95％CI 0.57-0.72)(P＜0.05).Conclusion Preoperative frailty is the independent risk factors for pulmonary complications after cardiac surgery in elderly patients,and the Fried frailty scale has a better predictive efficacy compared to EuroSCORE Ⅱ,a traditional risk predictor.

Objective:To explore the value of pre-treatment contrast-enhanced computed tomography (CT)-based texture analysis in predicting response to non-small cell lung cancer (NSCLC) immunotherapy.Methods:From January to July 2018, a total of 51 lesions from 42 patients with advanced non-small cell lung cancer receiving immunotherapy at Shanghai Chest Hospital were selected in this retrospective study. Pre-treatment contrast-enhanced CT-based texture features were extracted by MaZda software. Ten optimal texture features were chosen based on three different methods: Fisher coefficient, mutual information measure (MI) and minimization of classification error probability combined average correlation coefficients(POE+ ACC), respectively. According to the efficacy of the first immunotherapy, 51 lesions were divided into non-progressive disease (non-PD, n=26) and progressive disease (PD, n=25). The differences were tested in each texture feature set between the two groups. The immunotherapy effects of target lesions were analyzed by principal component analysis(PCA), linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA). The sensitivity, specificity, accuracy, positive-predictive value (PPV) and negative-predictive value (NPV) were calculated. The area under the curve (AUC) was used to quantify the predictive accuracy of the three analysis models for each texture feature set and compare them with the actual classification results. Results:In all of three texture feature sets, the texture parameter differences of Perc.50%, Perc.90%, "S(5, 5)SumEntrp" and "S(4, 4)SumEntrp" were higher in PD group than those in non-PD group (all P<0.05). The classification result of texture feature set chosen by POE+ ACC and analyzed by NDA was identified as the best model (AUC=0.802, 95% CI: 0.674-0.930), and its sensitivity, specificity, accuracy, PPV and NPV were 72%, 88.5%, 80.4%, 85.7%, 76.7%, respectively. Conclusion:Pre-treatment contrast-enhanced CT-based texture characteristics of NSCLC may function as non-invasive biomarkers for the evaluation of response to immunotherapy.

Objective:To explore the value of pre-treatment contrast-enhanced computed tomography (CT)-based texture analysis in predicting response to non-small cell lung cancer (NSCLC) immunotherapy.Methods:From January to July 2018, a total of 51 lesions from 42 patients with advanced non-small cell lung cancer receiving immunotherapy at Shanghai Chest Hospital were selected in this retrospective study. Pre-treatment contrast-enhanced CT-based texture features were extracted by MaZda software. Ten optimal texture features were chosen based on three different methods: Fisher coefficient, mutual information measure (MI) and minimization of classification error probability combined average correlation coefficients(POE+ ACC), respectively. According to the efficacy of the first immunotherapy, 51 lesions were divided into non-progressive disease (non-PD, n=26) and progressive disease (PD, n=25). The differences were tested in each texture feature set between the two groups. The immunotherapy effects of target lesions were analyzed by principal component analysis(PCA), linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA). The sensitivity, specificity, accuracy, positive-predictive value (PPV) and negative-predictive value (NPV) were calculated. The area under the curve (AUC) was used to quantify the predictive accuracy of the three analysis models for each texture feature set and compare them with the actual classification results. Results:In all of three texture feature sets, the texture parameter differences of Perc.50%, Perc.90%, "S(5, 5)SumEntrp" and "S(4, 4)SumEntrp" were higher in PD group than those in non-PD group (all P<0.05). The classification result of texture feature set chosen by POE+ ACC and analyzed by NDA was identified as the best model (AUC=0.802, 95% CI: 0.674-0.930), and its sensitivity, specificity, accuracy, PPV and NPV were 72%, 88.5%, 80.4%, 85.7%, 76.7%, respectively. Conclusion:Pre-treatment contrast-enhanced CT-based texture characteristics of NSCLC may function as non-invasive biomarkers for the evaluation of response to immunotherapy.

Objective:To investigate the effect of nurse-led integrated care on sense of coherence and relocation stress in family members of severe neurological disease patients after ICU transfer.Methods:A total of 78 severe neurological disease patients and family members were divided into study group and control group with 39 cases each by random digits table method. Participants in the control group received routine nursing, while the study group carried out nurse-led integrated care program. The scores of relocation stress and sense of coherence were assessed by Family Relocation Stress Scale (RFSS) and Sense of Coherence-29 (SOC-29), respectively.Results:After transfertion, the scores of preparation for relocation, family burden, satisfaction with the relocation process and total RFSS scores were (17.49 ± 3.57), (11.38 ± 1.93), (4.59 ± 0.59), (47.05 ± 4.72) points in the study group, and (13.79 ± 2.92), (9.51 ± 2.26), (3.51 ± 0.64), (39.44 ± 4.10) points in the control group, the difference was statistically significant ( t values were 3.937-7.675, P<0.05). After transfertion, the scores of comprehensibility, manageability, meaningfulness and total SOC-29 scores were (23.97 ± 2.61), (29.49 ± 4.55), (21.13 ± 3.73), (74.49 ± 6.77) points in the study group, and (21.49 ± 2.88), (27.23 ± 4.02), (17.05 ± 3.85), (65.79 ± 6.09) points, the difference was statistically significant ( t values were 2.321-5.960, P<0.05 or 0.01). Conclusions:Nurse-led integrated care can promote sense of coherence and alleviate relocation stress of family members of severe neurological disease patients after ICU transfer.

Objective To explore the efficiency of 6-18 F-fluoro-L-3,4-dihydroxyphenylalanine (18 F-FDOPA) PET/CT imaging in the diagnosis of pheochromocytoma/paraganglioma (PPGLs). Methods Twenty-six patients (15 males, 11 females;age:13-76 years) who were suspected of PPGLs with adrenal or retro-peritoneal mass were enrolled into this prospective study. All patients underwent 18 F-FDOPA PET/CT ima-ging. The clinical data, laboratory data and imaging results were collected. Region of interest ( ROI) was drawn on the liver and lesions, and the mean standardized uptake value ( SUVmean ) of the liver and the max-imum standardized uptake value ( SUVmax ) of lesions were calculated, as well as the ratio of tumor/lesion ratio ( T/L) . Based on the pathological results considered as the gold standard, the diagnostic efficiency of 18 F-FDOPA PET/CT imaging in PPGLs was calculated and compared with that of CT/MR. Besides, receiv-er operating characteristic ( ROC) curve analysis of T/L was used. Results Twenty-five patients were path-ologically confirmed, including 12 patients with PPGLs and 13 patients with non-PPGLs. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 18 F-FDOPA PET/CT ima-ging was 11/12, 12/13, 92.00％(23/25), 11/12 and 12/13, respectively. The area under the ROC curve of T/L was 0.978, with the cut-off value of 1.55. 18 F-FDOPA PET/CT imaging totally detected 29 positive foci, including 12 of pheochromocytoma (PCC) and 17 of paraganglioma (PGL). Among those 18F-FDOPA positive PGL foci, 11 were detected by CT/MR, while 6 with diameter less than 1 cm were missed. Conclu-sion 18 F-FDOPA PET/CT imaging can detect more small PGL lesions than CT/MR, suggesting that it may be a proper imaging modality of PPGLs.