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:A great deal of evidence indicates that regular exercise can improve the health status of elderly individuals,including reducing overall and abdominal fat levels,increasing muscle mass and bone mineral density of the limbs,thereby preventing or delaying the onset of sarcopenia and its comorbidities.This study aims to determine the most reliable type,duration,and intensity of exercise interventions through meta-analysis to prevent,delay,and alleviate sarcopenia and its comorbidities in elderly individuals.METHODS:Randomized controlled trials examining the effects of exercise interventions on elderly individuals with sarcopenia and its comorbidities were searched in the PubMed,Embase,Web of Science,Cochrane Library,CNKI,and WanFang databases.The Cochrane Risk of Bias Tool was used to assess the quality of the included studies,and RevMan 5.3 software was employed for meta-analysis.Subgroup analyses were conducted to explore the effects of different exercise intervention protocols on various outcome measures.In addition,Stata 16.0 software was used to perform sensitivity analysis to assess the stability of the results,and funnel plots and Egger's test were employed to evaluate publication bias,ensuring the comprehensiveness and reliability of the results.RESULTS:(1)Sixteen studies involving 861 patients with sarcopenia and its comorbidities were included.(2)The meta-analysis results indicated that,compared with the control group,exercise significantly improved grip strength,knee muscle strength,appendicular skeletal muscle mass,skeletal muscle index,Timed Up and Go test results,gait speed,and insulin-like growth factor 1 levels(P＜0.05).However,the effect of exercise intervention on the sit-to-stand test was not significantly improved(P＞0.05).(3)Based on the results of subgroup analysis,it is recommended that elderly patients with sarcopenia and its comorbidities engage in exercise at least three times per week,with each session lasting no more than 30 minutes or exceeding 45 minutes,for at least 12 weeks.The exercise protocol should be flexibly adjusted according to the patient's health status and individual needs.CONCLUSION:Exercise interventions significantly improve muscle mass,muscle strength,physical function,and insulin-like growth factor 1 levels in elderly individuals with sarcopenia and its comorbidities,thereby enhancing their quality of life.However,further research is needed to validate these findings and optimize specific intervention protocols.

OBJECTIVE:A great deal of evidence indicates that regular exercise can improve the health status of elderly individuals,including reducing overall and abdominal fat levels,increasing muscle mass and bone mineral density of the limbs,thereby preventing or delaying the onset of sarcopenia and its comorbidities.This study aims to determine the most reliable type,duration,and intensity of exercise interventions through meta-analysis to prevent,delay,and alleviate sarcopenia and its comorbidities in elderly individuals.METHODS:Randomized controlled trials examining the effects of exercise interventions on elderly individuals with sarcopenia and its comorbidities were searched in the PubMed,Embase,Web of Science,Cochrane Library,CNKI,and WanFang databases.The Cochrane Risk of Bias Tool was used to assess the quality of the included studies,and RevMan 5.3 software was employed for meta-analysis.Subgroup analyses were conducted to explore the effects of different exercise intervention protocols on various outcome measures.In addition,Stata 16.0 software was used to perform sensitivity analysis to assess the stability of the results,and funnel plots and Egger's test were employed to evaluate publication bias,ensuring the comprehensiveness and reliability of the results.RESULTS:(1)Sixteen studies involving 861 patients with sarcopenia and its comorbidities were included.(2)The meta-analysis results indicated that,compared with the control group,exercise significantly improved grip strength,knee muscle strength,appendicular skeletal muscle mass,skeletal muscle index,Timed Up and Go test results,gait speed,and insulin-like growth factor 1 levels(P＜0.05).However,the effect of exercise intervention on the sit-to-stand test was not significantly improved(P＞0.05).(3)Based on the results of subgroup analysis,it is recommended that elderly patients with sarcopenia and its comorbidities engage in exercise at least three times per week,with each session lasting no more than 30 minutes or exceeding 45 minutes,for at least 12 weeks.The exercise protocol should be flexibly adjusted according to the patient's health status and individual needs.CONCLUSION:Exercise interventions significantly improve muscle mass,muscle strength,physical function,and insulin-like growth factor 1 levels in elderly individuals with sarcopenia and its comorbidities,thereby enhancing their quality of life.However,further research is needed to validate these findings and optimize specific intervention protocols.

OBJECTIVE:To explore the efficacy of different exercise regimens to reduce fall risks in older adults.METHODS:PubMed,Embase,Web of Science,The Cochrane Library,WanFang,and CNKI were searched for studies about exercise interventions on fall risk in healthy older adult individuals at the age of 60 years and above.The search timeframe should cover from the inception of each database to July 2023.Quality assessment and risk-of-bias were assessed using the Cochrane risk of bias tool.Meta-analysis,subgroup analysis,sensitivity analysis,and publication bias were conducted using Review Manager 5.3 and Stata 16.0.RESULTS:A total of 45 papers containing 54 studies with 3 074 participants were included in the analysis.Overall,exercise intervention can improve the interventional effects on balance(the unipedal stance test with eyes open,functional reach,Timed"Up & Go",and Berg balance scale),lower limb muscle strength(30-second chair-stand test,Five-Times Sit-To-Stand Test,and Short Physical Performance Battery),and fall-efficacy(Falls Efficacy Scale-International),leading to reduced fall risk(P＜0.05).The Meta-analysis results revealed a dosage effect of different exercise regimens to reduce fall risk in the elderly.Mind-body exercise could efficiently increase scores of the unipedal stance test[mean difference(MD)=6.81,95％confidence interval(CI)(2.17,11.44),P＜0.01];resistance exercise could efficiently increase the scores of the Timed"Up & Go"[MD=-3.12,95％CI(-5.72,-0.52),P＜0.05]and the 30-second chair-stand test[MD=1.22,95％CI(0.37,2.08),P＜0.01];and multicomponent physical activity could efficiently increase the scores of functional reach[MD=4.50,95％CI(2.58,6.42),P＜0.01],Berg Balance Scale[MD=1.05,95％CI(0.39,1.71),P＜0.01],Five-Times Sit-To-stand Test[MD=-3.15,95％CI(-4.80,-1.50),P＜0.01],Short Physical Performance Battery[MD=0.55,95％CI(0.37,0.74),P＜0.01],and Falls Efficacy Scale-International[MD=-0.41,95％CI(0.69,-0.13),P＜0.01].Conclusion:Exercise interventions can effectively improve balance,enhance limb strength and functional ability,and reduce fear of falling,and lower the risk of falls in older adults.The components of different intervention programs(such as type of exercise,duration,frequency,and session length)have varying dose-response relationships with the results of fall risk screening tests in older adults.

AIM:To evaluate the application effec-tiveness of a Bayesian mixture model based on the principal stratum strategy for estimating the com-plier average causal effect(CACE)in clinical trials with non-compliance.METHODS:Using a non-infe-riority randomized controlled trial investigating a novel drug for primary type 2 diabetes mellitus(non-inferiority margin:-0.4)as a case study,the primary analysis applied a Bayesian mixture model under the monotonicity assumption to estimate CACE of between-group differences in glycated he-moglobin(HbA1c)changes within the compliant stratum,followed by non-inferiority testing.Sensi-tivity analyses included a Bayesian mixture model relaxing the monotonicity assumption and compar-ing results with per-protocol set(PPS)analysis.RE-SULTS:In the primary analysis,the posterior mean of CACE for HbA1c change in the compliant stratum was 0.081％,with a one-sided 97.5％credible inter-val lower bound of-0.124,exceeding the non-infe-riority margin(-0.4％),supporting the non-inferiori-ty efficacy of the novel drug in the compliant stra-tum(P(H1|Data)=1).Consistent findings were ob-served in PPS analyses(estimated effect:0.136％;one-sided 97.5％credible interval lower bound:-0.069％),further validating methodological robust-ness.CONCLUSION:In clinical trials with noncom-pliance as an intercurrent event,the Bayesian mix-ture model under the principal stratum strategy ef-fectively adjusts for compliance-related bias and yields conservative,robust estimates of causal ef-fects,supporting its value in efficacy evaluation un-der complex compliance scenarios.

OBJECTIVE:To explore the efficacy of different exercise regimens to reduce fall risks in older adults.METHODS:PubMed,Embase,Web of Science,The Cochrane Library,WanFang,and CNKI were searched for studies about exercise interventions on fall risk in healthy older adult individuals at the age of 60 years and above.The search timeframe should cover from the inception of each database to July 2023.Quality assessment and risk-of-bias were assessed using the Cochrane risk of bias tool.Meta-analysis,subgroup analysis,sensitivity analysis,and publication bias were conducted using Review Manager 5.3 and Stata 16.0.RESULTS:A total of 45 papers containing 54 studies with 3 074 participants were included in the analysis.Overall,exercise intervention can improve the interventional effects on balance(the unipedal stance test with eyes open,functional reach,Timed"Up & Go",and Berg balance scale),lower limb muscle strength(30-second chair-stand test,Five-Times Sit-To-Stand Test,and Short Physical Performance Battery),and fall-efficacy(Falls Efficacy Scale-International),leading to reduced fall risk(P＜0.05).The Meta-analysis results revealed a dosage effect of different exercise regimens to reduce fall risk in the elderly.Mind-body exercise could efficiently increase scores of the unipedal stance test[mean difference(MD)=6.81,95％confidence interval(CI)(2.17,11.44),P＜0.01];resistance exercise could efficiently increase the scores of the Timed"Up & Go"[MD=-3.12,95％CI(-5.72,-0.52),P＜0.05]and the 30-second chair-stand test[MD=1.22,95％CI(0.37,2.08),P＜0.01];and multicomponent physical activity could efficiently increase the scores of functional reach[MD=4.50,95％CI(2.58,6.42),P＜0.01],Berg Balance Scale[MD=1.05,95％CI(0.39,1.71),P＜0.01],Five-Times Sit-To-stand Test[MD=-3.15,95％CI(-4.80,-1.50),P＜0.01],Short Physical Performance Battery[MD=0.55,95％CI(0.37,0.74),P＜0.01],and Falls Efficacy Scale-International[MD=-0.41,95％CI(0.69,-0.13),P＜0.01].Conclusion:Exercise interventions can effectively improve balance,enhance limb strength and functional ability,and reduce fear of falling,and lower the risk of falls in older adults.The components of different intervention programs(such as type of exercise,duration,frequency,and session length)have varying dose-response relationships with the results of fall risk screening tests in older adults.

AIM:To evaluate the application effec-tiveness of a Bayesian mixture model based on the principal stratum strategy for estimating the com-plier average causal effect(CACE)in clinical trials with non-compliance.METHODS:Using a non-infe-riority randomized controlled trial investigating a novel drug for primary type 2 diabetes mellitus(non-inferiority margin:-0.4)as a case study,the primary analysis applied a Bayesian mixture model under the monotonicity assumption to estimate CACE of between-group differences in glycated he-moglobin(HbA1c)changes within the compliant stratum,followed by non-inferiority testing.Sensi-tivity analyses included a Bayesian mixture model relaxing the monotonicity assumption and compar-ing results with per-protocol set(PPS)analysis.RE-SULTS:In the primary analysis,the posterior mean of CACE for HbA1c change in the compliant stratum was 0.081％,with a one-sided 97.5％credible inter-val lower bound of-0.124,exceeding the non-infe-riority margin(-0.4％),supporting the non-inferiori-ty efficacy of the novel drug in the compliant stra-tum(P(H1|Data)=1).Consistent findings were ob-served in PPS analyses(estimated effect:0.136％;one-sided 97.5％credible interval lower bound:-0.069％),further validating methodological robust-ness.CONCLUSION:In clinical trials with noncom-pliance as an intercurrent event,the Bayesian mix-ture model under the principal stratum strategy ef-fectively adjusts for compliance-related bias and yields conservative,robust estimates of causal ef-fects,supporting its value in efficacy evaluation un-der complex compliance scenarios.

Objective The MMV-Net,a deep learning framework based on mammogram multiple views,was constructed to evaluate the classification performance of the model for benign and malignant masses.Methods A retrospective analysis was conduc-ted on a dataset of 1 585 breast X-ray images from Harbin Medical University Cancer Hospital from 2018 to 2020,including 806 be-nign cases and 779 malignant cases.The dataset was divided into the training set(n=1268)and the test set(n=317)according to an 8∶2 ratios,and the training set was stratified according to the 5-fold cross validation.The integrated DDSM dataset and INBreast dataset were used as external test sets(n=1645)to evaluate the model performance.Each case in the input layer contained 4 views.The MMV-Net model was constructed by removing the last two layers of the ResNet22 network structure and adding an average poo-ling layer as the feature extraction layer,as well as fully connection layer and softmax activation function as the decision layers.Bayes-ian hyperparameter optimization was used.The performance of MMV-Net,MFA Net,and ensemble inception V4 models in AUC val-ues,accuracy,precision,recall and F1 scores were compared.Results The AUC values of MMV-Net model for distinguishing benign and malignant masses on the test set were 0.913,0.882 for MFA-Net,and 0.865 for inception V4.The accuracy and precision evalu-ation metrics of the MMV-Net model were also higher than the other two models.Conclusion The deep learning MMV-Net model based on multiple views of mammogram is helpful for the classification of benign and malignant breast masses.

Objective To investigate the effect of standardized lymph node sorting on postoperative results of gas-troesophageal junction malignant tumors.Methods The data of all patients with malignant gastroesophageal junc-tion in gastric cancer database were analyzed retrospectively.Lymph nodes were sorted according to whether sur-geons were present immediately after surgery.Patients were divided into lymph node sorting group(sorting group)and lymph node unsorting group(unsorting group).General data included gender,age,body mass index(BMI),carcinogenic antigen(CEA),postoperative albumin level,preoperative hemoglobin,etc.Perioperative and patho-logical data included operation time,intraoperative blood loss,postoperative hospital stay,tumor differentiation,distance from superior incisal margin,total number of lymph nodes,number of positive lymph nodes,etc.Kaplan-Meier curve and Log-rank test were used for survival analysis,and propensity score matching analysis adjusted for confounding factors between groups.Results A total of 386 patients were included,including 133 in lymph node sorting group and 253 in non-sorting group.The median follow-up time was 40.18 months.The total number of lymph nodes and the number of positive lymph nodes in the sorting group were(26.38±12.18)and(6.63±10.14),respectively,while the total number and the number of positive lymph nodes in the non-sorting group were(12.25±7.06)and(3.07±3.77),respectively.There were statistically significant differences in the total num-ber of lymph nodes and the number of positive lymph nodes between the sorting group and the non-sorting group(P＜0.05).There was no statistically significant difference in survival between the sorting group and the non-sorting group before matching.There were 112 and 203 patients with advanced gastric cancer in the two groups,respec-tively.The overall survival curve of patients in the sorting group was better than that in the non-sorting group,and the difference in median survival time was statistically significant(P＜0.05).The caliper value was set to 0.02,and 94 pairs of patients were preferentially matched.After matching,the total number of lymph nodes and the num-ber of positive lymph nodes in the sorting group were(24.71±12.03)and(5.70±9.95),respectively,while the total number and the number of positive lymph nodes in the non-sorting group were(13.05±7.63)and(3.37±4.32),respectively.The difference between the two groups was statistically significant(P＜0.05).The overall survival curve of patients in the sorting group was better than that in the non-sorting group,and the median survival time was statistically significant(P＜0.05).Conclusion Postoperative lymph node sorting for gastric cancer can significantly increase the number of total lymph nodes and positive lymph nodes,reduce lymph node migration,and improve postoperative survival time.

Objective:To investigate the current comorbidity status among hypertension, diabetes, and dyslipidemia in residents aged 35-75 years in Tianjin and to explore the main influencing factors to provide a scientific basis for the prevention and treatment of chronic disease comorbidity.Methods:From June 2019 to November 2023, 10 districts (Hedong, Hexi, Dongli, Beichen, Nankai, Xiqing, Wuqing, Baodi, Jizhou, and Binhai New District) in Tianjin were selected as the project sites. The community and natural village was used as the primary sampling unit, and each project site selected the screening sites by cluster random sampling method. Residents aged 35-75 who lived in the screening sites for 6 months and above were surveyed by questionnaire, physical examination, and biochemical tests. The chi-square test, analysis of variance, and multivariate unconditional logistic regression analysis were used for statistical analysis. Age-standardized prevalence was based on the data of the sixth national census.Results:A total of 146 832 participants were included in this study, including 61 994 males (42.22%) and 84 838 females (57.78%), with an age of (56.83±8.84) years. The number of people with only one disease was 55 485 (37.79%), the number of people with two diseases was 36 942 (25.16%), and the number of people with three diseases was 9 683 (6.59%). The prevalence of hypertension combined with dyslipidemia was the highest (17.23%), and the standardized prevalence were 14.44%. The prevalence rates of three diseases and hypertension combined with diabetes was 6.59% and 4.98%, respectively, and the standardized prevalence was 5.42% and 4.11%, respectively. The prevalence of diabetes combined with dyslipidemia was 2.95%, and the standardized prevalence was 2.45%. Multivariate unconditional logistic regression analysis showed that advanced age (65- 75 years old: OR=2.69, 95% CI: 2.28-3.18), overweight/obesity (overweight: OR=2.21, 95% CI: 2.02-2.41; obesity: OR=4.50, 95% CI: 4.03-5.02), daily smoking ( OR=1.96, 95% CI: 1.72-2.24), regular and heavy drinking ( OR=1.63, 95% CI: 1.18-2.27), family history of hypertension/diabetes/hyperlipidemia (family history of hypertension: OR=81.17, 95% CI: 74.68-88.22; family history of diabetes: OR=15.26, 95% CI: 13.71-16.99; family history of hyperlipidemia: OR=7.13, 95% CI: 5.92-8.59), tea drinking (occasional tea drinking group: OR=1.74, 95% CI: 1.52-2.00; frequent tea drinking group: OR=2.23, 95% CI: 1.92-2.59) were risk factors for the comorbidity of hypertension, diabetes and dyslipidemia (all P<0.05), while higher education level was a protective factor (senior high school/technical secondary school: OR=0.79, 95% CI: 0.72-0.86; college/bachelor's degree and above: OR=0.60, 95% CI: 0.53-0.68, all P<0.001). Conclusions:The comorbidity rate of hypertension, diabetes, and dyslipidemia is high in residents aged 35-75 years in Tianjin. It is necessary to strengthen the co-management of blood pressure, blood glucose, and blood lipid in key populations with old age, overweight/obesity, junior high school education or below, daily smoking, daily drinking, occasional or frequent tea drinking, and family history of hypertension/diabetes/dyslipidemia, and promote a healthy lifestyle.