Objective To compare the differences in dosimetry and treatment efficiency of three radiotherapy plans after left-sided breast-conserving surgery,including modified intensity-modulated radiation therapy(IMRT),cross-field volume-modulated arc therapy(VMAT)or improved VMAT,so as to provide references for clinical practice.Methods Three radiotherapy plans of modified IMRT,cross-field VMAT and improved VMAT were designed for 12 patients after left-sided-breast-conserving surgery.The modified IMRT with five irradiation fields and the improved VMAT with two arcs were modified by not setting cross-fields while determining the start and end angles with the rays passing through the least lung area.The cross-field VMAT had its start and end angles set based on the cross-fields.The doses to the target areas,peripheral organs at risk,heart and its substructures were evaluated,and dose verification was carried out.The three plans were compared in terms of treatment efficiency and gamma pass rate.SPSS 22.0 was used for statistical analysis.Results All the three plans behaved well in dose distribution.In terms of planning gross tumor volume dosimetry dosimetry,the improved VMAT and modified IMRT gained advantages than others in CI and D50,respectively,with the differences being significant(all P<0.05).In terms of planning target volume dosimetry,the modified IMRT had the V107 and D50 lower than those of the others,with the differences being significant(P<0.05).In terms of the protection of peripheral organs at risk,V5 of the left lung,Dmean of the right lung and Dmean of the healthy breast were lower in the modified IMRT plan than in the other 2 plans,with statistically significant differences(P<0.05);V20,V30,V35 and V40 of the left lung were lower in the modified VMAT plan than in the other 2 plans,with statistically significant differences(P<0.05).In terms of protection of heart and its substructures,the left ventricle V20,V30 and Dmean of the improved VMAT plan behaved better than those of other 2 plans,and the difference was statistically significant(all P<0.05).In terms of treatment efficiency,the cross-field VMAT plan had the lowest MU while highest treatment efficiency;the improved VMAT plan had the MU higher while the treatment efficiency lower than the cross-field VMAT plan;the modified IMRT plan had the highest MU while the lowest gamma pass rate,and the differences in the MUs and gamma pass rates among the three plans were statistically significant(P<0.05).Conclusion Under the same standard conditions,the cross-field VMAT and improved VMAT plans show technical advantages.Though the improved VMAT plan has the treatment efficiency lower than the cross-field VMAT,it decreases the possibility of radiocardiac injury in terms of dosimetry and thus can be used for radiotherapy after left-sided breast-conserving surgery.[Chinese Medical Equipment Journal,2025,46(4):45-51]

Objective To investigate the distribution and antibiotic resistance of clinical isolates in the Traditional Chinese Medicine Hospital of Xinjiang Medical University.Methods Bacterial strains were collected from January 1,2020,to December 31,2023,and tested for antimicrobial susceptibility using automated systems and disk diffusion methods.The results were interpreted according to the breakpoints recommended in the CLSI M100.Results Over the four-year period,22 121 bacterial strains were analyzed,including Gram-positive bacteria(24.1％,5 338/22 121)and Gram-negative bacteria(75.9％,16 783/22 121).The prevalence of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)was 26.4％and 68.9％,respectively.MRSA and MRCNS strains showed higher resistance rates to most antimicrobial agents compared to methicillin-susceptible strains(MSSA and MSCNS).No Staphylococcus strains were found resistant to linezolid or vancomycin.E.faecium showed higher resistance rates to most of the antimicrobial agents tested than E.faecalis.A few vancomycin-resistant strains were identified in E.faecium and limited number of linezolid-resistant strains were identified in E.faecalis.All S.pneumoniae isolates were isolated from specimens other than cerebrospinal fluid.The prevalence of penicillin-resistant S.pneumoniae(PRSP)was 9.4％.Overall,13.2％of Klebsiella isolates were resistant to imipenem and 13.1％to meropenem,while the prevalence of carbapenem-resistant strains was less than 10％in Escherichia coli or other genera of Enterobacterales.As for non-fermenting Gram-negative bacteria,P.aeruginosa was largely susceptible to most antimicrobial agents.Overall,11.8％and 10.9％of P.aeruginosa strains were resistant rates to imipenem and meropenem,respectively.However,47.1％of Acinetobacter strains were resistant to imipenem and 47.9％to meropenem,while 14.9％to 53.2％of the strains were resistant to other antimicrobial agents tested.Conclusions The clinical strains isolated in the Traditional Chinese Medicine Hospital of Xinjiang Medical University were predominantly Gram-negative bacteria.The prevalence of carbapenem-resistant strains in Klebsiella spp.was higher than that in other species of Enterobacterales.Acinetobacter spp.showed high resistance rate to carbapenems.The prevalence of methicillin-resistant strains was high in Staphylococcus.Vancomycin-resistant and linezolid-resistant strains were identified in Enterococcus spp.Infection prevention and control and stewardship of antimicrobial agents should be strengthened to contain the emergence and spread of resistant bacteria.

Objective To investigate the peripheral blood cytokine levels in patients with acute myocardial infarction(AMI),and to analyze its correlation with Killip classification,N-terminal brain natriuretic peptide precursor(NT-proBNP),cardiac troponin I(cTnI),creatine kinase isoenzymes(CK-MB),and to provide a theoretical basis for assessing the severity and prognosis of the disease.Methods A total of 312 patients with AMI admitted to Minhang Hospital,Fudan University from Jul 2021 to Oct 2023 were enrolled as the case group,and 201 patients with unstable angina pectoris were selected as the control group.General clinical data of the subjects were collected,and the concentrations of cytokines(IL-5,IFN-α,IFN-γ,IL-10,IL-12p70,IL-17,IL-1β,IL-2,IL-4,IL-6,IL-8,and TNF-α)in peripheral blood were detected by multiplex bead-based flow cytometry.NT-proBNP,cTnI and CK-MB were measured by chemiluminescence methods.The levels of cytokines between the two groups were compared,and their correlations with Killip classification,NT-proBNP,cTnI and CK-MB were analyzed.The predictive efficacy of cytokines for AMI was evaluated by receiver operating characteristic(ROC)curves.Results There were no significant differences in baseline data between the AMI group and the control group(P>0.05),with the exception of age.The levels of IL-6,IL-8 and TNF-α in the AMI group were higher than those in the control group(all P<0.01).The correlation analyses showed that IL-6 was positively correlated with Killip classification,NT-proBNP,cTnI and CK-MB(all P<0.01).ROC analyses showed that IL-6 levels had good predictive efficacy for AMI(AUC=0.882 9,P<0.01).Conclusion The expression of IL-6 was significantly increased in patients with AMI,and it was positively correlated with Killip classification,NT-proBNP,cTnI and CK-MB,suggesting that IL-6 may serve as a potential biomarker for assessing the severity of AMI.

Objective To identify risk factors for severe hand-foot-mouth disease(HFMD)cases in Fuzhou,providing scientific evidence for disease prevention and control.Methods Severe pediatric HFMD cases in Fuzhou between 2017 and 2024 were collected from the"China Disease Prevention and Control Information System".Non-severe cases were frequency-matched based on the same onset period,same affected region,same parents'educational level,and age(±1 year)to form a non-severe group.Demographic characteristics,clinical symptoms,medical history,and pathogen types of both groups were collected.Logistic regression was used to identify the risk factors for severe cases.Results From 2017 to 2024,Fuzhou reported 503 severe HFMD cases and 1053 matched non-severe cases.Demographically,severe group had a higher proportion of home-based childcare,rural residence,care-seeking delay>2 d,while EV71 vaccination rates,handwashing habits before meals and after defecation,and caregivers with HFMD prevention education were lower than those in non-severe group,with statistically significant difference(P<0.001).Clinically,severe group showed more frequent fever>3 d,altered consciousness/seizure,limb tremors/convulsions,the proportion of infectious disease and the proportion of EV71-positive cases than those in non-severe group(P<0.001).Multivariate logistic regression analysis showed that home-based childcare(OR=3.213,95%CI 1.913-5.398),rural residence(OR=2.121,95%CI 1.513-2.973),lack of EV7 vaccination(OR=3.141,95%CI 1.996-4.945),care-seeking delay>2 d(OR=2.004,95%CI 1.410-2.849),no handwashing habits before meals and after defecation(OR=3.927,95%CI 1.718-5.356),caregiver without HFMD education(OR=2.465,95%CI 1.807-3.362),fever>3 d(OR=2.585,95%CI 1.801-3.709),altered consciousness/seizures(OR=4.059,95%CI 2.731-6.031),limb tremors/convulsions(OR=2.087,95%CI 1.398-3.117),history of infectious disease(OR=3.369,95%CI 1.725-6.335)and EV71 positivity(OR=3.854,95%CI 2.678-5.545)were risk factors for severe HFMD cases.The recovery time in severe group was significantly longer than that in non-severe group[18(5,32)d vs.11(4,23)d,P<0.001].Conclusions Prevention and control efforts should target high-risk groups by strengthening health education,promoting EV71 vaccination and improving the treatment of severe HFMD cases to reduce the incidence of severe HFMD.

Objective To compare the differences in dosimetry and treatment efficiency of three radiotherapy plans after left-sided breast-conserving surgery,including modified intensity-modulated radiation therapy(IMRT),cross-field volume-modulated arc therapy(VMAT)or improved VMAT,so as to provide references for clinical practice.Methods Three radiotherapy plans of modified IMRT,cross-field VMAT and improved VMAT were designed for 12 patients after left-sided-breast-conserving surgery.The modified IMRT with five irradiation fields and the improved VMAT with two arcs were modified by not setting cross-fields while determining the start and end angles with the rays passing through the least lung area.The cross-field VMAT had its start and end angles set based on the cross-fields.The doses to the target areas,peripheral organs at risk,heart and its substructures were evaluated,and dose verification was carried out.The three plans were compared in terms of treatment efficiency and gamma pass rate.SPSS 22.0 was used for statistical analysis.Results All the three plans behaved well in dose distribution.In terms of planning gross tumor volume dosimetry dosimetry,the improved VMAT and modified IMRT gained advantages than others in CI and D50,respectively,with the differences being significant(all P<0.05).In terms of planning target volume dosimetry,the modified IMRT had the V107 and D50 lower than those of the others,with the differences being significant(P<0.05).In terms of the protection of peripheral organs at risk,V5 of the left lung,Dmean of the right lung and Dmean of the healthy breast were lower in the modified IMRT plan than in the other 2 plans,with statistically significant differences(P<0.05);V20,V30,V35 and V40 of the left lung were lower in the modified VMAT plan than in the other 2 plans,with statistically significant differences(P<0.05).In terms of protection of heart and its substructures,the left ventricle V20,V30 and Dmean of the improved VMAT plan behaved better than those of other 2 plans,and the difference was statistically significant(all P<0.05).In terms of treatment efficiency,the cross-field VMAT plan had the lowest MU while highest treatment efficiency;the improved VMAT plan had the MU higher while the treatment efficiency lower than the cross-field VMAT plan;the modified IMRT plan had the highest MU while the lowest gamma pass rate,and the differences in the MUs and gamma pass rates among the three plans were statistically significant(P<0.05).Conclusion Under the same standard conditions,the cross-field VMAT and improved VMAT plans show technical advantages.Though the improved VMAT plan has the treatment efficiency lower than the cross-field VMAT,it decreases the possibility of radiocardiac injury in terms of dosimetry and thus can be used for radiotherapy after left-sided breast-conserving surgery.[Chinese Medical Equipment Journal,2025,46(4):45-51]

Objective To investigate the distribution and antibiotic resistance of clinical isolates in the Traditional Chinese Medicine Hospital of Xinjiang Medical University.Methods Bacterial strains were collected from January 1,2020,to December 31,2023,and tested for antimicrobial susceptibility using automated systems and disk diffusion methods.The results were interpreted according to the breakpoints recommended in the CLSI M100.Results Over the four-year period,22 121 bacterial strains were analyzed,including Gram-positive bacteria(24.1％,5 338/22 121)and Gram-negative bacteria(75.9％,16 783/22 121).The prevalence of methicillin-resistant S.aureus(MRSA)and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)was 26.4％and 68.9％,respectively.MRSA and MRCNS strains showed higher resistance rates to most antimicrobial agents compared to methicillin-susceptible strains(MSSA and MSCNS).No Staphylococcus strains were found resistant to linezolid or vancomycin.E.faecium showed higher resistance rates to most of the antimicrobial agents tested than E.faecalis.A few vancomycin-resistant strains were identified in E.faecium and limited number of linezolid-resistant strains were identified in E.faecalis.All S.pneumoniae isolates were isolated from specimens other than cerebrospinal fluid.The prevalence of penicillin-resistant S.pneumoniae(PRSP)was 9.4％.Overall,13.2％of Klebsiella isolates were resistant to imipenem and 13.1％to meropenem,while the prevalence of carbapenem-resistant strains was less than 10％in Escherichia coli or other genera of Enterobacterales.As for non-fermenting Gram-negative bacteria,P.aeruginosa was largely susceptible to most antimicrobial agents.Overall,11.8％and 10.9％of P.aeruginosa strains were resistant rates to imipenem and meropenem,respectively.However,47.1％of Acinetobacter strains were resistant to imipenem and 47.9％to meropenem,while 14.9％to 53.2％of the strains were resistant to other antimicrobial agents tested.Conclusions The clinical strains isolated in the Traditional Chinese Medicine Hospital of Xinjiang Medical University were predominantly Gram-negative bacteria.The prevalence of carbapenem-resistant strains in Klebsiella spp.was higher than that in other species of Enterobacterales.Acinetobacter spp.showed high resistance rate to carbapenems.The prevalence of methicillin-resistant strains was high in Staphylococcus.Vancomycin-resistant and linezolid-resistant strains were identified in Enterococcus spp.Infection prevention and control and stewardship of antimicrobial agents should be strengthened to contain the emergence and spread of resistant bacteria.

The p21-activated kinase 4 (PAK4), a key regulator of malignancy, is negatively correlated with immune infiltration and has become an emergent drug target of cancer therapy. Given the lack of high efficacy PAK4 inhibitors, we herein reported the identification of a novel inhibitor 13 bearing a tetrahydrobenzofuro[2,3-c]pyridine tricyclic core and possessing high potency against MIA PaCa-2 and Pan02 cell lines with IC₅₀ values of 0.38 and 0.50 μmol/L, respectively. This compound directly binds to PAK4 in a non-ATP competitive manner. In the mouse Pan02 model, compound 13 exhibited significant tumor growth inhibition at a dose of 100 mg/kg, accompanied by reduced levels of PAK4 and its phosphorylation together with immune infiltration in mice tumor tissue. Overall, compound 13 is a novel allosteric PAK4 inhibitor with a unique tricyclic structural feature and high potency both in vitro and in vivo, thus making it worthy of further exploration.

Objective:To explore the feasibility of shortening the time of long exercise test (LET) from 120 to 60 minutes by analyzing the positive rate within 60 minutes among periodic paralysis (PP) patients who were positive in 120-minute test.Methods:The data of patients undergoing 120-minute LET from January 2015 to October 2021 in Beijing Tiantan Hospital, Capital Medical University were retrospectively analyzed, with 30%, 33%, and 40% as diagnostic cut-off values, respectively. PP patients with positive results within 120 minutes after exercise were enrolled in the study. The positive rate within 30 minutes and 60 minutes after exercise was calculated. The change rates of compound muscle action potential (CMAP) amplitude and the sensitivity and specificity of LET at 30 minutes, 60 minutes, and 120 minutes after exercise were analyzed. The change rate of CMAP amplitude in PP patients who did not show positive results within 60 minutes was further calculated.Results:A total of 254 patients were examined, including 114 PP patients. With 30%, 33%, and 40% as diagnostic cut-off values, the results showed that there were 88, 88, and 82 positive PP patients, respectively. Under each diagnostic cut-off values, the age of positive PP patients was (32±10) years, with a male proportion of 98% (86/88), 98% (86/88), and 99% (81/82), respectively; the positive rate of PP patients within 30 minutes after exercise was 60% (53/88), 58% (51/88), and 41% (34/82), respectively; the positive rate of PP patients within 60 minutes after exercise was 91% (80/88), 86% (76/88), and 83% (68/82), respectively. At the cut-off values of 30%, 33% and 40%, the change rate of CMAP amplitude at 30 minutes [-36% (-49%, -23%), -36% (-49%, -23%), -37% (-51%, -24%)], 60 minutes [-51% (-66%, -40%), -51% (-66%, -40%), -53% (-66%, -42%)] and 120 minutes [-57% (-67%, -45%), -57% (-67%, -45%), -58% (-67%, -46%)] after exercise showed statistically significant difference among 3 time points ( H=57.764, 57.764, 59.616, respectively, all P<0.001); the further comparison between time points showed that there was statistically significant difference in the change rate of CMAP amplitude between 60 minutes ( Z=5.419, 5.419, 5.531, respectively, all P<0.001), 120 minutes ( Z=7.325, 7.325, 7.431, respectively, all P<0.001) and 30 minutes after exercise, but there was no statistically significant difference in the change rate of CMAP amplitude between 120 minutes and 60 minutes after exercise ( Z=1.906, 1.906, 1.899, respectively, all P>0.05); the sensitivity of LET for the diagnosis of PP at 60 minutes after exercise was 70.2% (80/114), 66.7% (76/114) and 59.6% (68/114), and the specificity of LET for the diagnosis of PP was 77.9% (109/140), 84.3% (118/140) and 91.4%(128/140), respectively. When 30%, 33% and 40% were used as the diagnostic cut-off values, and the change rate of CMAP amplitude at 60 minutes after exercise fell below these cut-off values but showed a decline of ≥20%, ≥22% and ≥24%, respectively, the detection time should be extended to 120 minutes. Conclusions:Whether using 30%, 33%, or 40% as diagnostic cut-off values, it is feasible to shorten the LET time from 120 minutes to 60 minutes. The 60-minute LET has good sensitivity and specificity for the diagnosis of PP. It is recommended to extend the detection time to 120 minutes for patients with a ≥20%, ≥22%, or ≥24% decline in CMAP amplitude at 60 minutes after exercise while falling short of corresponding diagnostic cut-off values when 30%, 33%, and 40% are used as diagnostic cut-off values. This method can not only improve the examination efficiency of LET, but also minimize the missed diagnosis as much as possible.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the efficacy and toxicity of blinatumomab in the first-line and second-line treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL).Methods:A multi-center retrospective cohort study was conducted to analyze clinical data from 323 pediatric B-ALL patients treated with blinatumomab across 14 hospitals in China from May 2021 to July 2023. Patients were divided into four groups based on the treatment phase and disease status when blinatumomab was used: relapsed/refractory group, post-consolidation minimal residual disease (MRD)-positive group, early MRD-positive group, and MRD-negative group. Blinatumomab for the relapsed/refractory group was considered as second-line treatment, while the other 3 groups as first-line treatment. The MRD negativity rate after treatment, the survival rates and the incidence of severe adverse events were compared across these groups. Patients who received blinatumomab for more than 7 days were included in the efficacy analysis. Survival analysis was performed using the Kaplan-Meier method, and Log-Rank test was used to compare the survival rates among groups.Results:Among the 323 patients, 191 (59.1%) were male, with the age of 6.2 (3.9, 10.5) years. There were 117 patients in the relapsed/refractory group, 62 cases in the post-consolidation MRD-positive group, 43 cases in the early MRD-positive group, and 101 cases in the MRD negative group. In the relapsed/refractory group, the complete remission rate and MRD negativity rate after one course of blinatumomab were 71.4% (35/49) and 81.5% (75/92) for the 49 children without complete remission and the 92 children with flow cytometry-positive MRD, respectively. In the post-consolidation MRD-positive group, the MRD negativity rates after one course of blinatumomab were 100.0% (27/27), 12/16 and 9/19 for patients with MRD positivity detected by flow cytometry, polymerase chain reaction and next-generation sequencing, respectively. In the early MRD-positive group, the MRD negativity rates were 96.7% (29/30) and 9/9 for flow cytometry and next-generation sequencing, respectively. The 2-year overall survival rate and event-free survival rate for the 319 children evaluable for efficacy were (90.6±1.7)% and (87.6±1.9)%, respectively, with the relapsed/refractory group showing significantly lower overall survival rates and event-free survival rate compared to the other groups ( χ2=21.40, 26.21,both P<0.001). Grade 3 or higher adverse events occurred in 128 cases (39.6%), with hematological toxicity observed in 101 cases, while cytokine release syndrome (CRS), infection, and neurotoxicity occurred in 11, 26 and 8 cases, respectively. In addition, there were statistically significant differences in the grade 3 or higher CRS among the four groups ( χ2=8.03, P<0.05). Conclusion:Blinatumomab can clear MRD more effectively and achieve superior survival outcomes when used as first-line treatment for pediatric B-ALL, with less CRS.