Objective:To develop a treatment-related quality of life scale for Chinese patients with multiple myeloma (MM) and to test its reliability and validity.Methods:The initial scale was constructed through a literature search, Delphi expert correspondence, and cognitive testing. This study conducted a preliminary survey of 379 patients with MM and a formal survey of 865 patients from the hematology departments of 155 hospitals nationwide from February 2024 to March 2024. The final scale was obtained after conducting item analysis and reliability and validity tests on the initial scale.Results:The constructed scale contains 36 items covering six domains: physiological, psychological, social, treatment side effects, general health, and others. In the preliminary survey, the Cronbach’s alpha coefficient of each item ranged from 0.597 to 0.939, and the test-retest reliability was 0.747 ( P<0.001). Exploratory factor analysis extracted eight common factors with a cumulative variance contribution of 60.058%. In the formal survey, the Cronbach’s alpha coefficient of each item ranged from 0.484 to 0.930, and the test-retest reliability was 0.835 ( P<0.001). Confirmatory factor analysis revealed a comparative fit index of 0.750, a root-mean-square error of approximation of 0.090, and a root-mean-square residual of 0.067. Conclusion:The treatment-related quality of life scale for Chinese patients with MM designed in this study exhibited good reliability and validity, reflecting the impact of treatment on the quality of life of patients. This scale can provide a reference to clinicians for assessing the disease status of patients.

Objective To explore the relationship between serum levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT)combined with endotoxin(ET)and prognosis of patients with severe pneumonia.Methods 200 cases of severe pneumonia and 100 cases of common pneumonia admitted to Jinhua People's Hospital from January 2022 to January 2023 were selected as study group and control group respectively.Patients in study group were divided into death group and survival group according to the prognosis of 28 days.Serum sTREM-1,PCT and ET levels were detected in all patients,and the differences among all groups were compared;The relationship between serum indexes and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)on the first day of admission was analyzed;Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of serum sTREM-1,PCT and ET levels on the first day after admission to the hospital.Results Serum sTREM-1,PCT and ET levels in study group were significantly higher than those in control group on the 1st day after admission(P＜0.05).Serum sTREM-1,PCT,ET levels and APACHE Ⅱ score in death group were significantly increased on the 4th and 7th day after admission compared with the 1st day(P＜0.05),while the above indexes in survival group were significantly decreased on the 4th and 7th day after admission compared with the 1st day(P＜0.05).Serum sTREM-1,PCT,ET levels and APACHE Ⅱ scores in severe pneumonia death group were significantly higher than those in survival group on the 1st day,4th day and 7th day after admission(P＜0.05).Serum sTREM-1,PCT,ET levels were positively correlated with APACHE Ⅱ score(P＜0.05),and serum indexes were positively correlated in severe pneumonia patients on the 1st day after admission(P＜0.05).When serum sTREM-1＞56.90ng/L on the 1st day after admission,the sensitivity and specificity of patients with severe pneumonia was 89.13％and 75.32％respectively;When PCT＞12.97μg/L,the sensitivity and specificity was 76.09％and 85.06％;When ET＞13.62pg/ml,the sensitivity was 73.91％and the specificity was 66.88％;The sensitivity and specificity was 89.13％and 96.75％respectively detected by the three indexes combined.Conclusion Serum sTREM-1,PCT,ET levels are highly expressed in severe pneumonia,which is closely related to the prognosis of patients,and the combined detection of the three indexes is of great value in predicting the death of patients with severe pneumonia.

Objective To explore the relationship between serum levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT)combined with endotoxin(ET)and prognosis of patients with severe pneumonia.Methods 200 cases of severe pneumonia and 100 cases of common pneumonia admitted to Jinhua People's Hospital from January 2022 to January 2023 were selected as study group and control group respectively.Patients in study group were divided into death group and survival group according to the prognosis of 28 days.Serum sTREM-1,PCT and ET levels were detected in all patients,and the differences among all groups were compared;The relationship between serum indexes and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)on the first day of admission was analyzed;Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of serum sTREM-1,PCT and ET levels on the first day after admission to the hospital.Results Serum sTREM-1,PCT and ET levels in study group were significantly higher than those in control group on the 1st day after admission(P＜0.05).Serum sTREM-1,PCT,ET levels and APACHE Ⅱ score in death group were significantly increased on the 4th and 7th day after admission compared with the 1st day(P＜0.05),while the above indexes in survival group were significantly decreased on the 4th and 7th day after admission compared with the 1st day(P＜0.05).Serum sTREM-1,PCT,ET levels and APACHE Ⅱ scores in severe pneumonia death group were significantly higher than those in survival group on the 1st day,4th day and 7th day after admission(P＜0.05).Serum sTREM-1,PCT,ET levels were positively correlated with APACHE Ⅱ score(P＜0.05),and serum indexes were positively correlated in severe pneumonia patients on the 1st day after admission(P＜0.05).When serum sTREM-1＞56.90ng/L on the 1st day after admission,the sensitivity and specificity of patients with severe pneumonia was 89.13％and 75.32％respectively;When PCT＞12.97μg/L,the sensitivity and specificity was 76.09％and 85.06％;When ET＞13.62pg/ml,the sensitivity was 73.91％and the specificity was 66.88％;The sensitivity and specificity was 89.13％and 96.75％respectively detected by the three indexes combined.Conclusion Serum sTREM-1,PCT,ET levels are highly expressed in severe pneumonia,which is closely related to the prognosis of patients,and the combined detection of the three indexes is of great value in predicting the death of patients with severe pneumonia.

Objective:To develop a treatment-related quality of life scale for Chinese patients with multiple myeloma (MM) and to test its reliability and validity.Methods:The initial scale was constructed through a literature search, Delphi expert correspondence, and cognitive testing. This study conducted a preliminary survey of 379 patients with MM and a formal survey of 865 patients from the hematology departments of 155 hospitals nationwide from February 2024 to March 2024. The final scale was obtained after conducting item analysis and reliability and validity tests on the initial scale.Results:The constructed scale contains 36 items covering six domains: physiological, psychological, social, treatment side effects, general health, and others. In the preliminary survey, the Cronbach’s alpha coefficient of each item ranged from 0.597 to 0.939, and the test-retest reliability was 0.747 ( P<0.001). Exploratory factor analysis extracted eight common factors with a cumulative variance contribution of 60.058%. In the formal survey, the Cronbach’s alpha coefficient of each item ranged from 0.484 to 0.930, and the test-retest reliability was 0.835 ( P<0.001). Confirmatory factor analysis revealed a comparative fit index of 0.750, a root-mean-square error of approximation of 0.090, and a root-mean-square residual of 0.067. Conclusion:The treatment-related quality of life scale for Chinese patients with MM designed in this study exhibited good reliability and validity, reflecting the impact of treatment on the quality of life of patients. This scale can provide a reference to clinicians for assessing the disease status of patients.

A system for achieving two-dimensional(2D)visualization and three-dimensional(3D)reconstruction of lung images using CT data is designed.After DICOM image processing,and lung nodule segmentation and labeling,the multi-view and multi-resolution 3D display of lung parenchyma and nodules is realized using techniques such as resampling of CT sequences,3D reconstruction based on surface rendering,and morphological processing.Finally,the interactive interface is designed for implementing the functions of image enhancement,2D visualization,nodule delineation,3D reconstructions of lung parenchyma and nodules,rotation,zooming and switching the viewpoint.Experimental results show that the system provides clear and accurate 2D image visualization and lesion delineation,while reconstructing nodules in the generated 3D images completely and smoothly.Compared with the existing similar medical processing software,the developed system substantially improves the reconstruction and visualization efficiencies,enabling doctors to observe 3D images more quickly and accurately,and assisting in disease diagnosis and surgical planning.

Objective:To study the feasibility of magnetic resonance imaging(MRI)technique with amide proton transfer(APT)in predicting the prognosis of cerebral stroke.Methods:A total of 71 patients with acute cerebral stroke who admitted to the Nanjing First Hospital,Nanjing Medical University from September 2022 to May 2023 were selected.All of them underwent the test of National Institute of Health Stroke Scale(NIHSS),and received the MRI examination with chemical exchange saturation transfer(CEST).According to the modified Rankin scale(mRS)values of 1-month follow-up,they were divided into favorable recovery group(mRS<2,44 cases)and poor group(mRS≥2,27 cases).The asymmetric magnetization transfer ratio(MTRasym)image(APT)was obtained by analyzing data with special software.And then,the difference(△APTw)of APT values between ischemic zone and contralateral normal tissue was further calculated.The △APTw values of two groups were compared and analyzed,and the Pearson correlation analysis was adopted to analyze the correlation among △APTw,NIHSS and mRS.The receiver operating characteristics(ROC)curve was drawn,and the area under curve(AUC)of ROC curve was calculated.Results:There were significant positive correlations among △APTw,NIHSS and mRS scores(R2=0.659,0.522,P<0.001),and the differences of △APTW,NIHSS and mRS scores between the favorable recovery group and poor group were significant(t=5.73,6.36,13.92,P<0.05),respectively.The AUC value was 0.886,and the sensitivity and specificity of prediction were respectively 77.8%and 95.5%.The positive and negative predictive values were respectively 91.3%and 87.5%.Conclusion:APT imaging technique has feasibility in predicting the prognosis of acute cerebral ischemic stroke.

Objective:To develop an Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses and test its reliability and validity.Methods:Based on the theory of knowledge, attitude, and practice, a preliminary scale draft was formed through a literature review, three rounds of Delphi expert consultation, and a pre-survey. Using convenience sampling, 311 hemodialysis nurses were selected for a survey from December 2022 to February 2023 for item analysis, exploratory factor analysis and reliability testing. Another survey was conducted on 260 hemodialysis nurses from February to June 2023 for confirmatory factor analysis, convergent validity, and discriminant validity testing.Results:The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses included three subscales and five dimensions, with a total of 33 items. The content validity index at the item level was 0.867 to 1.000, and the content validity index at the scale level was 0.992. After exploratory factor analysis, two, one, and two common factors were extracted from the knowledge, attitude, and practice subscales, with cumulative variance contribution rates of 70.114%, 75.192%, and 67.467%, respectively.Confirmatory:factor analysis showed that the model fitted well. The Cronbach's α coefficients of the three subscales were 0.929 to 0.943, the half reliability coefficients were 0.861 to 0.903, and the retest reliability coefficients were 0.824 to 0.874. Conclusions The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses has good reliability and validity and can be used to evaluate the physical examination ability of hemodialysis nurses for arteriovenous fistula.

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.

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

Objective:To investigate the correlation of peripheral blood 25-hydroxyvitamin D3 [25 (OH) D3] level with T cell subsets in multiple myeloma (MM).Methods:The clinical data of 11 newly diagnosed MM patients hospitalized in Heze Municipal Hospital and the First People's Hospital of Jining from June 2019 to June 2021 were retrospectively analyzed, and 8 healthy people were selected as the healthy control group. The patients achieved disease remission after 4 courses of BD (bortezomib + dexamethasone) regimen. High performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to measure the peripheral blood 25-(OH) D3 level in MM patients at initial diagnosis and after 4 courses of treatment, as well as people in the healthy control group. The proportion of peripheral blood helper T cell (Th) 1, Th2, Th17, and regulatory T cells (Treg cells) in CD3 + CD8 + T cells was measured by using flow cytometry. IgA, IgG, IgM, lactic dehydrogenase (LDH), β 2-microglobulin (β 2-MG) levels were analyzed by using fully automatic biochemical analyser. Cytoanalyze was used to detect the hemoglobin level in the peripheral blood. The differences of all indicators in MM patients at initial diagnosis, remission after treatment and the healthy control group were compared. Pearson method was used to analyze the correlation of the peripheral blood 25-(OH) D3 level with T cell subsets and other biochemical indicators in MM patients at initial diagnosis and remission after treatment. Results:Compared with the healthy control group, the peripheral blood 25-(OH) D3 level, Th1-to-Th2 ratio (Th1/Th2), the proportion of Treg cells were all decreased (all P < 0.01), and Th17-to-Treg cells ratio (Th17/Treg) was increased ( P = 0.002). The proportion of Th17 and Th17/Treg in MM patients achieving remission after treatment was higher than that in the healthy control group (all P < 0.05); the proportion of Treg cells in MM patients achieving remission after treatment was lower than that in the healthy control group ( P = 0.010); 25-(OH) D3 level in MM patients achieving remission after treatment was lower than that in the healthy control group, while the difference was not statistically significant ( P = 0.060). The peripheral blood IgM in MM patients at initial diagnosis and those achieving remission after treatment was lower than that in the healthy control group (all P < 0.01); the levels of LDH and β 2-MG in MM patients at initial diagnosis and those achieving remission after treatment was higher than that in the healthy control group (all P < 0.05). The peripheral blood 25-(OH) D3 level in MM patients at initial diagnosis was positively correlated with the proportion of Th1, Th1/Th2 ( r values 0.89, 0.60, all P < 0.05), and negatively correlated with the proportion of Th17 and Th17/Treg ( r values -0.61, -0.75, all P < 0.05). After treatment, there was no correlation of the proportion of Th1, Th2, Th17, Treg, Th1/Th2, Th17/Treg with peripheral blood 25- (OH) D3 level for patients achieving remission ( r values were -0.36, -0.45, -0.10, 0.10, 0.19, 0.03, all P > 0.05). IgM, LDH, β 2-MG was negatively correlated with 25- (OH) D3 level in the peripheral blood of MM patients at initial diagnosis ( r values were -0.76, -0.71, -0.62, all P < 0.05); while there was no correlation of 25-(OH) D3 level with IgA, IgG, IgM, LDH, β 2-MG, hemoglobin for patients achieving remission after treatment ( r values were -0.36, 0.19, -0.09, 0.47, 0.47, -0.11, all P > 0.05). Conclusions:MM patients show the decreased peripheral blood 25-(OH) D3 level, the increased Th17 and the decreased Treg cells; 25-(OH) D3 level is related to the imbalance of Th1/Th2/Th17/Treg, which suggests that 25-(OH) D3 may be related to the development, progression, prognosis and abnormal immune responses in the body of MM.