Objective:To explore the dosimetric characteristics of proton and photon radiotherapy in the treatment of breast cancer.Methods:Four female breast cancer patients who needed radiotherapy at Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. The target area ranges of 4 patients were left-sided breast cancer with lymph node involvement, left-sided breast cancer with lymph node involvement and internal mammary node, right-sided breast cancer with lymph node involvement and internal mammary node and synchronous bilateral breast cancer. Intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) plans were designed respectively based on the prescribed dose in the target area and the limits of organs at risk (tomotherapy plan for bilateral breasts). The conformity index (CI), homogeneity index (HI), gradient index (GI) and organs at risk doses were evaluated. The dosimetric characteristics of IMPT and photon radiotherapy were compared.Results:Both IMPT and photon radiotherapy plans of the 4 breast cancer cases met the clinical dose requirements. The HI value of IMPT plans (0.10-0.14) was comparable to that of photon radiotherapy plans (0.10-0.12), and the average CI of the photon radiotherapy plans was 0.10 higher than that of the IMPT plans, and the average GI was 0.55 lower than that of the IMPT plans. The D mean of ipsilateral lung and heart of IMPT was lower, especially in the low-dose area (V 0-3), which was significantly lower than the photon radiotherapy plans, D mean of ipsilateral lung was reduced by 12.2%, 6.1%, 16.1% and 34.8%, respectively, D mean of heart was reduced by 47.2%, 57.0%, 72.4% and 83.0%, respectively. The ipsilateral lung V 20 of IMPT was not lower than photon radiotherapy plans (unilateral breast: IMPT was 30.0%-34.0%, IMRT was 29.0%-35.9%) . Conclusions:IMPT significantly reduces the D mean to the ipsilateral lung and heart while ensuring dose coverage of the target in breast cancer, preventing more volume of surrounding normal tissues from being irradiated. However, IMPT does not show much more advantage than photon radiotherapy plans in the ipsilateral lung V 20.

Objective:To establish a multi-factor prediction model for vascular aging based on psychological behavior and physical exercise using nomogram and structural equation method.Methods:A total of 701 inpatients or physical examination patients who underwent carotid ultrasound examination in the Affiliated Hospital of Qingdao University from October 2021 to March 2023 were selected by cross-sectional method. The subjects were randomly divided into training queue( n=492) and verification queue( n=209) according to the ratio of 7∶3.The psychological and behavioral factors, lifestyle, demography and accompanying diseases data were collected. Multi-factor binary Logistic regression method in SPSS 25.0 software was used to screen independent influencing factors of vascular aging, R 4.2.2 software was used to build a nomogram prediction model of vascular aging, and the ROC curve, calibration chart and decision curve analysis were used to evaluate the nomogram, and AMOS software was used to build a structural equation model of vascular aging. Results:Multivariate Logistic regression analysis showed that type A behavior( B=1.757, OR(95% CI)=5.790(2.750-12.210), P<0.001), physical exercise( B=-3.019, OR(95% CI)=0.050(0.020-0.100), P<0.001), high-fat diet( B=0.679, OR(95% CI)=1.970(1.350-2.880), P<0.001), sleep quality( B=-1.451, OR(95% CI)=0.230(0.120-0.460), P<0.001), tea drinking habits( B=-2.349, OR(95% CI)=0.100(0.050-0.200), P<0.001), age( B=0.061, OR(95% CI)=1.060(1.020-1.110), P=0.005), sex( B=-1.263, OR(95% CI)=0.280(0.140-0.570), P<0.001), hyperlipidemia( B=0.679, OR(95% CI)=1.970(1.350-2.880), P<0.001) and diabetes( B=0.838, OR(95% CI)=2.310(1.140-4.700), P=0.021)were independent influencing factors of vascular aging. The nomogram model showed that type A behavior, physical exercise, high-fat diet, sleep quality, tea drinking habits, age, sex, hyperlipidemia and diabetes were independent influencing factors of vascular aging.Advanced age, type A behavior, hyperlipidemia, diabetes and the score of high-fat diet were risk factors for vascular aging, while better sleep quality, tea drinking habit and the score of physical exercise were protective factors for vascular aging.Men were more prone to vascular aging than women. Structural equation model showed that type A behavior had the strongest direct positive effect on vascular aging (the effect coefficient=0.197, P<0.01), and physical exercise had the strongest direct negative effect on vascular aging (the effect coefficient=-0.452, P<0.01), which could indirectly affect vascular aging through various factors. Conclusions:The nomogram model shows the independent influencing factors of vascular aging and has certain predictive value.Structural equation model shows that many factors such as psychological behavior and lifestyle can directly or indirectly affect the occurrence of vascular aging, among which type A behavior and physical exercise have more extensive effects.

Background::Whether the dynamic weight change is an independent risk factor for mortality remains controversial. This study aimed to examine the association between weight change and risk of all-cause and cause-specific mortality based on the Linxian Nutrition Intervention Trial (NIT) cohort.Methods::Body weight of 21,028 healthy residents of Linxian, Henan province, aged 40-69 years was measured two times from 1986 to 1991. Outcome events were prospectively collected up to 2016. Weight maintenance group (weight change <2 kg) or stable normal weight group was treated as the reference. Cox proportional hazard model was performed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the risk of mortality.Results::A total of 21,028 subjects were included in the final analysis. Compared with the weight maintenance group, subjects with weight loss ≥2 kg had an increased risk of death from all-cause (HR All-cause = 1.14, 95% CI: 1.09-1.19, P <0.001), cancer (HR Cancer = 1.12, 95% CI: 1.03-1.21, P = 0.009), and heart disease (HR Heart diseases = 1.21, 95% CI: 1.11-1.31, P <0.001), whereas subjects with weight gain ≥5 kg had 11% (HR Cancer = 0.89, 95% CI: 0.79-0.99, P = 0.033) lower risk of cancer mortality and 23% higher risk of stroke mortality (HR Stroke = 1.23,95% CI: 1.12-1.34, P <0.001). For the change of weight status, both going from overweight to normal weight and becoming underweight within 5 years could increase the risk of total death (HR Overweight to normal = 1.18, 95% CI: 1.09-1.27; HR Becoming underweight = 1.35, 95% CI: 1.25-1.46) and cancer death (HR Overweight to normal = 1.20, 95% CI: 1.04-1.39; HR Becoming underweight = 1.44, 95% CI: 1.24-1.67), while stable overweight could increase the risk of total death (HR Stable overweight = 1.11, 95% CI: 1.05-1.17) and death from stroke (HR Stable overweight = 1.44, 95% CI: 1.33-1.56). Interaction effects were observed between age and weight change on cancer mortality, as well as between baseline BMI and weight change on all-cause, heart disease, and stroke mortality (all Pinteraction <0.01). Conclusions::Weight loss was associated with an increased risk of all-cause, cancer, and heart disease mortality, whereas excessive weight gain and stable overweight were associated with a higher risk of stroke mortality. Efforts of weight management should be taken to improve health status.Trial registration::https://classic.clinicaltrials.gov/, NCT00342654.

Objective To investigate the impact of the precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy on the improvement in postoperative urinary control in patients with prostate cancer.Methods A retrospective study was conducted.A total of 131 prostate cancer patients who underwent robot-assisted radical prostatectomy at our institution between January 1,2023 and December 31,2023 were enrolled.The subjects were divided into two groups,with 64 in the experimental group and 67 in the control group.Patients in the experimental group underwent radical prostatectomy in a modified approach,while those in the control group underwent conventional radical prostatectomy.Propensity score matching was employed to match the two groups at a 1-to-l ratio based on age,body mass index(BMI),preoperative prostate specific antigen(PSA),prostate volume,Prostate Imaging Reporting and Data System(PI-RADS)scores,biopsy Gleason score,and preoperative urinary control status.After matching,we compared the preoperative baseline data,surgical margin positivity rates,and urinary control status at 3 months post operation between the two groups.Urinary control was assessed before and after surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF)scale.Results A total of 56 pairs of patients were successfully matched between the experimental group and the control group through 1-to-l propensity score matching.At 3 months after surgery,the median score for ICIQ-SF scale of the experimental group was 7.0 points,while that of the control group was 9.5 points,with the difference being statistical significant(P＜0.05).There was no significant difference in the positive rate of incision margins between the experimental group and the control group.Multiple linear regression analysis showed that both the prostate volume and the Gleason score in the experimental group were positively correlated with the ICIQ-UI SF scores 3 months after surgery(P＜0.05),while the age of patients in the control group was positively correlated with ICIQ-UI SF score 3 months after surgery(P＜0.05).Conclusion Precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy significantly improve the postoperative urinary control of patients at 3 months after surgery.

While neuroblastoma accounts for 15% of childhood tumor-related deaths, treatments against neuroblastoma remain scarce and mainly consist of cytotoxic chemotherapeutic drugs. Currently, maintenance therapy of differentiation induction is the standard of care for neuroblastoma patients in clinical, especially high-risk patients. However, differentiation therapy is not used as a first-line treatment for neuroblastoma due to low efficacy, unclear mechanism, and few drug options. Through compound library screening, we accidently found the potential differentiation-inducing effect of AKT inhibitor Hu7691. The protein kinase B (AKT) pathway is an important signaling pathway for regulating tumorigenesis and neural differentiation, yet the relation between the AKT pathway and neuroblastoma differentiation remains unclear. Here, we reveal the anti-proliferation and neurogenesis effect of Hu7691 on multiple neuroblastoma cell lines. Further evidence including neurites outgrowth, cell cycle arrest, and differentiation mRNA marker clarified the differentiation-inducing effect of Hu7691. Meanwhile, with the introduction of other AKT inhibitors, it is now clear that multiple AKT inhibitors can induce neuroblastoma differentiation. Furthermore, silencing AKT was found to have the effect of inducing neuroblastoma differentiation. Finally, confirmation of the therapeutic effects of Hu7691 is dependent on inducing differentiation in vivo, suggesting that Hu7691 is a potential molecule against neuroblastoma. Through this study, we not only define the key role of AKT in the progression of neuroblastoma differentiation but also provide potential drugs and key targets for the application of differentiation therapies for neuroblastoma clinically.

One of the distinct hallmarks of cancer cells is aerobic glycolysis (Warburg effect). Lactate dehydrogenase A (LDHA) is thought to play a key role in aerobic glycolysis and has been extensively studied, while lactate dehydrogenase C (LDHC), an isoform of LDHA, has received much less attention. Here we showed that human LDHC was significantly expressed in lung cancer tissues, overexpression of Ldhc in mice could promote tumor growth, and knock-down of LDHC could inhibit the proliferation of lung cancer A549 cells. We solved the first crystal structure of human LDHC4 and found that the active-site loop of LDHC4 adopted a distinct conformation compared to LDHA4 and lactate dehydrogenase B4 (LDHB4). Moreover, we found that (ethylamino) (oxo)acetic acid shows about 10 times selective inhibition against LDHC4 over LDHA4 and LDHB4. Our studies suggest that LDHC4 is a potential target for anticancer drug discovery and (ethylamino) (oxo)acetic acid provides a good start to develop lead compounds for selective drugs targeting LDHC4.

Background : Studies showed that esophageal body dysmotility is associated with gastroesophageal reflux disease (GERD), however, their interactions are still unclear. Aims: To explore the influence of proportion of ineffective swallows on esophageal motility and gastroesophageal reflux in esophageal high-resolution manometry (HRM). Methods: Patients who completed esophageal HRM and 24 h esophageal impedanee-pH monitoring and were identified as normal esophageal motility or mild dysmotility from March 2018 to December 2019 at the First Affiliated Hospital of Nanjing Medical University were recruited retrospectively. According to the times of ineffective swallows in 10 warm water swallows in HRM, these patients were allocated into four groups; Group A (0 times), Group B (1-4 times), Group C (5-7 times), Group D (8-10 times). The parameters of esophageal HRM and 24 h esophageal impedance-pH monitoring were analyzed, and the value of ineffective swallows for assistant diagnosis of pathological acid reflux was assessed. Results: A total of 142 patients were included. There were no significant differences in abnormal manometric parameters between the four groups (all P > 0. 05). In Group D, the number of weak and non-peristalsis were increased, while the mean and maximum value of distal contractile integral (DCI) were decreased as compared with those in Group A and Group B (all P < 0. 05). Between Group C and Group D, the differences in mean and maximum DCI value were significant (all P < 0. 05). As the times of ineffective swallows increased, the acid exposure time (AET) and DeMeester score gradually increased from Group A to Group D (all P < 0. 05). Times of ineffective swallows and weak peristalsis were moderately and positively correlated with AET, DeMeester score, and the total number of acid exposure (all P < 0. 05). ROC curve analysis revealed that the area under the curve (AUC) of ineffective swallows for assistant diagnosis of pathological acid reflux was 0. 625 (95 % CI; 0.523-0. 727, P = 0. 027); the optimal cut-off value was 4. 5, and the sensitivity and specificity were 62. 9% and 61. 7 %, respectively. The diagnostic performance of weak peristalsis was superior to that of non-peristalsis (AUC: 0. 625 vs. 0. 590). Conclusions: Different proportions of ineffective swallows suggest different clinical significance. The clinical relevance of ineffective swallows > 70 % might be most significant, and to a certain extent, can predicts pathological acid reflux.

Esophageal cancer (EC) is one of the most fatal cancers worldwide. According to GLOBOCAN 2020, it was estimated that there were 600, 000 new EC cases and 540 000 EC deaths, while nearly half of all newly diagnosed cases of EC and associated deaths worldwide occurred in China. The annual incidence and mortality of EC have been reduced in the last 20 years in China. However, the early symptoms and signs of EC are not easily distinguished and the disease tends to be within the middle and late stage of pathogenesis when identified, leading to its low 5-year survival rate. Therefore, it could help effectively reduce the burden of EC by clarifying its etiology and risk factors, as well as taking preventive and early diagnosis measures. This article reviews the epidemiology, etiology, screening and early diagnosis of EC in China, to provide systematic references for EC prevention and control.

Pancreatic cancer (PC) is one of most fatal cancers worldwide. According to the 2020 cancer registry data, PC was the 12th common cancer and the 7th leading cause of cancer deaths globally. PC is a rare cancer, but the 5-year survival is very low because of its rapid progress and poor prognosis. The disease burden of PC in China is quite different from western countries, indicating that the distribution of genetic factors, lifestyle and environmental factors varies from different regions. This article reviews the epidemiology, etiology and screening of PC in China, to provide systematic references for PC prevention and control.

Objective:To understand the infection and distribution of syphilis in hospitalized patients, thus to provide reference for syphilis prevention and control.Methods:TP-ELISA test was used to examine early syphilis antibody, and adopted the TPPA test to validation syphilis antibody, and TRUST was used to determine the titer of syphilis antibody in 80 478 hospitalized patients from January 2015 to November 2017, then the results were retrospectively analyzed.Results:Among 80 478 inpatients, 1 326 cases were positive by TP-ELISA test(1 223 cases positive, 101 cases weak positive and 2 cases negative by TPPA confirmed). The positive rates of TP-ELISA in different years were 1.62%(445/27 394), 1.72%(490/28 412) and 1.58%(389/24 672), respectively, and the difference was not statistically significant( P>0.05). The positive rates of male and female patients were 2.02%(689/33 985) and 1.37%(635/46 479), and the difference was statistically significant(χ 2=52.91, P=0.00). The positive rates of ≤18 years old, >18-59 years old, >59-79 years old and>79 years old were 0.32%(7/2 161), 1.44%(765/53 001), 2.31%(488/21 163) and 1.50%(62/4 153), respectively.The highest proportion of syphilis patients was in the group of >59-79 years old, and the differences were statistically significant compared with the other groups(χ 2=37.08, 67.05, 10.80, all P<0.01). Among the TP-ELISA positive patients, 54.90%(728/1 326) had TRUST titer negative, 36.50%(484/1 326) had titer less than 1∶8, and the others had 8.44%(112/1 326). Conclusion:The incidence of syphilis was higher in males than in females in 80 478 hospitalized patients.The highest positive rate was found in >59-79 years old group, and the number of elderly cases increased rapidly.Therefore, the effective interventions should be developed to control the transmission of syphilis according to the epidemiological features.