Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective To investigate the disparities in the activities of daily living(ADL)among older adults living in urban and rural areas of Sichuan Province,China and the influencing factors,and to provide a basis for promoting the health of older adults and formulating relevant policies.Methods Using data from the Seventh Health Services Survey of Sichuan Province,we enrolled 7 369 older adults from urban and rural areas and analyzed their ability to perform ADL and the relevant influencing factors.All participants were aged 60 years or older.Chi-square tests and logistic regression were performed to identify the influencing factors.Results The ADL impairment rate among older adults living in urban areas of Sichuan Province was 17.7％,which was higher than the rate of 13.8％among older adults living in rural areas.According to the results of logistic regression analysis,age≥80 years(odds ratio[OR]=3.725;95％CI,2.460-5.639),accidental injuries(OR=2.375;95％CI,1.597-3.532),and good sleep quality(OR=0.420,95％CI:0.289-0.612)were factors influencing ADL among older adults living in urban areas,while age ≥ 80 years(OR=1.867;95％CI,1.459-2.390),being married(OR=0.805;95％CI,0.664-0.976),accidental injuries(OR=1.936;95％CI,1.564-2.397),and participation in social activities(OR=0.417;95％CI,0.352-0.495)were factors influencing ADL among older adults living in rural areas.Conclusion There are differences in ADL impairment rates and the relevant influencing factors between urban and rural older adults in Sichuan Province.These findings underscore the need to consider urban-rural differences when adopting relevant policies and measures.

Objective To explore the effect of tumor necrosis faction-α(TNF-α)gene rs1799964 and C-reactive protein(CRP)gene rs2794521 polymorphism and their interaction on the therapeutic effect of dagliaglozin in patients with heart failure.Meth-ods 98 patients with HF who received treatment in Chengdu Wenjiang District People's Hospital from January 2021 to October 2023 were retrospectively selected for the study.According to the different therapeutic effects,the patients were divided into effective group(n=61)and ineffective group(n=37).The laboratory indexes of the effective group and the ineffective group were compared.The polymorphism,genotype and allele distribution of TNF-α gene(rs1799964)and CRP gene(rs2794521)were analyzed.Multiple regression model was used to analyze the risk factors affecting the efficacy of dagaglizin in the treatment of HF.The association between TNF-α gene(rs1799964)and CRP gene(rs2794521)and cardiac function index was analyzed.To analyze the interaction between TNF-α polymorphism(rs1799964)and CRP polymorphism(rs2794521)on the efficacy of daglipzin in the treatment of HF.Results The frequencies of CC genotype,CT genotype and C allele of TNF-α gene(rs1799964)in ineffective group were 24.32%(9/37),54.05%(20/37)and 51.35%(38/74),respectively,which were higher than those in effective group 11.48%(7/61),40.98%(25/61)and 31.97%(39/122),the differences were statistically significant(χ2=7.284,7.256,7213,all P<0.05).The frequencies of CC genotype and C allele of CRP gene(rs2794521)in ineffective group were 24.32%(9/37)and 47.30%(35/74),respectively,which were higher than those in effective group 6.56%(4/61)and 28.69%(35/122),and the differences were statistically significant(χ2=7.578,6.947,all P<0.05).In the dominant mode and in the cumula-tive mode in the association between TNF-α gene(rs1799964)and CRP gene(rs2794521)was statistically significant(all P<0.05).TNF-α gene(rs1799964)CC genotype(β=1.134,95%CI:1.028～1.964),CRP gene(rs2794521)CT genotype(β=1.357,95%CI:1.239～2.154),CC genotype(β=2.017,95%CI:1.674～4.231)were independent risk factors for the efficacy of daglipzin in treating HF(all P<0.05).The association differences between TNF-α gene(rs1799964)and CRP gene(rs2794521)polymorphism and left ventricular end-systolic dimension(LVESd),left ventricular end diastolic dimension(LVEDd),left ventric-ular ejection fractions(LVEF)and stroke volume(SV)in additive and dominant models were statistically significant(all P<0.05).There were multiplicative and additive interactions between TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC(all P<0.05).Conclusion The TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC have a multiplicity and additional interaction,and the risk of daglaglizin in treating heart failure is higher when these two factors coexist.

Objective To explore the effect of tumor necrosis faction-α(TNF-α)gene rs1799964 and C-reactive protein(CRP)gene rs2794521 polymorphism and their interaction on the therapeutic effect of dagliaglozin in patients with heart failure.Meth-ods 98 patients with HF who received treatment in Chengdu Wenjiang District People's Hospital from January 2021 to October 2023 were retrospectively selected for the study.According to the different therapeutic effects,the patients were divided into effective group(n=61)and ineffective group(n=37).The laboratory indexes of the effective group and the ineffective group were compared.The polymorphism,genotype and allele distribution of TNF-α gene(rs1799964)and CRP gene(rs2794521)were analyzed.Multiple regression model was used to analyze the risk factors affecting the efficacy of dagaglizin in the treatment of HF.The association between TNF-α gene(rs1799964)and CRP gene(rs2794521)and cardiac function index was analyzed.To analyze the interaction between TNF-α polymorphism(rs1799964)and CRP polymorphism(rs2794521)on the efficacy of daglipzin in the treatment of HF.Results The frequencies of CC genotype,CT genotype and C allele of TNF-α gene(rs1799964)in ineffective group were 24.32%(9/37),54.05%(20/37)and 51.35%(38/74),respectively,which were higher than those in effective group 11.48%(7/61),40.98%(25/61)and 31.97%(39/122),the differences were statistically significant(χ2=7.284,7.256,7213,all P<0.05).The frequencies of CC genotype and C allele of CRP gene(rs2794521)in ineffective group were 24.32%(9/37)and 47.30%(35/74),respectively,which were higher than those in effective group 6.56%(4/61)and 28.69%(35/122),and the differences were statistically significant(χ2=7.578,6.947,all P<0.05).In the dominant mode and in the cumula-tive mode in the association between TNF-α gene(rs1799964)and CRP gene(rs2794521)was statistically significant(all P<0.05).TNF-α gene(rs1799964)CC genotype(β=1.134,95%CI:1.028～1.964),CRP gene(rs2794521)CT genotype(β=1.357,95%CI:1.239～2.154),CC genotype(β=2.017,95%CI:1.674～4.231)were independent risk factors for the efficacy of daglipzin in treating HF(all P<0.05).The association differences between TNF-α gene(rs1799964)and CRP gene(rs2794521)polymorphism and left ventricular end-systolic dimension(LVESd),left ventricular end diastolic dimension(LVEDd),left ventric-ular ejection fractions(LVEF)and stroke volume(SV)in additive and dominant models were statistically significant(all P<0.05).There were multiplicative and additive interactions between TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC(all P<0.05).Conclusion The TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC have a multiplicity and additional interaction,and the risk of daglaglizin in treating heart failure is higher when these two factors coexist.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

Objective:To analyze the safety of reduced clinical target volume (CTV) irradiation of suspicious positive lymph nodes in IIa region in patients with N 0-N 1 nasopharyngeal carcinoma (NPC) and the protective effect of submandibular gland and long-term resting dry mouth, and to explore the diagnostic value of multimodal imaging for suspicious cervical lymph nodes. Methods:Clinical data of T 0-4N 0-1M 0 stage NPC patients admitted to Jiangsu Cancer Hospital from July 2015 to April 2017 were retrospectively analyzed. Clinical, radiation therapy planning, multimodal imaging and other relevant data were collected. All patients were treated with an optimized regimen of IMRT with a prophylactic radiation dose of 50.4 Gy (named as CTV50) for IIa region. Imaging characteristics and treatment response of suspicious lymph nodes were monitored by MRI, MRI-DWI, PET-CT and repeated enhanced positioning CT, etc. The dosimetry of the submandibular gland between optimized and standard dose plans (CTV50 vs. CTV60) was compared by paired t-test. The long-term dry mouth degree of the patients was evaluated using advanced radiation injury from Radiation Therapy Oncology Group (RTOG), Jiangsu Cancer Hospital Multi-dimensional Dry Mouth Evaluation Scale and summated xerostomia inventory (SXI). The difference of dry mouth degree was analyzed by rank-sum test. Results:A total of 106 patients were included in this study, including 149 cervical lymph node negative sides, 73 sides of which had ≤3 recognizable lymph nodes, and 76 of which were>3 in Ⅱa region. Among patients with N 1 stage, 63 patients underwent contralateral single neck area optimization, and 43 patients (N 0 stage and N 1 stage patients with retropharyngeal lymph node metastasis) underwent double-neck area optimization. A total of 109 suspicious lymph nodes with a short diameter of >5 mm were found on the largest cross section, of which 105 had clear portal structure. The ratio of long to short diameter was ≥1.5 in 93 cases, and the maximum standardized uptake value (SUV max) in PET-CT was ≥2.5 in 76 cases. No lymph node recurrence was found in the CTV optimized area. There was no significant difference in the average dose of GTV in tumor target area after optimization ( P>0.05), and the D mean and V 39 Gy in submandibular gland were significantly lower than those in unoptimized plan (both P<0.01). There was no significant difference in long-term dry mouth and resting dry mouth between patients with unilateral and bilateral optimization of submandibular gland (both P>0.05). Conclusions:The optimal program of CTV50 reduction irradiation in Ⅱa area of N 0-N 1 NPC patients is safe and effective. The submandibular gland has obvious dosimetric advantages, and patients have a good subjective response to resting dry mouth. The multimodal imaging tools such as enhanced CT, MRI-DWI and PET-CT should be performed to deliver individual evaluation and treatment for suspicious lymph nodes.

The promise of regeneration therapy for restoration of damaged myocardium after cardiac ischemic injury relies on targeted delivery of proliferative molecules into cardiomyocytes whose healing benefits are still limited owing to severe immune microenvironment due to local high concentration of proinflammatory cytokines. Optimal therapeutic strategies are therefore in urgent need to both modulate local immunity and deliver proliferative molecules. Here, we addressed this unmet need by developing neutrophil-mimic nanoparticles NM@miR, fabricated by coating hybrid neutrophil membranes with artificial lipids onto mesoporous silica nanoparticles (MSNs) loaded with microRNA-10b. The hybrid membrane could endow nanoparticles with strong capacity to migrate into inflammatory sites and neutralize proinflammatory cytokines and increase the delivery efficiency of microRNA-10b into adult mammalian cardiomyocytes (CMs) by fusing with cell membranes and leading to the release of MSNs-miR into cytosol. Upon NM@miR administration, this nanoparticle could home to the injured myocardium, restore the local immunity, and efficiently deliver microRNA-10b to cardiomyocytes, which could reduce the activation of Hippo-YAP pathway mediated by excessive cytokines and exert the best proliferative effect of miR-10b. This combination therapy could finally improve cardiac function and mitigate ventricular remodeling. Consequently, this work offers a combination strategy of immunity modulation and proliferative molecule delivery to boost cardiac regeneration after injury.

Objective:To explore the therapeutic effect of Jianpi Huoxue Jiedu recipe on upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin internal knot type after modified radical surgery for breast cancer.Methods:From January 2020 to May 2022, a total of 60 patients with upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin internal knot type after modified radical surgery for breast cancer were selected and treated in Longyan Hospital of Traditional Chinese Medicine Affiliated to Xiamen University. They were divided into control group and observation group according to random number table, with 30 cases in each group. The control group was treated with routine western medicine comprehensive swelling reduction surgery, while the observation group was treated with a combination of Jianpi Huoxue Jiedu recipe (1 dose/day, warmly-taken in the morning and evening) for one month on the basis of the control group. The clinical efficacy, traditional Chinese medicine (TCM) syndrome score, edema diameter, breast cancer quality of life scale (FACT), and joint range of motion were compared between the two groups after treatment.Results:After one month of treatment, the total clinical effective rate of the observation group (93.33%) was significantly higher than that of the control group (70.00%, P<0.05). After treatment, the TCM syndrome scores (upper limb swelling, pain, fullness, sense of restraint, skin keratinization, itching, heaviness, stuffiness, and fatigue) of both groups of patients decreased compared to those before treatment, and the observation group was lower than the control group (all P<0.05). After treatment, the diameter of edema in the affected limbs was significantly reduced in both groups of patients, and the diameter of 10 cm above the wrist and elbow stripes in the observation group was smaller than that in the control group (all P<0.05). After treatment, the FACT scores of the two groups of patients significantly decreased, and the FACT scores of the observation group were lower than those of the control group (all P<0.05). After treatment, the joint activity of the two groups of patients significantly increased, and the joint activity of the observation group was greater than that of the control group (all P<0.05). Conclusions:The clinical efficacy of Jianpi Huoxue Jiedu recipe combined with western medicine in treating upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin accumulation type after modified radical operation of breast cancer is better than that of western medicine alone. It can significantly improve the clinical symptoms, signs, quality of life, and joint mobility of upper limbs of patients, and reduce upper limb edema.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.

Objective To study the effect of hemilaminectomy, total laminectomyand recapping laminoplasty on stability of the cervical spine. Methods Fourteen fresh adult sheep cervical spine specimens were divided into two groups, with 7 cases in each group. Each specimen was applied with a pure moment load of 3.0 N·m under flexion/extension, left/right lateral bending, and left/right axial rotation. The range of motion (ROM) and neutral zone (NZ) of specimens were measured. In the first group, the ROMs and NZs of the specimens were measured and compared under the intact state, C5 hemilaminectomy state and C4-6 hemilaminectomy state respectively. In the second group, the ROMs and NZs of specimens under the intact state, C4-6 total laminectomy state and C4-6 recapping laminoplasty state were measured and compared. Results There were no significant differences in ROMs and NZs between C5 hemilaminectomy state and C4-6 hemilaminectomy state compared with the intact state (P<0.05). Compared with the intact state, ROMs of the specimens were significantly increased during flexion and extension under C4-6 laminectomy state and C4-6 recapping laminoplasty state (P<0.05). In addition, compared with the C4-6 laminectomy state, ROMs of the specimen were significantly decreased only during extension unde C4-6 recapping laminoplasty state (P<0.05), while no significant differences were found in ROMs between total laminectomy and laminoplasty under other loads. Conclusions With hemilaminectomy, ROMs and NZs of the cervical spine did not increase significantly, and stability of the cervical spine was not affected. With C4-6 total laminectomy, ROMs and NZs during flexion and extension increased significantly, and stability of the cervical spine was affected. Recapping laminoplasty did not significantly improve stability of the cervical spine with total laminectomy.