Objective To investigate the current distribution of radiotherapy resources in Gansu Province, evaluate the equity of resource allocation, and provide a scientific basis for optimizing regional resource allocation. Methods A questionnaire survey was carried out to assess radiotherapy resources in medical institutions across Gansu Province, China. The equity of radiotherapy resource distribution and associated disparities were assessed using the Gini coefficient, Lorenz curve, and Theil index. Results A total of 23 medical institutions in Gansu Province provided radiotherapy services, comprising 39 radiotherapy devices and 438 professionals, of whom medical physicists accounted for 16.9%. The radiotherapy frequency was 0.47 cases per thousand population. The Gini coefficients for radiotherapy resource distribution ranged from 0.38 to 0.56 by population and from 0.52 to 0.70 by geography. The Theil index for radiotherapy resources ranged from 1.36 to 3.67. Conclusion Radiotherapy resources in Gansu Province were insufficient, and the capacity of radiotherapy service was suboptimal. The equity of radiotherapy resource allocation by geography was worse than that by population. Therefore, it is imperative to address the shortage of radiotherapy resources, strengthen the professional workforce, enhance the capacity radiotherapy service and resource utilization, optimize resource allocation, and promote regional equity in radiotherapy provision in Gansu Province.

This study summarizes Professor Qin Zhenhua's clinical experience in treating cutaneous pruritus using a modified self-prescribed formula,Yinqiao Xingzi Decoction.Following the viewpoints from the classical Chinese medical literature and after years of clinical practice,Professor Qin proposes that the onset of cutaneous pruritus is often associated with the attack of exogenous pathogens,disharmony of qi and blood,or debility due to prolonged illness.The disease primarily involves the skin,with the fundamental pathogenesis of pathogens stagnating in the muscular superficies.Clinically,the treatment is frequently conducted from the perspective of fire-heat syndrome,and the therapeutic methods of clearing heat and removing toxins,releasing muscles and dispersing pathogens from the superficies,and dispelling wind to relieve itching are utilized.The approaches aim to cool heat in the blood,expel pathogens from the muscular layer,eliminate heat for stopping itching,and extinguish wind for calming the skin.The basic prescription,Yinqiao Xingzi Decoction(composed of Lonicerae Japonicae Flos,Forsythiae Fructus,Armeniacae Semen Amarum,Arnebiae Radix,Tribuli Fructus,Dictamni Cortex,Kochiae Fructus,and Glycyrrhizae Radix et Rhizoma),is used by modification depending on the predominance of pathogenic factors of wind,heat,dryness,or dampness-toxins,and according to the various syndromes like blood-heat,yin deficiency,or qi-blood deficiency.Yinqiao Xingzi Decoction is applicable to cutaneous pruritus with the most of clinical common syndrome types,but it is unsuitable for cases caused by yang deficiency or qi stagnation with blood stasis.

Objective:To investigate the feasibility and optimal expansion width of replacing the left anterior descending coronary artery (LADCA) with the region of heart sparing (RHS) to reduce cardiac radiation dose during breast cancer radiotherapy.Methods:Retrospective analysis was conducted on data from 88 patients with left-sided breast cancer who underwent radiotherapy at 2 centers: Nanfang Hospital of Southern Medical University (50 cases for the training set, 15 cases for the internal test set) and Ganzhou Hospital of Nanfang Hospital (23 cases for the external test set) from March 2022 to January 2024. All patients had left-sided invasive ductal carcinoma with axillary lymph node metastasis, and had undergone modified radical mastectomy and chemotherapy. Based on simulation CT images, 2 radiation oncologists delineated the LADCA and 8 RHSs. The RHSs were delineated by expanding the LADCA contour by 0.5 cm increments, totaling 8 expansions. The RHS widths were defined as 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 cm. The nnU-Net model was trained for 3D automatic segmentation of the LADCA and RHSs. Model performance was evaluated using the Dice similarity coefficient (DSC), relative volume error (RVE), sensitivity, specificity, and 95% Hausdorff distance (HD95). Additionally, the minimum, maximum, and average relative dose variations (RDV) as well as V5% and V20% indicators were calculated for the LADCA and each RHS. Correlation analysis was performed using the least squares regression, with the slope and coefficient of determination ( R2) employed to evaluate the accuracy of the model fitting, the relationship between the LADCA and RHS, and the degree of their correlation, thereby assessing the substitutive effect of the RHS for the LADCA. Results:The DSC for the LADCA was 0.415, while the DSCs for RHS widths of 0.5 cm and 4.0 cm were 0.718 and 0.835, respectively. Overall, the automatic segmentation performance improved with increasing RHS width. The DSC, RVE, sensitivity, specificity, and HD95 for the external test set were largely consistent with those of the internal test set, demonstrating the model's good robustness across different datasets. All RDVmin values were negative, while RDVmax and RDVmean showed a positive correlation with RHS width. RDVmean increased from 39.01% to 75.89% as the RHS width increased. In the correlation analysis, the slopes for RHS widths of 1.5 cm and 2.0 cm were 0.95 and 1.05, respectively, with R2 values and coefficients of variation of 0.79 and 0.73, and 21.11% and 24.03%, respectively. Conclusions:The automatic segmentation model trained on nnU-Net can accurately segment RHSs. Based on geometric and dosimetric indicators, a 1.5 cm-wide RHS is the most suitable substitute for the LADCA, effectively limiting the radiation dose to the LADCA without compromising target dose coverage.

Objective:To investigate the feasibility and optimal expansion width of replacing the left anterior descending coronary artery (LADCA) with the region of heart sparing (RHS) to reduce cardiac radiation dose during breast cancer radiotherapy.Methods:Retrospective analysis was conducted on data from 88 patients with left-sided breast cancer who underwent radiotherapy at 2 centers: Nanfang Hospital of Southern Medical University (50 cases for the training set, 15 cases for the internal test set) and Ganzhou Hospital of Nanfang Hospital (23 cases for the external test set) from March 2022 to January 2024. All patients had left-sided invasive ductal carcinoma with axillary lymph node metastasis, and had undergone modified radical mastectomy and chemotherapy. Based on simulation CT images, 2 radiation oncologists delineated the LADCA and 8 RHSs. The RHSs were delineated by expanding the LADCA contour by 0.5 cm increments, totaling 8 expansions. The RHS widths were defined as 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 cm. The nnU-Net model was trained for 3D automatic segmentation of the LADCA and RHSs. Model performance was evaluated using the Dice similarity coefficient (DSC), relative volume error (RVE), sensitivity, specificity, and 95% Hausdorff distance (HD95). Additionally, the minimum, maximum, and average relative dose variations (RDV) as well as V5% and V20% indicators were calculated for the LADCA and each RHS. Correlation analysis was performed using the least squares regression, with the slope and coefficient of determination ( R2) employed to evaluate the accuracy of the model fitting, the relationship between the LADCA and RHS, and the degree of their correlation, thereby assessing the substitutive effect of the RHS for the LADCA. Results:The DSC for the LADCA was 0.415, while the DSCs for RHS widths of 0.5 cm and 4.0 cm were 0.718 and 0.835, respectively. Overall, the automatic segmentation performance improved with increasing RHS width. The DSC, RVE, sensitivity, specificity, and HD95 for the external test set were largely consistent with those of the internal test set, demonstrating the model's good robustness across different datasets. All RDVmin values were negative, while RDVmax and RDVmean showed a positive correlation with RHS width. RDVmean increased from 39.01% to 75.89% as the RHS width increased. In the correlation analysis, the slopes for RHS widths of 1.5 cm and 2.0 cm were 0.95 and 1.05, respectively, with R2 values and coefficients of variation of 0.79 and 0.73, and 21.11% and 24.03%, respectively. Conclusions:The automatic segmentation model trained on nnU-Net can accurately segment RHSs. Based on geometric and dosimetric indicators, a 1.5 cm-wide RHS is the most suitable substitute for the LADCA, effectively limiting the radiation dose to the LADCA without compromising target dose coverage.

AIM: To observe the changes of corneal densitometry(CD)in patients with keratoconus after corneal cross-linking(CXL).METHODS: Retrospective study. A total of 32 patients(43 eyes)with keratoconus in Ningxia Eye Hospital from April 2020 to April 2022 were selected. Pentacam analysis system divided the cornea into three layers: anterior 120 μm, middle layer and posterior 60 μm, and divides it into five regions with diameters of 0-2, 2-6, 6-10, 10-12 mm and full diameter according to the diameter, and measures the CD in different ranges. The changes of CD were compared before operation and at 1, 3 and 6 mo after operation.RESULTS: There were differences in uncorrected visual acuity, best corrected visual acuity and intraocular pressure before and 6 mo after operation(all P<0.05), and there was no difference in corneal endothelial cells(P=0.477). CD reached its peak at 1 mo after operation, and decreased at 3 mo and 6 mo after operation, but it was still higher than that before operation. There is a significant positive correlation between CD and Kmax in the anterior layer and the whole layer(r=0.164, P=0.016; r=0.152, P=0.023).CONCLUSION: The values of CD peaked at 1 mo after CXL, then it gradually decreased, tending to become stable at 6 mo postoperatively.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

Objective:To investigate the effect and mechanism of human umbilical cord mesenchymal stem cells (hUCMSCs) transplantation on testicular function in aging mice with oxidative damage.Methods:Totally 18 SPF grade C57BL/C male mice aged 6-8 weeks were randomly divided into 3 groups using a complete randomization method. In control group, mice were injected with an equal amount of physiological saline; in model group, mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with physiological saline via the tail vein; in hUCMSCs group: mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with hUCMSCs via the tail vein of each mouse. After 9 weeks, body weight and testicular weight of the three groups mice were measured and testicular index was calculated. The contents of testosterone, malondialdehyde (MDA) and superoxide dismutase (SOD) in serum and testicular tissue were detected by enzyme-linked immunosorbent assay (ELISA) method. Visual observation of testicular appearance, the histopathological changes of testis were observed by hematoxylin-eosin (HE) staining, and the expression of NF-E2-related factor 2 (Nrf2) signal transduction-related genes and proteins were detected by RT-PCR and Western blotting, respectively.Results:Compared with control group [(0.81±0.13)%], the testicular index of mice in model group [(0.64±0.05)%, P=0.006] was decreased. In model group, the volume of testis was reduced, the integrity of spermatogenic tubules was damaged, spermatogenic cells and sperm were reduced, and the interstitium was sparse. In model group, serum testosterone [(4.10±0.67) μg/L] and SOD [(48.87±6.40) U/mg Prot] were decreased compared with control group [(5.71±0.81) μg/L, P=0.002; (78.53±9.70) U/mg Prot, P=0.001], MDA [(1.11±0.19) nmol/mg Prot] was increased compared with control group [(0.77±0.07) nmol/mg Prot, P=0.001], Keap1 mRNA and protein expression were increased ( P=0.006, P=0.043). The expression levels of Nrf2, SOD and NQO1 mRNA were significantly lower than those in control group ( P=0.002, P<0.001, P=0.001), and the expression levels of Nrf2 and HO-1 protein were significantly lower than those in control group ( P=0.011, P=0.021). Compared with the model group, the testicular index [(0.79±0.03)%, P=0.010] increased in hUCMSCs group, and the tissue structure of testis was clear and complete, spermatogenic cells at all levels of spermatogenic tubules, spermatogenic cells and stromal cells were abundant. Compared with the model group, the content of dihydrotestosterone [(5.24±0.21) μg/L, P=0.028] in serum and SOD [(79.47±14.32) U/mg Prot, P=0.001] in testicular tissue increased in hUCMSCs group, while the content of MDA [(0.77±0.08) nmol/mg Prot, P=0.001] decreased, Nrf2, SOD and NQO1 mRNA expression levels increased ( P=0.024, P=0.037, P=0.005), Keap1 mRNA expression decreased ( P=0.044), Nrf2 and HO-1 proteins expression increased ( P=0.009, P=0.012), while Keap1 protein expression decreased ( P=0.035). There were no statistically significant differences in testicular index, serum testosterone, SOD and MDA between hUCMSCs group and control group (all P>0.05). Conclusion:hUCMSCs significantly improve testicular structure and function damage caused by oxidative damage in aging mice, and the mechanism of action is related to upregulating Nrf2 signaling and downstream antioxidant activity SOD and HO-1 protein expression, reducing Keap1 mediated Nrf2 degradation.

Objective:To investigate the effectiveness of preeclampsia risk prediction models based on maternal risk factors during the first trimester in a local population.Methods:This was a diagnostic study. Pregnant women who underwent prenatal examination in People′s Hospital of Rizhao from May 2019 to May 2022 and had risk factors for preeclampsia were enrolled at 11-13 +6 weeks gestation, and were divided into preterm preeclampsia group, term preeclampsia group and non-preeclampsia group according to the occurrence and the gestational week. Baseline clinical data were collected. The effectiveness of different models in predicting preeclampsia risk was evaluated using receiver operating characteristic (ROC) curves. Results:Among the 559 pregnant women enrolled, 78(14.0%) had preeclampsia, including 35(6.3%) with preterm preeclampsia (preterm preeclampsia group), 43 (7.7%) with term preeclampsia (term preeclampsia group), and 481 (86.0%) without preeclampsia (non-preeclampsia group).The most effective model for predicting preterm preeclampsia in the first trimester was maternal risk factor+mean arterial pressure (MAP)+serum placental growth factor (PLGF)+uterine artery pulse index (UTPI). The area under ROC curve was 0.805, and the sensitivity was 56.6% with a false-positive rate of 10%; the most effective model for predicting term preeclampsia and preeclampsia was maternal risk factor+MAP+UTPI. The area under ROC curve was 0.777, and the sensitivity was 52.6% and 53.5% with a false-positive rate of 10%.Conclusion:The combined predicting strategy for preterm preeclampsia based on maternal risk factors in the first trimester maybe effective among our population.

Objective:To investigate the effect and mechanism of human umbilical cord mesenchymal stem cells (hUCMSCs) transplantation on testicular function in aging mice with oxidative damage.Methods:Totally 18 SPF grade C57BL/C male mice aged 6-8 weeks were randomly divided into 3 groups using a complete randomization method. In control group, mice were injected with an equal amount of physiological saline; in model group, mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with physiological saline via the tail vein; in hUCMSCs group: mice were subcutaneous injected D-galactose into the neck and back for 9 consecutive weeks, on the 4th weekend of modeling, the mice were injected with hUCMSCs via the tail vein of each mouse. After 9 weeks, body weight and testicular weight of the three groups mice were measured and testicular index was calculated. The contents of testosterone, malondialdehyde (MDA) and superoxide dismutase (SOD) in serum and testicular tissue were detected by enzyme-linked immunosorbent assay (ELISA) method. Visual observation of testicular appearance, the histopathological changes of testis were observed by hematoxylin-eosin (HE) staining, and the expression of NF-E2-related factor 2 (Nrf2) signal transduction-related genes and proteins were detected by RT-PCR and Western blotting, respectively.Results:Compared with control group [(0.81±0.13)%], the testicular index of mice in model group [(0.64±0.05)%, P=0.006] was decreased. In model group, the volume of testis was reduced, the integrity of spermatogenic tubules was damaged, spermatogenic cells and sperm were reduced, and the interstitium was sparse. In model group, serum testosterone [(4.10±0.67) μg/L] and SOD [(48.87±6.40) U/mg Prot] were decreased compared with control group [(5.71±0.81) μg/L, P=0.002; (78.53±9.70) U/mg Prot, P=0.001], MDA [(1.11±0.19) nmol/mg Prot] was increased compared with control group [(0.77±0.07) nmol/mg Prot, P=0.001], Keap1 mRNA and protein expression were increased ( P=0.006, P=0.043). The expression levels of Nrf2, SOD and NQO1 mRNA were significantly lower than those in control group ( P=0.002, P<0.001, P=0.001), and the expression levels of Nrf2 and HO-1 protein were significantly lower than those in control group ( P=0.011, P=0.021). Compared with the model group, the testicular index [(0.79±0.03)%, P=0.010] increased in hUCMSCs group, and the tissue structure of testis was clear and complete, spermatogenic cells at all levels of spermatogenic tubules, spermatogenic cells and stromal cells were abundant. Compared with the model group, the content of dihydrotestosterone [(5.24±0.21) μg/L, P=0.028] in serum and SOD [(79.47±14.32) U/mg Prot, P=0.001] in testicular tissue increased in hUCMSCs group, while the content of MDA [(0.77±0.08) nmol/mg Prot, P=0.001] decreased, Nrf2, SOD and NQO1 mRNA expression levels increased ( P=0.024, P=0.037, P=0.005), Keap1 mRNA expression decreased ( P=0.044), Nrf2 and HO-1 proteins expression increased ( P=0.009, P=0.012), while Keap1 protein expression decreased ( P=0.035). There were no statistically significant differences in testicular index, serum testosterone, SOD and MDA between hUCMSCs group and control group (all P>0.05). Conclusion:hUCMSCs significantly improve testicular structure and function damage caused by oxidative damage in aging mice, and the mechanism of action is related to upregulating Nrf2 signaling and downstream antioxidant activity SOD and HO-1 protein expression, reducing Keap1 mediated Nrf2 degradation.

Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.