Objective To observe the clinical effect of Huangqi Yixin Decoction combined with sacubitril/valsartan in treatment of patients with heart failure with preserved ejection fraction(HFpEF)of Qi deficiency and blood stasis type.Methods A total of 86 patients with HFpEF of Qi deficiency and blood stasis type were randomly divided into western medicine group and combination group using the random number table method,with 43 cases in each group.The western medicine group was trea-ted with sacubitril/valsartan sodium tablets on the basis of conventional anti-heart failure therapy,while the combination group was additionally treated with Huangqi Yixin Decoction on the basis of the western medicine group's treatment.The therapeutic efficacy,traditional Chinese medicine(TCM)syndrome scores,cardiac function indicators[Tei index,N-terminal pro-brain natriuretic peptide(NT-proBNP)],exercise tolerance[6-minute walk distance(6MWD),maximum exercise heart rate,metabolic equivalent(MET)],and the occurrence of adverse reactions were compared between the two groups.Results The overall clinical effective rate in the combination group was 93.02％,which was higher than that in the western medicine group(76.74％),and the difference was statistically significant(P＜0.05).After treatment,the TCM syndrome scores in both groups were lower than those before treatment,and the scores in the combination group were lower than those in the western medicine group,with a statistically significant difference(P＜0.05).After treatment,the levels of Tei index and NT-proBNP in both groups were lower than those before treatment,and the levels in the combination group were lower than those in the western medicine group,with a statistically sig-nificant difference(P＜0.05).After treatment,the 6MWD,maximum exercise heart rate,and MET in both groups were higher than those before treatment,and the values in the combination group were higher than those in the western medicine group,with a statistically significant difference(P＜0.05).The incidence of adverse reactions in the western medicine group was 18.60％,which was higher than that in the combination group(4.65％),and the difference was statistically signifi-cant(P＜0.05).Conclusion Huangqi Yixin Decoction combined with sacubitril/valsartan has a good therapeutic effect on HFpEF of Qi deficiency and blood stasis type.It can reduce the TCM syn-drome scores of patients,improve exercise tolerance,and has good safety.

BACKGROUND:The maximum muscle strength is typically used for evaluating the recovery of muscle function after anterior cruciate ligament reconstruction.Recent studies have suggested that neuromuscular function should also be considered,such as rate of force development,which measures the slope of the force time curve at different time intervals under conditions of isometric muscle contraction. OBJECTIVE:To elaborate on the current research status and shortcomings of muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction surgery,and analyze the degree of defects in quadriceps femoris and hamstring isometric rate of force development at different times after surgery;to analyze the effect of isometric rate of force development on postoperative functional performance,thereby providing important information for optimizing postoperative rehabilitation following anterior cruciate ligament reconstruction,reducing secondary injury to patients,and reducing the incidence of knee osteoarthritis. METHODS:Literature retrieval of CNKI,VIP,WanFang and PubMed was performed using"anterior cruciate ligament,rate of force development"as Chinese search terms and"anterior cruciate ligament,rate of force development,rate of torque development"as English search terms.Finally,69 articles were included according to inclusion and exclusion criteria. RESULTS AND CONCLUSION:Most studies have found defects in bilateral muscle isometric rate of force development in patients undergoing anterior cruciate ligament reconstruction within 6 months.Early isometric rate of force development of the bilateral hamstring muscles(i.e.the slope of the force time curve at any time interval during muscle contraction of 100 ms)showed significant improvement after 6 months.However,long-term defects in early isometric rate of force development of the bilateral quadriceps indicate long-term damage to the neuromuscular function of the quadriceps after surgery.There is limited research on late isometric rate of force development(the slope of the force time curve at any time interval after 100 ms of muscle contraction),and conclusions cannot be drawn.Regarding landing exercises(jumping to the ground,lateral cutting,etc.)and daily activities(walking,running),early isometric rate of force development of the quadriceps is more correlated with isometric peak torque.Abnormal biomechanical changes during exercise are considered an important risk factor for secondary injury and traumatic knee osteoarthritis in patients.Actively improving early isometric rate of force development of the quadriceps may reduce the incidence of secondary injury and traumatic knee osteoarthritis.Currently,there is limited evidence to suggest that whole-body vibration training can improve early isometric rate of force development of the quadriceps femoris in patients undergoing anterior cruciate ligament reconstruction.It is recommended to use neuromuscular electrical stimulation to intervene in the quadriceps and hamstring in the early postoperative stage and implement explosive force and high resistance training in the late postoperative stage,which may improve the isometric rate of force development in patients.Generating sufficient muscle strength in a short period of time is necessary to effectively protect the anterior cruciate ligament,while the relationship between isometric rate of force development in the hamstring muscle and functional performance is still unclear,which may provide information on preventing secondary injury in patients.It is recommended to use the isometric rate of force development as one of the evaluation indicators for guiding rehabilitation and restoring movement.In addition to focusing on improving symmetry and differences from normal individuals,the hamstring to quadriceps strength ratio should also be considered.An appropriate range of ratios can ensure the balance of muscles during rapid muscle exertion,which may reduce the occurrence of secondary injuries.However,the normal range of ratios is not yet clear.Future research should consider the effects of graft type and knee flexion angle on isometric rate of force development,in order to identify neuromuscular dysfunction in patients as much as possible and help them recover better.

Objective:To evaluate the effects of different imaging frequencies and matching strategies of cone-beam computed tomography (CBCT) on dose-volume parameters in target and organs at risk (OAR) during image-guided radiotherapy for prostate cancer.Methods:A total of 561 sets of CBCT images from 21 patients treated with radical prostate radiotherapy who were admitted to Peking University First Hospital from June 2022 to May 2023 were retrospectively analyzed. All patients received volumetric intensity modulated arc therapy (VMAT) at a prescribed dose of 70 Gy divided into 25 times, 2.8 Gy per time. Clinical target volume (CTV) and OAR were delineated by the same oncologist on each CBCT image. The planned CT (pCT) was rigorously registered to CBCT after calibration of positioning errors according to different image guidance modes and frequencies, and CT values and structures were propagated to CBCT through deformable image registration (DIR). The daily dose was mapped to pCT according to the deformation vector field (DVF) for dose accumulation. The actual cumulative dose of daily online CBCT validation was compared with the weekly CBCT validation regimen (days 1, 2, 3, 6, 11, 16 and 21 online imaging). The dosimetric comparison was also made between bone-based matching and soft tissue-based matching (after automatic bone-based matching, manual prostate-based matching was performed and fine-tuning was made regarding the anterior wall of rectum). Wilcoxon signed rank-sum test was utilized to analyze dose-volume parameters between planned and cumulative doses that exhibited non-normal distribution, while paired t-test was employed for assessing shift values and average dose parameters that demonstrated normal distribution. Results:Compared with daily CBCT image guidance, the CTV_D 98% in weekly CBCT was significantly reduced [(69.08±1.58) vs. (65.24±3.64) Gy, P<0.001]. The CTV_D 98% of bone-based matching was (69.27±2.14) Gy, but the high-dose volume of the rectum were significantly increased: V 60 Gy was 3.18%±3.10%, V 65 Gy was 0.77%±1.23%. The target area coverage using soft tissue-based matching is sufficient, with a CTV_D 98% of (69.08±1.58) Gy. And the percentage volume of high-dose volume of the rectum was significantly reduced, with V 60 Gy being 2.02%±2.42% and V 65 Gy being 0.34%±0.68%. Conclusions:In prostate cancer patients undergoing moderately-fractionated radiotherapy, daily CBCT image guidance demonstrates superior target coverage compared to a weekly scheme. Soft tissue-based matching, which is automatic bone-based matching followed by manual soft tissue-based matching and fine-tuning according to the anterior rectal wall, offers better rectal protection while maintaining target coverage.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To compare the efficacy and safety of standard treatment with or without adjuvant chemotherapy in patients with highly malignant non-metastatic prostate cancer.Methods:In this prospective non-randomized controlled study, consecutive non-metastatic prostate cancer patients with pathologically proven Gleason score of 9-10 or Gleason score of 5 admitted to Peking University First Hospital were enrolled. Four to six cycles of chemotherapy using docetaxel ± carboplatin regimen were added or not after standard radical therapy. The primary end point was 5-year event-free survival (EFS), and the secondary end points were distant metastasis-free survival (MFS), overall survival (OS), and treatment-related adverse events. The survival curve was drawn by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test.Results:A total of 176 patients were consecutively enrolled from November 2019 to January 2022 of which 138 patients received only standard radical therapy (control group), and 38 patients received adjuvant chemotherapy after standard radical therapy (chemotherapy group). The median follow-up time was 13.4 (2.0-34.0) months. All patients survived. The 30-month EFS rates in the chemotherapy and control groups were 100% and 85.6%, respectively ( P=0.064). There were no events in the chemotherapy group, while there were 12 cases of events in the control group, including 6 cases of biochemical recurrence and 6 cases of imaging progression. The 30-month MFS rates in two groups were 100% and 91.9%, respectively ( P=0.205). After the 1 vs. 2 propensity score matching, the EFS and MFS rates in two groups were 100% vs. 85.7% ( P=0.056), and 100% vs. 92.2% ( P=0.209), respectively. The incidence rates of grade 2 and above urinary toxicity in the chemotherapy and control groups were 2.6% and 7.2% ( P=0.354), respectively. The incidence rates of grade 2 and above rectal toxicity were 5.3% and 5.1% ( P=0.711), respectively. Grade 3 and above chemotherapy-related toxicity in the chemotherapy group were leukopenia (31.6%), thrombocytopenia (2.6%) and alopecia (13.2%). Conclusion:The addition of adjuvant chemotherapy after standard radical therapy tends to improve the overall EFS of patients with highly malignant prostate cancer, and the adverse effects are tolerable, which should be confirmed by long-term follow-up results.

Objective:Partial stereotactic ablative boost radiotherapy(P-SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ-at-risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non-small cell lung cancer(the tumor length greater than 8 cm).Methods:Nine patients with bulky NSCLC treated with photon P-SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity-modulated radiation treatment plan(proton-IMPT), a photon intensity-modulated radiation treatment plan(photon-IMRT)and a photon volumetric modulated arc therapy(photon-VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared.Results:The volume ratio of GTVb-photon and GTVb-proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively( P<0.001). In photon-IMRT, photon-VMAT, and proton-IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton-IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton-IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon-IMRT, photon-VMAT and proton-IMPT, respectively(all P<0.001). Conclusions:Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P-SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.

Objective:To investigate the efficacy and safety of radiotherapy for all metastases in patients with metachronous oligo-metastatic prostate cancer after radical treatment.Methods:From October 2011 to February 2021, 41 patients with prostate cancer with less than 5 metastases after radical treatment were retrospectively analyzed in a single center. The median age at radiotherapy was 68 (57-81) years. Forty patients (98%) received androgen deprivation therapy (ADT). There were 28 patients in the hormone sensitive (HSPC) group and 13 patients in the hormone resistant (CRPC) group. The median initial PSA was 24.4 (7.4-399.0) ng/ml. Tumor stage: T 2 stage 11 patients, T 3 stage 27 patients, T 4 stage 3 patients.30 patients were in N 0 stage and 11 patients in N 1 stage. Gleason score was 7 in 12 patients, 8 in 9 patients, 9 in 18 patients, and 10 in 2 patients.33 patients were treated with surgery, and 8 patients were treated with radiotherapy. The time span from diagnosis to metastasis was 3.1 (0.2-1.8) years. Conventional imaging examination (CT/ MRI/bone scan) before radiotherapy was used in 7 patients, and PSMA PET/CT examination was used in 34 patients.The median PSA before radiotherapy was 1.3(0.1-33.8) ng/ml. There were 62 metastases in 41 patients, including 1 lesion in 28 patients, 2 lesions in 9 patients, 3 lesions in 2 patients, and 5 lesions in 2 patients. Fifty-four patients had bone metastases and eight had retroperitoneal lymph node metastases. Twenty-two bone metastases were located in the pelvis, 18 in the vertebral body, 12 in the ribs, one in the femur and one in the sternum.The median metastatic volume was 5.8(0.2-81.7) cm 3.Daily image-guided rotational intensity modulated radiotherapy was used to cover all metastases.Dose segmentation modes include 37.5Gy/7.5Gy/5F, 60Gy/3Gy/20F, 65-70Gy/2.6-2.8Gy/25F.The median biological effective dose (BED 3) was 120 (67-147) Gy. The primary endpoint was biochemical progression-free survival (BPFS), the secondary endpoints were acute and late toxic side effects, local relapse-free survival (LPFS), and overall survival (OS). Results:The median follow-up time was 21 months (range 5-72 months). All patients completed radiotherapy, and 16 patients had grade 1 to 2 acute toxicity and side effects, and no grade 3 or above acute and late stage side effects. 1-year LPFS was 97.1%.The 1-year and 2-year BPFS were 77.5% and 59.2%, respectively. The median BPFS time was 29 months (range 13.9-44.2 months). Univariate analysis showed that the HSPC group ( P<0.001) and the group with total metastatic volume ≤ 5.8cm 3 ( P=0.010) had higher BPFS. The median BPFS time was 37 months in the retroperitoneal lymph node metastases subgroup and 17 months in the bone metastases subgroup ( P=0.141). In the HSPC group, the median BPFS was 30(22-38) months. After radiotherapy, PSA decreased in all 28 patients, and increased in 6 patients. The median BPFS was 12(4-18) months. In the CRPC group, the median BPFS was 4(0-8) months. PSA decreased in 10 patients (76.9%) after radiotherapy, and PSA decreased in 6 patients. The median BPFS was 5(3-28) months. Three patients’PSA did not decrease after radiotherapy, and they were treated with new endocrine therapy drugs, chemotherapy, immunotherapy and other systemic therapy. Conclusions:For patients with metachronous metastases after radical treatment, full coverage radiotherapy has good safety and high local control rate. HSPC patients and patients with low tumor load could be recommended to receive radiotherapy for all metastatic lesions preferentially, and patients with only retroperitoneal lymph node metastases may have better prognosis after radiotherapy than patients with bone metastases.

Objective:To evaluate the efficacy of 125I interstitial brachytherapy in the treatment of local advanced parotid adenoid cystic carcinoma (ACC), and to analyze prognostic factors affecting treatment outcome, in order to provide references for the treatment of local advanced parotid adenoid cystic carcinoma. Methods:Patients with histology-confirmed ACC of the parotid who received 125I interstitial brachytherapy in Peking University Hospital of Stomatology between Aug 2007 and Jan 2018 were included.Prognostic factors affecting overall survival (OS), progression-free survival (PFS), and local control rate (LCR) were analyzed.Meanwhile, distant metastases as well as acute and long-term radiological toxicities were described. Results:A total of 16 patients (11 females, mean age 55.4 years) of stage cT 4bN 0M 0 who received definitive 125I interstitial brachytherapy were included.The median follow-up period was 41.5 months (8-104 months), and the 1-, 3- and 5-year OS were 86.7%, 72% and 54%, respectively.Five patients suffered from local recurrence, the 1-, 3- and 5-year LCR were 93.7%, 80% and 68.7%, respectively, and the 1-, 3- and 5-year PFS were 74%, 53%, and 18.9%, respectively.Nine cases developed distant metastases.Among them, intracranial and pulmonary metastases took place the most frequently and six patients who had skull base invasion developed multi-organ metastases.An encased carotid artery was an independent prognostic factor for distant metastases (HR=12, P=0.045). Severe radiological toxicities were observed in eight patients (8/16, 50%), including radio-dermatitis, hearing loss, progressive trismus, and eye toxicities. Conclusions:The 5-year LCR in patients treated with definitive 125I interstitial brachytherapy for local advanced ACC of the parotid was 68.7%, and skull base invasion and an encased carotid artery were independent adverse prognostic factors of bad prognosis and multi-organ metastases.