Objective:To investigate the correlation between serum neuron-specific enolase (NSE) levels and poor neurological outcomes in cardiac arrest (CA) patients supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:This retrospective analysis was conducted on adult CA patients treated with VA-ECMO at Hangzhou First People's Hospital Affiliated to Westlake University School of Medicine, and Second Affiliated Hospital Zhejiang University School of Medicine, from December 2018 to February 2024. General clinical data and serial serum NSE levels at 24, 48, and 72 h after ECMO initiation were collected. Based on the Glasgow-Pittsburgh Cerebral Performance Category (CPC) at discharge, patients were divided into poor neurological outcome group (CPC 3-5) and good neurological outcome group (CPC 1-2). Differences in serum NSE levels between the two groups were compared. The accuracy of serum NSE levels at three time points in predicting poor neurological outcomes in CA patients was assessed via receiver operating characteristic curves, and the optimal cut-off values were determined by the Youden index. Multivariate logistic regression analysis was performed to determine the relationship between serum NSE levels and poor neurological outcomes. Subgroup analysis was based on age, sex, location of CA, and extracorporeal cardiopulmonary resuscitation (ECPR).Results:A total of 120 eligible CA patients were included, with 88 patients (73.3%) having poor neurological outcomes at discharge. Serum NSE levels at 24, 48, and 72 h after ECMO initiation were higher in the poor outcome group compared to the good outcome group (all P<0.05). The serum NSE level at 72 h had the highest accuracy in predicting poor outcomes, with an area under the curve (AUC) of 0.91 (95% CI: 0.85-0.96), and a cut-off value of 42.0 μg/L. The AUCs for 24 and 48 h were 0.78 (95% CI: 0.69-0.86) and 0.87 (95% CI: 0.80-0.94), with cut-off values of 70.6 μg/L and 64.5 μg/L, respectively. Multivariate logistic regression analysis suggested that the serum NSE level at 72 h was associated with poor outcomes ( P<0.05), and an NSE level >42.0 μg/L was an independent risk factor for poor outcomes ( OR=20.29, 95% CI: 2.90-92.15). Subgroup analysis showed that serum NSE level at 72 h was an independent risk factor for poor neurological outcomes in CA patients aged<60 years old, male or female, out-of-hospital or in-hospital CA, and whether to perform ECPR (all P<0.05). Conclusion:Elevated serum NSE levels at 72 h after VA-ECMO initiation are associated with poor neurological outcomes in CA patients, with the cut-off value of 42.0 μg/L.

Objective:To explore the feasibility and advantages of applying visualized thermosensitive color-changing bolus in postmastectomy radiotherapy (PMRT) for breast cancer.Methods:Forty patients with breast cancer treated with PMRT in the Second Affiliated Hospital of Soochow University from June 2023 to June 2024 were prospectively selected. They were randomly divided into test and control groups (also referred to as groups A and B, respectively), with 20 patients in each group. Group A, underwent two CT scans: the first scan without bolus (image A1) and the second scan with visualized thermosensitive color-changing bolus (image A2). They were treated with visualized thermosensitive color-changing bolus. Group B also underwent two CT scans: the first scan without bolus (image B1) and the second scan with conventional commercial bolus (image B2), and then were treated with conventional commercial bolus. In the radiotherapy planning, images A1 and A2 were designed as A1-Plan and A2-Plan, and A3-Plan was created by transferring the A1-Plan onto image A2. Images B1 and B2 were designed as B1-Plan and B2-Plan, and B3-Plan was created by transferring the B1-Plan onto image B2. The radiation fields and target optimization functions were identical. The dosimetric differences and skin toxicity reactions between different plans were compared.Results:In Group A, A1-Plan and A2-Plan manifested no statistically significant differences ( P > 0.05) in the doses to organs at risk (OARs), including the ipsilateral lung ( V5 Gy, V10 Gy, V20 Gy), heart ( Dmean), contralateral breast ( Dmean), and skin ( Dmax and Dmean), target homogeneity index (HI), conformity index (CI), prescription dose volume ( V50 Gy), depth of maximum dose ( Dmax), and monitor unit (MU). In Group B, B3-Plan compared to B1-Plan showed reduced V50 Gy (89.9% vs. 95%), HI (0.153 vs. 0.136), and CI (0.817 vs. 0.810), while the two plans displayed no statistically significant differences in doses to OARs. In contrast, A3-Plan and B3-Plan exhibited statistically significant differences ( t = 2.78, 2.29, -0.47, 0.51, 3.13, P < 0.05) in V50 Gy (94.05% vs. 89.90%), Dmax (5 665.4 cGy vs. 5 632.7 cGy), HI (0.148 vs. 0.163), CI (0.83 vs. 0.82), and skin Dmean (5 153.6 cGy vs. 5 048.2 cGy). Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus yielded a significantly reduced air cavity volume (3 833 mm 3vs. 21 498 mm 3,t = -9.65, P < 0.05). Both groups experienced only grade I skin toxicity reactions. Conclusions:Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus shows a more effective dosimetric distribution in terms of target coverage, HI, and CI, a higher fit to the skin, highly visualized air cavity, and higher positional repeatability in fractionated radiotherapy, demonstrating high practicality and safety.

Objective:To explore the feasibility and advantages of applying visualized thermosensitive color-changing bolus in postmastectomy radiotherapy (PMRT) for breast cancer.Methods:Forty patients with breast cancer treated with PMRT in the Second Affiliated Hospital of Soochow University from June 2023 to June 2024 were prospectively selected. They were randomly divided into test and control groups (also referred to as groups A and B, respectively), with 20 patients in each group. Group A, underwent two CT scans: the first scan without bolus (image A1) and the second scan with visualized thermosensitive color-changing bolus (image A2). They were treated with visualized thermosensitive color-changing bolus. Group B also underwent two CT scans: the first scan without bolus (image B1) and the second scan with conventional commercial bolus (image B2), and then were treated with conventional commercial bolus. In the radiotherapy planning, images A1 and A2 were designed as A1-Plan and A2-Plan, and A3-Plan was created by transferring the A1-Plan onto image A2. Images B1 and B2 were designed as B1-Plan and B2-Plan, and B3-Plan was created by transferring the B1-Plan onto image B2. The radiation fields and target optimization functions were identical. The dosimetric differences and skin toxicity reactions between different plans were compared.Results:In Group A, A1-Plan and A2-Plan manifested no statistically significant differences ( P > 0.05) in the doses to organs at risk (OARs), including the ipsilateral lung ( V5 Gy, V10 Gy, V20 Gy), heart ( Dmean), contralateral breast ( Dmean), and skin ( Dmax and Dmean), target homogeneity index (HI), conformity index (CI), prescription dose volume ( V50 Gy), depth of maximum dose ( Dmax), and monitor unit (MU). In Group B, B3-Plan compared to B1-Plan showed reduced V50 Gy (89.9% vs. 95%), HI (0.153 vs. 0.136), and CI (0.817 vs. 0.810), while the two plans displayed no statistically significant differences in doses to OARs. In contrast, A3-Plan and B3-Plan exhibited statistically significant differences ( t = 2.78, 2.29, -0.47, 0.51, 3.13, P < 0.05) in V50 Gy (94.05% vs. 89.90%), Dmax (5 665.4 cGy vs. 5 632.7 cGy), HI (0.148 vs. 0.163), CI (0.83 vs. 0.82), and skin Dmean (5 153.6 cGy vs. 5 048.2 cGy). Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus yielded a significantly reduced air cavity volume (3 833 mm 3vs. 21 498 mm 3,t = -9.65, P < 0.05). Both groups experienced only grade I skin toxicity reactions. Conclusions:Compared to the conventional commercial bolus of the same thickness, the visualized thermosensitive color-changing bolus shows a more effective dosimetric distribution in terms of target coverage, HI, and CI, a higher fit to the skin, highly visualized air cavity, and higher positional repeatability in fractionated radiotherapy, demonstrating high practicality and safety.

Objective To establish an index system for assessing the quality of hospital accreditation data and determine the hierarchical weights of indices at different levels,providing a reference for enhancing the governance of such data.Methods A quality assessment system for hospital accreditation data was developed using literature analysis method and Delphi method.The analytic hierarchy process was employed to create a pairwise comparison judgment matrix to determine the weights of indices.Results An evaluation system was constructed with the following levels:"Indicator Screening Quality-Data Reporting Quality-Data Quality Control Quality-Data On-Site Verification Quality."The system includes 4 first-level indicators and 18 second-level indicators.The indicator with the highest weight among the first-level indicators was Data Reporting Quality(0.496 5),followed by Data Quality Control Quality(0.313 2).Among the second-level indicators,Timeliness(0.428 6)and Cooperation(0.428 6)had the highest weights.Conclusion The establishment of the quality evaluation system of hospital accreditation da-ta is a strategy to optimize the control of hospital accreditation data quality and is beneficial for continuous improvement of hospital accreditation data quality.

Objective:To investigate the feasibility and safety of endoscopic surgery for the treatment of primary hyperthyroidism with goiter.Methods:A total of 140 patients with primary hyperthyroidism and different degrees of thyroid enlargements were included who underwent endoscopic surgeries via a trans breast approach in the Second Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2023, including 137 females and 3 males, aged from 16 to 49 years old. Thirty-one cases had normal thyroid size, 25 cases had Grade Ⅰ enlargement, 56 cases had Grade Ⅱ enlargement, and 28 cases had Grade Ⅲ enlargement. Demographic characteristics, operative time, intraoperative blood loss, and postoperative complications were described, analyzed, and compared among groups. Student′s t-test, Mann-Whitney U test, chi-square test, Fisher exact test or one-way analysis of variance (ANOVA) were used for statistical analyses. Results:The patients with Grade Ⅲ enlargement were younger compared to other groups ( F=5.58, P<0.01), and also had significantly longer operative time ( F=2.81, P=0.04). The probability of conversion to open surgery in the Grade Ⅲ enlargement group was 10.7% (3/28), significantly higher than other groups (0/31, 0/25, 1/56, χ2=8.11, P=0.04). There were no significant differences among the four groups in terms of other demographic indicators and the incidences of postoperative complications (including recurrent laryngeal nerve injury, hypocalcemia, and surgical site infection). There was no significant difference in the probability of temporary hypoparathyroidism among the 4 groups. One patient with permanent hypoparathyroidism appeared respectively in the normal size group and Grade Ⅱ enlargement group. The average follow-up time was 4.2±3.7 years and 14 cases were lost to follow-up, and the patients had high satisfaction with"no neck scar"but with mild chest discomfort. Conclusion:The risk of endoscopic thyroid surgery in the treatment of primary hyperthyroidism with goiter is controllable, and patients with hyperthyroidism combined with Grade Ⅲ enlargement should be especially vigilant against the risk of conversion to open surgery.

Objective:To investigate the feasibility and safety of endoscopic surgery for the treatment of primary hyperthyroidism with goiter.Methods:A total of 140 patients with primary hyperthyroidism and different degrees of thyroid enlargements were included who underwent endoscopic surgeries via a trans breast approach in the Second Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2023, including 137 females and 3 males, aged from 16 to 49 years old. Thirty-one cases had normal thyroid size, 25 cases had Grade Ⅰ enlargement, 56 cases had Grade Ⅱ enlargement, and 28 cases had Grade Ⅲ enlargement. Demographic characteristics, operative time, intraoperative blood loss, and postoperative complications were described, analyzed, and compared among groups. Student′s t-test, Mann-Whitney U test, chi-square test, Fisher exact test or one-way analysis of variance (ANOVA) were used for statistical analyses. Results:The patients with Grade Ⅲ enlargement were younger compared to other groups ( F=5.58, P<0.01), and also had significantly longer operative time ( F=2.81, P=0.04). The probability of conversion to open surgery in the Grade Ⅲ enlargement group was 10.7% (3/28), significantly higher than other groups (0/31, 0/25, 1/56, χ2=8.11, P=0.04). There were no significant differences among the four groups in terms of other demographic indicators and the incidences of postoperative complications (including recurrent laryngeal nerve injury, hypocalcemia, and surgical site infection). There was no significant difference in the probability of temporary hypoparathyroidism among the 4 groups. One patient with permanent hypoparathyroidism appeared respectively in the normal size group and Grade Ⅱ enlargement group. The average follow-up time was 4.2±3.7 years and 14 cases were lost to follow-up, and the patients had high satisfaction with"no neck scar"but with mild chest discomfort. Conclusion:The risk of endoscopic thyroid surgery in the treatment of primary hyperthyroidism with goiter is controllable, and patients with hyperthyroidism combined with Grade Ⅲ enlargement should be especially vigilant against the risk of conversion to open surgery.

Objective: To investigate the drug resistance of kaempferol reversed adriamycin (ADM)-resistant K562/ADM cells in chronic myelogenous leukemia (CML) and its related mechanism. Methods: Methyl thiazolyl tetrazolium (MTT) method was used to detect the toxicity of ADM on K562 and K562/ADM cells for 24 h. The half inhibitory concentration (IC₅₀) of ADM and the drug resistance multiple for 24 h were calculated. MTT method was used to detect the toxicity of kaempferol on K562/ADM cells for 24 h. The 5% inhibitory concentration (IC₅) and 10% inhibitory concentration (IC₁₀) of kaempferol for 24 h were calculated to determine the concentration of kaempferol in the subsequent experiments. And the cells untreated by the kaempferol were selected as the control group. The cell inhibition after the treatment of ADM for 24 h of the blank control group and kaempferol intervention group was detected by using MTT method. And then the cell inhibition for 24 h and ADM IC₅₀ for 24 h in the above groups were calculated. The ratio of IC₅₀ in the blank control group and kaempferol group was the reversal drug resistance multiple of kaempferol. The fluorescence intensity of ADM in K562/ADM cells treated by kaempferol was detected by using flow cytometry. Western blotting was used to detect the expressions of P-glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1), phosphorylated p38 (p-p38), and total p38 (t-p38) protein in K562/ADM cells after the treatment of kaempferol, the specific inhibitor of p38-MAPK signaling pathway SB202190, and the combination of kaempferol and SB202190. Results: After the treatment of ADM for 24 h, the IC₅₀ value of K562 and K562/ADM cells was (0.9±0.6), (28.1 ±3.5) μg/ml, respectively. The drug resistance multiple of K562/ADM cells on the treatment of ADM for 24 h was 31.16 compared with the K562 cells. MTT method showed that kaempferol inhibited the proliferation of K562/ADM cells in a dose-dependent manner. According to the IC₅ and IC₁₀, 0.5 μmol/L and 1.0 μmol/L kaempferol were determined to do the subsequent experiments. After the combined interaction of kaempferol and ADM for 24 h, the ADM IC₅₀ of K562/ADM cells in the blank control group, 0.5 μmol/L kaempferol group and 1.0 μmol/L kaempferol group was (33.7±5.7), (21.4±0.6), (15.9±1.8) μg/ml, respectively (F = 30.85, P < 0.05), and there was a statistical difference of pairwise comparison (both P < 0.05). The reversal drug resistance multiple of K562/ADM cells for 24 h in 0.5 μmol/L kaempferol group and 1.0 μmol/L kaempferol group was 1.58 and 2.12, respectively. Flow cytometry results showed that the mean fluorescence intensity (MFI) of ADM in the blank control group, 0.5 μmol/L kaempferol group and 1.0 μmol/L kaempferol group was 138.4±8.9, 154.3±2.2, 165.7±4.8, respectively, and the difference was statistically significant (F = 161.48, P < 0.05). Compared with the blank control group, after treatment of K562/ADM cells with 0.5 μmol/L and 1.0 μmol/L kaempferol for 24 h, the relative expressions of P-gp, MRP1 and p-p38 protein were decreased in K562/ADM cells (all P < 0.05), but there was no statistical difference in the expression of t-p38 protein (P > 0.05); SB202190 could reduce the relative expressions of P-gp, MRP1 and p-p38 protein (all P < 0.05); after the treatment of SB202190 combined with different concentration of kaempferol, the relative expressions of P-gp, MRP1 and p-p38 protein in K562/ADM cells did not decrease (P > 0.05). Conclusions Kaempferol can decrease the relative expressions of P-gp and MRP1 in K562/ADM cells by inhibiting p38-MAPK pathway, so as to increase the concentrations of ADM and to reverse the drug resistance of K562/ADM cells.

Objective To explore the clinical value of untrasonographically guided fine needle puncture ab -sorbing cytology examination in the diagnosis of cervical lymph node tuberculosis .Methods In March 2013 to June 2015 454 cases of suspected cervical lymph node tuberculosis cases were selected , and 454 suspected cases according to the voluntary principle were divided into two groups : US -FNAC groups: 326 cases with US -FNAC detection;FNAC groups: 128 cases, using FNAC.Statistical degree of two groups of detection sensitivity , specific, positive predictive value, negative predictive value and accuracy , and follow -up of two groups of complications .Results In US -FNAC group 326 cases, after the US -FNAC tested positie 308 cases, 304 cases confirmed by pathology after true positive and false positive 4 cases, through US -FNAC tested negatie 18 cases, were confirmed by pathology af -ter true negative, 15 cases of false negative in 3 cases; FNAC in the group of 128 cases of FNAC tested positie 107 cases, 102 cases confirmed by pathology after true positive and false positive in 5 cases, by FNAC tested negatie 21 cases, 12 cases confirmed by pathology after really negative , 9 cases of false negative.US -FNAC, the sensitivity of the detection of cervical lymph node tuberculosis (99.02%) than FNAC (91.89%), the difference was statisti-cally significant (p <0.05); US -FNAC and FNAC cervical lymph node tuberculosis detection specificity , positive predictive value, negative predictive value differences had no statistical significance (p >0.05); US -FNAC, the accuracy of the detection of cervical lymph node tuberculosis (95.30%) than FNAC (89.47%), the difference was statistically significant (p <0.05); US - FNAC, incidence of complications (1.23%) is lower than the FNAC group (4.69%), and the difference was statistically significant (chi -square =5.1095, p =5.1095,p <0.05). Conclusion US -FNAC is used for the diagnosis of cervical lymph node tuberculosis , and has the advantages of high sensitivity, high accuracy.So US -FNAC diagnosis in cervical lymph node tuberculosis suspected cases has the important clinical value.

Objective:To investigate the efficacy of pidotimod in the treatment of elderly patients with bronchial pneumonia and its effect on immune function. Methods: Totally 85 cases of elderly patients with bronchial pneumonia were randomly divided into two groups:the pidotimod treatment group (43 cases) and the conventional therapy group (42 cases). The conventional therapy group was given moxifloxacin 400 mg·d-1 , ivd, the pidotimod treatment group was additionally with pidotimod oral solutions 800 mg,po,bid, and the treatment course was 10 days. The changes of immune function in the two groups were detected, and the symptoms including fever, cough, asthma, rale and lung spots in X-ray radiation and the symptom duration in the two groups were also compared. Results:After the treatment, the levels of CD4, CD4 / CD8 and NK cells in the two groups were significantly higher than those before the treat-ment, the level of CD8 cells and IgA, IgG, IgM expression levels were significantly lower than those before the treatment (P<0. 05), and the changes in the pidotimod treatment group were much notable than those in the conventional therapy group(P<0. 05). The in-cidence of fever, cough, asthma, rale and lung spots in X-ray radiation in the pidotimod treatment group was lower than that in the con-ventional therapy group(P<0. 01), and the symptom duration was shorter than that in the conventional therapy group(P<0. 01). Conclusion:The mechanisms of pidotimod in the effective treatment of bronchial pneumonia in elderly patients are relative to the im-provement of T cell subsets, NK cells and humoral immunity levels and the enhancement of immunity.

Objective To evaluate the effects of preoperative regional intra-arterial infusion chemotherapy for patients with advanced gastric cancer (AGC). Methods A total of 82 patients with clinical stage Ⅲ,Ⅳ gastric cancer received two cycles of neoadjuvant regional intra-arterial infusion chemotherapy (arterial infusion group, n=42) or neoadjuvant systemic chemotherapy (systemic chemotherapy group, n=40). The operation was administrated in 10 to 15 days before chemotherapy. All patients received 6 course of systemic chemotherapy after surgery. Chemotherapy toxicity and sur-vival rate were retrospectively analyzed. Results No significant difference was found in chemotherapy toxicity between two groups. The median survival period was 25.3 months in arterial infusion group and 19.1 months in systemic chemotherapy group. 3-year survival rate was 36.4% in arterial infusion group and 21.0% in systemic chemotherapy group respectively, there were significant differences (P<0.05). Conclusion Preoperative regional intra-arterial infusion chemotherapy is well tolerated in advanced gastric cancer patients and could improve short-term survival.