Objective:To analyze the incidence and influencing factors of lymphopenia in prostate cancer patients undergoing pelvic radiotherapy.Methods:A retrospective analysis was conducted on 123 prostate cancer patients treated at the Department of Radiation Oncology, Peking University First Hospital, from November 2011 to May 2015. Radiotherapy was administered using conventional fractionated intensity-modulated radiotherapy. Blood routine, including absolute lymphocyte count (ALC), was performed on patients before radiotherapy, weekly during radiotherapy, and at the end of radiotherapy. Severe lymphopenia was defined as an ALC <500 cells/μl. Based on whether the minimum ALC during radiotherapy was lower than 500 cells/μl, the entire cohort and 55 patients (excluding those with undelineated pelvic bone marrow due to radiotherapy planning system issues) with delineated pelvic bone marrow (divided into pelvic bone marrow, iliac bone marrow, and lower pelvic bone marrow) were stratified into a severe lymphopenia group (33 cases and 16 cases, respectively) and a mild lymphopenia group (90 cases and 39 cases, respectively). Differences in clinical factors and dosimetric parameters were compared between the groups using the chi-square test (or Fisher's exact test), t-test, and Wilcoxon rank-sum test. Univariate and multivariate logistic regression analyses were performed to identify the clinical and dosimetric factors influencing severe lymphopenia. Results:All 123 prostate cancer patients experienced lymphopenia during radiotherapy, with a median minimum ALC of 0.6×10 9/L [range: (0.2-2.3)×10 9/L]. Severe lymphopenia occurred in 26.8% (33 cases) of patients. Univariate analysis of the entire cohort showed that pre-radiotherapy baseline ALC, initial neutrophil-to-lymphocyte ratio, prostate-specific antigen value, Gleason score, and pelvic radiotherapy were promoting factors for severe lymphopenia ( P<0.05). Multivariate analysis identified pre-radiotherapy baseline ALC ( OR=0.217, 95% CI: 0.072-0.650, P=0.006) and pelvic radiotherapy ( OR=23.852, 95% CI: 2.834-200.787, P=0.004) as promoting factors for severe lymphopenia. In patients with delineated pelvic bone marrow, univariate analysis showed that pelvic bone marrow V 30 Gy and V 40 Gy, iliac bone marrow V 30 Gy and V 40 Gy, lower pelvic bone marrow V 30 Gy and V 40 Gy were promoting factors for severe lymphopenia during treatment ( P<0.05). Conclusions:Lymphopenia is common in prostate cancer patients undergoing radiotherapy, with a high incidence of severe lymphopenia. Pre-radiotherapy baseline ALC, as well as pelvic, iliac, and lower pelvic bone marrow V 30 Gy and V 40 Gy, are promoting factors for severe lymphopenia during radiotherapy.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

Meniere's disease represents an idiopathic inner ear disorder characterized by endolymphatic hy-drops.Currently,the research methods for identifying genes associated with this disease mainly involve first-genera-tion sequencing and second-generation sequencing.This article reviews research on the genetic study of Meniere's disease,mainly summarizing the candidate genes with repeated pedigree validation in familial Meniere's disease,as well as those frequently reported in sporadic Meniere's disease.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

Meniere's disease represents an idiopathic inner ear disorder characterized by endolymphatic hy-drops.Currently,the research methods for identifying genes associated with this disease mainly involve first-genera-tion sequencing and second-generation sequencing.This article reviews research on the genetic study of Meniere's disease,mainly summarizing the candidate genes with repeated pedigree validation in familial Meniere's disease,as well as those frequently reported in sporadic Meniere's disease.

Objective:To analyze the incidence and influencing factors of lymphopenia in prostate cancer patients undergoing pelvic radiotherapy.Methods:A retrospective analysis was conducted on 123 prostate cancer patients treated at the Department of Radiation Oncology, Peking University First Hospital, from November 2011 to May 2015. Radiotherapy was administered using conventional fractionated intensity-modulated radiotherapy. Blood routine, including absolute lymphocyte count (ALC), was performed on patients before radiotherapy, weekly during radiotherapy, and at the end of radiotherapy. Severe lymphopenia was defined as an ALC <500 cells/μl. Based on whether the minimum ALC during radiotherapy was lower than 500 cells/μl, the entire cohort and 55 patients (excluding those with undelineated pelvic bone marrow due to radiotherapy planning system issues) with delineated pelvic bone marrow (divided into pelvic bone marrow, iliac bone marrow, and lower pelvic bone marrow) were stratified into a severe lymphopenia group (33 cases and 16 cases, respectively) and a mild lymphopenia group (90 cases and 39 cases, respectively). Differences in clinical factors and dosimetric parameters were compared between the groups using the chi-square test (or Fisher's exact test), t-test, and Wilcoxon rank-sum test. Univariate and multivariate logistic regression analyses were performed to identify the clinical and dosimetric factors influencing severe lymphopenia. Results:All 123 prostate cancer patients experienced lymphopenia during radiotherapy, with a median minimum ALC of 0.6×10 9/L [range: (0.2-2.3)×10 9/L]. Severe lymphopenia occurred in 26.8% (33 cases) of patients. Univariate analysis of the entire cohort showed that pre-radiotherapy baseline ALC, initial neutrophil-to-lymphocyte ratio, prostate-specific antigen value, Gleason score, and pelvic radiotherapy were promoting factors for severe lymphopenia ( P<0.05). Multivariate analysis identified pre-radiotherapy baseline ALC ( OR=0.217, 95% CI: 0.072-0.650, P=0.006) and pelvic radiotherapy ( OR=23.852, 95% CI: 2.834-200.787, P=0.004) as promoting factors for severe lymphopenia. In patients with delineated pelvic bone marrow, univariate analysis showed that pelvic bone marrow V 30 Gy and V 40 Gy, iliac bone marrow V 30 Gy and V 40 Gy, lower pelvic bone marrow V 30 Gy and V 40 Gy were promoting factors for severe lymphopenia during treatment ( P<0.05). Conclusions:Lymphopenia is common in prostate cancer patients undergoing radiotherapy, with a high incidence of severe lymphopenia. Pre-radiotherapy baseline ALC, as well as pelvic, iliac, and lower pelvic bone marrow V 30 Gy and V 40 Gy, are promoting factors for severe lymphopenia during radiotherapy.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

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.