ObjectiveTo evaluate the impact of yang-reinforcing and blood-activating therapy on the long-term prognosis for patients with dilated cardiomyopathy （DCM） of yang deficiency and blood stasis syndrome. MethodsA retrospective cohort study was conducted involving 371 DCM patients with yang deficiency and blood stasis syndrome. The yang-reinforcing and blood-activating therapy was defined as the exposure factor. Patients were categorized into exposure group （186 cases） and non-exposure group （185 cases） according to whether they received yang-reinforcing and blood-activating therapy combined with conventional western medicine for 6 months or longer. The follow-up period was set at 48 months， and the Kaplan-Meier survival analysis was used to assess the cumulative incidence of major adverse cardiovascular events （MACE） in both groups. Cox regression analysis was used to explore the impact of yang-reinforcing and blood-activating therapy on the risk of MACE， and subgroup analysis was performed. Changes in traditional Chinese medicine （TCM） syndrome score， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end-diastolic diameter （LVEDD）， and Minnesota Living with Heart Failure Questionnaire （MLHFQ） score were compared between groups at the time of first combined use of yang-reinforcing and blood-activating therapy （before treatment） and 1 year after receiving the therapy （after treatment）. ResultsMACE occurred in 31 cases （16.67%） in the exposure group and 47 cases （25.41%） in the non-exposure group. The cumulative incidence of MACE in the exposure group was significantly lower than that in the non-exposure group ［HR=0.559， 95%CI（0.361，0.895）， P=0.014］. Cox regression analysis showed that yang-reinforcing and blood-activating therapy was an independent factor for reducing the risk of MACE in DCM patients ［HR=0.623， 95%CI（0.396，0.980）， P=0.041］， and consistent results were observed in different subgroups. Compared with pre-treatment， the exposure group showed decreased TCM syndrome score and MLHFQ score， reduced LVEDD， and increased LVEF and LVFS after treatment （P＜0.05）； in the non-exposure group， TCM syndrome score decreased， LVEF and LVFS increased， and LVEDD reduced after treatment （P＜0.05）. After treatment， the exposure group had higher LVEF and LVFS， smaller LVEDD， and lower TCM syndrome score and MLHFQ score compared with the non-exposure group （P＜0.05）. ConclusionCombining yang-reinforcing and blood-activating therapy with conventional western medicine can reduce the risk of MACE in DCM patients with yang deficiency and blood stasis syndrome， meanwhile improving their clinical symptoms， cardiac function， and quality of life.

Objective:To explore the efficacy of deep learning-based automatic segmentation technology in the segmentation of hepatocellular carcinoma (HCC) lesions using gadoxetate disodium-enhanced MRI (EOB-MRI), and to investigate the prognostic value of radiomics analysis in predicting patient outcomes.Methods:This was a cross-sectional, retrospective study that collected data from 352 patients with solitary HCC who underwent imaging at the Harbin Medical University Cancer Hospital between June 2015 and May 2023. The patients were randomly divided into a training set ( n=213) and a validation set ( n=139) in a 3∶2 ratio using weighted random sampling. Two radiologists manually annotated the lesions. Hepatobiliary-phase EOB-MRI images were standardized, and six deep learning models,nnU-Net, nnFormer, UnetR, Swin-UnetR, UnetR++ and MedNeXt,were trained for automatic segmentation on the training set. The segmentation performance was evaluated on the validation set, and the segmentation efficacy was assessed using the Dice coefficient and 95% Hausdorff distance (HD 95), identifying of the optimal model. Radiomics features were extracted from both manual and automatic segmentation regions, and the radiomics score (Radscore) was calculated to stratify patients into high-risk and low-risk groups. Kaplan-Meier curves and log-rank tests were used to analyze the differences in relapse-free survival (RFS) and overall survival (OS) between the different stratified groups. Results:Among the automatic segmentation models, the MedNeXt model performed best in the validation set, with a Dice coefficient of 76.0%, HD 95 of 7.2, and a segmentation success rate of 90.6% (126/139). The nnFormer model was the second-best, with a Dice coefficient of 75.3%, HD 95 of 10.1, and a segmentation success rate of 89.9% (125/139). Other models showed Dice coefficients ranging from 66.3% to 74.1%. A MedNext-nnF model was established by combining the MedNeXt and nnFormer models, achieving a Dice coefficient of 78.2%, HD 95 of 5.9, and a segmentation success rate of 92.1% (128/139) in the validation group. After constructing the automatic segmentation radiomics prognostic model, patients were stratified by Radscore. Both manual and automatic segmentation models showed statistically significant differences in RFS and OS between different risk groups ( P<0.001). Conclusions:The Mednext-nnF fusion model enables efficient and automated segmentation of HCC lesions in EOB-MRI. The radiomics model constructed based on the automated segmentation demonstrates strong performance in predicting and stratifying prognostic risk.

Objective:To explore the survival and prognostic factors of a long-course venetoclax-based(VEN-based)regimen in patients with de novo acute myeloid leukemia(AML)and provide evidence for the maintenance treatment of AML.Methods:A retrospective study was conducted in patients who received a VEN-based regimen and completed at least four courses of efficacy evaluation at The First Affiliated Hospital of Nanchang University from May 2021 to January 2024.The composite complete response rate(cCR),minimal residual disease(MRD)-negative rate,overall survival(OS)time,relapse-free survival(RFS)time,and adverse events were analyzed.Results:Overall,30 newly diagnosed patients with AML were enrolled in this study.The median age was 65(range,53-78)years,and the median number of treat-ment cycles was 7(range,4-20)years.After one cycle,the CR-and MRD-negative rates were 80.0%and 63.3%,respectively.The cumulative cCR was 96.7%,and MRD negative rate was 80.0%,respectively.The median follow-up time was 21.3(95%confidence intervals 14.7-27.9)months.The median OS time was 32.3 months and RFS time was not reached.The 2-year OS and RFS rates were 70.6%and 54.8%,respect-ively.Univariate analysis suggested that ELN2017 risk stratification and relapse status affected RFS and OS(P<0.05).However,the multivari-ate analysis failed to reveal any relationship between these factors and survival(P>0.05).In terms of safety,hematological adverse events were the most common,followed by infections.Overall,the VEN-based regimen was tolerated for patients with AML.Conclusions:A long-course VEN-based regimen is effective and safe.More than half of patients survive for>2 years,and it can be used as an effective mainten-ance treatment option for patients with AML.

Objective:To explore the effects of quercetin on autophagy and proliferation in HBV-positive liver cancer HCCLM3 cells based on STING signaling and its underlying mechanism.Methods:HCCLM3 cells were treated with quercetin (50 μmol/L or 100 μmol/L), designated as the 50 μmol/L group and 100 μmol/L group, respectively. The inhibitory effect of quercetin on HCCLM3 cells was detected using the CCK-8 method. A scratch assay was conducted to assess the impact of quercetin on the migration ability of HCCLM3 cells. A CCK8 and ROS kit was used to detect the effect of quercetin on the levels of reactive oxygen species in HCCLM3 cells. Western blotting was employed to measure the effect of quercetin on the expression of STING signaling and autophagy-related proteins in HCCLM3 cells. RNA interference technology was used to assess the effects of STING signaling inhibition on the expression of autophagy-related proteins and reactive oxygen species levels in HCCLM3 cells. The combined effects of STING activators and quercetin on HCCLM3 cell proliferation and autophagy were evaluated. The t-test was used to detect data differences between two groups, while ANOVA was employed for comparisons among multiple groups, followed by the SNK- q test for further pairwise comparisons. Results:Compared with the control group, quercetin (50 μmol/L and 100 μmol/L groups) significantly inhibited HCCLM3 cell survival activity in a dose-dependent manner (control group: 100%; 50 μmol/L group: 75.25%; 100 μmol/L group: 50.36%, P<0.01 ). Quercetin inhibited HCCLM3 cell migration in a dose-dependent manner (>2 h, control group: 187.16 μm; 50 μmol/L group: 145.22 μm; 100 μmol/L group: 88.21 μm, P<0.01), which significantly increased intracellular reactive oxygen species (ROS) levels in HCCLM3 cells (control group: 1.00; 50 μmol/L group: 1.565; 100 μmol/L group: 2.175, P<0.01). The phosphorylation level of STING was significantly increased ( P<0.01), and the expression of autophagy-related protein microtubule-related protein 1A/1B light chain 3 (LC3) protein was significantly promoted ( P<0.01). Compared with the quercetin group, the cell viability of the small interfering-STING+quercetin group was increased (quercetin group: 56.3%; small interfering-STING+quercetin group: 85.7%, P<0.05), while the expression of autophagy-related protein LC3 was decreased. Compared with the quercetin group, the cell viability of the quercetin+STING activator group was further decreased (quercetin group: 56.7%; quercetin+STING activator group: 35.4%, P<0.01), and the expression levels of STING and autophagy protein LC3 were significantly increased ( P<0.05). Conclusions:STING signaling-regulated cell autophagy mediates the inhibitory effect of quercetin on the proliferation of HCCLM3 cells, and this effect is enhanced after administration of the STING agonist.

Objective:To observe the effect of acupuncture-synchronized exercise training on the learning and memory of rats after middle cerebral artery occlusion (MCAO), and to explore its mechanism.Methods:Among sixty 8-week-old SPF-grade Sprague-Dawley male rats, 6 were randomly chosen to form a sham group, and the rest received MCAO. After successful modeling, 18 rats were assigned at random to either the model, asynchronous or synchronous group, each of 6. The asynchronous group received 20 minutes of acupuncture followed by 20 minutes of treadmill training, while the synchronous group received the acupuncture during their treadmill training. There was no special intervention for the sham and model groups. There were 5 sessions/week for 21 days. Neurological deficit in the rats was assessed using Longa scoring 24h after the modeling and after the 21 days. The localization navigation test was performed on days 17-20 of the experiment, and the latency to escape was recorded. A space exploration experiment was performed the next day, and rats were tested for dwell time and the number of transits of the original platform quadrant. After the intervention, the morphology of hippocampal tissue was observed using HE staining. The mitochondria of the rats′ hippocampal neurons were observed using transmission electron microscopy. MDA and SOD levels were recorded. And the protein expression levels of the Parkin, PINK1, LC3-II/ LC3-Ⅰ, P62 and Beclin-1 genes were detected using western blotting.Results:The model group showed significantly higher average Longa scores than the sham group, with less time spent in the target quadrant and fewer crossings of the platform quadrant. The HE staining revealed numerous degenerating neurons, and swollen mitochondria with vacuolization and sparse cristae. There was also a significant decrease in Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and in SOD. But there was a significant increase in P62 expression and MDA, on average. Compared with the model group, both the non-synchronous and synchronous groups showed significantly lower average Longa scores, with more time spent in the target quadrant and more platform crossings. Their neuron morphology was close to normal, with more intact cristae and autophagic bodies in the mitochondria. Those groups showed greater Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and had higher SOD levels, on average, with significantly lower P62 expression and less MDA. But compared with the non-synchronous group, the synchronous group spent more time in the target quadrant and had significantly more platform crossings. LC3-II/LC3-I and Beclin-1 expression were higher, on average, as were SOD levels. P62 expression and MDA levels were significantly lower.Conclusions:Acupuncture synchronized with exercise improves the learning and memory of rates after MCAO. The mechanism may be related to reducing oxidative stress levels and activating mitochondrial autophagy.

Objective To explore the value of analysis on the incidence of healthcare-associated infection(HAI)based on disease diagnosis-related grouping(DRG),case mix index(CMI),and relative weight(RW).Methods All discharged cases,DRG and HAI status in a tertiary first-class general hospital from January 1 to December 31,2023 were analyzed retrospectively.Incidences of HAI in different departments were adjusted and compared by CMI.Incidences of HAI in different DRG groups were adjusted by RW.Results Among the 47 695 cases included in the analysis,757 were HAI cases,including 225 DRG groups.The department of critical care medicine had the highest incidence of HAI(11.98％).After CMI adjustment,departments with higher incidence of HAI were main-ly the department of respiratory and critical care medicine(3.96％),department of critical care medicine(3.04％),and department of neurology(2.85％),et al.DRG groups with the top five high incidence of HAI were AH11(tracheotomy and with ventilator support ≥96 hours or extracorporeal membrane oxygenation[ECMO],accompa-nied by major complications and comorbidity[MCC],50.00％),BC29(ventricular shunt and revision surgery,31.43％),BB21(craniotomy other than trauma,accompanied by MCC,27.56％),BB11(craniotomy of brain trauma,accompanied by MCC,26.32％),and GB1A(major surgery of esophagus,stomach,and duodenum,accompanied by major or moderate complications and comorbidity,16.00％).After RW adjustment,the DRG groups with the top five high incidence of HAI were ES21(respiratory system infection/inflammation,accompanied by MCC,5.89％),BR21(cerebral ischemic disease,accompanied by MCC,5.17％),FR11(heart failure,shock,accompanied by MCC,4.80％),BC29(4.57％)and AH11(3.57％).Conclusion Analyzing the incidence of HAI based on CMI and RW can help to identify key departments and disease groups for infection prevention and control,and provide reference for precise prevention and control of HAI in the new era.

Objective To explore the value of analysis on the incidence of healthcare-associated infection(HAI)based on disease diagnosis-related grouping(DRG),case mix index(CMI),and relative weight(RW).Methods All discharged cases,DRG and HAI status in a tertiary first-class general hospital from January 1 to December 31,2023 were analyzed retrospectively.Incidences of HAI in different departments were adjusted and compared by CMI.Incidences of HAI in different DRG groups were adjusted by RW.Results Among the 47 695 cases included in the analysis,757 were HAI cases,including 225 DRG groups.The department of critical care medicine had the highest incidence of HAI(11.98％).After CMI adjustment,departments with higher incidence of HAI were main-ly the department of respiratory and critical care medicine(3.96％),department of critical care medicine(3.04％),and department of neurology(2.85％),et al.DRG groups with the top five high incidence of HAI were AH11(tracheotomy and with ventilator support ≥96 hours or extracorporeal membrane oxygenation[ECMO],accompa-nied by major complications and comorbidity[MCC],50.00％),BC29(ventricular shunt and revision surgery,31.43％),BB21(craniotomy other than trauma,accompanied by MCC,27.56％),BB11(craniotomy of brain trauma,accompanied by MCC,26.32％),and GB1A(major surgery of esophagus,stomach,and duodenum,accompanied by major or moderate complications and comorbidity,16.00％).After RW adjustment,the DRG groups with the top five high incidence of HAI were ES21(respiratory system infection/inflammation,accompanied by MCC,5.89％),BR21(cerebral ischemic disease,accompanied by MCC,5.17％),FR11(heart failure,shock,accompanied by MCC,4.80％),BC29(4.57％)and AH11(3.57％).Conclusion Analyzing the incidence of HAI based on CMI and RW can help to identify key departments and disease groups for infection prevention and control,and provide reference for precise prevention and control of HAI in the new era.

Objective:To explore the efficacy of deep learning-based automatic segmentation technology in the segmentation of hepatocellular carcinoma (HCC) lesions using gadoxetate disodium-enhanced MRI (EOB-MRI), and to investigate the prognostic value of radiomics analysis in predicting patient outcomes.Methods:This was a cross-sectional, retrospective study that collected data from 352 patients with solitary HCC who underwent imaging at the Harbin Medical University Cancer Hospital between June 2015 and May 2023. The patients were randomly divided into a training set ( n=213) and a validation set ( n=139) in a 3∶2 ratio using weighted random sampling. Two radiologists manually annotated the lesions. Hepatobiliary-phase EOB-MRI images were standardized, and six deep learning models,nnU-Net, nnFormer, UnetR, Swin-UnetR, UnetR++ and MedNeXt,were trained for automatic segmentation on the training set. The segmentation performance was evaluated on the validation set, and the segmentation efficacy was assessed using the Dice coefficient and 95% Hausdorff distance (HD 95), identifying of the optimal model. Radiomics features were extracted from both manual and automatic segmentation regions, and the radiomics score (Radscore) was calculated to stratify patients into high-risk and low-risk groups. Kaplan-Meier curves and log-rank tests were used to analyze the differences in relapse-free survival (RFS) and overall survival (OS) between the different stratified groups. Results:Among the automatic segmentation models, the MedNeXt model performed best in the validation set, with a Dice coefficient of 76.0%, HD 95 of 7.2, and a segmentation success rate of 90.6% (126/139). The nnFormer model was the second-best, with a Dice coefficient of 75.3%, HD 95 of 10.1, and a segmentation success rate of 89.9% (125/139). Other models showed Dice coefficients ranging from 66.3% to 74.1%. A MedNext-nnF model was established by combining the MedNeXt and nnFormer models, achieving a Dice coefficient of 78.2%, HD 95 of 5.9, and a segmentation success rate of 92.1% (128/139) in the validation group. After constructing the automatic segmentation radiomics prognostic model, patients were stratified by Radscore. Both manual and automatic segmentation models showed statistically significant differences in RFS and OS between different risk groups ( P<0.001). Conclusions:The Mednext-nnF fusion model enables efficient and automated segmentation of HCC lesions in EOB-MRI. The radiomics model constructed based on the automated segmentation demonstrates strong performance in predicting and stratifying prognostic risk.

Objective:To explore the survival and prognostic factors of a long-course venetoclax-based(VEN-based)regimen in patients with de novo acute myeloid leukemia(AML)and provide evidence for the maintenance treatment of AML.Methods:A retrospective study was conducted in patients who received a VEN-based regimen and completed at least four courses of efficacy evaluation at The First Affiliated Hospital of Nanchang University from May 2021 to January 2024.The composite complete response rate(cCR),minimal residual disease(MRD)-negative rate,overall survival(OS)time,relapse-free survival(RFS)time,and adverse events were analyzed.Results:Overall,30 newly diagnosed patients with AML were enrolled in this study.The median age was 65(range,53-78)years,and the median number of treat-ment cycles was 7(range,4-20)years.After one cycle,the CR-and MRD-negative rates were 80.0%and 63.3%,respectively.The cumulative cCR was 96.7%,and MRD negative rate was 80.0%,respectively.The median follow-up time was 21.3(95%confidence intervals 14.7-27.9)months.The median OS time was 32.3 months and RFS time was not reached.The 2-year OS and RFS rates were 70.6%and 54.8%,respect-ively.Univariate analysis suggested that ELN2017 risk stratification and relapse status affected RFS and OS(P<0.05).However,the multivari-ate analysis failed to reveal any relationship between these factors and survival(P>0.05).In terms of safety,hematological adverse events were the most common,followed by infections.Overall,the VEN-based regimen was tolerated for patients with AML.Conclusions:A long-course VEN-based regimen is effective and safe.More than half of patients survive for>2 years,and it can be used as an effective mainten-ance treatment option for patients with AML.

Objective:To observe the effect of acupuncture-synchronized exercise training on the learning and memory of rats after middle cerebral artery occlusion (MCAO), and to explore its mechanism.Methods:Among sixty 8-week-old SPF-grade Sprague-Dawley male rats, 6 were randomly chosen to form a sham group, and the rest received MCAO. After successful modeling, 18 rats were assigned at random to either the model, asynchronous or synchronous group, each of 6. The asynchronous group received 20 minutes of acupuncture followed by 20 minutes of treadmill training, while the synchronous group received the acupuncture during their treadmill training. There was no special intervention for the sham and model groups. There were 5 sessions/week for 21 days. Neurological deficit in the rats was assessed using Longa scoring 24h after the modeling and after the 21 days. The localization navigation test was performed on days 17-20 of the experiment, and the latency to escape was recorded. A space exploration experiment was performed the next day, and rats were tested for dwell time and the number of transits of the original platform quadrant. After the intervention, the morphology of hippocampal tissue was observed using HE staining. The mitochondria of the rats′ hippocampal neurons were observed using transmission electron microscopy. MDA and SOD levels were recorded. And the protein expression levels of the Parkin, PINK1, LC3-II/ LC3-Ⅰ, P62 and Beclin-1 genes were detected using western blotting.Results:The model group showed significantly higher average Longa scores than the sham group, with less time spent in the target quadrant and fewer crossings of the platform quadrant. The HE staining revealed numerous degenerating neurons, and swollen mitochondria with vacuolization and sparse cristae. There was also a significant decrease in Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and in SOD. But there was a significant increase in P62 expression and MDA, on average. Compared with the model group, both the non-synchronous and synchronous groups showed significantly lower average Longa scores, with more time spent in the target quadrant and more platform crossings. Their neuron morphology was close to normal, with more intact cristae and autophagic bodies in the mitochondria. Those groups showed greater Parkin, PINK1, LC3-II/LC3-I and Beclin-1 expression and had higher SOD levels, on average, with significantly lower P62 expression and less MDA. But compared with the non-synchronous group, the synchronous group spent more time in the target quadrant and had significantly more platform crossings. LC3-II/LC3-I and Beclin-1 expression were higher, on average, as were SOD levels. P62 expression and MDA levels were significantly lower.Conclusions:Acupuncture synchronized with exercise improves the learning and memory of rates after MCAO. The mechanism may be related to reducing oxidative stress levels and activating mitochondrial autophagy.