Objective To observe the changes in myocardial energy metabolism in elderly patients with chronic heart failure(CHF),and analyze its influence on major adverse cardiovascular events(MACE).Methods A retrospective study was conducted on 90 elderly CHF patients(observation group)admitted to our department from January 2021 to January 2024.They were assigned into Class Ⅱ(23 cases),Ⅲ(37 cases)and Ⅳ subgroups(30 cases)according to NYHA functional classification.And another 30 healthy individuals who taking physical examination in our hospital during same period served as control group.Their myocardial energy metabolism indicators,inclu-ding free fatty acids(FFA),circumferential end-systolic wall stress(cESS)and myocardial energy expenditure(MEE)were compared between the two groups.The patients in the observation group were followed up for 6 months after discharge,and then divided into MACE subgroup(40 cases)and non-MACE subgroup(50 cases)according to whether MACE occurred.The differences of FFA,cESS and MEE were compared between the two subgroups,and Spearman correlation analy-sis was used to analyze the correlation of the indicators,multivariate logistic regression analysis was employed to identify the influencing factors,and ROC curve was plotted to analyze the pre-dictive values of the indicators.Results The values of FFA,cESS and MEE were significantly in-creased in the NYHA Class Ⅱ,Ⅲ and Ⅳ subgroups in turn(P＜0.01),and these values were ob-viously higher in the observation group than the control group(P＜0.05).The MACE group had advanced age,larger proportion of NYHA ClassⅣ,and higher NT-proBNP and FFA levels,cESS and MEE values,but lower LVEF than the non-MACE group(P＜0.01).FFA,cESS and MEE were positively correlated with MACE in elderly CHF patients(r=0.512,0.495,0.503,P＜0.05,P＜0.01).Age(OR=2.344,95％CI:1.255-3.464),NYHA cardiac function grade(OR=2.079,95％CI:1.354-2.804),LVEF(OR=2.173,95％CI:1.179-3.167),NT-proBNP(OR=2.257,95％CI:1.149-3.365),FFA(OR=2.713,95％CI:1.103-4.323),cESS(OR=1.868,95％CI:1.111-2.625)and MEE(OR=3.010,95％CI:1.064-4.956)were risk factors for MACE in eld-erly CHF patients with.The AUC value of FFA,cESS and MEE in predicting the occurrence of MACE in elderly CHF patients was 0.732,0.707 and 0.768,respectively,and the AUC value of their combination was 0.893,which was greater than that of the single indicator(Z=6.325,6.581,6.247;P=0.022,0.015,0.026).Conclusion FFA,cESS and MEE are positively correlated with the occurrence of MACE in elderly CHF patients,and are risk factors for MACE occurrence in them.The three indicators have certain predictive performance for MACE,and their combina-tion can further improve the predictive value.

Objective:To explore the value of preoperative diffusion tensor imaging (DTI) in predicting motor function outcomes in patients with moderate-volume basal ganglia cerebral hemorrhage after minimally invasive puncture and drainage.Methods:A retrospective study was performed; 54 patients with moderate-volume hypertensive basal ganglia hemorrhage (30-50 mL) admitted to Department of Neurosurgery, First People's Hospital of Chenzhou from March 2018 to December 2019 were enrolled. All patients accepted DTI within 24 h of onset; fractional anisotropy (FA) and mean diffusivity (MD) of the bilateral cerebral peduncles were measured and converted to relative FA (rFA) and relative MD (rMD). Patients accepted minimally invasive puncture and drainage within 24 h of DTI. Motor function score (MFS) was used to evaluate the prognoses of limb motor function 90 d after puncture and drainage; and these patients were divided into good motor function outcome group (MFS scores of 0-3) and poor motor function outcome group (MFS scores of 4-8). The clinical data and DTI indexes were compared between the 2 groups; receiver operating characteristic (ROC) curve was used to analyze the efficacy of rFA in preoperative DTI in predicting limb motor function 90 d after puncture and drainage.Results:Fifty-four patients successfully completed minimally invasive puncture and drainage, without intracranial infection or obvious rebleeding. Twenty-two patients (40.7%) had good motor function outcome and 32 (59.3%) had poor one 90 d after puncture and drainage. No significant difference in age, gender, Glasgow coma scale score at admission, preoperative hematoma volume or postoperative residual hematoma volume was noted between the good function outcome group and poor function outcome group ( P>0.05). Compared with the good function outcome group, the poor function outcome group had statistically lower FA and rFA in the affected side of cerebral peduncles ( P<0.05). ROC curve showed that the area under the curve of preoperative rFA in predicting motor function 90 d after puncture and drainage was 0.984, with cutoff value of 0.78, sensitivity of 100%, and specificity of 96.9%. Conclusion:Preoperative DTI can effectively predict limb motor function 90 d after minimally invasive puncture and drainage in patients with moderate-volume hypertensive basal ganglia hemorrhage.

Objective:To investigate the effect and associated mechanism of tumor tissue-infiltrating NK cells after receiving radiotherapy for hepatocellular carcinoma (HCC).Methods:A HCC tumor-bearing mouse model was constructed using human hepatocellular carcinoma cell line (SK-Hep-1) and divided into four groups: control, radiotherapy, NK cell clearance, and NK clearance combined with radiotherapy. Tumor growth condition was simultaneously recorded. The NK cell ratio in peripheral blood and the NK cell intratumoral infiltration condition were detected by flow cytometry and immunohistochemistry. Lentiviral-constructed SK-Hep-1 cells was used to detect the effect of radiotherapy on the regulation of CXCL10 and NK cell chemotaxis following EZH2 overexpression. SK-Hep-1 cells were irradiated in vitro and in vivo. The expression levels of EZH2 and CXCL10 mRNA and protein in the two groups of cell lines and mouse tumor tissues were detected by reverse transcription polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), western blotting (WB), and immunohistochemistry. The chemotaxis and blocking experiments were used to validate the chemotaxis effect of CXCL10 on NK cells. The independent sample t-test was used to compare the groups. P<0.05 was considered statistically significant. Results:The HCC tumor-bearing mouse model experiment showed that HCC tumor growth was most remarkable in the NK clearance combined with the radiotherapy group compared to the radiotherapy group ( P<0.05). Compared with the control group, the number of NK cells in the peripheral blood of nude mice in the radiotherapy group was significantly reduced, while the NK cell intratumoral infiltration was significantly increased ( P<0.05). Flow cytometry and immunohistochemistry showed invitro and invivo expressional alterations. The average expression levels of EZH2 mRNA and protein in hepatocellular carcinoma cell lines and tumor tissues were decreased in the radiotherapy group than the control group and mouse tumor tissues ( P<0.05), while the mRNA and protein expression levels of CXCL10 increased ( P<0.05). The cell supernatant following radiotherapy enhanced NK cell chemotaxis but inhibited CXCL10 neutralization. EZH2 overexpression validated that radiotherapy up-regulated CXCL10 mRNA and down-regulated protein expression levels in in vitro and in vivo experiments ( P<0.05). The chemotactic effect on NK cells was significantly weakened with EZH2 overexpression following radiotherapy. Conclusion:NK cells, as immune effector cells, are directly involved in radiotherapy- activated anti-HCC immunity. Importantly, radiotherapy inhibits EZH2 expression in hepatocellular carcinoma, thereby upregulating CXCL10 expression and enhancing intratumoral NK cell invasion.

ObjectiveTo investigate the survival and adverse reactions of patients with unresectable cholangiocarcinoma after stereotactic body radiation therapy （SBRT）. MethodsA total of 27 patients with unresectable solitary cholangiocarcinoma without metastasis who underwent SBRT in The Fifth Medical Center of Chinese PLA General Hospital from February 2012 to July 2020 were enrolled. The prescribed dose to planning target volume was 42-60 Gy in 5-8 fractions， with 5-11 Gy/fraction. Among these patients， five patients were also treated with chemotherapy and transcatheter arterial chemoembolization. The 6-， 12-， 18-， and 24-month overall survival （OS） rates， progression-free survival （PFS） rates， and local control （LC） rates were used as the assessment indices for treatment outcome； Common Terminology Criteria for Adverse Events v.4.03 was used to evaluate adverse reactions； the Kaplan-Meier method was used to calculate OS， PFS， and LC rates. ResultsThe median follow-up time was 17 months. For all 27 patients， the 6-， 12-， 18-， and 24-month OS rates were 100%， 88%， 57.5%， and 47.9%， respectively； the 6-， 12-， 18-， and 24-month PFS rates were 74.1%， 58.6%， 47.9%， and 35.9%， respectively； the 6-， 12-， 18-， and 24-month LC rates were 96.3%， 91.9%， 84.8%， and 76.4%， respectively. No grade 3 or above toxic reactions were observed. Five patients were diagnosed with radiation-induced liver injury， but there was no death due to radiation-induced liver injury. ConclusionSBRT is safe and effective in the treatment of unresectable cholangiocarcinoma， with relatively high survival rate， PFS rate， and LC rate and low toxicity， and therefore， SBRT can be used as an alternative treatment method for patients with cholangiocarcinoma who are not candidates for surgery.

Objective:To investigate the optimal monoenergetic level of virtual monoenergetic images (VMI) in transplanted renal artery on a dual-layer spectral detector CT.Methods:A retrospective study was performed on 16 renal transplant patients who underwent transplanted renal angiography on a dual-layer spectral detector CT in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2020 to April 2021. Conventional 120 kVp polyenergetic images (PI) were reconstructed, and virtual monoenergetic images (VMIs) in range of 40-200 keV with interval of 10 keV were reconstructed, too. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of 120 kVp PI and VMIs were measured. Meanwhile, the subjective scores of the display of transplanted renal artery were performed on volume rendering images of 120 kVp PI and VMIs. Spearman correlation analysis was used to explore the correlation between energy levels and SNR or CNR. Rank sum tests were performed to compare the parameters of image quality between the VMI which had the highest SNR and CNR, and the other VMIs, or 120 kVp PI.Results:Among the VMIs, SNR or CNR was negatively correlated with energy levels ( r =-0.86 and -0.88, all P<0.001). The SNR [22.80(18.57, 34.16)] and CNR [35.38(25.97, 39.01)] of 40 keV VMI were the highest, and significantly higher than that of 120 kVp PI and 50-200 keV VMIs, all the differences were statistically significant (all P<0.05). The subjective scores of 40 keV VMI and 120 kVp PI were 5 (5, 5) and 4 (3, 5), respectively. The score of 40 keV VMI was significantly higher than that of 120 kVp PI ( Z=-2.60, P=0.009). There were no significant differences in subjective scores between 40 keV VMI and 50-70 keV VMIs ( Z=-1.00, -1.41, -1.73, P=0.317, 0.157, 0.083), but the subjective score of 40 keV VMI was higher than that of 80-200 keV VMIs and the differences were statistically significant (all P<0.05). Conclusions:As for the images of transplanted renal angiography on a dual-layer spectral detector CT, the image quality of 40 keV VMI was best, thus 40 keV was the optimal monoenergetic level.

ObjectiveTo investigate the efficacy and safety of sequential lenvatinib therapy after stereotactic body radiotherapy (SBRT) in the treatment of advanced primary liver cancer. MethodsA total of 18 patients with advanced primary liver cancer who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2018 to May 2019 were enrolled, among whom there were 4 patients with BCLC stage B liver cancer and 14 patients with BCLC stage C liver cancer. The prescribed dose of planning target volume was 48-55 Gy (median 50 Gy) in 6-9 fractions, and the median of single dose was 6 (5-9) Gy per fraction. Oral administration of lenvatinib was given since 1 week after SBRT was finished, with a median medication time of 9.5 (3.6-25.8) months. Follow-up was performed once a month for the first 3 months after treatment and once every 3 months after 3 months of treatment. The Kaplan-Meier method was used to calculate overall survival (OS) rate, progression-free survival (PFS) rate, and local control (LC) rate, and the incidence rates of adverse reactions and complications were also observed. ResultsUp to the follow-up on November 30, 2020, a total of 8 patients died, among whom 3 died of liver failure, 3 died due to tumor progression, 1 died of perforation of gallbladder, and 1 died of gastrointestinal bleeding. At 3, 6, 9, 12, and 18 months of treatment, the OS rates were 100%, 94%, 83%, 72%, and 67%, respectively, the PFS rates were 100%, 67%, 50%, 22%, and 17%, respectively, and the LC rates were 100%, 94%, 94%, 94%, and 94%, respectively; the median OS time was ＞18 months, and the median PFS time was 9 months. Of all patients, 1 (6%) had a grade 3 adverse reaction during SBRT and 2 (11%) experienced a grade 3 adverse reaction during lenvatinib treatment, and no fatal adverse reaction was observed. ConclusionIt is preliminarily proved that sequential lenvatinib therapy after SBRT is an effective and safe treatment method for advanced primary liver cancer.

Ferroptosis is a non-apoptotic regulated cell death caused by iron accumulation and subsequent lipid peroxidation. Currently, the therapeutic role of ferroptosis on cancer is gaining increasing interest. Baicalin an active component in

Objective:To analyze the factors influencing radiation-induced liver injury after receiving Cyberknife stereotactic radiotherapy in patients with primary hepatocellular carcinoma.Methods:278 cases with primary hepatocellular carcinoma from July 2016 to April 2019 were prospectively enrolled. Stereotactic radiosurgery with a prescription dose of 48-55gy/5-8 times were given. Liver function, coagulation function, Child-Pugh score, and liver imaging changes were dynamically observed before and after treatment to evaluate the occurrence of radiation-induced liver injury. Logistic regression model was used to analyze the factors influencing radiation-induced liver injury.Results:Among 278 cases, 3 cases of tumor progression were excluded, and a total of 275 cases were included for analysis. The overall survival rate after 8 months of treatment was 100%. Among them, 22 cases were diagnosed as radiation-induced liver injury, with an incidence rate of 8%, and all cases were recovered after symptomatic treatment. Multivariate analysis result suggested that the peripheral white blood cell count was factors influencing the occurrence of radiation-induced liver injury.Conclusion:Cyberknife stereotactic radiotherapy has a low incidence of radiation-induced liver injury in patients with liver cancer, and it is a relatively safe treatment method. Patients with low peripheral white blood cell counts before treatment should be closely monitored for early detection and treatment.

Objective:To explore the clinical application value of fetal heart quantification (fetal HQ) in the analysis of 24-segment spherical index (SI) of fetal heart in normal second and third trimestries.Methods:In July 2019, sixty-five normal singletons with gestational age (GA) of 28(24, 31) weeks were examined by echocardiography in Sir Run Run Shaw Hospital. The global spherical index (GSI) of the heart was measured and the dynamic images of the standard four chamber view were collected. Twenty-four-segment SI of the left and right ventricles were measured by using the fetal HQ analysis system and the correlation between SI and gestational age was analyzed.Results:There were no significant correlations between GSI, SI of left and right ventricles and gestational age ( r s=-0.22-0.14, all P>0.05). The SI of the first segment of left ventricle was lower than those of the other 23 segments (all P<0.05). There were no significant differences of SI among the second to the eleventh segments of the left ventricle (all P>0.05). In the 13th to the 24th segments of the left ventricle, the closer to the apex of the heart, the greater the SI of the segment were noted (all P<0.05). For the right ventricle, the closer to the apex of the heart, the greater the SI of the 4th to the 24th segments were found (all P<0.05), and there were no significant differences in SI among the first to third segment( P>0.05). The success rate of fetal HQ software was 95.4%. Conclusions:The 24-segment SI of RV and LV provides a feasible and reliable quantitative method which allows for the assessment of fetal heart function from the four-chamber view.