Objective To investigate the factors influencing the efficacy of intravesical Bacille Calmette-Guérin(BCG)instillation after transurethral resection of bladder tumor(TURBT)in patients with intermediate-and high-risk non-muscle invasive bladder cancer(NMIBC),and to construct a prediction model for recurrence after BCG treatment.Methods A retrospective cohort study was conducted on the subjected patients diagnosed with intermediate-and high-risk NMIBC undergoing TURBT followed by standard BCG instillation.The 110 patients treated in Department of Urology of Army Medical Center of PLA from January 2018 to December 2023 were assigned into a training set,while the 52 patients treated at Department of Urology of General Hospital of Central Theater Command from January 2015 to December 2020 were into an external validation set.A total of 17 variables were included and analyzed.Univariate and multivariate Cox regression analyses were performed to identify factors associated with recurrence after BCG instillation,and nomograms were plotted to predict 1-year,3-year,and 5-year recurrence-free survival(RFS).Calibration curve,decision curve analysis(DCA),and receiver operating characteristic(ROC)curve analysis were conducted for internal and external validation to evaluate the predictive performance and clinical utility of the model.Results In the training set,26 patients(23.64%)experienced recurrence during the follow-up period,with a median RFS of 32.00(18.00～50.50)months.Univariate Cox regression analysis suggested that platelet count,eosinophil to lymphocyte ratio(ELR),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),systemic immune inflammation(SII)index,and neutrophil-monocyte to lymphocyte ratio(NMLR),pathological T1 stage(pT1)tumor and hemoglobin,albumin,lymphocyte,and platelet(HALP)score were potential factors influencing recurrence after BCG instillation.Multivariate Cox regression analysis identified high HALP score(HR=0.185,95%CI:0.046～0.736,P=0.017)as an independent protective factor,while high ELR(HR=3.599,95%CI:1.505～8.608,P=0.004)and pT1 stage(HR=3.240,95%CI:1.191～8.818,P=0.021)were independent risk factors for recurrence.Based on this,a nomogram prediction model was constructed.The calibration curves demonstrated good agreement between predicted and actual 1-,3-,and 5-year recurrence risks.Decision curve analysis indicated clinical utility across a wide threshold probability range.In the training set,the model showed strong predictive performance for 1-(AUC=0.842),3-(AUC=0.847),and 5-year(AUC=0.887)recurrence risks,which was further validated in the external cohort.Conclusion Higher HALP score prior to BCG instillation therapy is a protective factor against tumor recurrence,while higher ELR and pT1 stage are risk factors.Our nomogram prediction model based on HALP score,ELR and pathological T stage,can identify individuals at high risk of recurrence after BCG instillation therapy.

Objective To investigate risk factors for residual lesions after initial transurethral resection of bladder tumors(TURBT)and risk factors for tumor recurrence after second TURBT in patients with non-muscle-invasive bladder cancer(NMIBC)in order to provide reference for clinical management.Methods A case-control study design was adopted to include 120 NMIBC patients who underwent initial TURBT and then second surgery within 2～8 weeks in our department from January 2017 to January 2025.Based on the presence of residual lesions after the initial TURBT or not,the patients were divided into a residual lesion group(n=34)and a non-residual lesion group(n=86).Chi-square test and multivariate logistic regression analysis were performed to identify potential risk factors for residual lesions following the initial TURBT.Univariate and multivariate Cox regression models were used to analyze potential risk factors for tumor recurrence after the second TURBT.Results The residual lesion rate after initial TURBT was 28.33％.Chi-square test analysis revealed that tumor stage T1(Chi-square=5.756,P=0.016)and broad tumor base(Chi-square=4.331,P=0.037)were factors influencing residual lesions after initial TURBT.Multivariate logistic regression analysis identified tumor stage T1(OR=3.047,95％CI:1.128～8.226,P=0.028)as an independent risk factor for residual lesions after initial TURBT.The tumor recurrence rate after second TURBT was 17.5％.Multivariate Cox regression analysis identified tumor stage T1(OR=4.258,95％CI:1.248～14.532,P=0.021),intravesical chemotherapy instillation after second TURBT(OR=3.539,95％CI:1.284～9.752,P=0.015),history of urinary system tumors(OR=3.002,95％CI:1.145～7.873,P=0.025)and high platelet-to-lymphocyte(PLR)ratio(OR=2.798,95％CI:1.115～7.023,P=0.028)as independent risk factors for tumor recurrence after second TURBT.Conclusion Tumor stage T1 and broad tumor base are risk factors for residual lesions after initial TURBT,while tumor stage T1,intravesical chemotherapy instillation after second TURBT,history of urinary system tumors and high PLR ratio are risk factors for tumor recurrence after second TURBT.Comprehensive analysis on above 4 indicators can effectively assess the risk of tumor recurrence in NMIBC patients following second TURBT,and timely early medical intervention is beneficial for improving patient outcomes.

The Portable Life Support System(PLSS),serving as a core component of the Extravehicular Activity spacesuit,must balance the requirements of life support protection and lightweight design.This study proposes a sandwich structure design based on Carbon Fiber Reinforced Polymer and validates the structural reliability of the composite backpack under launch/return segment overloads and space collision conditions through multi-scenario mechanical simulations.Simulation results demonstrate that the design achieves maximum deformations of 0.372 mm(mounting plate)under 6 g acceleration and 7.4 mm(skeleton)under 0.97 MPa impact loading,satisfying structural integrity requirements under extreme loads.The composite backpack manufactured by the autoclave molding process has passed the impact protection test under load conditions,verifying the manufacturing feasibility of the composite PLSS.This research provides a technically reliable pathway for lightweight design of EVA spacesuit structures by using composite materials,offering practical engineering value.

Nasopharyngeal carcinoma (NPC) is a common head and neck malignant tumor with high incidence in southern China. Local recurrence is one of the main failure modes of locally advanced NPC. The dose-escalation after radical radiotherapy for locally advanced NPC remains controversial. In the era of modern radiotherapy, the mainstream treatment mode of locally advanced NPC is neoadjuvant chemotherapy plus concurrent chemoradiotherapy. There is no consensus on whether to prescribe dose-escalation, how and when to conduct dose-escalation, how much dose to prescribe for patients with residual lesion proved by MRI or pathology. How to accurately determine the target volume and dose / fraction to maximize the local control of the tumor are the directions of clinical practice for locally advanced NPC, which remain to be further studied.

Objective: To evaluate the efficacy, toxicity and cosmetic outcomes of hypofractionated simultaneous integrated boost intensity-modulated radiotherapy (IMRT-SIB) after breast conservative surgery (BCS) for early breast cancer patients. Methods: A total of 76 patients with stage TisT_1-2N₀M₀ breast cancer treated with BCS were enrolled in the analysis. The patients who underwent breast radiotherapy without regional lymph node irridiation and hypo fractionated IMRT/VMAT were used. All patients received whole breast IMRT/VMAT with tumor bed SIB. The doses delivered to the whole breast was 42.4 Gy in 16 fractions, and the dose delivered to tumor bed for SIB was 49.6 Gy in 16 fractions. Cosmetic evaluation was based on the Harvard system. Acute and late toxicities were scored according to CACAT version 3.0. Survival and recurrence rates were calculated by Kaplan-Meier method. The univariate and multivariate analysis were conducted with logistic regression. Results: The median follow-up was 29 months (range 16-40 months). The follow-up rate was 100%. The 1-, 2-and 3-year overall survival rates were 100%. No recurrence or metastasis was observed in this study. The incidence of grade 1 acute skin toxicity was 68.4%, grade 2 was 7.9%. The late skin toxicity of grade 1 was 13.1%, grade 2 was 2.6%.In all, 82.4% of patients had excellent and good cosmetic outcome. The Mean dose of the tumor bed was predictive factor for grade 2 dermatitis. Conclusion: The efficacy, cosmetic effect, the acute and late treatment-related toxicity of hypofractionated IMRT/VMAT-SIB in patients with early breast cancer following BCS might be acceptable. A longer follow-up is needed to define the efficacy on outcomes. Trial registration Chinese clinical trial registry, ChiCTR1800016287

Objective To investigate the clinical, neuroimaging and serum risk factors of cerebral microbleeds (CMBs) in patients with ischemic stroke and find the associations between these risk factors and the location and num?bers of CMBs were also analyzed. Methods One hundred and fifty-three patients with acute ischemic stroke were re?cruited in this study and their data werewas retrospectively analyzed. All of the patients underwent MRI- susceptibility weighted imaging (SWI). The location and numbers of CMBs were recordedexamined. The severity of WMLs was assessed using the Fazekas scale. Logistic regressions were performed to find the predictors of the presence of CMBs. The relation?ships between these risk factors and the location and numbers of CMBs were also analyzed. Results Fifty-nine(38.6%) cases had at least one CMB. The frequency of cortical-subcortical, deep and infratentorial CMBs were 34.0%, 24.8%and 27.5%, respectively. Multivariate logistic regression showed that male sex, hypertension and moderate-to-severe deep white matter hyperintensities (DWMH) were independent risk factors of the presence of CMBs. Adjusted with age and sex, partial correlation showed that hypertension only correlated with the numbers of deep CMBs significantly (r=0.174, P=0.032). Moderate-to-severe DWMH significantly correlated with the numbers of cortical-subcortical and deep CMBs (r=0.285, P<0.001 and r=0.258, P=0.001, respectively). Conclusion Male sex, hypertension and moderate-to-severe DWMH were are independent risk factors of CMBs in patients with ischemic stroke. Hypertension correlates with Deep deep CMBs, while Moderatemoderate-to-severe DWMH correlates with cortical-subcortical and deep CMBs.

ObjectiveTo analyze the role of postmastectomy radiotherapy in different molecular subtypes of breast cancer patients with Stage T1 -T2 and one to three positive axillary nodes. MethodsA total of 436 breast cancer patients with T1 -T2 and one to three positive axillary lymph nodes treated with mastectomy and axillary dissection were retrospectively analyzed. Patients were grouped as the following four subtypes:Luminal A, Luminal B, Her2+ and triple-negative. The local recurrence (LR), distant metastasis ( DM ), disease free survival (DFS) and overall survival (OS) rates were compared between paitents with or without radiotherapy in univariate analyses. Multivariate analyses for LR were performed. Results The follow-up rate was 86. 0％. In patients with Luminal A subtype, radiotherapy decreased the 5-year LR rate (4.6％ vs 15.8％ ,x2 =5.74,P=0.017) but had no influences on DM, DFS or OS rates (17.2％ vs 19.7％,x2 =0. 17,P=0.682;77.0％ vs 67. 1％ ,x2 =1.99,P=0. 158 or87.4％:85. 5％ ,x2 =0. 12,P=0. 733 ). In patients with Luminal B subtype, radiotherapy decreased the 5-year LR rate (3.7％ vs 12. 1％,x2 =4. 13, P =0. 042), increased DFS and OS ( 84. 0％ vs 57.6％ ( x2 =14.61, P =0. 000) and 91.4％ vs 70. 7％ ( x2 =11.87, P =0. 001 ), but had no influence on DM ( 12. 3％ vs 22. 2％, x2 =2. 97, P =0. 085).In patients with Her2+ subtype, radiotherapy decreased the 5-year LR rate (5. 6％ vs 31.0％ ,x2 =4. 31,P=0. 035) , increased DFS (61. 1％ vs 13. 8％ ,x2 =11.44,P=0.001 ) ,but had no influence on DM and OS (27.8％ vs 41.4％, x2 =0. 89, P =0. 345 and 66. 7％ vs 48. 3％, x2 =1.52,P =0. 218 ). In patients with triple-negative subtype, radiotherapy had no influence in LR, DM, DFS or OS (8. 7％ vs 26. 1％ ,x2 =2.42,P=0.120;39.1％ vs47.8％,x2=0.35,P=0.552;52.2％ vs 26.1％ , x2 =3. 29, P =0. 070 or 65.2％ vs 56. 5％ ,x2 =0. 37 ,P =0. 546). Tumor size and radiotherapy were independent prognostic factors for LR rate in multivariate analyses ( x2 =4. 76, P =0. 029 and x2 =8.06, P =0. 005 ). ConclusionsFor patients with stage T1 -T2 and one to three positive axillary nodes, patients with all molecular subtypes except triple-negative can benefit from postmasteetomy radiotherapy.