1.Progress of clinical detection methodology of varicella vaccine serum antibody
Yaru QUAN ; Yanli DAI ; Changgui LI ; Kangwei XU ; Jizong JIA
Chinese Journal of Laboratory Medicine 2025;48(6):785-790
Varicella is a common infectious disease caused by varicella-zoster virus (VZV), with high transmissibility and pathogenicity, and vaccination is a better preventive measure. The clinical diagnosis of varicella, the clinical immunogenicity evaluation of varicella vaccine, the continuous monitoring of the immune effect after marketing and the epidemiological investigation all require the detection of the antibody level of VZV in patients. Fluorescent antibody to membrane antigen method (FAMA) is the gold standard for detection of VZV antibody in serum, possessing advantages of high sensitivity and good specificity, playing an important role in detection of VZV antibody. However, the defects of FAMA operation complexity and low throughput are also troubling the clinical testing personnels. This article reviews research progress both at home and abroad on the technology of VZV serum antibody detection. The advantages and limitations of the current detection methods are discussed and the future development direction are highlighted on the dectection of VZV serum antibody IgG.
2.Progress of clinical detection methodology of varicella vaccine serum antibody
Yaru QUAN ; Yanli DAI ; Changgui LI ; Kangwei XU ; Jizong JIA
Chinese Journal of Laboratory Medicine 2025;48(6):785-790
Varicella is a common infectious disease caused by varicella-zoster virus (VZV), with high transmissibility and pathogenicity, and vaccination is a better preventive measure. The clinical diagnosis of varicella, the clinical immunogenicity evaluation of varicella vaccine, the continuous monitoring of the immune effect after marketing and the epidemiological investigation all require the detection of the antibody level of VZV in patients. Fluorescent antibody to membrane antigen method (FAMA) is the gold standard for detection of VZV antibody in serum, possessing advantages of high sensitivity and good specificity, playing an important role in detection of VZV antibody. However, the defects of FAMA operation complexity and low throughput are also troubling the clinical testing personnels. This article reviews research progress both at home and abroad on the technology of VZV serum antibody detection. The advantages and limitations of the current detection methods are discussed and the future development direction are highlighted on the dectection of VZV serum antibody IgG.
3.Long-term outcome of patients with rectal cancer who achieve complete or near complete clinical responses after neoadjuvant therapy: a multicenter registry study of data from the Chinese Watch and Wait Database
Yiming ZHAO ; Weihu WANG ; Wei ZHANG ; Lin WANG ; Shuai LI ; Jingwen WANG ; Leen LIAO ; Guanyu YU ; Zhen SUN ; Yanli QU ; Yang GONG ; Yun LU ; Tao WU ; Yunfeng LI ; Quan WANG ; Guohua ZHAO ; Yi XIAO ; Peirong DING ; Zhen ZHANG ; Aiwen WU
Chinese Journal of Gastrointestinal Surgery 2024;27(4):372-382
Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.
4.Study on Self-management Level of Elderly Diabetic Mellitus Patients in Dongcheng District of Beijing and Its Influencing Factors
Yuqing YANG ; Quan CHEN ; Qile HE ; Jinyao ZHANG ; Zhuocun WU ; Yanli WAN
Journal of Medical Informatics 2024;45(1):59-63,88
Purpose/Significance To investigate the status quo and influencing factors of self-management level of elderly diabetic mellitus patients in Dongcheng District of Beijing,and to provide references for further development of community diabetes health educa-tion and health management.Method/Process The survey is conducted on 1 962 cases of elderly patients with type 2 diabetes mellitus who are randomly selected from community-level health service institutions in Dongcheng District of Beijing and are investigated by self-made questionnaires and the summary of diabetes self-care activities.Multiple stepwise regression and logistic regression are used to analyze the influencing factors of patients'self-management level.Result/Conclusion The self-management level of elderly diabetic mellitus patients is affected by many factors,among which the awareness of disease-related knowledge,the form of medical security and the use of health-related software to manage chronic diseases are the main influencing factors(P<0.05).Local management depart-ments can take targeted health interventions to further improve the self-management ability of elderly diabetic mellitus patients.
5.Long-term outcome of patients with rectal cancer who achieve complete or near complete clinical responses after neoadjuvant therapy: a multicenter registry study of data from the Chinese Watch and Wait Database
Yiming ZHAO ; Weihu WANG ; Wei ZHANG ; Lin WANG ; Shuai LI ; Jingwen WANG ; Leen LIAO ; Guanyu YU ; Zhen SUN ; Yanli QU ; Yang GONG ; Yun LU ; Tao WU ; Yunfeng LI ; Quan WANG ; Guohua ZHAO ; Yi XIAO ; Peirong DING ; Zhen ZHANG ; Aiwen WU
Chinese Journal of Gastrointestinal Surgery 2024;27(4):372-382
Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.
6.Analysis of clinical characteristics and genetic variants in a child with Isolated sulfite oxidase deficiency.
Zhigang YANG ; Yali QUAN ; Yuan WANG ; Guohong CHEN ; Yanli MA ; Kaili XU
Chinese Journal of Medical Genetics 2023;40(8):986-989
OBJECTIVE:
To explore the genetic basis for a child with Isolated sulfite oxidase deficiency (ISOD).
METHODS:
The child and her parents were subjected to targeted capture and next-generation sequencing. Pathogenicity of candidate variants was assessed based on the guidelines from the American College of Medical Genetics and Genomics (ACMG).
RESULTS:
The child was found to harbor compound heterozygous variants of the SUOX gene, namely c.1200C>G (p.Tyr400*) and c.1406_1421delCCTGGCAGGTGGCTAA (p.Thr469Serfs*20), which were inherited from her mother and father, respectively. The c.1200C>G was a known pathogenic variant, while the c.1406_1421delCCTGGCAGGTGGCTAA was unreported previously and predicted to be a pathogenic variant (PVS1+PM2_Supporting +PM3) based on the guidelines from the American College of Medical Genetics and Genomics.
CONCLUSION
The compound c.1200C>G and c.1406_1421delCCTGGCAGGTGGCTAA variants of the SUOX gene probably underlay the pathogenesis of ISOD in this child. Above finding has expanded the spectrum of SUOX gene variants and provided molecular evidence for the clinical diagnosis and genetic counseling for this pedigree.
Child
;
Female
;
Humans
;
Amino Acid Metabolism, Inborn Errors/genetics*
;
Genetic Counseling
;
Genomics
;
High-Throughput Nucleotide Sequencing
;
Mutation
7.Effects of miRNA-373-3p on the proliferation of nephroblastoma cells through targeted regulation of CD44 expression
Yanjun WANG ; Yanxia KONG ; Xueli QUAN ; Yanli YUAN ; Yongtao DUAN ; Feng WANG ; Jie WANG
Cancer Research and Clinic 2022;34(2):86-91
Objective:To explore the effects of miRNA-373-3p (miR-373-3p) on the proliferation of nephroblastoma G401 cells through targeted regulation of CD44 expression.Methods:Bioinformatic method was used to predict the possible targeted genes of miR-373-3p based on bioinformatic databases including miRDB, miRanda, PITA and DIANA-microT. G401 cells were taken and transfected with miR-373-3p mimic, mimic negative control, miR-373-3p inhibitor or inhibitor negative control, respectively. Cell proliferation ability was detected by using CCK-8 assay. The number of clones was detected by using clone formation assay. The relative expression level of CD44 mRNA was detected by using real-time fluorescent quantitative polymerase chain reaction (qRT-PCR), and the expression level of CD44 protein was detected by using Western blotting. The dual luciferase gene reporter assay was carried out in HEK-293T cells to vertify the target gene of miR-373-3p.Results:Bioinformatic analysis indicated that CD44 was a targeted gene of miR-373-3p. After 24 h transfection, the proliferation activity of G401 cells in miR-373-3p mimic group was decreased compared with that in mimic negative control group (all P < 0.05). After 48 h transfection, the proliferation activity of tumor cells in miR-373-3p inhibitor group was increased compared with that inhibitor negative control group (all P < 0.05). The formed number of clones in miR-373-3p mimic group was reduced compared with that in the mimic negative control group (55.3±2.5 vs. 90.7±2.9), and the difference was statistically significant ( t = 14.57, P < 0.01). The formed number of clones in miR-373-3p inhibitor group was more than that in inhibitor negative control group (115.0±2.7 vs. 92.0±2.4), and the difference was statistically significant ( t = 8.86, P < 0.01). The dual-luciferase gene reporter assay showed that CD44 was a direct targeted gene of miR-373-3p. The relative expression levels of CD44 mRNA in miR-373-3P mimic and mimic negative control group were 0.62±0.03 and 1.00±0.01, respectively, and the difference was statistically significant ( t = 11.28, P < 0.01). The relative expression levels of CD44 mRNA in miR-373-3p inhibitor and inhibitor negative control group were 1.31±0.02 and 1.00±0.00, respectively, and the difference was statistically significant ( t = 12.65, P < 0.01). The CD44 protein expression was decreased in miR-373-3p mimic group, while increased in miR-373-3p inhibitor group. Conclusion:miR-373-3p can inhibit tumor cell proliferation by targeting CD44 in nephroblastoma.
8.Distinctive Roles of Wnt Signaling in Chondrogenic Differentiation of BMSCs under Coupling of Pressure and Platelet-Rich Fibrin
Baixiang CHENG ; Fan FENG ; Fan SHI ; Jinmei HUANG ; Songbai ZHANG ; Yue QUAN ; Teng TU ; Yanli LIU ; Junjun WANG ; Ying ZHAO ; Min ZHANG
Tissue Engineering and Regenerative Medicine 2022;19(4):823-837
BACKGROUND:
Although newly formed constructs of feasible pressure-preadjusted bone marrow mesenchymal stem cells (BMSCs) and platelet-rich fibrin (PRF) showed biomechanical flexibility and superior capacity for cartilage regeneration, it is still not very clear how BMSCs and seed cells feel mechanical stimuli and convert them into biological signals, and the difference in signal transduction underlying mechanical and chemical cues is also unclear.
METHODS:
To determine whether mechanical stimulation (hydrostatic pressure) and chemical cues (platelet-rich fibrin, PRF) activate canonical or noncanonical Wnt signaling in BMSCs, BMSCs cocultured with PRF were subjected to hydrostatic pressure loading, and the activation of the Wnt signaling molecules and expression of cartilage-associated proteins and genes were determined by western blotting and polymerase chain reaction (PCR). Inhibitors of canonical or noncanonical Wnt signaling, XVX-939 or L690,330, were adopted to investigate the role of Wnt signaling molecules in mechanically promoted chondrogenic differentiation of BMSCs.
RESULTS:
Hydrostatic pressure of 120 kPa activated both Wnt/b-catenin signaling and Wnt/Ca2+ signaling, with the the maximum promotion effect at 60 min. PRF exerted no synergistic effect on Wnt/b-catenin signaling activation. However, the growth factors released by PRF might reverse the promotion effects of pressure on Wnt/Ca2+ signaling. Real-time PCR and Western blotting results showed that pressure could activate the expression of Col-II, Sox9, and aggrecan in BMSCs cocultured with PRF. Blocking experiment found a positive role of Wnt/b-catenin signaling, and a negative role of Wnt/ Ca2+ signaling in chondrogenic differentiation of the BMSCs. Mutual inhibition exists between canonical and noncanonical Wnt signaling in BMSCs under pressure.
CONCLUSION
Wnt signaling participates in the pressure-promoted chondrogenesis of the BMSCs co-cultured with PRF, with canonical and noncanonical pathways playing distinct roles during the process.
9.Comparison of application effects of different meibomian gland massage schemes in postoperative treatment of children with chalazion
Xiaojie QUAN ; Wei SHI ; Yanan WANG ; Shuang YU ; Fei GAO ; Yanli WU
Chinese Journal of Modern Nursing 2021;27(34):4727-4730
Objective:To explore application effects of different meibomian gland massage schemes in postoperative treatment of children with chalazion.Methods:Using the convenient sampling method, a total of 280 children with postoperative chalazion who were treated in Ophthalmology Clinic of Beijing Children's Hospital from January to September 2020 were selected as the research objects. According to the random number table method, the patients were randomly divided into groups A, B, C and D. Group A 70 cases received massage once every 2 weeks. Group B 70 cases received massage once every 4 weeks. Group C 70 cases received massage once every 2 weeks and hot compress nursing before massage. Group D 70 cases received massage once every 4 weeks and hot compress nursing before massage. At 3 and 6 months of intervention, the recurrence rate of postoperative chalazion and meibomian gland function of children in the 4 groups were compared.Results:There were 65, 67, 66, 67 children completed the research in A, B, C and D group. The recurrence rates of postoperative chalazion in groups A, B, C, and D were respectively 10.77% (7/65) ,19.40% (13/67) ,1.52% (1/66) and 1.49% (1/67) after the intervention for 3 months, and the differences were statistically significant ( P<0.05). Further pairwise comparison showed that the recurrence rate in group C was lower than that in group A and B, and that in group D was lower than that in group A and B, and the differences were statistically significant ( P< 0.05). There were no statistically significant differences among the other groups ( P>0.05). After 6 months of intervention, the recurrence rates of postoperative chalazion in groups A, B, C, and D were respectively 9.23% (6/65) ,16.42% (11/67) ,1.52% (1/66) and 1.49% (1/67), and the differences were statistically significant ( P<0.05). Further pairwise comparison showed that the recurrence rate of group C was lower than that of group A and B, and that of group D was lower than that of group A and B, and the differences were statistically significant ( P<0.05). There was no significant difference between group A and B ( P>0.05). There were statistically significant differences in scores of the difficulty of meibum discharge of children in the 4 groups after 3 and 6 months of intervention ( P<0.05). Further pairwise comparisons showed that the score of difficulty of meibum discharge in group C was lower than that in group A and B, and that in group D was lower than that in group A and B, and the differences were statistically significant ( P< 0.05). There were no statistically significant differences among other groups ( P>0.05). After 3 and 6 months of intervention, there were statistically significant differences in the score of eyelid fat traits among the 4 groups ( P<0.05). Further pairwise comparison showed that the score of eyelid fat trait in group C was lower than that in group A and B, and that in group D was lower than that in group A and B, and the differences were statistically significant ( P<0.05). There were no statistically significant differences among other groups ( P>0.05) . Conclusions:Hot compress nursing can enhance the massage effect of the meibomian glands, improve function of the meibomian glands and facilitate the discharge of meibomian gland secretions, which can effectively reduce the recurrence rate of postoperative chalazion in children and is worthy of clinical promotion.
10.The clinical effect of computerized cognitive remediation therapy in schizophrenic patients with different levels of cognitive impairment
Jie ZHANG ; Hongzhen FAN ; Xiaolin ZHU ; Yunhui WANG ; Yunlong TAN ; Fude YANG ; Zhiren WANG ; Yanli ZHAO ; Fengmei FAN ; Junhua GUO ; Zhanjiang LI ; Wenxiang QUAN ; Xiangqun WANG ; Dongfeng ZHOU ; Yizhuang ZOU ; Shuping TAN
Chinese Journal of Psychiatry 2020;53(4):328-334
Objective:To explore the improvement rate of the cognitive function of computerized cognitive remediation therapy (CCRT) on patients with schizophrenia and the clinical effect of CCRT in patients with different levels of cognitive impairment.Methods:A random number table was used to divide 311 patients with schizophrenia into CCRT group ( n=196) and work and amusement therapy (WAT) group ( n=115). The independently developed CCRT and operational music and dance therapy were given for 12 weeks to two treatment groups respectively. All patients were assessed using the MATRICS Consensus Cognitive Battery (MCCB) before and after treatment. According to the total score of MCCB at baseline, the patient′s cognition function was divided into 4 levels: severe cognitive impairment, moderate cognitive impairment, mild cognitive impairment and normal cognitive function. According to the change of MCCB total score, the efficacy of the treatment was divided into 3 levels: no improvement (≤0 points), improvement (0-9.57 points), superior improvement (>9.57 points). The improvement rate of cognitive function between two treatment groups was compared. Results:In the CCRT group, there were 19 cases with superior improvement, 105 cases with improvement, and 46 cases with no improvement. In the WAT group, there were 7 cases with superior improvement, 39 cases with improvement, and 41 cases with no improvement. The improvement of cognitive function of CCRT group was better than that of WAT group, and the difference was statistically significant ( Z=2.978, P=0.003). The patients with serious cognitive impairment in the CCRT group had a higher improvement rate than those in the WAT group ( Z=1.860, P=0.032). The patients with moderate cognitive impairment in the CCRT group had a lower no improvement rate than those in the WAT ( Z=-1.817, P=0.035).The patients with mild cognitive impairment in the CCRT group had a lower no improvement rate ( Z=-3.294, P=0.001) and higher improvement rate and superior improvement rate ( Z=2.084, P=0.019; Z=1.969, P=0.025) than those in the WAT group. There was no statistically significant difference in improvement rate between patients with normal cognitive function in the CCRT group and in the WAT group ( P>0.05).The patients with improvement and superior improvement of cognition were combined as responder, and the two treatment groups were compared. The patients with mild cognitive impairment in the CCRT group had a higher improvement rate than those in the WAT group (77.2%(44/57) vs. 41.4%(12/29),χ2=10.853, P=0.001). However, for patients with serious and moderate cognitive impairment or with normal cognitive function at baseline, rates of improvement after treatment did not differ significantly between CCRT group and WAT group. According to Cohen′s d, the level of effect size in cognition improvement after CCRT treatment in patients with different cognitive dysfunction level was: mild cognitive impairment (0.59)>moderate cognitive impairment (0.48)>normal cognitive function (-0.12)>serious cognitive impairment (-0.24). Conclusions:Schizophrenic patients treated with CCRT had a higher improvement rate of cognitive function than those with WAT, and the improvement rate of cognitive function is higher in patients with mild cognitive impairment after CCRT treatment.

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