OBJECTIVE To evaluate the effect of clinical pharmacists participating in the treatment of chronic heart failure （CHF） based on the clinical pharmacy pathway （CPP）. METHODS Totally 226 CHF patients recruited from August 24th， 2024 to March 14th， 2025， were divided into an observation group and a control group based on the random number table method， with 113 cases in each group. All patients were treated with conventional therapy. The observation group was additionally given CPP management （including pharmaceutical care during hospitalization， the formulation of individualized discharge medication regimens， and pharmaceutical follow-up after discharge）. The cardiac function parameters at admission， at discharge， at 3 and 6 months after discharge， drug use at 6 months after discharge， economic indicators， as well as the readmission rate and mortality rate at 6 months after discharge were compared between the two groups. Morisky Medication Adherence Scale-8 Items （MMAS-8）， Somatic Self-rating Scale （SSS） and Patient Health Questionnaire-9 （PHQ-9） scores were compared at admission， at discharge and at 3 and 6 months after discharge. RESULTS Six months after discharge， 24 patients dropped out. Eventually， 104 patients in the observation group and 98 patients in the control group completed the study. Compared with at admission， New York Heart Association （NYHA） cardiac functional classification， left ventricular ejection fraction （LVEF） and N -terminal pro-B-type natriuretic peptide （NT-proBNP） of both groups of patients at discharge as well as at 3 and 6 months after discharge were significantly improved； moreover， the improvements at 3 and 6 months after discharge were significantly better than those at discharge. Meanwhile， the above indexes （except for NYHA cardiac functional classification at discharge， NT-proBNP and NYHA cardiac functional classification at 3 months after discharge） of the observation group at discharge， at 3 and 6 months after discharge were significantly better than the control group （ P ＜0.05）. The utilization rates of angiotensin converting enzyme inhibitor （ACEI）/angiotensin Ⅱ receptor blocker （ARB）/angiotensin receptor neprilysin inhibitor （ARNI）， the proportion of β-blockers reaching the target dose， the utilization rate of sodium-glucose linked transporter 2 inhibitor （SGLT2i）， and the proportion of SGLT2i reaching the target dose in the observation group were significantly higher than the control group （ P ＜0.05）， and the proportion of drugs and readmission rate were significantly lower than the control group （ P ＜0.05）. Compared with at admission， MMAS-8 scores of the patients in the observation group at discharge， at 3 and 6 months after discharge were significantly increased， while SSS and PHQ-9 scores were significantly lowered （ P ＜0.05）. And all the above scores gradually decreas ed with the extension of discharge time （ P ＜0.05）. CONCLUSIONS Clinical pharmacists can utilize CPP to significantly improve patients’ cardiac function， medication adherence， somatic symptoms and depression. Additionally， they can significantly improve the utilization rates of ACEI/ARB/ARNI and SGLT2i， as well as the proportion of target doses of β-blockers and SGLT2i， while simultaneously reducing readmission rates.

Objective:To development a deep learning（DL） model based on conventional MRI for automatic segmentation and differential diagnosis of nasopharyngeal carcinoma（NPC） and nasopharyngeal lymphoma（NPL）. Methods:The retrospective study included 142 patients with NPL and 292 patients with NPC who underwent conventional MRI at Renmin Hospital of Wuhan University from June 2012 to February 2023. MRI from 80 patients were manually segmented to train the segmentation model. The automatically segmented regions of interest（ROIs） formed four datasets: T1 weighted images（T1WI）, T2 weighted images（T2WI）, T1 weighted contrast-enhanced images（T1CE）, and a combination of T1WI and T2WI. The ImageNet-pretrained ResNet101 model was fine-tuned for the classification task. Statistical analysis was conducted using SPSS 22.0. The Dice coefficient loss was used to evaluate performance of segmentation task. Diagnostic performance was assessed using receiver operating characteristic（ROC） curves. Gradient-weighted class activation mapping（Grad-CAM） was imported to visualize the model's function. Results:The DICE score of the segmentation model reached 0.876 in the testing set. The AUC values of classification models in testing set were as follows: T1WI: 0.78（95%CI 0.67-0.81）, T2WI: 0.75（95%CI 0.72-0.86）, T1CE: 0.84（95%CI 0.76-0.87）, and T1WI+T2WI: 0.93（95%CI 0.85-0.94）. The AUC values for the two clinicians were 0.77（95%CI 0.72-0.82） for the junior, and 0.84（95%CI 0.80-0.89） for the senior. Grad-CAM analysis revealed that the central region of the tumor was highly correlated with the model's classification decisions, while the correlation was lower in the peripheral regions. Conclusion:The deep learning model performed well in differentiating NPC from NPL based on conventional MRI. The T1WI+T2WI combination model exhibited the best performance. The model can assist in the early diagnosis of NPC and NPL, facilitating timely and standardized treatment, which may improve patient prognosis.
Humans ; Nasopharyngeal Carcinoma/diagnostic imaging* ; Deep Learning ; Magnetic Resonance Imaging ; Retrospective Studies ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Lymphoma/diagnostic imaging* ; Diagnosis, Differential ; ROC Curve ; Male ; Female ; Middle Aged ; Adult

Objective:To evaluate the clinical efficacy of the Magpie-bridge Microskin Grafting (hereinafter briefly referred to as Magpie-bridge surgery) in treating linear white scars (LWS).Methods:This study was a retrospective cohort study. From October 2022 to December 2023, 37 LWS patients were treated with the Magpie-bridge surgery at the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 9 males and 28 females, aged 25 (17, 36) years. All scars were <2 mm in width and 1–10 cm in length before surgery. Magpie-bridge surgery procedure: an electric punch was used to excise scar tissue at intervals to form wounds and harvest microskin grafts of the same size and thickness as the removed scar tissue from behind the ear or axillary apex. The microskin grafts were implanted at the wound sites and fixed with tension-reducing adhesive tape. The donor area wounds were treated with routine dressing changes. Twelve months after the first surgery, the efficacy was evaluated based on the degree of reduction in scar white area compared with that before the first surgery, and the treatment effectiveness rate was calculated. Before the first surgery and 12 months after the first surgery, the melanin scores of the normal skin area surrounding the scar and the scar area were evaluated using a skin imaging analysis system, and the difference between the two was calculated. Six of the aforementioned patients requested a second Magpie-bridge surgery in pursuit of better therapeutic effects. The white scar tissue left untreated during the first surgery (hereinafter referred to as untreated scar tissue) and the tissue from the site at 12 months post scar removal and microskin transplantation (hereinafter referred to as the recipient skin tissue at 12 months after the first surgery) were collected. The tissue structure, melanin quantity and distribution were examined by using hematoxylin eosin staining and Masson-Fontana staining, and the activity of tyrosinase positive melanocytes was observed by using immunofluorescence staining.Results:At 12 months after the first surgery, the results of efficacy evaluation showed that 24 cases were cured, 11 cases were improved, 1 case was ineffective, and 1 case was in a worsened condition, yielding a 94.6% (35/37) treatment effectiveness rate. The melanin score difference between the surrounding normal skin area of scar and the scar area was 0.45 (0.10, 1.65) at 12 months after the first surgery, which was significantly less than 2.50 (1.40, 5.96) before the first surgery ( Z=-5.02, P<0.05). Six patients had untreated scar tissue with flat epidermis and a flat junction between dermis and epidermis; the collagen fiber bundles in the dermis were thick and unidirectionally parallel; no skin appendages such as hair follicles were observed; the basal layer of the epidermis showed deposition of melanin particles, but no extensive depigmentation was observed. Compared with those of untreated scar tissue, the epidermal thickness increased, and epidermal protrusions appeared at the junction of dermis and epidermis of the recipient skin tissue at 12 months after the first surgery; hair follicles and sebaceous glands were visible, and collagen fibers in the dermis were arranged vertically and horizontally in an orderly manner. Melanin particles were deposited in the basal layer of the epidermis, and the melanin content per unit area of tissue was increased. Tyrosinase-positive melanocytes in untreated scar tissue and in the recipient skin tissue at 12 months after the first surgery were mainly located at the basal layer of the epidermis, with normal cell activity and no significant difference. Conclusions:The Magpie-bridge surgery can significantly improve the appearance of LWS in patients, with definite therapeutic effects and value for clinical promotion; the improvement of LWS appearance by Magpie-bridge surgery may be related to the increase of melanin content per unit area of tissue and the normalization of tissue structure.

Objective:To evaluate the diagnostic value of targeted next-generation sequencing (tNGS) of throat swab samples for detecting community-acquired respiratory viruses (CARV) in patients with hematological diseases.Methods:Clinical and laboratory data from 64 episodes involving patients with hematological diseases and suspected infections—who underwent both pharyngeal swab tNGS and CARV polymerase chain reaction (PCR) testing concurrently—were retrospectively analyzed. The cases were drawn from the Department of Hematology, Peking University People’s Hospital, between September 2023 and April 2024. Concordance between tNGS and CARV PCR results, as well as the diagnostic performance of tNGS in detecting CARV, were evaluated.Results:Among the 64 episodes, 29 were clinically diagnosed with respiratory tract infections, including one case of cytomegalovirus pneumonia and 28 CARV-positive cases. The remaining 35 episodes involved patients with fever or respiratory symptoms attributed to other causes, including 14 with extrapulmonary infections and 21 with noninfectious etiologies. The median follow-up duration was 215.5 days (range: 7-271 days). PCR detected 24 strains of seven CARV types, whereas tNGS detected 25 strains of eight CARV types. Using PCR results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tNGS were 85.0%, 88.6%, 77.3%, 92.9%, and 87.5%, respectively. The two methods showed good concordance (Kappa=0.717, P<0.001) . Conclusion:Pharyngeal swab tNGS may serve as a viable alternative to PCR for diagnosing CARV infections in patients with hematological diseases.

OBJECTIVE: To evaluate the early effectiveness of transosseous suture fixation in treating recurrent acute patellar dislocation with patellar osteochondral fractures (OCFs). METHODS: A retrospective analysis was conducted on 19 patients with recurrent acute patellar dislocation and patellar OCFs, who underwent transosseous suture fixation between January 2018 and December 2022 and were followed up 2 years. The cohort included 8 males and 11 females, aged 13-21 years (mean, 16.2 years). Patients experienced 2-5 times of patellar dislocation (mean, 3.2 times). The interval from the last dislocation to operation ranged from 3 to 15 days (mean, 9.6 days). Preoperative imaging revealed the intra-articular osteochondral fragments and medial patellofemoral ligament (MPFL) injury. Clinical outcomes were evaluated using the visual analogue scale (VAS) score for pain, the International Knee Documentation Committee (IKDC) score, the Hospital for Special Surgery (HSS) knee score, the Lysholm score, and the Tegner score. Postoperative complications were recorded. During follow-up, the knee X-ray films, CT, and MRI were taken to evaluate fragment healing, displacement, and the morphology and tension of the MPFL reconstruction graft. RESULTS: All incisions healed primarily, and no complication occurred such as infection, joint stiffness, patellofemoral arthritis, or redislocation. Patients were followed up 24-60 months (mean, 43.5 months). At 12 months postoperatively and the last follow-up, significant improvements ( P<0.05) were observed in VAS, Lysholm, IKDC, HSS, and Tegner scores compared to preoperative values. Further improvements were observed at last follow-up compared with the 12 months postoperatively, and the differences were significant ( P<0.05). Imaging studies demonstrated satisfactory osteochondral fragment positioning with stable fixation. At last follow-up, all fragments had healed, and MPFL reconstruction grafts exhibited optimal morphology and tension. No joint adhesion or fragment displacement occurred. CONCLUSION For recurrent acute patellar dislocation with patellar OCFs, transosseous suture fixation proves to be both safe and effective, achieving satisfactory early effectiveness.
Humans ; Male ; Female ; Patellar Dislocation/surgery* ; Adolescent ; Young Adult ; Retrospective Studies ; Patella/surgery* ; Suture Techniques ; Treatment Outcome ; Recurrence ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Follow-Up Studies

Prostate cancer (PC) is one of the common malignant tumors among men, and its incidence has been increased in China across these years. Radiotherapy is the mainstay therapy for PC. Due to the special biological characteristics of PC and the development of precision radiotherapy technology, hypofractionated regimens of radiotherapy are progressing rapidly, which has been increasingly applied in clinical practice and extensively studied by more and more researchers. In this review, the biological mechanisms of hypofractionated regimens, related clinical research, and practical applications of hypofractionated radiotherapy (such as definitive radiotherapy, postoperative adjuvant / salvage radiotherapy, oligometastasis radiotherapy, and pelvic lymph node radiotherapy) were summarized and its efficacy and toxicity profiles were analyzed, aiming to provide reference for scientific promotion of short‐course, hypofractionated precision radiotherapy for PC in China.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

Objective:To evaluate the diagnostic value of targeted next-generation sequencing (tNGS) of throat swab samples for detecting community-acquired respiratory viruses (CARV) in patients with hematological diseases.Methods:Clinical and laboratory data from 64 episodes involving patients with hematological diseases and suspected infections—who underwent both pharyngeal swab tNGS and CARV polymerase chain reaction (PCR) testing concurrently—were retrospectively analyzed. The cases were drawn from the Department of Hematology, Peking University People’s Hospital, between September 2023 and April 2024. Concordance between tNGS and CARV PCR results, as well as the diagnostic performance of tNGS in detecting CARV, were evaluated.Results:Among the 64 episodes, 29 were clinically diagnosed with respiratory tract infections, including one case of cytomegalovirus pneumonia and 28 CARV-positive cases. The remaining 35 episodes involved patients with fever or respiratory symptoms attributed to other causes, including 14 with extrapulmonary infections and 21 with noninfectious etiologies. The median follow-up duration was 215.5 days (range: 7-271 days). PCR detected 24 strains of seven CARV types, whereas tNGS detected 25 strains of eight CARV types. Using PCR results as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tNGS were 85.0%, 88.6%, 77.3%, 92.9%, and 87.5%, respectively. The two methods showed good concordance (Kappa=0.717, P<0.001) . Conclusion:Pharyngeal swab tNGS may serve as a viable alternative to PCR for diagnosing CARV infections in patients with hematological diseases.

Objective:To evaluate the clinical efficacy of the Magpie-bridge Microskin Grafting (hereinafter briefly referred to as Magpie-bridge surgery) in treating linear white scars (LWS).Methods:This study was a retrospective cohort study. From October 2022 to December 2023, 37 LWS patients were treated with the Magpie-bridge surgery at the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 9 males and 28 females, aged 25 (17, 36) years. All scars were <2 mm in width and 1–10 cm in length before surgery. Magpie-bridge surgery procedure: an electric punch was used to excise scar tissue at intervals to form wounds and harvest microskin grafts of the same size and thickness as the removed scar tissue from behind the ear or axillary apex. The microskin grafts were implanted at the wound sites and fixed with tension-reducing adhesive tape. The donor area wounds were treated with routine dressing changes. Twelve months after the first surgery, the efficacy was evaluated based on the degree of reduction in scar white area compared with that before the first surgery, and the treatment effectiveness rate was calculated. Before the first surgery and 12 months after the first surgery, the melanin scores of the normal skin area surrounding the scar and the scar area were evaluated using a skin imaging analysis system, and the difference between the two was calculated. Six of the aforementioned patients requested a second Magpie-bridge surgery in pursuit of better therapeutic effects. The white scar tissue left untreated during the first surgery (hereinafter referred to as untreated scar tissue) and the tissue from the site at 12 months post scar removal and microskin transplantation (hereinafter referred to as the recipient skin tissue at 12 months after the first surgery) were collected. The tissue structure, melanin quantity and distribution were examined by using hematoxylin eosin staining and Masson-Fontana staining, and the activity of tyrosinase positive melanocytes was observed by using immunofluorescence staining.Results:At 12 months after the first surgery, the results of efficacy evaluation showed that 24 cases were cured, 11 cases were improved, 1 case was ineffective, and 1 case was in a worsened condition, yielding a 94.6% (35/37) treatment effectiveness rate. The melanin score difference between the surrounding normal skin area of scar and the scar area was 0.45 (0.10, 1.65) at 12 months after the first surgery, which was significantly less than 2.50 (1.40, 5.96) before the first surgery ( Z=-5.02, P<0.05). Six patients had untreated scar tissue with flat epidermis and a flat junction between dermis and epidermis; the collagen fiber bundles in the dermis were thick and unidirectionally parallel; no skin appendages such as hair follicles were observed; the basal layer of the epidermis showed deposition of melanin particles, but no extensive depigmentation was observed. Compared with those of untreated scar tissue, the epidermal thickness increased, and epidermal protrusions appeared at the junction of dermis and epidermis of the recipient skin tissue at 12 months after the first surgery; hair follicles and sebaceous glands were visible, and collagen fibers in the dermis were arranged vertically and horizontally in an orderly manner. Melanin particles were deposited in the basal layer of the epidermis, and the melanin content per unit area of tissue was increased. Tyrosinase-positive melanocytes in untreated scar tissue and in the recipient skin tissue at 12 months after the first surgery were mainly located at the basal layer of the epidermis, with normal cell activity and no significant difference. Conclusions:The Magpie-bridge surgery can significantly improve the appearance of LWS in patients, with definite therapeutic effects and value for clinical promotion; the improvement of LWS appearance by Magpie-bridge surgery may be related to the increase of melanin content per unit area of tissue and the normalization of tissue structure.

Prostate cancer (PC) is one of the common malignant tumors among men, and its incidence has been increased in China across these years. Radiotherapy is the mainstay therapy for PC. Due to the special biological characteristics of PC and the development of precision radiotherapy technology, hypofractionated regimens of radiotherapy are progressing rapidly, which has been increasingly applied in clinical practice and extensively studied by more and more researchers. In this review, the biological mechanisms of hypofractionated regimens, related clinical research, and practical applications of hypofractionated radiotherapy (such as definitive radiotherapy, postoperative adjuvant / salvage radiotherapy, oligometastasis radiotherapy, and pelvic lymph node radiotherapy) were summarized and its efficacy and toxicity profiles were analyzed, aiming to provide reference for scientific promotion of short‐course, hypofractionated precision radiotherapy for PC in China.