Objective:To investigate the predictive value of neutrophil percentage-to-albumin ratio (NPAR) on the outcome after intravenous thrombolysis (IVT) in elderly patients with acute ischemic stroke (AIS).Methods:Elderly patients with AIS who received IVT in Fuyang People's Hospital from October 2021 to September 2023 were retrospectively included. Clinical outcome were assessed by the modified Rankin Scale at 90 days after onset, with a score of >2 defined as poor outcome. Multivariate logistic regression analysis was used to determine the association between NPAR and poor clinical outcome after IVT in elderly AIS patients. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of NPAR for poor outcome. Results:A total of 148 patients were included, including 86 males (58.1%), aged (74.11±6.17) years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 5 (interquartile range: 3-8), and the NPAR was 1.58±0.30. The neutrophil count, neutrophil percentage, NPAR, fasting blood glucose and baseline NIHSS score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher baseline NPAR (odds ratio [ OR] 2.659, 95% confidence interval [ CI] 1.117-5.324; P<0.001), NIHSS score ( OR 1.191, 95% CI 1.083-1.309; P<0.001) and fasting blood glucose ( OR 1.224, 95% CI 1.013-1.479; P=0.037) were independent risk factors for poor outcome. ROC curve analysis showed that the area under the curve for NPAR to predict poor outcome was 0.712 (95% CI 0.613-0.812; P<0.001), the optimal cut-off value was 1.728, and the predictive sensitivity and specificity were 65.1% and 75.2%, respectively. Conclusion:Higher baseline NPAR may be a predictor of poor outcome after IVT in elderly AIS patients.

Objective To address the challenges of poor performance and lack of interpretability in existing models,the SHAP algorithm is used to develop an interpretable machine learning model that offers a novel approach to wound age estimation,Methods Based on the previous discovery of the expression of 35 wound age healing-related genes in contused skeletal muscle,the woun age estimaton model was constructed using four algorithms,namly,Multilayer Perceptron(MLP),Random Forest(RF),LightGBM(LGBM),and Support Vector Machine(SVM).The SHAP(Shapley Additive Explanation)algorithm was used to rank the importance of genetic features,eliminate redundant attributes,and optimize the model for accurate wound age estimation.the genetic features of the optimal model were analyzed using SHAP's local interpretation capabilities.Results The best results were obtained using model of MLP(area under the curve(AUC)=0.99)The wound ages were classified into four categories:4～12 h,16～24 h,28～36 h,and 40～48 h,using only 15 gene features.According to SHAP analysis,Fam210a was identified as the most relevant gene.Local analysis revealed that high expression of Fam210a contributed to an increase in the predicted probability of 4 h～12 h,while high expression of Rae1 contributed to an increase in the predicted probability of 16 h～24 h.Additionally,low expression of Tbx18 contributed to an increase in the predicted probability of 28 h～36 h,whereas high expression of Tbx18 contributed to an increase in the predicted probability of 40 h～48 h.Conclusions The combined MLP and SHAP model can be used to predict wound age.Using the SHAP interpreter can better understand the degree of contribution of feature genes to the model prediction,and lay the foundation for further in-depth study of wound age estimation.

Objective:To investigate the effects of peritoneal dialysis combined with hemodialysis on improving cardiac and renal function, peritoneal function, and nutritional status, and reducing complications in patients with end-stage renal disease.Methods:A total of 90 patients with end-stage renal disease who received treatment at Lishui Municipal Central Hospital and Lishui People's Hospital from January 2019 to May 2022 were retrospectively included in this study. The patients were divided into a control group and an observation group, with 45 patients in each group, based on the treatment methods used. The control group received peritoneal dialysis treatment, while the observation group received a combination of peritoneal dialysis and hemodialysis treatment. The changes in cardiac and renal function, peritoneal function, nutritional status, and the occurrence of complications were observed in both groups.Results:After treatment, the observation group showed significantly lower values in the cardiothoracic ratio [(57.02 ± 3.35)%], brain natriuretic peptide [(8 849.34 ± 124.65) ng/L], left ventricular mass index [(181.32 ± 8.56) g/m2], blood urea nitrogen [(14.04 ± 1.94) mmol/L], and serum creatinine [(181.47 ± 27.06) μmol/L] compared with the control group [(58.92 ± 3.11)%, (15 126.39 ± 322.82) ng/L, (187.28 ± 8.95) g/m2, (18.49 ± 2.82) mmol/L, (196.56 ± 31.07) μmol/L, t = 2.79, 121.68, 3.23, 8.72, 2.46, all P < 0.05]. Additionally, the observation group had significantly higher levels of ejection fraction [(63.47 ± 5.23)%], albumin [(52.98 ± 6.37) g/L], and hemoglobin [(114.94 ± 13.61) g/L] compared with the control group [(60.46 ± 5.18)%, (47.01 ± 6.04) g/L, (98.04 ± 10.93) g/L, t = -2.74, -4.52, -6.49, all P < 0.05]. The observation group also exhibited a significantly lower dialysate/plasma creatinine ratio [(0.56 ± 0.09)] and a lower level of β 2-microglobulin [(18 032.29 ± 718.11) mg/L] compared with the control group [(0.61 ± 0.07), (18 424.42 ± 736.43) mg/L, t = 2.54, 2.06, both P < 0.05]. The incidence of complications in the observation group was 11.11% (5/45), which was significantly lower than that in the control group [31.11% (14/45), χ2 = 4.27, P < 0.05]. Conclusion:Peritoneal dialysis combined with hemodialysis can improve cardiac and renal function, peritoneal function, and nutritional status and decrease the incidence of complications in patients with end-stage renal disease. This approach deserves to be clinically promoted. The findings of this study are of significant innovation and scientific value.

Objective:To retrospectively analyze efficacy and safety of granulocyte colony-stimulating factor(G-CSF)in relapsed/refractory B cell acute lymphoblastic leukemia(R/R B-ALL)patients with neutropenia(NE)after receiving CAR-T cell therapy.Methods:From March 2017 to December 2022,99 patients with R/R B-ALL developed NE after receiving CAR-T cell therapy in Tianjin First Central Hospital were collected and divided into two groups according to using time of G-CSF.One was early G-CSF group(received G-CSF within 7 days,n=56),the other was control group(received G-CSF after 7 d,n=43),whose recovery of NE and occurrence of adverse reactions after G-CSF were compared.Results:Duration of NE in early G-CSF group was shorter than control group[4(2,5.7)vs 11(9,14),P<0.05],but there were no significant differences in the lowest absolute neutrophil count(ANC),degree of NE inhibition and incidence of infection(P=0.261,P=0.09,P=0.111).There was no significant difference between incidence and severity of cytokine release syndrome(CRS)between two groups,and CRS was controllable in all patients.Conclusion:Early application of G-CSF in R/R B-ALL patients after CAR-T cell therapy can shorten duration of NE,and has no significant effect on adverse reactions after CAR-T cells.

Objective To investigate the clinical value of high resolution vascular wall imaging(HRVWI)in the diagnosis and treatment of central nervous system vasculitis(CNSV)in children.Methods A total of 36 children with CNSV underwent HRVWI examination were selected.The HRVWI imaging features,involved vessel types and stenosis degree were analyzed retrospectively and compared with magnetic resonance angiography(MRA).Combined with some patients'follow-up and reviewed imaging after treatment.Results HRVWI showed that all of the 36 children with CNSV had cerebral arteritis,and the affected inflammatory ves-sels showed varying degrees of focal arterial wall thickening and enhancement,mainly uniform thickening and centripetal enhance-ment of the affected arterial wall.Most were mid-enhanced,and the stenosis degree was mostly at level 1(21/36).According to the type of involvement cerebrovascular,there were 26 cases of large-medium vessel type,6 cases of small vessel type and 4 cases of mixed type.Compared with MRA,HRVWI had a higher sensitivity in diagnosing CNSV(P＜0.05).13 cases were followed up after treat-ment,and HRVWI showed cerebral vasculitis relief in 8 cases and progression in 5 cases,consistent with changes in clinical symp-toms and laboratory indicators.Conclusion The imaging features of CNSV in children with different causes are different.HRVWI has a high sensitivity in the diagnosis of CNSV in children.HRVWI plays an important role in the diagnosis and treatment of CNSV in children.

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Objective:To validate the efficacy of chimeric antigen receptor T cells targeting CD7 (CD7 CAR-T cells) modified with protein blocking technology and analyze whether pretreatment with dasatinib can enhance CD7 CAR-T killing ability or reverse the depletion phenotype.Methods:Green fluorescent protein (GFP)-labeled tumor cells were co-incubated with CD7 CAR-T cells or T cells at different potency-to-target ratios, but the culture volume and the numbers of CAR-T/T cells were same. The number of tumor cells was detected using flow cytometry. The killing effect of CAR-T cells on tumor cells was evaluated. A mouse model of acute T-lymphoblastic leukemia (T-ALL) was constructed by injecting 1×10 6 luciferase-expressing CCRF-CEM cells into the mouse tail vein to evaluate the therapeutic effect of CD7 CAR-T cells. Results:CD7 CAR-T cells had a significant killing effect on CCRF-CEM and Jurkat cells, but not on CD7-negative NALM6 cells. The mice in the group receiving CD7 CAR-T cells had a significantly reduced in vivo tumor load and a significantly prolonged survival time as compared with the mice in the group receiving untransduced T cells ( P<0.05). Dasatinib pretreatment significantly reversed the depletion phenotype of CD7 CAR-T cells ( P<0.05) and had no adverse effects on the killing effect and the proliferation of the cells. Conclusions:Protein-blocking technology-modified CD7 CAR-T cells are protected from killing each other, and pretreatment with dasatinib is expected to improve the efficacy and durability of CD7 CAR-T cells.

Purpose: Oligometastatic non–small cell lung cancer (NSCLC) patients have been increasingly regarded as a distinct group that could benefit from local treatment to achieve a better clinical outcome. However, current definitions of oligometastasis are solely numerical, which are imprecise because of ignoring the biological heterogeneity caused by genomic characteristics. Our study aimed to profile the molecular alterations of oligometastatic NSCLC and elucidate its potential difference from polymetastasis. Materials and Methods: We performed next-generation sequencing to analyze tumors and paired peripheral blood from 77 oligometastatic and 21 polymetastatic NSCLC patients to reveal their genomic characteristics and assess the genetic heterogeneity. Results: We found ERBB2, ALK, MLL4, PIK3CB, and TOP2A were mutated at a significantly lower frequency in oligometastasis compared with polymetastasis. EGFR and KEAP1 alterations were mutually exclusive in oligometastatic group. More importantly, oligometastasis has a unique significant enrichment of apoptosis signaling pathway. In contrast to polymetastasis, a highly enriched COSMIC signature 4 and a special mutational process, COSMIC signature 14, were observed in the oligometastatic cohort. According to OncoKB database, 74.03% of oligometastatic NSCLC patients harbored at least one actionable alteration. The median tumor mutation burden of oligometastasis was 5.00 mutations/Mb, which was significantly associated with smoking, DNA damage repair genes, TP53 mutation, SMARCA4 mutation, LRP1B mutation, ABL1 mutation. Conclusion Our results shall help redefine oligometastasis beyond simple lesion enumeration that will ultimately improve the selection of patients with real oligometastatic state and optimize personalized cancer therapy for oligometastatic NSCLC.

Background Steel workers are exposed to occupational hazardous factors such as dust, noise, and heat, and often work in shifts, making them prone to sleep disorders. Objective To explore potential influencing factors of sleep disorders among workers in a steel enterprise in Gansu Province, and provide a basis for reducing the risk of sleep disorders among them. Methods From January to March 2022, a self-made questionnaire combined with the Pittsburgh Sleep Quality Index (PSQI) were used to investigate the employees of a steel enterprise in Gansu Province. According to their PSQI scores, they were divided into a normal sleep group and a sleep disorder group. The general demographic variables of the two groups were balanced by 1∶1 propensity score matching (PSM). Multiple logistic regression was used to analyze the contributing factors of sleep disorders. Restricted cubic spline (RCS) model was used to analyze potential dose-response relationship between weekly working hours and sleep disorders. Results The prevalence of sleep disorders in the steel workers was 48.06% (6029/12544). After PSM, 5847 pairs were successfully matched, and the distributions of matched variables were well balanced between the two groups. The results of multiple logistic regression showed that hypertension (OR=1.39, 95%CI: 1.24, 1.56), diabetes mellitus (OR=1.34, 95%CI: 1.07, 1.66), three-shift system (OR=1.26, 95%CI: 1.12, 1.41), dust exposure (OR=1.14, 95%CI: 1.01, 1.29), noise exposure (OR=1.23, 95%CI: 1.09, 1.39), heat exposure (OR=1.16, 95%CI: 1.04, 1.29), and work injury (OR=1.22, 95%CI: 1.02, 1.46) increased the risk of sleep disorders. Compared with workers with < 10 years of service, those with 10-20 years (OR=1.31, 95%CI: 1.19, 1.44), 20-30 years (OR=1.34, 95%CI: 1.19, 1.52), and ≥30 years of service (OR=1.35, 95%CI: 1.19, 1.53) had a higher risk of sleep disorders. Compared with non-exercise workers, the risk of developing sleep disorders was lower in workers with occasional exercise (OR=0.61, 95%CI: 0.56, 0.66) and regular exercise (OR=0.55, 95%CI: 0.49, 0.62). The RCS model showed that the weekly working hours and sleep disorders in the steel workers showed a nonlinear dose-response relationship (P<0.05 for overall trend, P<0.05 for nonlinear test). The relationship between weekly working hours and sleep disorders showed a "U" shaped distribution, with a significant increase in the risk of sleep disorders when the weekly working hours exceeded 49 h. Conclusion The non-occupational influencing factors of sleep disorders of employees in the steel enterprise include hypertension, diabetes, physical exercise, and occupational influencing factors include length of service, weekly working hours, shifts, dust exposure, noise exposure, heat exposure, and work injuries. It is recommended to consider both occupational and non-occupational factors to formulate appropriate sleep disorder prevention and control measures for steel employees to reduce the risk of sleep disorders.

{L-End}Objective To analyze the correlation between occupational burnout and sleep quality among steelworkers. {L-End}Methods A total of 11 491 steelworkers from a large steel enterprise in Gansu Province were selected as the research subjects using convenient sampling method. The Burnout Questionnaire and the Pittsburgh Sleep Quality Index Scale were used to investigate their occupational burnout and sleep quality. Hierarchical regression analysis was used to analyze the effects of occupational burnout on the sleep quality. {L-End}Results The detection rate of occupational burnout and sleep disorder were 50.4% and 39.0%, respectively. There was a positive correlation between the level of occupational burnout and the total score of sleep quality (Spearman correlation coefficient=0.454, P<0.05). The results of hierarchical regression analysis, adjusting for confounding factors such as gender, age, marital status, education level, alcohol consumption, exercise, weekly working hours, seniority, work shift, noise exposure, dust exposure, and high-temperature work, showed that the score of occupational burnout was positively related to the score of sleep quality(P<0.01), explaining 16.0% of the variance in the score of sleep quality among these steelworkers. {L-End}Conclusion The detection rate of occupational burnout and sleep disorders are relatively high among the steelworkers in this enterprise. Higher levels of occupational burnout are associated with poorer sleep quality. Alleviating occupational burnout among steelworkers may contribute to improving their sleep quality.