Objective:To investigate the clinical application value of commonly used preoperative indicators of sarcopenia in predicting postoperative pneumonia in patients aged 70 years and above with esophageal cancer.Methods:A retrospective analysis was conducted on the clinical data of 398 elderly patients(≥70 years old)with esophageal squamous cell carcinoma who underwent thoracic laparoscopic radical resection of esophageal cancer in our hospital from January 2020 to December 2021.The study aimed to investigate the correlation between clinical pathological indicators and commonly used measurement indicators of sarcopenia and postoperative pneumonia.Statistical analysis was performed to analyze the data.Results:The study found that the proportion of postoperative pneumonia in esophageal squamous cell carcinoma patients aged 70 years and above was 27.9%(111 out of 398). The pneumonia group had significantly lower preoperative BMI and peak expiratory flow(PEF)measurements compared to the non-pneumonia group, with statistically significant differences( t=2.799, 2.674, both P<0.05). Logistic multivariate analysis revealed that low PEF, low psoas major muscle index(PMI), and low psoas muscle density(PMD)were the primary risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and above(Wald χ2 values were 7.577, 6.091, 6.845, all P<0.05). The risk of postoperative pneumonia in esophageal cancer patients aged 70 years and above with low PEF, low PMI, and low PMD was found to be 1.969 times higher(95% CI: 1.215-3.185, P=0.006), 1.912 times higher(95% CI: 1.143-3.205, P=0.014), and 1.832 times higher(95% CI: 1.164-2.882, P=0.009)respectively, compared to patients with high PEF, high PMI, and high PMD. Conclusions:Low PEF, low PMI, and low PMD are significant risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and older.Preoperative PEF, PMI, and PMD, which are commonly utilized measurement indicators for sarcopenia, can be utilized as early screening indicators for postoperative pneumonia.

Objective: To investigate the prevalence and influencing factors of smoking among grassroots healthcare workers in Shaoxing City, Zhejiang Province, so as to provide insights into effective implementation of tobacco control measures in primary healthcare organizations. Methods: Grassroots healthcare workers of community health service centers (health institutes) were sampled from four streets (townships) in each of 6 counties (cities, districts) in Shaoxing City using a stratified cluster sampling method from May to June 2023. Participants' demographics, current smoking and quit smoking information were collected through questionnaire surveys, and factors affecting current smoking among grassroots healthcare workers were identified using a multivariable logistic regression model. Results: Totally 2 801 questionnaires were allocated, and 2 595 valid questionnaires were recovered, with an effective recovery rate of 92.65%. Participants included 719 men (27.71%) and 1 876 women (72.29%), with a mean age of (39.39±10.11) years. There were 119 current smokers and the prevalence of current smoking was 4.59%. The median number of cigarettes smoked per day was 10.00 (interquartile range, 14.25) and the median duration of smoking was 20.00 (interquartile range, 15.00) years. There were 52 people with intention to quit smoking (43.70%), and 51 people with attempts to quit smoking (42.86%). Multivariable logistic regression analysis identified men (OR=22.998, 95%CI: 10.912-48.473), alcohol consumption (OR=3.907, 95%CI: 2.528-6.037) and length of service (15 years and more, OR=3.115, 95%CI: 1.305-7.434) as factors affecting current smoking among grassroots healthcare workers. Conclusions The prevalence of current smoking among grassroots healthcare workers in Shaoxing City is 4.59%, and there is low willingness to quit smoking. Current smoking status may be affected by gender, alcohol consumption and length of service.

Objective: To investigate the status and identify the influencing factors of smoking among residents in Shaoxing City, Zhejiang Province, so as to provide insights into tobacco control. Methods: Permanent residents aged 15 to 69 years in Shaoxing City were recruited using the stratified multistage random sampling method from June to December 2022, and smoking behaviors and health literacy were collected using the National Questionnaire for Surveillance on Healthy Literacy in Chinese Residents. Factors affecting smoking were identified using a multivariable logistic regression model. Results: Totally 4 156 questionnaires were allocated, and 4 055 valid questionnaires were recovered, with an effective recovery rate of 97.57%. There were 1 899 men (46.83%), 2 073 residents in rural areas (51.12%), and 3 256 married residents (80.30%). There were 805 smokers, and the rate of smoking was 19.85%. Multivariable logistic regression analysis showed that male (OR=169.861, 95%CI: 92.335-312.481), age (25-<35 years, OR=8.768, 95%CI: 2.964-25.937; 35-<45 years, OR=9.271, 95%CI: 3.077-27.933; 45-<55 years, OR=10.467, 95%CI: 3.498-31.327; 55-<65 years, OR=8.880, 95%CI: 2.964-26.608; 65-69 years, OR=6.115, 95%CI: 1.992-18.774), marital status (divorced, OR=2.035, 95%CI: 1.260-3.287; widowed, OR=2.317, 95%CI: 1.337-4.016), educational level (illiterate or semi-literate, OR=2.724, 95%CI: 1.515-4.898; primary school, OR=2.734, 95%CI: 1.823-4.100; junior high school, OR=2.003, 95%CI: 1.423-2.820; high school/vocational high school /technical secondary school, OR=1.625, 95%CI: 1.148-2.299), self-rated health status (general, OR=0.788, 95%CI: 0.623-0.996; relatively poor, OR=0.343, 95%CI: 0.191-0.617) and lack of basic health skills (OR=1.290, 95%CI: 1.007-1.653) were associated with smoking. Conclusions The smoking rate among residents in Shaoxing City is relatively low, and might be influenced by gender, age, marital status, educational level, self-rated health status, and basic health skills.

Objective To understand the awareness status of health education projects in basic public health services among medical personnel in primary medical institutions of Shaoxing City,to analyze its influ-encing factors aiming at promoting the awareness rate of basic public health services.Methods A multi-stage sampling method was adopted.The four village and town(street)health centers were extracted from each of 6 districts and counties(city)of Shaoxing City from May to June in 2023.The medical personnel in the extrac-ted units served as the respondents and completed the questionnaire survey of health education projects in bas-ic public health services through links or scanning the two-dimensional codes.The survey results conducted the statistics and the influencing factors were analyzed.Results A total of 2 595 medical personnels participa-ted in the survey,including 1926 respondents in urban areas and 669 respondents in rural areas.There were 1565 medical personnels with the awareness of health education projects,accounting for 60.31％.The results of the multivariate logistic regression analysis showed that the awareness rate of health education projects in the females(OR=1.401,95％CI:1.167-1.682),15-＜35 years old(OR=1.223,95％CI:0.874-1.712),35-＜55 years old(OR=1.454,95％CI:1.055-2.002),health education personnels(OR=1.219,95％CI:1.017-1.461),willingness of health education work(OR=1.647,95％CI:1.261-2.152)and participating in the health education training(OR=1.421,95％CI:1.185-1.705)was higher than that in the males,≥55 years old,non-health education personnel,no willingness to work in health education and not participating in health education training(P＜0.05).Conclusion The awareness rate of basic public health service health ed-ucation project is not high in Shaoxing City,and intervention should be carried out according to the influencing factors.

Objective:To investigate the value of machine learning model based on MRI in predicting the abundance of tumor infiltrating CD 8+ T cell and prognosis of pancreatic cancer patients. Methods:The clinical data of 156 patients with pathological confirmed pancreatic cancer who underwent pre-operative MRI within 7 days before surgery in the First Affiliated Hospital of Naval Medical University from January 2017 to April 2018 was retrospectively analyzed. According to the international consensus on the predictive model, a total of 116 patients from January to December 2017 were included in the training set, and a total of 40 patients from January to April 2018 were included in the validation set. With the overall survival of patients as the outcome variable, X-Tile software was used to obtain cut-off values of the percentage of CD 8+ T cells, and all patients were divided into CD 8+ T-high and -low groups. The clinical, pathological and radiological features were compared between two groups. 3D slicer software was used to draw the region of interest in each layer of the primary MR T 1- and T 2-weighted imaging, arterial phase, portal venous phase, and delayed phase images for tumor segmentation. Python package was applied to extract the radiomics features of pancreatic tumors after segmentation and the extracted features were reduced and chosen using the least absolute shrinkage and selection operator (Lasso) logistic regression algorithm. Lasso logistic regression formula was applied to calculate the rad-score. The extreme gradient boosting (XGBoost) were used to construct the machine learning predicted model. The models′ performances were determined by area under the ROC curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results:The cut-off value of the CD 8+ T-cell level was 19.09% as determined by the X-tile program. Patients in the high CD 8+ T cell group had a longer median survival than those in the low CD 8+ T cell group (25.51 month vs 22.92 month, P=0.007). The T stage in the training set and tumor size in the validation set significantly differed between the groups (all P value <0.05). A total of 1 409 radiomics features were obtained, and 19-selected features associated with the level of CD 8+ T cell were determined after being reduced by the Lasso logistic regression algorithm. The rad-score was significantly lower in the CD 8- high group (median: -0.43; range: -1.55 to 0.65) than the CD 8- low group (median: 0.22; range: -0.68 to 2.54, P<0.001). The prediction model combined the radiomics features and tumor size. In the training set, the AUC, sensitivity, specificity, accuracy, and positive and negative predictive value were 0.90 (95% CI 0.85-0.95), 75.47%, 90.48%, 0.84, 0.87, and 0.81. In the validation set, the AUC, sensitivity, specificity, accuracy, and positive and negative predictive value were 0.79 (95% CI 0.63-0.96), 90.00%, 80.00%, 0.85, 0.82, and 0.89. The predictive model can accurately distinguish patients with high and low CD 8+ T cells in pancreatic cancer. Conclusions:The radiomics-based machine learning model is valuable in predicting the CD 8+ T cells infiltrating level in pancreatic cancer patients, which could be useful in identifying potential patients who can benefit from immunotherapies.

Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK⁺ and 9 ones (27.3%) ALK^-. Of them, 25 patients (19 ALK⁺ and 6 ALK^-) underwent auto-HSCT and 8 cases (5 ALK⁺ and 3ALK^-) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.

Objective:To summarize the MRI features of intrapancreatic accessory spleen (IPAS) and G1 grade pancreatic neuroendocrine neoplasms (PNENs), and clarify the radiological features for differential diagnosis.Methods:The data of 11 patients with IPAS confirmed by surgical pathology or 99mTc thermal denatured red blood cell imaging and 9 patients with G1 grade PNENs confirmed by surgical pathology in the tail of pancreas from January 2013 to December 2019 admitted in First Affiliated Hospital of Navy Medical University were retrospectively analyzed. MRI features of IPAS group and PNENs group, including shape, size, whether it protruded beyond the contour of the pancreas, cystic degeneration, plain scan of T 2WI, DWI signal, multistage enhancement mode, false capsule, etc. were studied and compared. Results:There was significantly statistical difference between the two groups in the terms of contour protrusion, T 2WI and DWI signals, multistage enhancement, and pseudomembrane (all P< 0.05). Protruded lesion was more common in the PNENs group (9/9 cases) than in the IPAS group (3/11). The T 2WI and DWI signals of lesions in the PNENs group were slightly higher than those in the IPAS group, and the proportion of high T 2WI and DWI signal lesions in the PNENs group was 6/9 cases and 4/9 cases, respectively, while the proportion of high T 2WI and DWI signal lesions in the IPAS group was 0/11 cases. Multistage enhancement of lesions in the PNENs group was more likely to be consistent (6/9), while lesions in the IPAS group were more inconsistent (10/11). In the PNENs group, all lesions showed false envelope after enhancement (9/9), while in the IPAS group, no false envelope was observed after enhancement (0/11). Conclusions:The presence of protruded lesions, the characteristics of T 2WI and DWI signals, the mode of multiphase enhancement and the false envelope were essential signs for differentiating IPAS and G1 grade PNENs.

Objective: To investigate the protective effect of propofol on neurological function in rats after traumatic brain injury (TBI) and its possible mechanism. Methods: A total of 96 SD rats were randomly divided into sham operation group, sham operation+ propofol group, TBI group and TBI + propofol group, with 24 rats in each group. The TBI model was prepared by modified Feeney method. The sham operation+ propofol group and the TBI+ propofol group were given 50 mg/kg of propofol once daily. The sham operation group and the TBI group were injected with the same amount of normal saline. Modified neurobehavioral functional scores (mNSS) were evaluated at 1, 3, 7 and 14 days after injury; dry-wet specific gravity method was used to detect brain water content in injured area; TUNEL staining was used to detect neuronal apoptosis; chemiluminescence was used to detect activity of Oxygen cluster (ROS) content; Western blot was used to determine the expressions of inositol requirement enzyme 1 (IRE-1), enhancer binding protein homolog protein (CHOP), heme oxygenase 1 (HO-1), quinone oxidoreductase 1 (NQO1) and nuclear factor E2 related factor 2 (Nrf2) protein. Results: Compared with the sham operation group and the sham operation + propofol group, the mNSS, brain tissue water content, apoptosis number and ROS increased at 1, 3, 7 and 14 days after TBI in the TBI group and TBI + propofol group (P<0.05). Compared with TBI group, mNSS in TBI+ propofol group decreased significantly [(9.3±1.4)points ∶(10.9±1.2)points] 7 days after injury (P<0.05); the brain tissue water content decreased significantly [(81.0±0.8)%∶(82.1±0.8)%] 3 days after injury (P<0.05); the number of apoptotic cells decreased significantly 7 days after injury[(14.1±1.4)%∶(15.6±1.6)%], with the most significant decrease at 14 days after injury [( 10.4±1.5)%∶(13.2±1.4)% (P<0.05); and ROS decreased significantly 7 days after injury [(61.5±4.0)RFU∶(77.3±5.5)RFU](P<0.05). Compared with the sham operation group and the sham operation+ propofol group, the expressions of IRE-1 and CHOP were significantly up-regulated in the TBI group and the TBI+ propofol group (P<0.05); the expressions of HO-1, NQO1 and Nrf2 in the TBI group were significantly decreased (P<0.05); the expressions of HO-1 and NQO1 in TBI+ propofol group were increased (P<0.05) while the expression of Nrf2 were decreased slightly (P<0.05). Compared with the TBI group, the expressions of IRE-1 and CHOP in TBI+ propofol group were decreased (P<0.05), while the expressions of HO-1, NQO1 and Nrf2 were significantly increased (P<0.05). Conclusion After TBI in rats, propofol can reduce oxidative stress by activating the Nrf2-antioxidant element (ARE) pathway, reduce brain edema, and inhibit neuronal apoptosis, thus playing a neuro-protective role.

Objective To observe the clinical efficacy of surgical operation combined with photodynamic therapy for plantar warts.Methods From July 2017 to June 2018,16 patients with plantar warts were enrolled in the Department of Dermatology,the Fifth People's Hospital of Suzhou City.The enrolled patients aged 10 to 42 years,including 12 males and 4 females,with a course of 4 to 15 month,and a total of 47 plantar warts.The plantar warts was removed by surgical operation and bipolar coagulation,followed by the photodynamic treatment with 5-aminolevulinic acid for 3 to 4 times with an interval of 7-10 days.Results Eleven patients showed complete clearance after operation and three times photodynamic treatments,and the other 5 patients underwent 2 operations and four times photodynamic treatments.47 plantar warts in 16 patients were disappeared completely during 6-month post-treatment follow up.The plantar warts clearance rate was 100％,and the skin texture still presented.In addition to local mild erythematous,pain and burning sensation presented after surgery,but no adverse reactions such as infection,ulcers and obvious scars occurred.Conclusions Surgery combined with 5-aminolevulinic acid photodynamic therapy is a favorable treatment for plantar warts.

Objective To compare the dosimetric difference among plans designed by 4-field,6-field TomoDirect and TomoHelical techniques in Tomotherapy system for left-breast cancer patients with radiotherapy after breast-conserving surgery.Method A total of 16 patients with left-breast cancer following breast-conserving surgery and intensity-modulated radiation therapy were enrolled in this retrospective study.The 4-field TomoDirect (TD4),6-field TomoDirect (TD6),and TomoHelical (TH) techniques were applied to design simulation plans in tomotherapy system for each patient,respectively.The differences of dose distribution and treatment parameters were analyzed in this study.Results Three plans all met the clinical requirement.Thereinto,TD4 was superior to TH in the dose limitation of organs at risk (OARs),especially the max dose of cord and right-breast,thc 5 Gy radiation volume of lung,and the mean dose of heart(F =595.60,129.24,60.44,65.37,P ＜ 0.05),but inferior to TH in dose homogeneity (HI) and conformity (CI) (F =2.78,60.93,P ＜ 0.05).However,TD6 improved TD4's HI and CI when delivered the lower OARs dose compared to TH.Meanwhile,the number of monitor units was less in TD technique and reduced the treatment times (F =24.89,3.75,P ＜ O.05).Conclusions For the radiotherapy of left-breast cancer patients after breast-conserving surgery,TD6 technique appeared to be superior,with the lower radiation dose of OARs compared to TH technique,and the better target's HI and CI in comparison with TD4 technique,especially in patients with early stage breast cancer.