Background and purpose:The incidence of autonomic dysfunction(AD)in patients with advanced cancer is approximately 65%-80%.The neurasthenic symptoms such as dizziness,palpitations and fatigue caused by AD are difficult to alleviate even with sufficient rest,seriously affecting the patients'quality of life.Meanwhile,the cardiovascular autonomic nervous system plays a significant regulatory role in heart rate,myocardial function and myocardial blood flow.AD increases the morbidity and mortality risk of cardiovascular diseases in patients.AD is not only a functional state but might also be an early sign of overall myocardial lesion.Research indicates that after adjusting for age,gender and cardiovascular risk factors,previous radiation exposure is associated with AD manifestations such as increased resting heart rate and abnormal heart rate recovery after exercise.However,there are currently few relevant studies on the effect of radiotherapy on cardiac autonomic function,and the specific injury effects and dose threshold of injury occurrence remain unclear.This study aimed to explore the impact of thoracic radiotherapy on the cardiac autonomic function of patients with malignant tumors by comparing the differences in heart rate variability(HRV)analysis parameters before and after radiotherapy,and to explore the dosimetric risk factors for the occurrence of AD by comparing the dosimetry between the case group and the control group,providing a theoretical basis for optimizing the dose distribution of radiotherapy regimens in order to improve patient prognosis and reduce the occurrence of complications.Methods:We prospectively collected data of patients with malignant tumors who underwent thoracic radiotherapy in the Radiotherapy Department of the Affiliated Hospital of North China University of Science and Technology from February 2023 to December 2023.Inclusion criteria:① Patients who were pathologically confirmed to have malignant tumors(lung cancer breast cancer or esophageal cancer);② patients with radiation therapy indications as recommended by the guidelines;③ patients with an ECOG score of 0-1;④ patients with no significant abnormalities in electrocardiogram and echocardiography results.Exclusion criteria:① previously received chest radiotherapy;② patients with obvious palpitation,chest tightness and chest pain before treatment;③ diabetes,heart disease and other serious underlying diseases;④ anti-arrhythmic drugs are currently being used;⑤ patients who cannot tolerate radiotherapy and who were lost or lost during follow-up.HRV analysis was used to evaluate changes in autonomic nerve function after radiotherapy.Patients with AD were included in the case group,and the remaining patients were included in the control group.Univariate and multivariate logistic regression analysis methods were used to explore the dosimetric risk factors and cardiac dose limitations for the occurrence of AD after thoracic radiotherapy.This study was approved by the ethics committee of Affiliated Hospital of North China University of Science and Technology(ethics number:20230228020).Results:A total of 89 patients with thoracic tumors meeting the study criteria were enrolled in the study.Among them,41(46%)patients experienced cardiac AD after radiotherapy.The cardiac Dmax(6 273.500 cGy vs 4 675.900 cGy,P＜0.001),cardiac Dmean(1513.700 cGy vs 452.050 cGy,P＜0.001),cardiac V5(49.000%vs 21.250%,P＜0.001),V20(30.500%vs 7.300%,P＜0.001),V30(18.700%vs 3.600%,P＜0.001)and V40(10.900%vs 1.500%,P＜0.001)were significantly higher in the case group than in the control group.The results of multivariate logistic regression analysis showed that cardiac V30 was an independent risk factor for the occurrence of cardiac AD[OR(95%CI)=1.583(1.093-2.291),P=0.015].Cardiac V30 could predict the occurrence of radiation-induced cardiac injury with an area under the curve of 0.788,and 17.1%was the optimal cut-offvalue of cardiac V30 for predicting the occurrence of cardiac AD.Conclusion:After thoracic radiotherapy,the cardiac irradiation dose-volume was significantly higher in patients with cardiac AD than in the control group.When cardiac V30 was higher than 17.1%,the risk of cardiac AD in patients significantly increased.

Objective To explore the changes of fatigue status before and after radiotherapy in tumor patients and its influencing factors.Methods A total of 150 tumor patients with radiotherapy in the radiother-apy department of this hospital from February to September 2023 were selected as the study subjects.The general data questionnaire and the Multidimensional Fatigue Scale (MFI-20) were adopted to conduct the sur-vey.The fatigue scores and the changes in autonomic nervous function were compared between before and af-ter radiotherapy.The multifactor logistic regression was applied to analyze the influencing factors of changes in fatigue status.Results Compared with before radiotherapy,the average fatigue scores after radiotherapy were higher[(63.99±14.54)points vs. (52.75±17.18)points],low frequency (LF),and high frequency (HF),total power (TP),time domain indicators sinus heart beat RR interval standard deviation (SDNN) and the root-mean-square value of the difference between adjacent NN interval (rMSSD) were lower,LF/HF was higher,and the differences were statistically significant (P<0.05).The univariate analysis results showed that the fatigue situation had statistical difference among the patients with different clinical stages,chronic dis-ease history,pain scores,hemoglobin,lymphocyte,WBC and heart rate variability (HRV,P<0.05).The mul-tivariate logistic regression analysis results showed that the decrease of hemoglobin,WBC and HRV were the independent risk factors of fatigue aggravation (P<0.05).Conclusion It is necessary to guide the clinic to conduct the intervention on the influencing factors aggravating fatigue to improve the outcome of the patients with tumor.

[Abstract] Blood transfusion is a common therapeutic measure with indispensable role in clinical medicine. However, there is a risk of transmitting diseases during blood transfusion, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), etc. To reduce these risks and ensure blood transfusion safety, detection of disease markers in blood transfusion is particularly important. Biological sensing technology, with its advantages of high sensitivity, rapid response and portability, has broad application prospects in the detection of disease markers in blood transfusion. However, the biological sensing strategies for detection of disease markers in blood transfusion have not yet been systematically classified or fully discussed. Therefore, this paper first elucidates the common disease markers in blood transfusion and their importance. Then, it focuses on the application of biological sensors in the detection of disease markers in blood transfusion and discusses the challenges faced and the direction of future development in this field.

Partial nephrectomy (PN) is primarily used to treat small size renal cell carcinoma (RCC), aiming to minimize the impact on kidney function. Although the recurrence rate post-PN is low, vigilance in diagnosing recurrence is crucial to differentiate it from inflammatory pseudotumor (IPT) and therefore prevent unnecessary interventions. In the case of a 56-year-old female patient who underwent PN for RCC of the right kidney, a mass was identified in the original surgical site over a year later, raising concerns of local recurrence based on imaging findings. However, when the patient declined puncture biopsy, a Radical Nephrectomy (RN) was performed instead. Subsequent pathology results revealed the presence of IPT, not tumor recurrence. This case underscores the importance of a comprehensive analysis of imaging features to accurately diagnose postoperative recurrence following PN. Where uncertainty persists, puncture biopsy should be considered to provide a definitive diagnosis. Moreover, emphasizing ongoing training in PN techniques and adherence to established protocols is essential to minimize the likelihood of complications such as trauma and infection, thereby reducing the occurrence of both postoperative PN recurrence and IPT.

Objective:To observe whether hair follicle cells from mice of different species can integrate to generate new pigmented hair follicles, and to explore the role of different melanocyte populations in pigmented hair follicle reconstruction in mice.Methods:The epidermal cell population, hair follicle epithelial cell population and dermal cell population were isolated from the skin of fetal or neonatal C57BL/6J and BALB/C mice, and epidermal melanocytes were obtained by culture and purification of the epidermal cell population. The experiments were divided into 3 parts: (1) hair follicle reconstruction experiment in neonatal C57BL/6J mice, which included 2 groups: epidermal cells + hair follicle epithelial cells group and dermal cells group; (2) chimeric hair follicle reconstruction experiment, which included 4 groups: dermal cells of neonatal C57BL/6J mice group, dermal cells of neonatal BALB/C mice group, dermal cells of neonatal BALB/C mice + dermal cells of neonatal C57BL/6J mice group, and dermal cells of fetal BALB/C mice + dermal cells of fetal C57BL/6J mice group; (3) pigmented hair follicle reconstruction experiment, which included 3 groups: dermal cells of neonatal BALB/C mice + epidermal cells of neonatal C57BL/6J mice group, dermal cells of neonatal BALB/C mice + hair follicle epithelial cells of neonatal C57BL/6J mice group, and dermal cells of neonatal BALB/C mice + cultured C57BL/6J epidermal melanocytes group. Different cells were implanted into dorsal skin fold chambers of the nude mice, and there were 4 mice in each group. At weeks 4 and 8 after inoculation, hair follicle reconstruction was assessed by gross observation, histological examination and immunofluorescence assay.Results:Among the 8 BALB/C nude mice in the 2 groups in the hair follicle reconstruction experiment, 7 survived and 1 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, no hair growth was observed in the epidermal cells + hair follicle epithelial cells group (3 mice) , while normal hair grew out in the dermal cells group (4 mice) mixed with epithelial components. Among the 16 BALB/C nude mice in the 4 groups in the chimeric hair follicle reconstruction experiment, 14 survived and 2 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, brown-grey hair grew well in the dermal cells of neonatal BALB/C mice + dermal cells of neonatal C57BL/6J mice group (4 mice) , and dermal cells of fetal BALB/C mice + dermal cells of fetal C57BL/6J mice group (3 mice) . Among the 12 BALB/C nude mice in the 3 groups in the pigmented hair follicle reconstruction experiment, 10 survived and 2 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, only white hair grew out in the dermal cells of neonatal BALB/C mice + cultured C57BL/6J epidermal melanocytes group (3 mice) , and no hair follicle melanocytes were observed by immunofluorescence assay, while brown-grey hair grew well in the dermal cells of neonatal BALB/C mice + epidermal cells of neonatal C57BL/6J mice group (4 mice) , and dermal cells of neonatal BALB/C mice + hair follicle epithelial cells of neonatal C57BL/6J mice group (3 mice) .Conclusions:The interaction between mesenchymal cells and hair follicle epithelial cells is a necessary condition for hair follicle reconstruction. The hair follicle cells from different species of mice can integrate to generate new pigmented hair follicles. Both hair follicle melanocytes and epidermal melanocytes can participate in the formation of pigmented hair follicles, but differentiated melanocytes have no such ability.

OBJECTIVE To accurately identify the rare adverse drug reactions （ADR） of vancomycin-pancytopenia in order to promote its safe use. METHODS Through a case report of a child with suppurative hip arthritis who developed pancytopenia combined with delayed drug fever caused by intravenous infusion of vancomycin，Naranjo score method and related literature were used to summarize the association between the ADR and vancomycin and its possible mechanism， and suggestions for rational use of vancomycin in pediatric patients were put forward. RESULTS & CONCLUSIONS The association of pancytopenia combined with delayed drug fever and vancomycin in this child is “very likely”. In clinical practice， it is difficult to distinguish between pancytopenia combined with delayed drug fever from fever and hematopenia caused by aggravation of infection. Medical staff should increase their awareness of vancomycin rare ADR such as pancytopenia， and pharmacists should assist medical staff in timely screening for ADR. The initial dose of vancomycin infusion for children should start from 60 mg/（kg·d），and the blood concentration should be monitored 48 h after the first infusion and the dose should be adjusted in time to maintain the valley concentration of vancomycin at 5-15 mg/L to prevent the occurrence of ADR caused by excessive blood concentration. For children who have been using vancomycin for more than one week，the blood routine should be rechecked regularly. Once pancytopenia occurs，the drug should be stopped immediately，and symptomatic treatment should be given according to the situation.

【Objective】 To study the incidence and specificity of platelet antibody in blood donors in Suzhou, analyze the distribution characteristics of platelet antibody in blood donors in this area, and explore the significance of platelet antibody detection in blood donors to reduce the adverse reactions toplatelet transfusion in clinical. 【Methods】 Platelet antibody detection was performed in 2178 blood donors in this area by solid-phase immunosorbent assay. The antibody specificity of the positive samples was analyzed by commercial kit, and the anti-CD36 antibody positive samples were further identified by flow cytometry and gene sequencing. 【Results】 Twelve positive samples were detected by platelet antibody screening, with a positive rate of 0.55%(12/2 178), including 5 males (0.33%, 5/2 178)and 7 females(1.06%, 7/2 178). Among the positive samples, anti-HLA-Ⅰ antibody was identified in 2 cases, anti-CD36 antibody in 1 case, and the antibody specificity was not identified in the other 9 cases. In one case, the positive rate of anti-HLA-Ⅰ antibody PRA was 31.31%(31/ 99), which was mainly specific to anti-B15, anti-B35 and anti-B40. The positive rate of anti-HLA-Ⅰ antibody PRA in the other case was 45.45%(45/ 99), which was mainly specific to anti-A2, anti-A11, anti-A24, anti-A29, anti-A33, anti-A66, anti-B15 and anti-B35. The blood donor with anti-CD36 antibody was type I CD36 deficiency, and 329_330delAC mutation occurred in exon 5. 【Conclusion】 Through antibody screening and specificity identification, the positive rate of platelet antibody in females was significantly higher than that in males(P<0.05). In addition to the common anti-HLA-I antibodies, anti-CD36 antibody was also detected in type I CD36 deficient blood donor. Therefore, the detection of platelet antibodies in blood donors is of certain clinical significance to reduce the adverse reactions to blood transfusion caused by antibodies in platelet products.

Objective To investigate the risk factors which can lead to chronic kidney disease (CKD) after radical nephroureterectomy and guide adjuvant chemotherapy for the patients with upper tract urothelial carcinoma (UTUC).Methods 239 patients with UTUC,who were treated at our hospital from October 2010 to February 2015 was analyzed retrospectively.Serum creatinine levels were measured preoperatively and 1 month (range:21days to 35 days) after radical nephroureterectomy.129 males and 110 females patients were enrolled.Ages were from 41 to 94,and mean age was 66 years.All patients underwent radical surgery.The pathological stages included Ta/T1/T2/T3/T4,and grades included G1/G2/G3.We calculated GFR using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in consideration of age,sex,and serum creatinine level.The new-onset CKD after RNU was defined as when the calculated CKD-EPI GFR decreased to less than 60 ml/(min · 1.73 m2).These patients were divided into 2 groups which depended on whether they got CKD after RNU.Cohorts were stratified by gender,age,smoking,BMI,hypertension,diabetes mellitus (DM),tumor location,tumor size,multifocality,pathologic stage,grade,hydronephrosis and preoperative CKD-EPI GFR.The chi-square test was used to examine the relationship among the various cohorts and the CKD after RNU.The Kaplan-Meier method was adopted to identify the relationship between Overall survival (OS).Cancer-specific survival (CSS) and CKD.Univariate and multivariate analyses were performed to study the relationship between clinical factors and CKD after RNU using the Cox proportional hazards regression model and chi-square test.Results In our study,the median follow-up time was 41.3 (range from 2-82) months for 239 patients.Median CKD-EPI GFR for all patients before and after surgery was 71.4 (65.2-108.7) ml/(min · 1.73 m2) and 54.7 (37.6-93.8) ml/(min · 1.73 m2),meanwhile 105 cases became new-onset CKD.There was no significant difference in overall or cancer specific survival between CKD + and CKD-(P =0.137,P =0.190).However age (HR =1.825,95％ CI 1.203-2.768,P =0.017),hydronephrosis (HR =0.243,95 ％ CI 0.106-0.613,P =0.034) and preoperative CKD-EPI GFR (HR =0.237,95 ％ CI 0.109-0.524,P =0.021) were significantly correlative with postoperative new-onset CKD.Conclusion Age,absence of hydronephrosis and preoperative CKD-EPI GFR were independent risk factors predicting new-onset CKD.They can be the predictor of new-onset CKD.

Objective To assess the value of preoperative neutrophil-lymphocyte ratio ( NLR) for predict the prognosis in patients with high grade T1 bladder.Methods From January 2004 to December 2014, the data of 307 patients diagnosed as bladder cancer of Stage 1 and high grade after undergoing TURBT were analyzed, including gender, age, smoking status, tumor number and size, hydronephrosis, intravesical instillations and preoperative blood transfusion of 307 patients diagnosed as bladder cancer of stage 1 and high grade after undergoing TURBT were analyzed retrospectively.All patients were primary urothelial carcinoma.According to preoperative NLR,patients were divided into the low NLR group( NLR≤2.42,n=197) and the high NLR group(NLR >2.42,n =110).Recurrence-free survival (RFS) and progression-free survival ( PFS) were calculated according to the Kaplan-Meier model and compared by the log-rank model.Cox regression models were used for multivariate analyses of the association between NLR and bladder cancer, then the prognostic factors affecting RFS and PFS were evaluated.Result of these 307 patients, the low NLR group accounted for 64.2%(197/307), and the high NLR group accounted for 35. 8%(110/307).The mean follow-up period was 71(range, 1-123)months.The recurrence rate in the low NLR group and the high NLR group recurrence rate were 19.2%( 38/197 ) and 34.5%( 38/110 ) respectively, RFS were 73.0(range, 2-123)months and 67.5(range, 1-122)months respectively.The progression rates were 4.1%(8/197) and 10.9%(12/110) respectively.The recurrence and progression rates in the high NLR group is higher than those in the low NLR group(P<0.01 and P=0.008), and RFS was shorter( P=0.002).Multivariable Cox regression analysis showed that NLR>2.42(P=0.007,HR=1.912)and hydronephrosis (P<0.01, HR =2.485 ) are associated with higher risk of recurrence.Conclusion Elevated preoperative NLR is an independent predictor of RFS and PFS in patients with high grade T1 bladder cancer.

Objective To study three-dimensional reconstruction system (IQQA-Liver) in evaluation of resection volume and margin of hepatocellular carcinoma.Method Data of 51 hepatocellular carcinoma patients undergoing hepatectomy from March 2014 to October 2015 were analyzed retrospectively.All patients received preoperative ultrasound and CT/MIR evaluation.Three-dimensional reconstruction system (IQQA-Liver) was used to reconstruct tumor shape and location,the relationship between tumor and adjacent vessels or bile ducts.Then liver volume,liver resection volume,residual liver volume and surgical margin were calculated and compared with the actual resection liver values and actual margin.Results Images of three-dimensional reconstruction system (IQQA-Liver) were accurate,clear and directly perceived.In terms of the resection liver volume and resection margin,there was no significant difference between the predicted results and actual results [resection liver volume:(412.93 ± 471.26)cm3 vs.(487.02±529.01)cm3,t=0.75,P=0.46,resection margin:(13.72 ± 4.58) mm vs.(13.92 ±4.21)mm,t =0.23,P =0.82].The predicted resection liver volume was significantly correlated with the actual resection volume (r =0.91,P ＜ 0.01),the predicted resection margin was also correlated with the actual resection margin (r =0.89,P ＜ 0.01).Conclusion Three-dimensional reconstruction system (IQQALivcr) could accurately assess the resection volumc and margin of hepatocellular carcinoma.