Aim To investigate the effect of miR-141-5p/ZNF705A in chronic myeloid leukemia(CML)cell-derived exosome(Exo)on the adhesion of bone marrow mesenchymal stem cells(BMSCs). Methods The morphology and size of Exo in peripheral blood from CML patients and K562 cells were examined by electron microscopy and NTA particle size analysis. The expressions of Exo and BMSCs marker molecules and adhesion proteins in K562 cells were detected by qRT-PCR and Western blot before and after transfection. The adhesion ability of BMSCs was detected by cell adhesion assay, and the cellular activity of BMSCs was examined using CCK-8. miR-141-5p binding to ZNF705A was detected by luciferase assay. Results qRT-PCR results showed that miR-141-5p expression was significantly reduced in both CML patients and K562 cell-derived Exo. qRT-PCR, Western blot and other results showed that BMSCs in CML patients had significantly reduced the expression of adhesion proteins CD44 and CXCL12, and were able to phagocytose K562 cell-derived Exo. Further, K562-derived Exo was found to reduce CD44 and CXCL12 expression and adhesion in Exo-promoted BMSCs compared with CD34+ cells. Meanwhile, the results of dual luciferase reporter assay verified that miR-141-5p targeted binding to ZNF705A. Finally, we found ZNF705A could be targeted by up-regulating miR-141-5p expression in Exo of K562 cells, which in turn inhibited the adhesion of BMSCs. Conclusions K562 cells down-regulate miR-141-5p expression in Exo and inhibit the adhesion function of BMSCs by targeting ZNF705A, thus regulating the bone marrow hematopoietic function in CML patients.

Objective:To verify the feasibility of using Elekta accelerated go live (AGL) standard process for the acceptance of multiple accelerators.Methods:The beams of three accelerators were adjusted by PTW Beamscan three-dimensional water tank to reach the AGL standard. Dose verification was performed for three accelerators that met AGL standards. A simple field test example from Cancer Hospital Chinese Academy of Medical Sciences was used to compare the MapCheck 3 surface dose measurement results with the surface dose calculated by the same accelerator model. Images of 10 patients including head and neck, esophagus, breast, lung and rectum were randomly selected. volumetric-modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) treatment techniques were used for planning design, and the measured dose of ArcCheck was compared with the planned dose calculated by the same accelerator model. One-way ANOVA was used to statistically analyze the passing rates of two-dimensional and three-dimensional dose verification.Results:The 6 MV X-ray percentage depth dose at 10 cm underwater (PDD 10) of three accelerators was 67.45%, 67.36%, 67.47%, and the maximum deviation between the three accelerators was 0.11%. The 6 MV flattenting filter free (FFF) mode X-ray PDD 10 was 67.33%, 67.20%, 67.20%, and the maximum deviation between the three accelerators was 0.13%. All required discrete point doses on each energy 30 cm×30 cm Profile spindle of the three accelerator X-rays deviated less than ±1% from the standard data. Absolute γ analysis was performed on the results of MapCheck 3 two-dimensional dose matrix validation. Under the 10% threshold of 2 mm/3% standard, the average passing rate of the test cases in Cancer Hospital Chinese Academy of Medical Sciences was above 99%, and the difference was not statistically significant ( P>0.05). Absolute γ analysis was performed on the ArcCheck verification results. Under the 10% threshold, the pass rate of 2 mm/3% was all above 95%, the maximum average passing rate of the three accelerators with different energy and different treatment techniques was 0.28% (6 MV, VMAT), 0.19%(6 MV FFF, VMAT), 0.56% (6 MV, IMRT) and 0.05% (6 MV FFF, IMRT), and the difference was not statistically significant ( P>0.05). Conclusion:Compared with traditional accelerator acceptance process, the acceptance time of each accelerator is shortened by 4-6 weeks by using the AGL standard process, and the radiotherapy plan of patients can be interchangeably executed among different accelerators.

Objective:To assess the diagnostic performance of 68Ga-PSMA PET/CT and mpMRI in initial staging of prostate cancer. Methods:A retrospective analysis was conducted on patients with initial diagnosis of prostate cancer who underwent prostatectomy at Fudan University Shanghai Cancer Center from December 2021 to June 2023. All had biopsy-confirmed prostate cancer preoperatively and had not undergone any anti-tumor treatment. Prior to surgery, all patients underwent 68Ga-PSMA PET/CT and mpMRI scans. The surgical samples were processed by whole-mount slides pathology. Thirty patients were included, with a median age of 68 years (range 67-76 years). The preoperative median PSA level was 17.91 ng/ml (range 9.41-39.53 ng/ml). The median interval between the two examinations was 21.00 days (range 2.75-35.50 days). Based on the postoperative whole-mount slides pathology which was the gold standard, we compared the sensitivity and specificity of 68Ga-PSMA PET/CT and mpMRI in diagnosing extraprostatic extension, seminal vesicle invasion, and intraprostatic tumor lesion. Results:According to the postoperative pathology, among the 30 patients, 12 had extraprostatic extension (EPE), 8 had seminal vesicle invasion (SVI). Among the 50 lesions found before surgery, postoperative pathology showed that 38 of them were clinically significant prostate cancer lesions (76.0%, 38/50). Using whole-mount pathology, preoperative mpMRI, and 68Ga-PSMA PET/CT imaging for triple fusion comparison, the sensitivity and specificity of 68Ga-PSMA PET/CT in diagnosing EPE were 66.7% (8/12) and 88.9% (16/18), respectively. The sensitivity and specificity of mpMRI in diagnosing EPE were 50.0% (6/12) and 83.3% (15/18), respectively. In diagnosing SVI, the sensitivity and specificity of 68Ga-PSMA PET/CT were 50.0% (4/8) and 86.3% (19/22), respectively. The sensitivity and specificity of mpMRI were 75.0% (6/8) and 90.9% (20/22), respectively. When diagnosing clinically significant tumor lesions within the prostate, the sensitivity of 68Ga-PSMA PET/CT was 89.5% (34/38), which was significantly better than the mpMRI of 63.2% (24/38), with no significant difference in specificity. Conclusions:The sensitivity of 68Ga-PSMA PET/CT in diagnosing intraprostatic lesions was significantly higher than that of mpMRI, with no significant difference in specificity.

Objective:To explore the efficient prognostic factors of cryotherapy for prostate cancer in the real-world setting.Methods:The clinical data of 105 prostate cancer patients treated at the Fudan University Shanghai Cancer center from January 2021 to December 2023 were analyzed retrospectively. The patients were divided into a non-metastatic group (62 cases, 58.7%) and a metastatic group (43 cases, 41.3%) based on the presence or absence of distant metastasis. In the non-metastatic group, the median age was 79 years (range 73 to 82), the initial PSA was 20 ng/ml (range 10 to 47), 37 cases (59.7%) received neoadjuvant endocrine therapy, and the preoperative PSA was 8 ng/ml (range 2 to 14). The ISUP grades were Grade 1 in 4 cases (6.5%), Grade 2 in 11 cases (17.7%), Grade 3 in 16 cases (25.8%), Grade 4 in 16 cases (25.8%), and Grade 5 in 15 cases (24.2%). The T-stages were T 2 in 49 cases, T 3 in 6 cases, and T 4 in 7 cases. All cases were N 0. In the metastatic group, the median age was 68 years (range 62 to 74), the initial PSA was 64 ng/ml (range 27 to 200), 42 cases (97.7%) received neoadjuvant endocrine therapy, and the preoperative PSA was 0 ng/ml (range 0 to 3). The ISUP grades were Grade 1 in 0 cases, Grade 2 in 5 cases (11.6%), Grade 3 in 3 cases (7.0%), Grade 4 in 19 cases (44.2%), and Grade 5 in 16 cases (37.2%). The T-stages were T 2 in 29 cases (67.4%), T 3 in 8 cases (18.6%), and T 4 in 6 cases (14.0%). The N-stages were N 0 in 38 cases (88.4%) and N 1 in 5 cases (11.6%). The M-stages were M 1a in 5 cases (11.6%), M 1b in 35 cases (81.4%), and M 1c in 3 cases (7.0%). The difference in T-stage between the two groups was not statistically significant ( P=0.346), while differences in other indicators were statistically significant ( P<0.05). The cryotherapy for prostate cancer was performed under general or local anesthesia, with the patients in the lithotomy position and a F20 three-lumen catheter was placed for continuous irrigation. Under transrectal ultrasound guidance, the cryoprobes were inserted parallel to the probe through the perineum, with a safe distance of 3 mm from the bladder wall. A whole-gland freezing mode was adopted, starting from the ventral side and freezing layer by layer towards the rectal side. Ultrasound was used in real-time to observe the ice ball's position and extent, adjusting it during ablation to conform to the prostate's margins while protecting surrounding structures. After ablation, the cryoprobes were removed, the puncture sites were disinfected with povidone-iodine, and gauze was applied for 20 seconds to achieve hemostasis before applying dressings. The catheter was removed 10 days postoperatively. PSA levels were rechecked on the first postoperative day and at 6 and 12 weeks postoperatively. The ratio of PSA on the first postoperative day to preoperative PSA was defined as the PSA release rate. Biochemical recurrence was defined as a PSA increase of more than 0.2 ng/ml above the postoperative nadir. The PSA progression-free survival time and the incidence of complications were compared between the two groups. Results:All procedures were successfully completed. The PSA release rates for the non-metastatic and metastatic groups were 4.2 (2.2, 6.4) and 3.9 (1.5, 6.7), respectively, with no statistical significant difference ( P=0.8272). The median PSA at 6 weeks postoperatively was 0.23 (0.01, 1.22) ng/ml, and at 12 weeks it was 0.02 (0.01, 0.49) ng/ml. The median PSA for the non-metastatic group was 0.42 (0.25, 1.00) ng/ml at 6 weeks, and it was 0.03 (0.01, 0.57) ng/ml at 12 weeks. For the metastatic group, the median PSA was 0.30 (0.14, 0.50) ng/ml at 6 weeks, and it was 0.02 (0.01, 1.17) ng/ml at 12 weeks. The median follow-up period was 339 days (range 128 to 571). No Clavien-Dindo grade ≥2 complications occurred postoperatively. One case (0.9%) experienced bladder neck stricture one month postoperatively, which improved by transurethral resection of the prostate (TURP). Two cases (1.9%) experienced urinary retention seven days postoperatively, which resolved after re-catheterization for two weeks. No urinary incontinence was reported. Two non-tumor-related deaths occurred (1.9%), one due to cardiac disease and the other due to complications from COVID-19. During follow-up, 29 cases (27.6%) experienced PSA progression, with a median PSA progression-free survival time of 808.0 days. The median PSA progression-free survival time was not reached in the non-metastatic group, while it was 764.0 days in the metastatic group. There was no statistical significant difference in PSA progression-free survival between the two groups ( P=0.422). Univariate analysis showed that preoperative PSA ( HR=1.02, 95% CI 1.00-1.03, P=0.048), T 3 stage ( HR=9.00, 95% CI 2.59-31.25, P<0.01), and T 4 stage ( HR=5.83, 95% CI 1.68-20.21, P=0.005) were prognostic factors for PSA progression-free survival. Multivariate analysis showed that T 3 stage ( HR=9.08, 95% CI 2.47-33.45, P<0.01) and T 4 stage ( HR=4.50, 95% CI 1.18-17.22, P=0.028) were independent prognostic factors for PSA progression-free survival. Conclusions:Cryotherapy for prostate cancer has a high safety profile. The efficacy of Cryotherapy is better in patients with T-stage

Objective:To explore the effects of lower concentrations of ropivacaine on ultrasound-guided nerve block in pediatric orthopedic surgery.Methods:Using a retrospective study method, 75 children who underwent orthopedic surgery at Wu Jiang District Children′s Hospital from May 2023 to February 2024 were selected and divided into Group A (25 cases, 0.15% ropivacaine nerve block), Group B (25 cases, 0.20% ropivacaine nerve block) and Group C (25 cases, 0.25% ropivacaine nerve block). The heart rate; mean arterial pressure; onset time of anesthesia; analgesic maintenance time; recovery time of movement and sensation; child face, legs, activity, cry, consolability behavioral tool (FLACC) score at 2 h after surgery; adverse reactions incidence of postoperative local anesthetic drugs were compared.Results:There was no statistically significant difference in the physical indicators of heart rate and mean arterial pressure among the three groups ( P>0.05). As the concentration of ropivacaine increased, the onset time of anesthesia in the three groups of children was shortened: (11.04 ± 1.02) vs. (10.44 ± 1.04) and (7.16 ± 0.85) min, and the differences between the three groups were statistically significant ( P<0.05); There was no statistically significant difference in the analgesic maintenance time among the three groups ( P>0.05). As the concentration of ropivacaine increased, the recovery time of movement and sensation was increased: (194.64 ± 20.43) min vs. (207.72 ± 22.34) and (250.32 ± 30.18) min, (176.44 ± 16.18) min vs. (189.24 ± 20.66) and (224.08±29.56) min, and the differences among the three groups were statistically significant ( P<0.05). There was no statistically significant difference in FLACC scores among the three groups of patients at 2 h after surgery ( P>0.05). The total incidence of adverse reactions in Group A was lower than that in Groups B and C: 4% (1/25) vs. 24% (6/25) and 52% (13/25), and the differences among the three groups were statistically significant ( P<0.05). Conclusions:The 0.15% ropivacaine used for ultrasound-guided nerve block in pediatric orthopedic surgery can achieve good anesthesia effects with low incidence of adverse reactions, and is worthy of clinical promotion.

Objective:To explore the practical effects of achieving transformative learning in students based on the "case-based+problem-oriented" teaching method for the course of "orthopedic rehabilitation".Methods:A "case-based+problem-oriented" method was introduced in clinical courses for students in the rehabilitation therapy program at Tianjin Medical University. The students in the class were randomly divided into the "case-based+problem-oriented" teaching group (56 students) and the traditional teaching group (57 students). This study compared students' exam scores for different types of theoretical questions at the end of the semester. A self-filled anonymous questionnaire survey was conducted to evaluate the effectiveness of transformative learning, including the understanding of rehabilitation theory, learning interest, doctor-patient communication ability, disease analysis and judgment ability, and rehabilitation practice ability. SPSS 20.0 was used for t test and χ2 text. Results:The "case-based+problem-oriented" teaching group achieved significantly higher scores in various types of questions and total scores compared with the traditional teaching group [(85.67±4.78) vs. (72.98±6.49), t=8.78, P=0.004)]. Students in the "case-based+problem-oriented" teaching group showed higher interest in transformative learning and a considerably increased awareness of knowledge acquisition and innovative transformation. Students in the "case-based+problem-oriented" teaching group demonstrated higher abilities in theoretical learning, communication, disease exploration, and analytical judgment in this major and course. Conclusions:The "case-based+problem-oriented" clinical transformative teaching method integrates the theoretical teaching, clinical thinking, and medical training, promotes the students' enthusiasm for learning, and improves their proactive learning of knowledge and ability to transform and innovate.

Objective To investigate the acoustic characteristics of speech prosody in patients after stroke and to select sensitive acoustic parameters of speech prosody.Methods A total of 30 patients after stroke(stroke group)and 30 healthy adults of similar age(control group)were collected.Both groups read short texts aloud,and each syllable and pause of all short sentences in the whole text were recorded under the spectrogram.Acoustic analysis was performed on the inter-rogative sentence"What do you want to buy for your grandson's birthday?"and the stressed sentence"I want to buy toys!"The rhythm(unnatural pause number,speech rate,articulation rate),intonation(whole sentence fundamental frequency,fundamental frequency standard deviation and fundamental frequency slope of interrogative sentences,boundary tone funda-mental frequency and fundamental frequency slope of interrogative sentences,fundamental frequency and fundamental fre-quency slope of four tones),and stress(average intensity of stressed syllables,peak intensity,and stressed syllables dura-tion)of speech prosody were analyzed and compared between the two groups.Results The unnatural pause number and the stressed syllables duration in the stroke group were significantly higher than those in the normal control group(P＜0.01).The speech rate,articulation rate,whole sentence fundamental frequency standard deviation,whole sentence funda-mental frequency slope,and fourth tone fundamental frequency slope in the stroke group were significantly lower than those in the normal control group(P＜0.01).The boundary tone fundamental frequency slope of interrogative sentences and the third tone fundamental frequency slope were significantly lower than those in the normal control group(P＜0.05).Conclu-sion Patients after stroke have poor rhythm control,manifested as excessive pauses and slow speech rate;insufficient into-nation expression,manifested as insufficient interrogative sentence tone,and poor control ability of the third and fourth tones;compensatory expression of stress,characterized by prolonging the expression time of stressed syllables.