As a novel long-acting glucagon-like peptide-1 （GLP-1） receptor agonist， semaglutide plays a pivotal role in the treatment of obesity and related metabolic diseases. This article systematically reviews the research progress of semaglutide in the treatment of obesity and related metabolic diseases from three aspects： mechanism of action， clinical applications， and existing challenges. It is found that its mechanism of action involves multi-organ synergistic regulation and metabolic intervention. Its clinical applications encompass the treatment of obesity， diabetes， polycystic ovary syndrome， and liver-related metabolic syndromes， and it demonstrates groundbreaking value in cardiovascular and renal protection. However， it still faces multiple challenges in terms of adverse reactions， individualized treatment， economic accessibility， ethical controversies， and risks. In the future， it is essential to further accumulate long-term safety data on semaglutide， optimize combination treatment regimens， and address key issues such as individualized medication for special populations， in order to fully realize its clinical application value.

Objective To analyze the risk factors of cancer fatigue in patients with postoperative chemotherapy for lung cancer and establish a Nomogram prediction model.Methods Collect clinical data of 172 postoperative chemotherapy patients with lung cancer at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from October 2021 to September 2023.A survey was conducted using the revised Piper fatigue scale(RPFS)to evaluate the degree of cancerous fatigue in patients.A logistic multiple regression model was used to analyze the risk factors affecting the degree of cancerous fatigue in postoperative chemotherapy patients with lung cancer,and a Nomogram prediction model was constructed to evaluate the predictive performance of the model.Results There were statistically significant differences in RPFS scores in terms of education level,tumornede metastasis classification,(TNM)staging,depression,adverse reactions,and white blood cells(P＜0.05).The proportion of high school education or above,TNM stageⅢ/Ⅳ,depression,moderate/severe adverse reactions,and the proportion of white blood cells count below the lower limit of normal in postoperative chemotherapy patients with lung cancer were significantly higher than those without/with mild cancer fatigue,and the differences were statistically significant(P＜0.05).Logistic analysis showed that education level(above high school level),TNM staging(Ⅲ/Ⅳ),depression(present),degree of adverse reactions(moderate/severe),and white blood cells(below the lower limit of normal values)were independent risk factors affecting the degree of cancer-related fatigue in postoperative chemotherapy patients with lung cancer(P＜0.05).The internal validation results show that the C-index is 0.899(0.842-0.955),with good consistency.The threshold of the Nomogram model is greater than 0.21,and the clinical net benefit provided by the Nomogram model is higher than that of educational level,TNM stage,depression,degree of adverse reactions,and a single predictor of white blood cells.Conclusion This study constructs a Nomogram model based on risk factors for cancerous fatigue in postoperative chemotherapy patients with lung cancer,which can provide a good prediction for cancerous fatigue in clinical lung cancer patients undergoing postoperative chemotherapy.

【Objective】 To explore the relationship between the storage time of leukodepleted red blood cells and transfusion adverse reactions by analyzing the occurrence of transfusion adverse reactions of patients after leukodepleted red blood cells transfusion from four hospitals. 【Methods】 By using the electronic medical record management system, the collection and transfusion dates of leukodepleted red blood cells from four hospitals in Enshi Prefecture from 2018 to 2022, as well as the information on transfusion adverse reactions, were retrieved. 【Results】 From 2018 to 2022, a total of 697 61 bags of leukodepleted red blood cells were transfused in four hospitals, resulting in 166 cases of transfusion adverse reactions, among which 93 were allergic reactions, 63 were non hemolytic febrile reactions, and 10 were others, with a total incidence rate of transfusion adverse reactions at 0.24%. The average storage time of leukodepleted red blood cells with and without transfusion adverse reactions was (20.25±6.31) and (19.88±5.50) days, respectively. With a storage time of 7 days as the threshold, the incidence of transfusion adverse reactions was the lowest for a storage time of 15~21 days. The incidence of transfusion adverse reactions of leukodepleted red blood cells in two groups (with storage days ≤21 days and >21 days) was not statistically significant(P>0.05). 【Conclusion】 Allergic reactions were the main type of transfusion adverse reaction caused by leukodepleted red blood cells, and the incidence of transfusion adverse reactions decreased and then increased with the prolongation of the storage time of leukodepleted red blood cells. There was no significant difference in the incidence of transfusion adverse reactions with leukodepleted red blood cells stored for ≤ 21 days and >21 days.

Objective:To explore the effect of radiofrequency heating on the morphology of articular cartilage in the knee and the expression of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the synovium using a rabbit model of knee osteoarthritis (OA).Methods:Fifty-four male rabbits had OA induced in their right hind limbs using the modified Hulth method. They were then randomly divided into a model group, a cervus and cucumis polypeptide (CCP) group and a radiofrequency thermotherapy (RT) group, each of 18. The CCP group was injected with deer melon peptide intramuscularly every day, while the RT group was given daily radiofrequency hyperthermia treatment at 36.5-38.5 ℃. The model group was not provided with any special treatment. On the 6th, 12th and 18th day of the treatment, 6 rabbits in each group were sacrificed to resect the right femur′s medial condyle cartilage. The morphological characteristics of the cartilage were evaluated using modified Mankins scoring, while the contents of lL-1B and TNF-a in the synovial membrane were detected using enzyme-linked immuno-sorbent assays.Results:The average Mankins scores and the levels of IL-1β and TNF-α decreased significantly at each time point, and significant differences were observed among the three groups. In the RT group the average Mankins score as well as the IL-1β and TNF-α levels decreased significantly with time throughout the experiment.Conclusions:Radiofrequency hyperthermia is superior to the injection of deer melon polypeptide in knee osteoarthritis, at least in rabbits. The therapeutic mechanism may be related to the control of IL-1β and TNF- α levels in the synovial membrane.

Objective:To monitor and evaluate in vivo dose changes of intensity-modulated radiotherapy (IMRT) in patients with cervical cancer in a real-time manner. Methods:Twelve patients with cervical cancer admitted to our hospital were enrolled in this study. The in vivo doses were monitored by PerFRACTION?. Electronic portal imaging device (EPID) were collected in each treatment fraction for two-dimensional in vivo dose verification[γ index and dose difference (DD) index]. Log files were recorded for three-dimensional in vivo dose verification (γ index). The correlation between in vivo dose and treatment duration was analyzed by Pearson correlation analysis. Results:A total of 206 sets of EPID images and corresponding Log files were collected. The three-dimensional in vivo dose verification γ 1%/1mm of all patients was not correlated with treatment fraction ( P>0.05). Among them, the absolute difference of γ 1%/1mm of 94.66% fractions was< 1%. The mean DD 3% of two-dimensional in vivo dose verification of all patients was negatively correlated with treatment fraction ( P<0.05). Among which, the average γ 3%/3mm of 9 patients was>89% in the treatment fractions, and the average γ 3%/3mm of 98.57% fractions of these 9 patients was>93%. The other 3 patients had an average γ 3%/3mm ranged from 38% to 100%. CBCT images showed that the bladder volume of these 3 patients was significantly decreased with the relative changes by 82.08%, 84.41% and 73.59%, respectively, and the target area was retracted significantly with the relative changes by 38.12%, 59.79% and 24.46%, respectively. Conclusion:Combined with γ index and DD index, PerFRACTION? can monitor the mechanical stability of accelerator and MU delivery accuracy during treatment fractions, and monitor the changes of in vivo dose in patients with cervical cancer, which can improve the safety and quality assurance of IMRT for cervical cancer patients and provide guidance for patients with adaptive radiotherapy.

Objective To observe the clinical efficacy of radiofrequency ablation for treatment of discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope operation. Methods Thirty-six patients with discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope surgery admitted to the Affiliated Hospital of Logistics University of People's Armed Police from December 2011 to December 2017 were enrolled. According to difference in therapeutic methods, they were randomly divided into two groups, 18 cases in each group. The radiofrequency ablation group was treated with X-ray imaging guided lumbar spinal nerve posterior branch radiofrequency thermo-coagulation; the drug group received oral diclofenac sodium conservative treatment, 75 mg twice daily for 3 weeks. Both groups were followed up for 6 months, visual analogue scores (VAS) were used to evaluate the pain before and after treatment, the Oswestry dysfunction index was used to assess the degree of lumbar function recovery, and the surgical complications and adverse drug reactions were observed. Results The VAS scores in the two groups were similar before treatment; after treatment for 1 month, the VAS scores in both groups were significantly lower than those before treatment (radiofrequency ablation group: 1.83±0.71 vs. 5.67±0.77; drug group: 2.22±0.43 vs. 5.28±0.67, both P < 0.05); after treatment for 3 months and 6 months, the VAS scores were increased gradually, however, the scores of radiofrequency ablation group were significantly lower than those in the drug group (3 months was 2.00±0.59 vs. 3.39±0.70, 6 months was 2.17±0.51 vs. 3.61±0.50, both P < 0.05), moreover, the excellent and good rates of postoperative pain efficacy and of Oswestry dysfunction index improvement in the radiofrequency ablation group were significantly higher than those in the drug group [excellent and good rates of postoperative pain efficacy: 94.44% (17/18) vs. 22.22% (4/18), excellent and good rates of Oswestry dysfunction index improvement: 77.78% (14/18) vs. 44.44% (8/18), both P < 0.05]. There were no complications of infection and spinal nerve anterior branch injury in the radiofrequency ablation group, and 6 patients in the drug group presented mild gastric discomfort, which was relieved after symptomatic treatment. Conclusion The radiofrequency ablation is an effective method for treatment of discogenic lumbar neuralgia after vertebral column operation, compared with the conservative therapy, the ablation is more effective to relieve pain for a long time, promote the recovery of neural function, and the operation is safe with very few adverse reactions.

Objective To explore clinical characteristics of patients with Klinefelter′s syndrome(KS; 47,XXY).Methods 227 male patients with 47,XXY treated by artificial insemination with donor(AID)were included.Age, education, height, weight, body mass index(BMI), testicular volume, FSH, LH, testosterone(T), prolactin(PRL), estradiol(E2)were analyzed retrospectively.Results Of these patients, their height were(176.4±5.5)cm, weight(74.5±12.7)kg, BMI(23.89±3.66)kg/m2[77 of overweight(33.92%)and 34 of obesity(14.98%)], FSH(38.35±14.33)IU/L, LH(19.40±9.00)IU/L, T(132.00±194.50)ng/dl, E2(23.90±15.00)ng/L, PRL(10.50±8.20)μg/L, E2/T 0.21±0.80.Testicular volume had the positive association with the level of T(r=0.197, P=0.003).BMI had the negative association with the serum concentration of T(r=-0.284, P=0.000), while positive association with the E2(r=0.174, P=0.009)and ratio of E2/T(r=0.323, P=0.000).Age had no association with T, E2, and E2/T(P>0.05), but had negative association with the serum concentration of LH(r=-0.154, P=0.02)nd FSH(r=-0.196,P=0.03).The higher education group were older(P<0.01), while the level of T were lower(P<0.01).Conclusion In patients with Klinefelter′s syndrome(KS; 47,XXY), level of T may associate with testicular volume.T, E2, and the ratio of E2/T seem to associate with their height, BMI, and education level.

Two eases of Hashimoto's encephalopathy (HE) are reported and relative literature is reviewed in this article.Both cases were female,with disturbance of consciousness and dementia as initial symptoms.Marked increase of anti-thyroid antibodies was found in serum of the patients.The symptoms disappeared after steroids and maintenance therapies.A total of 126 cases of HE in Chinese literature were retrieved from 2006 to 2015 through the databases of China National Knowledge Infrastructure and Wanfang Med Online.The male/female radio was 1 ∶ 6 with an average age of 51.3 years.The clinical manifestations included cognitive impairment (44.5％),epilepsy (38.3％),psychiatric disorders (27.3％),stroke-like symptoms (25.8％),disturbance of consciousness (24.2％),and extrapyramidal symptoms (20.3％).Good response to steroids was observed in 77.2％ HE patients.Analysis indicates that HE is an autoimmune disease with the presence of neurological and psychiatric manifestations,elevated titers of anti-thyroid antibodies in serum and well response to steroids,with a good prognosis.

Objective To study the effect of the uncertain deflection of the Delta4 phantom (ScandiDos AB,Sweden) in setting up on the Gamma index passing rate during the VMAT plan verification.Methods Two patients with head and neck cancer,two with lung cancers and one with pelvic cancer receiving VMAT radiotherapy were randomly chosen.By means of Eclipse8.6 TPS the treatment plans elaborated for the five patients were picked up to make the verification plans and Delta4 was used to perform dose verification On VARIAN Clinac Ⅸ.The Delta4 phantom was precisely set up first,and then it was deflected in a given angle towards the horizontal direction in relation to the center of the linear accelerator isocenter to perform the dose verification for 11 times successively.To figure out the relationship between the deflection angle of the Delta4 phantom and the Gamma index passing rate.Results As the Delta4 phantom was deflected by 0.0°,0.2°,0.4°,0.6°,0.8°,1.0°,1.2°,1.4°,1.6°,1.8° and 2.0° in sequence,the measured Gamma index passing rates presented a slight decline,but all greater than 90％ (DD 3％,DTA 3 mm).Conclusions In the VMAT plan verification,the Gamma index passing rate of Delta4 has no dependence on the uncertain deflection of the Delta4 phantom provided that the uncertain deflection of the Delta4 phantom is no greater than 2°,but the passing rates of DD and DTA vary significantly with the uncertain deflection of the Delta4 phantom.

Objective To compare the effects of telmisartan and (or) amlodipine on the reversal left ventricular re-modeling in two-kidney one clip hypertensive rats. Methods A total of 50 healthy male SD rats were randomly divided into 5 groups (n=10):two-kidney one clip renal hypertensive (2KIC) model group, sham group, telmisartan (10 mg/kg) group, am-lodipine (2.5 mg/kg) group and telmisartan (10 mg/kg)+amlodipine(2.5 mg/kg) group. The model of two-kidney one clip re-nal hypertensive rats was established. The tail arterial blood pressure was detected once a week. After 20 weeks, rats were sacrificed and specimens were collected. The left ventricular mass index (LVMI) was assessed. The myocardial ultrastructur-al changes were observed by electron microscope. Values of plasma renin activity (PRA), angiotensionⅡ(AngⅡ) and atrial natriuretic peptide (ANP) were measured by enzyme linked immunosorbent assay (ELISA).Results Compared with sham group, the levels of systolic blood pressure (SBP), LVMI, PRA, AngⅡand ANP were significantly higher in 2KIC group (P＜0.01). Compared with 2KIC group, values of SBP, LVMI, PRA and ANP were significantly lower in telmisartan group and am-lodipine group (P＜0.01), but the value of AngⅡwas significantly higher (P＜0.01). The levels of SBP, LVMI, AngⅡand ANP were significantly lower in combined medication group than those of single drug medication group (P＜0.01). There was no significant difference in the plasma PRA level between those groups (P>0.05). Results of myocardial electron microsco-py showed that the left ventricular remodeling was significantly improved in combined treatment group. Conclusion Telmisartan and amlodipine can effectively improve the left ventricular remodeling induced by hypertension. There was more effective therapy using both medications together.