Objective:To systematically evaluate the efficacy and safety of ruxolitinib in the treatment of Chinese patients with refractory graft-versus-host disease(SR-GVHD) by using meta-analysis.Methods:China National Knowledge Infrastructure(CNKI), WanFang database, VIP database, China Biology Medicine disc, PubMed, Ebscore Medline, EMBASE, Web of Science Core Collection and Cochrane Library were searched by using "ruxolitinib" "Graft vs Host Disease" "graft versus host disease" "Graft-Versus-Host Disease" as key words. The retrieve time was from the establishment of the database to December 7th, 2021. The related literatures of ruxolitinib for Chinese patients with SR-GVHD were screened according to inclusion and exclusion criteria, and the characteristics of the literatures were extracted. Outcomes indexes included overall objective response rate (ORR), proportion of hormone reduction and discontinuation, survival indexes and incidence of adverse events. Meta-analysis of ORR, remission rate of affected organs, 12-month overall survival rate, overall mortality and mortality due to graft-versus-host disease (GVHD) were performed by using Stata 16.0 software or R3.6.3 software. The statistics analysis was performed on the hormone usage and adverse events.Results:A total of 19 literatures involving 775 Chinese patients with SR-GVHD treated by ruxolitinib were included. Meta analysis showed that the ORR of ruxolitinib for treatment of acute GVHD (aGVHD) was 84% (285/339), with moderate heterogeneity among studies ( I2 = 62.04%, P<0.01), and the complete remission (CR) rate, partial remission (PR) rate and non-remission (NR) rate was 56% (190/339), 28% (95/339), and 14%(47/339), respectively. The ORR of ruxolitinib for treatment of chronic GVHD (cGVHD) was 77% (332/431), with moderate heterogeneity among studies ( I2 = 50.17%, P = 0.02), and the CR rate, PR rate and NR rate was 36% (155/431), 41% (177/431) and 21% (91/431), respectively. As for hormone usage, 46.51% of aGVHD patients had steroid reduction and 34.88% patients had steroid discontinuation. Similarly, 28.2% of patients with cGVHD had steroid reduction and 36.9% had steroid discontinuation. The overall 12-month survival rate of patients with SR-GVHD after the treatment of ruxolitinib was 71% (95% CI: 63%-79%, I2 = 72.70%, P<0.01). Adverse events occurred for 760 times in total, among which 287 times (36.0%) of viral infection and 269 times (34.7%) of hemocytopenia were the most common adverse events. Conclusions:Ruxolitinib is effective in the treatment of Chinese patients with SR-GVHD, and it helps reduce hormone-dependency and prolong the survival time.

Objective:To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4.5 h in patients with acute ischemic stroke.Methods:A retrospective analysis was performed; 180 acute ischemic stroke patients admitted to Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen. Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0.4; good collateral circulation: HIR>0.4); clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4.5 h in patients with acute ischemic stroke. Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke. Role of HIR as agency between SIR and onset time was explored. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4.5 h in acute ischemic stroke patients.Results:Of the 180 patients, 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group; compared with the good collateral circulation group, the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia, larger DWI infarction volume before treatment, larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR ( P<0.05). In these 180 patients, 76 had onset time≤4.5 h and 104 had onset time>4.5 h. Univariate Logistic regression analysis showed that hyperlipidemia, DWI infarct volume before treatment, DWI-FLAIR mismatch, HIR and SIR were influencing factors for onset time≤4.5 h in acute ischemic stroke patients ( P<0.05). Multivariate Logistic regression analysis showed that hyperlipidemia ( OR=6.654, 95% CI: 5.751-8.824, P<0.001), HIR ( OR=0.724, 95% CI: 0.521-1.321, P=0.041) and SIR ( OR=739.881, 95% CI: 383.296-14 258.065, P<0.001) were independent influencing factors for onset time≤4.5 h in acute ischemic stroke patients. Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke ( r=0.420, P<0.05), and SIR was positively correlated to onset time in patients from poor collateral circulation group ( r=0.781, P<0.05). ROC curve showed that AUC of SIR in predicting onset time≤4.5 h was 0.917 (95% CI: 0.814-1.000, P<0.001) and that of DWI-FLAIR mismatch in predicting onset time≤4.5 h was 0.530 (95% CI: 0.509-0.757, P=0.075) in poor collateral circulation group, enjoying significant difference in predictive efficacy. Conclusion:Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4.5 h; SIR can more accurately predict the onset time in these patients with poor collateral circulation.

ObjectiveTo investigate the effects of Bushen Huoxue prescription on the cardiac function， inflammation， and quality of life of the patients with chronic heart failure resistant to diuretics. MethodA total of 78 patients who met the inclusion criteria were randomized into observation and control groups （39 cases）. Both groups received standardized treatment for diuretic resistance in accordance with the guidelines. In addition， the observation group received Bushen Huoxue prescription. The cardiac function indicators， total response rate regarding symptom alleviation， exercise endurance， urine volume， body mass， quality of life， and levels of inflammatory cytokines were compared between the two groups before and after treatment. ResultBefore treatment， the two groups of patients showed no significant differences in terms of 24 h urine volume， body mass， 6 minute walk test （6MWT）， Minnesota Living with Heart Failure Questionnaire （MLHFQ） score， N-terminal pro-B-type natriuretic peptide （NT-proBNP） level， left ventricular ejection fraction （LVEF）， stroke volume （SV）， and serum levels of interleukin-6 （IL-6）， interleukin-4 （IL-4）， and tumor necrosis factor-alpha （TNF-α）. After treatment， the observation group outperformed the control group in terms of the response rates regarding traditional Chinese medicine symptom scores and New York Heart Association （NYHA） grading of cardiac function （P<0.05）. After treatment， the body mass， MLHFQ score， and IL-6， TNF-α， and NT-proBNP levels decreased in both groups （P<0.05， P<0.01）， and the observation group showed more significant decreases than the control group （P<0.05， P<0.01）. Both groups showed increases in 24-h urine volume， 6MWT， LVEF， SV， and IL-4 after treatment （P<0.05， P<0.01）， and the observation group showed more significant increases than the control group （P<0.05， P<0.01）. ConclusionThe combination of Bushen Huoxue prescription with standardized treatment is effective in ameliorating the clinical symptoms of the patients with chronic heart failure resistant to diuretics. Moreover， it alleviates diuretic resistance and improves the cardiac function without causing obvious adverse reactions.

ObjectiveTo explore the clinical efficacy of Huangjin Shuangshen Jiawei （HJSSJW） granules in treating postoperative anxiety and depression after percutaneous coronary intervention （PCI） for coronary heart disease and the effects of this medicine on inflammatory cytokines. MethodNinety-four patients diagnosed with anxiety and depression after PCI were randomized into observation and control groups （47 cases） by the double-blind method. On the basis of conventional Western medical treatment， the observation group was treated with HJSSJW granules for 12 weeks， and the control group with the simulant of HJSSJW granules for 12 weeks. The two groups were compared in terms of Hamilton Anxiety and Depression Scales （HAMA-14， HAMD-24）， Pittsburgh Sleep Quality Inventory （PSQI）， Seattle Angina Score （SAQ）， TCM symptom scores， traditional Chinese medicine （TCM） symptom score and response rate， serum levels of hypersensitive-C reactive protein （hs-CPR）， tumor necrosis factor （TNF）-α， and interleukin （IL-6）， and incidence of major adverse cardiovascular events （MACEs） and adverse reactions. ResultAfter treatment， both groups showed declined scores of HAMA-14， HAMD-24， and PSQI （P<0.05， P<0.01） and the observation group had lower scores of HAMA-14， HAMD-24， and PSQI than the control group （P<0.01）. The scores of SAQ in both groups increased after treatment （P<0.01）， and the observation group had higher score of each dimension than the control group （P<0.05）. The TCM symptom scores decreased in both groups after treatment （P<0.01）， and they were lower in the observation group than in the control group （P<0.05）. The total response rate regarding TCM symptoms in the observation group was higher than that in the control group （χ²=9.225， P<0.01）. After treatment， the levels of hs-CPR， IL-6， and TNF-α became lowered in both groups （P<0.01）， and the observation group had lower levels of hs-CPR， IL-6， and TNF-α than the control group （P<0.05）. The incidence of MACEs in the observation group was lower than that in the control group during the 90 d of the follow-up period （χ²=4.242， P<0.05）. No adverse reactions associated with the use of HJSSJW granules were observed during the trial period. ConclusionHJSSJW granules can alleviate the bad mood， improve sleep， mitigate somatic symptoms， improve the quality of life， reduce inflammatory damage， and improve prognosis， being safe for clinical use in patients with postoperative anxiety and depression after PCI for coronary heart disease.

This study explores the potential application of computer aided design(CAD)/computer aided manufac-turing(CAM)for one-piece glass fiber posts and cores in restoring tooth defects post-removal of a broken fiber post using a digital guide plate.This paper reports a fractured left upper incisor fiber post removed using a customized needle and digital guide plate.Following root canal retreatment,CAD/CAM integrated fiber post-core and zirconia full crown restoration were completed.The occlusion testing was conducted using the T-Scan Ⅲ system.This study offers insights for managing secondary repair after fiber post fractures.

Objective To evaluate and analyze the resting-state MRI data of patients with chronic subjective tinnitus via the multilayer brain functional network and to find the relevant node parameters with certain dynamic characteristics.Methods A total of 28 chronic subjective tinnitus patients(tinnitus group)and 39 sex,age,and education-matched healthy volunteers(control group)were included.After completing relevant otologic and neuropsychiatric tests for all subjects,3.0T MRI data were collected.Data preprocessing,dynamic functional connection analysis,multilayer modularization and network switching rate were performed.Correlation analysis between MRI data results and clinical data were further conducted.Results There was no significant difference in terms of Q between tinnitus group and control group(P＞0.05).Compared with the control group,the network switching rate of bilateral anterior cingulate gyrus(P＜0.001)and right hippocampus(P＜0.01)was significantly decreased in the tinnitus group.Additionally,the network switching rate of right hippocampus was negatively correlated with the duration of tinnitus(r=-0.503,P=0.006).Conclusion Based on using multilayer brain functional network method,the signal regulations in anterior cingulate gyrus and hippocampus in chronic subjective tinnitus patients is changed,while the alteration of hippocampus may be related to the duration of disease.

Objective:To investigate the alterations of multilayer network and dynamic causal connectivity in patients with bilateral sudden sensorineural hearing loss.Methods:The hearing ability, neural-scale data and resting-state functional magnetic resonance imaging(fMRI)data of 60 patients with bilateral sudden sensorineural hearing loss from the Department of Otolaryngology and 60 healthy controls from Physical Examination Center, Nanjing First Hospital were collected from January 2022 to January 2024. Multilayer brain network analysis was computed to identify the nodes with abnormal switching rate. Then these abnormal nodes were used as regions of interest (ROIs) in the subsequent dynamic causal model analysis. The SPSS 26.0 software was used to analyze causal connectivity between two groups based on independent-sample Mann-Whitney U test. And Pearson correlation coefficients between fMRI results and clinical parameters were calculated. Results:Pure tone audiometry test showed that the left and right hearing thresholds of bilateral sudden sensorineural hearing loss were significantly higher than those of healthy controls( Z=-9.460, -9.462, both P<0.01). The score of depressive emotion in patients with bilateral sudden hearing loss was 6.00(2.00, 9.00).Multilayer brain network analysis showed that the switching rates in the left superior frontal gyrus (0.073(0.049, 0.102), Z=3.603, P<0.001), left anterior cingulate gyrus (0.077(0.044, 0.105), Z=3.189, P=0.001), right hippocampus (0.080(0.045, 0.116), Z=3.616, P<0.001), left para-hippocampal gyrus (0.080(0.043, 0.108), Z=3.577, P<0.001), left superior parietal gyrus (0.079(0.047, 0.103), Z=3.160, P=0.002), and right inferior parietal gyrus (0.078(0.043, 0.105), Z=3.396, P<0.001) in patients with bilateral sudden sensorineural hearing loss were lower that those in healthy controls. These six brain areas were used as ROIs to compute dynamic causal model analysis, and the results showed that the connection strength from left superior frontal gyrus to the left para-hippocampal gyrus in patients with bilateral sudden sensorineural hearing loss was significantly higher than that in healthy controls ( Z=-2.593, P<0.05). Additionally, enhanced connectivity from left superior frontal gyrus to the left para-hippocampal gyrus was positively correlated with duration of hearing loss ( r=0.376, P=0.003). Conclusions:Bilateral sudden sensorineural hearing loss patients have decreased switching rates in many brain areas, and the causal connectivity from left superior frontal gyrus to the left para-hippocampal gyrus is enhanced.

Objective:To evaluate the feasibility of using two-dimensional shear wave elastography (2D-SWE) based liver and spleen elastic hardness (L/S-SWE) in patients with liver cirrhosis, and to determine the exclusion and diagnostic thresholds for early identification of liver cirrhosis.Methods:A total of 574 patients with chronic hepatitis B (hepatitis B for short) were included in this study. The clinical characteristics, L-SWE and S-SWE of the patients were collected, and the differences between cirrhosis group ( n=311) and non cirrhosis group ( n=263) were analyzed. The success rate and stability of liver and spleen elastic surgery were evaluated in two groups. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of L-SWE, S-SWE, aspartate aminotransferase to platelet ratio index (APRI) alone and in combination in diagnosing liver cirrhosis. By analyzing the ROC curve, the double threshold for excluding and diagnosing liver cirrhosis was determined. Results:There was a statistically significant difference in platelet count and APRI between the cirrhosis group and the non cirrhosis group (all P<0.05). In the feasibility assessment of 2D-SWE technology, the success rate and stability of liver and spleen elastic operation were relatively high (success rate: 97.2% vs 81.3%; stability: 0.92 vs 0.84), and the success rate and stability of L-SWE operation were slightly better than S-SWE. The success rate of S-SWE operation in the cirrhosis group was higher than that in the non cirrhosis group ( P<0.05). The correlation analysis results showed that L-SWE, S-SWE, APRI were positively correlated with liver tissue pathological grading ( r=0.677, 0.528, 0.149, all P<0.05). The areas under the ROC curve for identifying liver cirrhosis using L-SWE, S-SWE, and APRI were 0.959, 0.896, and 0.706, respectively. When L-SWE and S-SWE were combined, the area under the ROC curve was 0.987, the sensitivity was 92.6%, and the specificity was 96.0%. The Delong test showed that the combined diagnosis of L-SWE and S-SWE had the same diagnostic efficacy as using L-SWE alone for liver cirrhosis ( P>0.05). Further analysis of the ROC curve showed that the likelihood of liver cirrhosis was low when L-SWE was less than 9.4 kPa, and high when L-SWE was greater than 12.0 kPa. Patients between 9.4 and 12.0 kPa can undergo further S-SWE testing; If the S-SWE was between 17.5 and 29.3 kPa, it was classified as 2D-SWE, which was difficult to determine whether there was liver cirrhosis, and further liver puncture and other examinations were needed. Conclusions:2D-SWE technology has high operational feasibility in the diagnosis of liver cirrhosis, and combined with S-SWE, it helps to improve the diagnostic efficiency of early non-invasive identification of liver cirrhosis, enabling more patients to avoid unnecessary liver puncture examinations.

Objective:To estimate tissue/organ doses and effective dose to operators in the overexposure incident during an interventional procedure using Monte Carlo method.Methods:The phantoms were constructed for both the operators and the patient based on the adult mesh-type reference computational phantoms (MRCPs) recommended by the International Commission on Radiological Protection (ICRP) Publication 145 and phantom deformation technology. Models of exposure scenario were constructed based on the on-site equipment and the irradiation conditions. The Monte Carlod simulation method was used to evaluate the absorbed dose to critical tissues and organs, such as the operator′s eye lens and thyroid, as well as the effective dose.Results:In the particular exposure conditions, the maximum absorbed doses in the primary organs of the two operators were in the left eye lens, with doses of 1.216 and 0.223 mGy, respectively. The thyroid absorbed doses were 0.074 and 0.019 mGy, while the effective doses to the two operators were 0.088 and 0.021 mSv, respectively. The reduction rates of effective dose for the two operators when wearing lead aprons and lead thyroid collars were 67.16% and 78.79%, respectively.Conclusions:The combination of Monte Carlo method and MRCPs can be used to restore a specific irradiation scenario to a high degree and to estimate the physical dose of to the irradiated persons.

Hepatocellular carcinoma(HCC)is one of the most common malignancies with high morbidity and mortality rates worldwide.With the advances in molecular biology and tumor immunology,molecular-targeted agents represented by tyrosine kinase inhibitors(such as sorafenib and lenvatinib)and immunotherapy represented by PD-1/PD-L1 monoclonal antibodies have brought hope for patients with advanced HCC.The combination of immunotherapy and anti-angiogenic therapy can further improve the treatment outcome of patients.In addition,the optimization and integration of stereotactic body radiotherapy,local treatment,and systemic treatment may maximize the benefits of patients.In the future,through a deep understanding of the heterogeneity of HCC,the development of precision molecular subtyping and individualized treatment,and the establishment of a multidisciplinary collaborative diagnosis and treatment system,systemic therapy is expected to achieve long-term management of advanced HCC.This article reviews the current status and advances in systemic therapy for advanced HCC.