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Technological advances in MRI-guided radiation therapy (MRIgRT) have improved real-time visualization of the prostate and its surrounding structures over CT-guided radiation therapy. Seminal studies have demonstrated safe dose escalation achieved through ultrahypofractionation with MRIgRT due to planning target volume (PTV) margin reduction and treatment gating. On-table adaptation with MRI-based technologies can also incorporate real-time changes in target shape and volume and can reduce high doses of radiation to sensitive surrounding structures that may move into the treatment field. Ongoing clinical trials seek to refine ultrahypofractionated radiotherapy treatments for prostate cancer using MRIgRT. Though these studies have the potential to demonstrate improved biochemical control and reduced side effects, limitations concerning patient treatment times and operational workflows may preclude wide adoption of this technology outside of centers of excellence. In this review, we discuss the advantages and limitations of MRIgRT for prostate cancer, as well as clinical trials testing the efficacy and toxicity of ultrafractionation in patients with localized or post-prostatectomy recurrent prostate cancer.

Tian Zhang,1 Xiangxiu Qi2 1The First Internal Medicine Comprehensive Ward, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China; 2Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: Xiangxiu Qi, Email 492215122@qq.comBackground: Bladder cancer ranks seventh in global cancer prevalence. Radical cystectomy and urinary diversion are standard for muscle-invasive bladder cancer. Family caregivers shoulder a substantial care burden, affecting their own quality of life, with repercussions extending to patients’ health-related quality of life (HRQOL).Objective: This narrative review aims to highlight the major concerns perceived by the caregivers and efficacy of nurse-led interventions in alleviating their concerns and improving HRQOL.Methods: A systematic search of the PubMed, CINAHL, and Science Direct databases was carried out to identify studies published in the last 5 years (from Jan 2018 to Aug 2023) that have evaluated the concerns and problems of caregivers attending bladder cancer patients with urinary diversion. Additionally, studies evaluating the efficacy of nurse-led interventions in alleviating these concerns were also searched.Results: Overall, 6 studies involving 933 BC patients with UD and 1042 caregivers were identified as suitable for inclusion in this narrative literature review. Major concerns identified included psychological well-being, medical assistance needs, and peer support. Significant psychological impact was evident in the caregivers which operated in a dyadic manner. Nurse-led stoma education programs have demonstrated potential in enhancing caregivers’ quality of life, although they remain restricted.Conclusion: Emphasizing caregivers’ role and program effectiveness is critical. Our review addresses these gaps, focusing on caregivers’ concerns and the impact of nursing education for improved patient outcomes.Implications for Practice: Holistic and collaborative approach could enhance the overall well-being and quality of life of bladder cancer patients and their caregivers.Keywords: caregiver, nursing care, nurse-led training, bladder cancer, urinary diversion, quality of life

Xiaoting Qi, Changmin Wang Department of Clinical Laboratory, The People’s Hospital of Xinjiang Uygur Autonomous Region, Uygur, 830001, People’s Republic of ChinaCorrespondence: Changmin Wang, Department of Clinical Laboratory, The People’s Hospital of Xinjiang Uygur Autonomous Region, Uygur, 830001, People’s Republic of China, Tel/Fax +86-991-8564761, Email xjtianshan100@yeah.netPurpose: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a critical condition associated with unfavorable survival rates. Recent studies have indicated that the platelet-to-monocyte ratio (PMR) is considered an effective prognostic marker in several diseases. However, there has been no study to evaluate the prognostic value of PMR in HBV-ACLF patients. Therefore, this study aimed to investigate the association between PMR and 28-day survival in these patients.Methods: In this retrospective study, data, including clinical and laboratory parameters, were collected for 184 HBV-ACLF patients. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score. Logistic regression analyses were conducted to identify predictors influencing 28-day survival. Receiver-operating characteristic curve (ROC) analyses were performed to assess the predictive abilities of the identified predictors.Results: During the 28-day follow-up period, 56 (30.4%) HBV-ACLF patients died. PMR was significantly lower in non-survivors than in survivors (P < 0.001). Logistic regression demonstrated that PMR (Odds ratio, 0.983; 95% Confidence interval, 0.976– 0.990; P=0.001) and MELD score (Odds ratio, 1.317; 95% Confidence interval, 1.200– 1.446; P < 0.001) were independent risk factors for mortality in HBV-ACLF patients. The area under ROC curve for PMR was 0.760 (sensitivity=0.840, specificity=0.620, P=0.001) at a cut-off value of 140.6, and the area under ROC curve for MELD score was 0.819 (sensitivity=0.700, specificity=0.860, P=0.001) at a cut-off value of 23.1. PMR and MELD score exhibited similar predictive performances (Z=1.229; P=0.219). Furthermore, the combined use of PMR and MELD score further increased the area under the ROC curve to 0.858, which more accurate prognosis prediction than use of either factor alone (both P< 0.05).Conclusion: The PMR could serve as a reliable tool for predicting mortality in HBV-ACLF patients. Additionally, combining the PMR with the MELD score could improve prognostic accuracy for predicting 28-day mortality in these patients. However, further and larger studies are needed to confirm our findings.Keywords: ACLF, PMR, HBV, prognosis, mortality

Jian Cui,1 Yunliang Sun,2 Haifeng Jing,3 Qiang Chen,1 Zhihao Huang,1 Xin Qi,1 Hao Cui1 1Department of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, Shandong, 257061, People’s Republic of China; 2Department of Respiratory and Sleep Medicine, Bin Zhou Medical University Hospital, Binzhou, Shandong, 256600, People’s Republic of China; 3College of Software and Microelectronics, Peking University, Beijing, 100000, People’s Republic of ChinaCorrespondence: Jian Cui, Department of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, 271 Bei Er Lu, Dongying City, Shandong Province, 257061, People’s Republic of China, Tel +86-15066073763, Email jian.cui@sdipct.edu.cnPurpose: Sleep structure is crucial in sleep research, characterized by its dynamic nature and temporal progression. Traditional 30-second epochs falter in capturing the intricate subtleties of various micro-sleep states. This paper introduces an innovative artificial neural network model to generate continuous sleep depth value (SDV), utilizing a novel multi-feature fusion approach with EEG data, seamlessly integrating temporal consistency.Methods: The study involved 50 normal and 100 obstructive sleep apnea–hypopnea syndrome (OSAHS) participants. After segmenting the sleep data into 3-second intervals, a diverse array of 38 feature values were meticulously extracted, including power, spectrum entropy, frequency band duration and so on. The ensemble random forest model calculated the timing fitness value for all the features, from which the top 7 time-correlated features were selected to create detailed sleep sample values ranging from 0 to 1. Subsequently, an artificial neural network (ANN) model was trained to delineate sleep continuity details, unravel concealed patterns, and far surpassed the traditional 5-stage categorization (W, N1, N2, N3, and REM).Results: The SDV changes from wakeful stage (mean 0.7021, standard deviation 0.2702) to stage N3 (mean 0.0396, standard deviation 0.0969). During the arousal epochs, the SDV increases from the range (0.1 to 0.3) to the range around 0.7, and decreases below 0.3. When in the deep sleep (≤ 0.1), the probability of arousal of normal individuals is less than 10%, while the average arousal probability of OSA patients is close to 30%.Conclusion: A sleep continuity model is proposed based on multi-feature fusion, which generates SDV ranging from 0 to 1 (representing deep sleep to wakefulness). It can capture the nuances of the traditional five stages and subtle differences in microstates of sleep, considered as a complement or even an alternative to traditional sleep analysis.Keywords: sleep depth value, sleep continuity, EEG features, timing fitness, ANN model

PURPOSE/OBJECTIVES: Malignant pleural mesothelioma (MPM) is a rare but aggressive cancer arising from the cells of the thoracic pleura with a poor prognosis. We aimed to develop a model, via interpretable machine learning (ML) methods, predicting overall survival for MPM following radiotherapy based on dosimetric metrics as well as patient characteristics. MATERIALS/METHODS: Sixty MPM (37 right, 23 left) patients treated on a Tomotherapy unit between 2013 and 2018 were retrospectively analyzed. All patients received 45 Gy (25 fractions). The multivariable Cox regression (Cox PH) model and Survival Support Vector Machine (sSVM) were applied to build predictive models of overall survival (OS) based on clinical, dosimetric, and combined variables. RESULTS: Significant differences in dosimetric endpoints for critical structures, i.e., the lung, heart, liver, kidney, and stomach, were observed according to target laterality. The OS was found to be insignificantly different (p = 0.18) between MPM patients who tested left- and right-sided, with 1-year OS of 77.3% and 75.0%, respectively. With Cox PH regression, considering dosimetric variables for right-sided patients alone, an increase in PTV_Min, Total_Lung_PTV_Mean, Contra_Lung_Volume, Contra_Lung_V20, Esophagus_Mean, and Heart_Volume had a greater hazard to all-cause death, while an increase in Total_Lung_PTV_V20, Contra_Lung_V5, and Esophagus_Max had a lower hazard to all-cause death. Considering clinical variables alone, males and increases in N stage had greater hazard to all-cause death; considering both clinical and dosimetric variables, increases in N stage, PTV_Mean, PTV_Min, and esophagus_Mean had greater hazard to all-cause death, while increases in T stage and Heart_V30 had lower hazard to all-cause-death. In terms of C-index, the Cox PH model and sSVM performed similarly and fairly well when considering clinical and dosimetric variables independently or jointly. CONCLUSIONS: Clinical and dosimetric variables may predict the overall survival of mesothelioma patients, which could guide personalized treatment planning towards a better treatment response. The identified predictors and their impact on survival offered additional value for translational application in clinical practice.

Siyao Wang,1 Yong Zhang,1,2 Xiaoya Qi,1 Xiaoyang Xu1 1Health Medicine Center, The Second Hospital Affiliated to Chongqing Medical University, Chongqing, People’s Republic of China; 2School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Xiaoyang Xu, Health Medicine Center, The Second Hospital Affiliated to Chongqing Medical University, Chongqing, People’s Republic of China, Email 302500@hospital.cqmu.edu.cnPurpose: Disagreements about the risk of non-obese, non-alcoholic fatty liver disease for cardiometabolic outcomes occurred widely. This study aims to characterize the cardiometabolic and metabolic profile of lean/normal, overweight and obese patients with nonalcoholic fatty liver disease on a big sample.Patients and methods: Appeared healthy adults who participated in health examinations during the year of 2019– 2022 were screened for fatty liver diagnosis. BMI classified fatty livers as lean, overweight and obese. Eleven cardiometabolic metrics (SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglycerides; HDL: high-density lipoprotein cholesterol; LDL: low-density lipoprotein cholesterol) and metabolic metrics (GLU: blood glucose; GHB: glycated haemoglobin; UA: uric acid; AST: aspartate aminotransferase; ALT: alanine aminotransferase) were included, described and compared among BMI categories.Results: There were 56,496 fatty livers diagnosed by ultrasound in this study. In total, the lean fatty liver had lowest mean SBP, DBP, GLU, TG, UA, AST, and ALT but highest TC and HDL among BMI categories (all p < 0.001). The number of abnormal metrics in total was 2.5, 2.9 and 3.4 in lean, overweight, and obesity, respectively (p < 0.001, p_trend < 0.001). Visualized data showed that lean fatty liver was similar but milder in all metabolic metrics than overweight and obesity at the young ages. However, lean fatty liver had higher coefficients of age and risk of metabolic abnormality regression (p < 0.001 for SBP, DBP, GLU, GHB, TC).Conclusion: The lean type of fatty livers at a younger age has a relatively favourable cardiometabolic and metabolic profile compared to overweight and obese fatty livers. Due to the possible catch-up effect of metabolic dysfunctions in young lean fatty liver, lean fatty liver may have the same health outcomes as overweight/obesity fatty liver in long term. The evaluation and intervention may be critical for young lean fatty liver management to slowdown the rapid progress of metabolic dysfunction.Keywords: fatty liver, cardiometabolic profile, metabolic profile, body mass index

Qianqian Li,&ast; Ran Wang,&ast; Xingshun Qi Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xingshun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, Liaoning Province, 110840, People’s Republic of China, Tel +86-24-28897603, Fax +86-24-28851113, Email xingshunqi@126.comAbstract: Isolated splenic vein thrombosis (ISVT) is a very rare venous thromboembolism in the absence of pancreatic diseases, which can cause acute abdominal pain and chronic left-side portal hypertension. Herein, we reported a 40-year-old female patient who developed ISVT after taking oral contraceptives. Anticoagulation with oral rivaroxaban was the first-line choice of therapy in this case. Since then, abdominal pain alleviated, but she did not achieve vessel recanalization. Thus, a 7-day systemic thrombolysis with urokinase was given. Abdominal pain disappeared, but ISVT was not significantly improved. During follow-up period, long-term anticoagulation with oral rivaroxaban was given. Collectively, this case indicates the possibility of oral contraceptives as a risk factor of ISVT as well as anticoagulation combined with systemic thrombolysis as a choice of treatment for ISVT. Certainly, long-term follow-up is necessary in this case.Keywords: splenic vein thrombosis, oral contraceptives, anticoagulation, rivaroxaban, thrombolysis

Yingfan Chen,1,2,&ast; Zhenhui Wu,3,&ast; Shaodan Li,2 Qi Chen,2 Liang Wang,2 Xiaorong Qi,1 Chujiao Tian,1 Minghui Yang2 1Medical School of Chinese People’s Liberation Army, Beijing, People’s Republic of China; 2Department of Traditional Chinese Medicine, the Six Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; 3College of Pharmacy, Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Minghui Yang, Department of Traditional Chinese Medicine, the Six Medical Center, Chinese People’s Liberation Army General Hospital, 6 Fucheng Road, Beijing, 100048, People’s Republic of China, Tel +86-10-66939651, Email ymh9651@sina.comMethods: Related studies on PD and ferroptosis were searched in Web of Science Core Collection (WOSCC) from inception to 2023. VOSviewer, CiteSpace, RStudio, and Scimago Graphica were employed as bibliometric analysis tools to generate network maps about the collaborations between authors, countries, and institutions and to visualize the co-occurrence and trends of co-cited references and keywords.Results: A total of 160 original articles and reviews related to PD and ferroptosis were retrieved, produced by from 958 authors from 162 institutions. Devos David was the most prolific author, with 9 articles. China and the University of Melbourne had leading positions in publication volume with 84 and 12 publications, respectively. Current hot topics focus on excavating potential new targets for treating PD based on ferroptosis by gaining insight into specific molecular mechanisms, including iron metabolism disorders, lipid peroxidation, and imbalanced antioxidant regulation. Clinical studies aimed at treating PD by targeting ferroptosis remain in their preliminary stages.Conclusion: A continued increase was shown in the literature within the related field over the past decade. The current study suggested active collaborations among authors, countries, and institutions. Research into the pathogenesis and treatment of PD based on ferroptosis has remained a prominent topic in the field in recent years, indicating that ferroptosis-targeted therapy is a potential approach to halting the progression of PD.Keywords: Parkinson’s disease, ferroptosis, bibliometric analysis, iron accumulation, alpha-synuclein, mitochondrial dysfunction, oxidative stress, lipid peroxidation

Yinqin Liu,1 Yan Wang,2 Chuanhao Mi,1 Ziyue Wang,1 Yu Han,1 Xianghua Qi,3 Xiao Ding3 1First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China; 2School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Neurology II, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of ChinaCorrespondence: Yinqin Liu; Xiao Ding, Email liuyinqin2022@163.com; 752568850@qq.comObjective: Migraine is a common neurological disorder, which resulting in significant societal and personal burdens. Acupuncture has attracted widespread attention in migraine prophylaxis and treatment in recent years. Although some studies have confirmed the effectiveness of acupuncture therapy in treating migraines, there is still a lack of comprehensive evaluation regarding the comparison between different types of migraines and various acupuncture therapies. Furthermore, certain special acupuncture methods have not received sufficient attention and research. Therefore, the objective of this study is to summarize and expand upon previous research, update existing evidence, and compare the efficacy of different acupuncture therapies for migraine. We aim to provide stronger evidence-based support for clinical practice through this study, thereby promoting wider application of acupuncture therapy in migraine treatment.Methods: A exhaustive and methodical search was conducted across the nine databases: PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, CBM, CNKI, WANFANG and VIP Data. The Visual Analog Scale (VAS) scores, migraine attack frequency, duration, days of attack and adverse effects were observation indicators.Results: This study included 34 studies involving a total of 3365 migraineurs. The results of the study demonstrated that acupuncture therapy reduced VAS scores of migraine patients better compared to medication (MD=− 1.29, 95% CI=[− 1.67,-0.92]) and exhibited greater efficacy in reducing the frequency of migraine attacks (MD=− 1.95, 95% CI=[− 3.06,-0.85]), the duration of attacks (MD=- 3.29, 95% CI=[− 4.65,-1.93]), and days of attack (MD=− 1.02, 95% CI=[− 1.58,-0.47]). Significant heterogeneity suggested that different acupuncture therapies had varying effects, and that the efficacy of the same therapy may also vary in different migraine types. In the context of network meta-analysis, the SUCRA of acupuncture therapies for reducing VAS scores was ranked as special acupuncture method (98.3%), acupuncture plus medicine (71.9%), and acupuncture (54.5%). Blood-letting and cupping was the most effective treatment for lowering the frequency of migraine attacks. The most effective treatment for shortening the duration of migraine was acupuncture plus medication (81.2%). When it comes to decreasing the days of migraine, acupuncture (80.3%) came out on top. 14 studies reported the occurrence of adverse effects, of which 4 studies had no adverse effects in the test group.Conclusion: Initial findings indicate that acupuncture-related therapy exhibits superior effectiveness in the treatment of migraine and clinical decision-making should be patient-specific.Keywords: acupuncture, migraine, systematic review, network meta-analysis

Locally advanced rectal cancer (LARC) presents a significant challenge in terms of treatment management, particularly with regards to identifying patients who are likely to respond to radiation therapy (RT) at an individualized level. Patients respond to the same radiation treatment course differently due to inter- and intra-patient variability in radiosensitivity. In-room volumetric cone-beam computed tomography (CBCT) is widely used to ensure proper alignment, but also allows us to assess tumor response during the treatment course. In this work, we proposed a longitudinal radiomic trend (LRT) framework for accurate and robust treatment response assessment using daily CBCT scans for early detection of patient response. The LRT framework consists of four modules: (1) Automated registration and evaluation of CBCT scans to planning CT; (2) Feature extraction and normalization; (3) Longitudinal trending analyses; and (4) Feature reduction and model creation. The effectiveness of the framework was validated via leave-one-out cross-validation (LOOCV), using a total of 840 CBCT scans for a retrospective cohort of LARC patients. The trending model demonstrates significant differences between the responder vs. non-responder groups with an Area Under the Curve (AUC) of 0.98, which allows for systematic monitoring and early prediction of patient response during the RT treatment course for potential adaptive management.

PurposeThis study aims to investigate practice changes among Southern and Northern California's radiation oncology centers during the COVID-19 pandemic.MethodsOn the online survey platform SurveyMonkey, we designed 10 survey questions to measure changes in various aspects of medical physics practice. The questions covered patient load and travel rules; scopes to work from home; new protocols to reduce corona virus disease-2019 (COVID-19) infection risk; availability of telemedicine; and changes in fractionation schedules and/or type of treatment plans. We emailed the survey to radiation oncology centers throughout Northern and Southern California, requesting one completed survey per center. All responses were anonymized, and data were analyzed using both qualitative and quantitative research methods.ResultsAt the end of a 4-month collection period (July 2, 2021 to October 11, 2021), we received a total of 61 responses throughout Southern and Northern California. On average, 4111 patients were treated per day across the 61 centers. New COVID-19-related department and hospital policies, along with hybrid workflow changes, infectious control policies, and changes in patient load have been reported. Results also showed changes in treatment methods during the pandemic, such as increased use of telemedicine, hypofractionation for palliative, breast cancer, and prostate cancer cases; and simultaneous boosts, compared to sequential boosts.ConclusionOur California radiation oncology center population study shows changes in various aspects of radiation oncology practices during the COVID-19 pandemic. This study serves as a pilot study to identify possible correlations and new strategies that allow radiation oncology centers to continue providing quality patient care while ensuring the safety of both staff and patients.

Jingjing Wang,1 Lin Wang,1 Zhe Pang,1 Qingmiao Ge,1 Yonggui Wu,1,2 Xiangming Qi1 1Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China; 2Center for Scientific Research of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of ChinaCorrespondence: Yonggui Wu; Xiangming Qi, Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China, Tel +86 551 6292 2111, Email wuyonggui@medmail.com.cn; qxm119@126.comPurpose: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) worldwide. Elucidation of the molecular mechanisms underlying ferroptosis and immunity in DKD could aid the development of potentially effective therapeutics. This study aimed to perform an integrated analysis of ferroptosis and immune-related differentially expressed mRNAs (DEGs) in DKD.Materials and Methods: Gene expression profiles of samples obtained from patients with DKD and controls were downloaded from the Gene Expression Omnibus (GEO) database. The potential differentially expressed genes (DEGs) were screened using R software, and ferroptosis immune-related differentially expressed genes (FIRDEGs) were extracted from the DEGs. We performed functional enrichment analyses, and constructed protein–protein interaction (PPI) networks, transcription factor (TFs)-gene networks, and gene-drug networks to explore their potential biological functions. Correlation analysis and receiver operating characteristic curves were used for evaluating the FIRDEGs. We used the CIBERSORT algorithm to examine the composition of immune cells and determine the relationship between FIRDEG signatures and immune cells. Finally, the RNA expression of six FIRDEGs was validated in animal kidney samples using RT-PCR.Results: We identified 80 FIRDEGs and performed their functional analyses. We identified six hub genes (Ccl5, Il18, Cybb, Fcgr2b, Myd88, and Ccr2) using PPI networks and predicted potential TF gene networks and gene-drug pairs. Immune cells, including M2 macrophages, resting mast cells, and gamma-delta T cells, were altered in DKD; the FIRDEGs (Fcgr2b, Cybb, Ccr2, and Ccl5) were closely correlated with the infiltration abundance of M2 macrophages and gamma-delta T cells. Finally, the hub genes were verified in mouse kidney samples.Conclusion: We identified six hub FIRDEGs (Ccl5, Il18, Cybb, Fcgr2b, Myd88, and Ccr2) in DKD, and predicted the potential transcription factor gene networks and possible treatment targets for future research.Keywords: diabetic kidney disease, ferroptosis, immunity, bioinformatics

Heng Wang,1,&ast; Tingting Gao,1,&ast; Ruijing Zhang,2,&ast; Jie Hu,1 Siqi Gao,1 Yuwen Wang,1 Xiaotong Qi,1 Yun Zhou,3 Guoping Zheng,1,4 Honglin Dong1 1Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 2Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China; 3Shanxi Provincial Integrated TCM and WM Hospital, Taiyuan, People’s Republic of China; 4Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia&ast;These authors contributed equally to this workCorrespondence: Honglin Dong, Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Xinghualing District, Taiyuan City, Shanxi Province, 030001, People’s Republic of China, Email honglindong@sxmu.edu.cn Guoping Zheng, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia, Email guoping.zheng@sydney.edu.auBackground: Contrast-induced acute kidney injury (CI-AKI) is considered to be the third leading cause of hospital-acquired kidney injury. Current studies mostly suggest that contrast agents mainly harm renal tubular epithelial cells, but we hypothesized that the development of CI-AKI should be the result of the interaction of renal vascular and tubular injury.Methods: First we constructed a CI-AKI mouse model and verified the success of the model by pathological injury and serum creatinine level. Immunohistochemistry, protein quantification and qRT-PCR were used to detect the location and level of expression of neutrophil extracellular traps (NETs) in the kidney. Then, we blocked the in vivo accumulation of NETs using GSK484 and DNase I and detected the expression of NETs and the damage of glomerular and peritubular capillaries.Results: We first identified the presence of NETs in CI-AKI mice, and NETs were mainly accumulated in glomeruli and peritubular capillaries. The expression of NETs was positively correlated with the severity of CI-AKI kidney. After inhibition of NETs release or promotion of NETs degradation by drugs, renal vascular endothelial cell injury was reduced and renal pathological changes and creatinine levels were reversed in CI-AKI mice. In addition, inhibition of NETs reduced apoptosis and pyroptosis of renal cells and attenuated inflammation in vivo.Conclusion: These findings suggest that NETs are involved in the development of CI-AKI by damaging glomerular and peritubular capillary endothelial cells. This study will provide a new strategy for clinical prevention and treatment of CI-AKI.Keywords: contrast-induced acute kidney injury, neutrophils, neutrophil extracellular traps, glomeruli, peritubular capillaries

Shan Chen,1 Jie Zhang,1 Chengjia Qian,2 Xiaowei Qi,3 Yong Mao,1 Tingxun Lu1 1Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, People’s Republic of China; 2Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, People’s Republic of China; 3Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214122, People’s Republic of ChinaCorrespondence: Tingxun Lu, Department of Oncology, Affiliated Hospital of Jiangnan University, 1000, Hefeng Road, Wuxi, 214122, Jiangsu, People’s Republic of China, Email lutingxun@163.comPurpose: We aim to investigate the clinical significance of dynamic changes in the lymphocyte-to-monocyte ratio (LMR) and neutrophil-lymphocyte ratio (NLR) in peripheral blood at different time points combined with CEA in the prediction of postoperative-recurrence-in-patients with colorectal cancer (CRC).Patients and Methods: This study collected 357 patients with stage I–III CRC between 2016 and April 2018. The dynamic changes from preoperative to postoperative LMR (p-LMR-p) and NLR (p-NLR-p) were analyzed using COX regression for multivariate analysis. Logistic regression was used to investigate whether the dynamic changes from post-treatment to pre-end of follow-up LMR (p-LMR-f) and NLR (p-NLR-f) were independent risk factors for CRC recurrence and to construct a predictive model. Internal validation using bootstrapping was performed to validate the discrimination ability of the model. The models’ discriminative effect, calibration degree, and clinical utility were assessed.Results: In both the total cohort and the adjuvant therapy group, the dynamic changes of p-LMR-p (High-High vs Low-Low: p=0.006; HR:2.210, 95% CI: 1.256– 3.890) were found to be independent prognostic factors for recurrence-free survival (RFS) in CRC patients. Additionally, logistic regression analysis revealed that N stage, CEA, LMR of pre-end of follow-up (f-LMR), and p-LMR-f were independent risk factors for CRC recurrence. In the total cohort, the p-LMR-f had an area under the curve (AUC) of 0.704, with a sensitivity of 64% and a specificity of 75.3%. By combining p-LMR-f with CEA, a predictive model was constructed, which showed an AUC of 0.913 (0.986– 0.913) in the total cohort and an AUC of 0.924 (0.902– 0.924) in the adjuvant therapy group during internal validation using bootstrapping.Conclusion: Dynamic changes in LMR can be used to predict the prognosis of CRC and serve as a biomarker for predicting CRC recurrence. Combined with CEA, it can improve the predictive performance for detecting CRC recurrence.Keywords: colorectal cancer, postoperative recurrence, predictive model, inflammatory markers

Lijun Zhou,&ast; Xinyu Qi,&ast; Guiying Guo, Yanling Wang, Jianjun Yang, Dingbin Yang, Shuqiong Huang Department of Dermatology, People’s Hospital of Leshan, Leshan, Sichuan, 614000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shuqiong Huang, Department of Dermatology, People’s Hospital of Leshan, No. 238, Bai Ta Road, Shi Zhong Qu, Leshan, Sichuan, 614000, People’s Republic of China, Email 793438717@qq.comAbstract: Cutaneous hyphomycosis caused by Purpureocillium lilacinus is a relatively uncommon event in patients, but there has been a gradual increase in reported cases. A 71-year-old female patient was hospitalized in May 2022 due to an acute episode of chronic obstructive pulmonary disease and received glucocorticoid infusion. The skin around the puncture point on the back of her right hand showed erythema, nodules, scabs, and pus discharge, which gradually worsened. Fungal examination revealed the presence of hyphae, while treatment with terbinafine was ineffective. After fungal culture, pathological analysis, and molecular biology identification techniques, this case was diagnosed as cutaneous and subcutaneous infections caused by Purpureocillium lilacinus. After 2 weeks of treatment with itraconazole, the patient recovered. Patients on long-term hormone preparations who undergo superficial venipuncture should be aware of the risk of skin damage and potential infection by Purpureocillium lilacinus. Prompt fungal culture, histopathological analysis, and molecular identification are crucial for accurate diagnosis. Antifungal susceptibility testing should be considered for effective treatment.Keywords: infection of Purpureocillium lilacinus, superficial venipuncture, a case report, infection

Computer-assisted textual enhancement (CATE) technology has been widely used to improve English as foreign language (EFL) learners' syntactical and grammatical learning. Visual attention, repetition, and prior knowledge are known as the vital factors in CATE-assisted knowledge-acquisition; however, there still lacks a model which can describe those factors' intrinsic cooperating-mechanism that works in the CATE-based knowledge-acquisition. Therefore, this paper built up a computational model (PESE) of using those factors as variables, by fitting and predicting the data collected from empirical experiments with an average accuracy of 78%, PESE testified and complemented the assumptions proposed by previous studies. PESE suggested that although the efficacy of CATE is majorly decided by learners' prior-knowledge of the targets, the interactive effects of visual-attention, repetition, and inductive activity could partly compensate for the effect from prior-knowledge, and the efficacy ceiling of repetition also could be estimated according to the 'easy-perceiving level' coefficient. At the end of this paper, 3 pedagogical implications were proposed for English teachers who are willing to integrate CATE into their teaching activities.

Feifei Lu,1,2,&ast; Wentao Xu,2,&ast; Xiaoye Shi,2,&ast; Honglu Yu,2,&ast; Xingshun Qi1,2 1College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, 110167, People’s Republic of China; 2Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, 110840, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xingshun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, 110840, People’s Republic of China, Email xingshunqi@126.comBackground: Until now, there is little evidence regarding clinical efficacy of 14-day vonoprazan-based bismuth quadruple therapy (BQT) for Helicobacter pylori (H. pylori) eradication.Methods: Overall, 65 treatment-naïve patients with H. pylori infection who received 14-day vonoprazan-based BQT regimen (VBCA, n=17) or pantoprazole-based BQT regimen (PBCA, n=48) for H. pylori eradication were retrospectively included.Results: Neither successful H. pylori eradication (88.2% versus 91.7%, p=1.000) nor adverse event (52.9% versus 64.6%, p=0.397) was significantly different between VBCA and PBCA groups.Conclusion: Vonoprazan seems to be as effective and safe as pantoprazole during a 14-day BQT regimen in treatment-naïve patients with H. pylori infection.Keywords: Helicobacter pylori, vonoprazan, pantoprazole, bismuth quadruple therapy, efficacy

Jihai Chen,1,2 Lijun Wei,2 Xiaoxia Zhu,2 Wenli Xu,2 Yuxin Zou,2 Xinyu Qi,2 Jia Fang,2 Xiaodong Wang,2 Xiaolan Shi,1 Yunlu Sheng,2 Guoxian Ding,2 Xiaojun Ouyang,1 Yu Duan2 1Department of Geriatric, Geriatric Hospital of Nanjing Medical University, Nanjing, 210024, People’s Republic of China; 2Department of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of ChinaCorrespondence: Yu Duan, Department of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Email duanyujsph@163.com Xiaojun Ouyang, Department of Geriatric, Geriatric Hospital of Nanjing Medical University, Luojia Road 30, Nanjing, 210024, People’s Republic of China, Email xiaojun_ouyang@aliyun.comBackground and Aims: Sarcopenia is a common disease in the elderly, and the thyroid hormone (TH) might participate in the pathogenesis of sarcopenia. However, the results of previous studies were not completely consistent. We performed this study to investigate the association between THs and sarcopenia in a Chinese elderly euthyroid population.Subjects and Methods: A total of 309 Chinese elderly euthyroid subjects with an average age of 85.19 ± 7.8 years were enrolled. Participants were divided into four groups (non-sarcopenia, possible sarcopenia, sarcopenia and serve sarcopenia) according to the consensus update of AWGS in 2019. Serum levels of TT3, FT3, TT4, FT4, TSH, rT3 and TBG were measured. Muscle mass was measured by multifrequency bioelectrical impedance analysis, hand grip (HG) was represented by spring-type dynamometer, and gait speed (GS) was determined by 6-metre walk test. The FRAIL scale was used to assess frailty.Results: Compared to the non-sarcopenia group, the sarcopenia group showed a significant increase in age and FRIAL score, while FT3 and TT3 levels decreased significantly. Partial correlation analysis (adjusted by age, gender and the scores of FRIAL scale) indicated that FT3, TT3 and TSH had significant positive correlations with HG, and there also was a significant positive correlation between TT3 and GS. In addition, after adjusting for age, gender, BMI, ALT, sCr, and score on the FRAIL scale, the multivariate linear regression analysis showed that TT3 was positively associated with muscle strength and negatively associated with sarcopenia risk.Conclusion: There is an association between the low TT3 level and sarcopenia. Therefore, maintaining higher T3 concentrations within the normal range appears to be beneficial for sarcopenia in the elderly. In addition, due to the fluctuation of FT3, TT3 is a more stable and practical indicator to evaluate the relationship between sarcopenia and thyroid hormone in the elderly euthyroid population.Graphical Abstract: Keywords: sarcopenia, thyroid hormone, elderly, muscle strength

Jianmin Li,1,2,&ast; Wenyi Zhang,1,2,&ast; Shuang Liu,1,2,&ast; Fan Yang,2 Yupeng Zhou,2 Lin Cao,1,2 Yiming Li,1,2 Yunfei Guo,1,2 Xiang Qi,1,2 Guoping Xu,1 Jing Peng,1 Yang Zhao1,2 1Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, People’s Republic of China; 2Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yang Zhao; Jing Peng, Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China, Email yang.zhao@tmu.edu.cn; jing.peng@tmu.edu.cnPurpose: BSA-biomineralized Gd nanoparticles (Gd@BSA NPs) have been recognized as promising nanoscale MR contrast agents. The aim of this study was to carry out a preclinical evaluation of these NPs in a middle-sized animal model (rabbits).Methods: New Zealand white rabbits were treated intravenously with Gd@BSA NPs (0.02 mmol Gd/kg) via a clinically-used high-pressure injector, with commercial Gd-diethylene triamine pentaacetate (Gd-DTPA)-injected group as control. Then MR angiography was performed according to the standard clinical protocol with a 3.0-T MR scanner. The SNR and CNR of the main arteries and branches were monitored. Pharmacokinetics and bioclearance were continuously evaluated in blood, urine, and feces. Gd deposition in vital organs was measured by ICP‒MS. Weight monitoring, HE staining, and blood biochemical analysis were also performed to comprehensively estimate systemic toxicity.Results: The ultrasmall Gd@BSA NPs (< 6 nm) exhibited high stability and T1 relaxivity. Compared to Gd-DTPA, Gd@BSA NPs demonstrated superior vascular system imaging performance at ultralow doses, especially of the cardiac artery and other main branches, and exhibited a significantly higher SNR and CNR. Notably, the Gd@BSA NPs showed a shorter half-life in blood, less retention in organs, and improved biocompatibility.Conclusion: The preclinical evaluations here demonstrated that Gd@BSA NPs are promising and advantageous MR CA candidates that can be used at a low dose with excellent MR imaging performance, thus suggesting its further clinical trials and applications.Keywords: preclinical evaluation, ultralow dose, high-pressure injector, MR angiography

Subseasonal-to-seasonal (S2S) prediction, especially the prediction of extreme hydroclimate events such as droughts and floods, is not only scientifically challenging, but also has substantial societal impacts. Motivated by preliminary studies, the Global Energy and Water Exchanges (GEWEX)/Global Atmospheric System Study (GASS) has launched a new initiative called "Impact of Initialized Land Surface Temperature and Snowpack on Subseasonal to Seasonal Prediction"(LS4P) as the first international grass-roots effort to introduce spring land surface temperature (LST)/subsurface temperature (SUBT) anomalies over high mountain areas as a crucial factor that can lead to significant improvement in precipitation prediction through the remote effects of land-atmosphere interactions. LS4P focuses on process understanding and predictability, and hence it is different from, and complements, other international projects that focus on the operational S2S prediction. More than 40 groups worldwide have participated in this effort, including 21 Earth system models, 9 regional climate models, and 7 data groups. This paper provides an overview of the history and objectives of LS4P, provides the first-phase experimental protocol (LS4P-I) which focuses on the remote effect of the Tibetan Plateau, discusses the LST/SUBT initialization, and presents the preliminary results. Multi-model ensemble experiments and analyses of observational data have revealed that the hydroclimatic effect of the spring LST on the Tibetan Plateau is not limited to the Yangtze River basin but may have a significant large-scale impact on summer precipitation beyond East Asia and its S2S prediction. Preliminary studies and analysis have also shown that LS4P models are unable to preserve the initialized LST anomalies in producing the observed anomalies largely for two main reasons: (i) inadequacies in the land models arising from total soil depths which are too shallow and the use of simplified parameterizations, which both tend to limit the soil memory; (ii) reanalysis data, which are used for initial conditions, have large discrepancies from the observed mean state and anomalies of LST over the Tibetan Plateau. Innovative approaches have been developed to largely overcome these problems.

Xiuhui He, Siya Chen, Xiaohui Wang, Min Kong, Fangzheng Shi, Xiaoxuan Qi, Yuxin Xu Department of Ophthalmology, Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of ChinaCorrespondence: Yuxin Xu, Department of Ophthalmology, Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, People’s Republic of China, Tel +86-13866752297, Email xuyuxin1168@sina.comIntroduction: TSG-6 plays a wide anti-inflammatory and therapeutic role in a variety of autoimmune diseases as the key mediator of mesenchymal stem cells (MSCs).Purpose: We aimed to test whether TSG-6 could exert similar effects as MSCS in TAO via establishing TAO animal model immunized by hTSHR-A subunit plasmid.Material and Methods: We tested the expression level of TSG-6 on intraconal orbital fat from controls and patients with TAO. We established a stable thyroid-associated ophthalmopathy animal model by immunizing 6-week-old female Balb/c mice with recombination hTSHR-A subunit plasmid. After four immunizations, TSG-6 or dexamethasone was injected through the tail vein. The effects of the drugs on body weight, thyroid function, orbital inflammation, fibrosis and lipogenesis were observed.Results: The expression of TSG-6 in the orbital tissues of TAO patient is lower than that of normal people. In our animal model, mice showed weight loss, higher TT4 and TSHR antibody levels, and ocular symptoms such as inflammation and proptosis. TSG-6 can reduce ocular fibrosis and lipogenesis by inhibiting the infiltration of CD3+ T lymphocytes and macrophages in the mouse model of thyroid associated ophthalmopathy. Compared with dexamethasone, TSG-6 showed comparable anti-inflammatory effect, moreover, it has given a better performance in inhibiting adipogenesis.Conclusion: It was demonstrated that TSG-6 has a considerable positive impact on improving eye symptoms of TAO mice, which could be a novel candidate for the early treatment of TAO.Keywords: TAO, TSG-6, hTSHR-A subunit plasmid, anti-inflammatory, anti-fibrosis, lipogenesis

Guangxin Hu,1,&ast; Xijuan Qi,1,&ast; Ben Li,1 Ting Ge,1 Xi Li,1 Zhijun Liu,1 Jiaxing Li,1 Xuemei Zhang,1 YinPing Li,1 Shichang Zhang,1 Yajuan Wang,2 Tingting Zhao,3 Botao Zhang,1 Qingbin Xu1 1Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China; 2Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China; 3Department of Respiratory Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750002, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangxin Hu, Email hugx8911_ecg@163.comObjective: To assess the effectiveness and safety of an IVUS-guided rotational atherectomy (RA) percutaneous coronary intervention (PCI) in chronic renal patients with complex coronary calcification who are at risk for contrast-related acute kidney injury (AKI).Methods: From October 2018 to October 2021, 48 patients with chronic renal disease who were receiving PCI with RA at the General Hospital of NingXia Medical University were informed for data collection for this research. They were randomly assigned to the IVUS-guided RA group and the Standard RA group, which did not use IVUS. According to a clinical expert consensus document on rotational atherectomy in China, both PCI procedures were performed. The intravascular ultrasound (IVUS) results from the study group were used to describe the morphology of the lesion and to guide the selection of burrs, balloons, and stents. IVUS and angiography were used to evaluate the outcome in the end. IVUS-guided RA PCI and Standard RA PCI groups’ effects and results were contrasted.Results: There were no appreciable differences in the clinical baseline characteristics between the IVUS-guided RA PCI group and the Standard RA PCI group. The average estimated glomerular filtration rate (eGFR) of two groups was (81.42 ± 20.22 vs 82.34 ± 22.19) mL/min/1.73 m2. Most of them (45.8% vs 54.2%) was in stage 60– 90 mL/min/1.73m2. When compared to the standard RA PCI group, RA in IVUS-Guided group was more performed electively (87.5% vs 58.3%; p = 0.02). The IVUS-guided RA PCI group was associated with shorter fluoroscopy time (20.6 ± 8.4 vs 36 ± 22; p< 0.01) and less contrast amount (32 ± 16 vs 184 ± 116mL; p< 0.01) than Standard-RA group. Five patients in the Standard RA PCI group developed contrast-induced nephropathy, which was 5 times than the IVUS-guided RA PCI group (20.8% VS 4.1%; p=0.19).Conclusion: In chronic renal patients with complex coronary calcification, an IVUS-guided RA PCI technique is effective and safe. It can also lower the volume of contrast and perhaps the incidence of contrast-related AKI.Keywords: rotational atherectomy, chronic renal disease, contrast-associated acute kidney injury, intravascular ultrasound

Jia Zeng,1 Peng Sun,1 Xinning Fang,1 Yicheng Jiang,1 Zhenghong Wu,1 Xiaole Qi1,2 1Key Laboratory of Modern Chinese Medicines, China Pharmaceutical University, Nanjing, People’s Republic of China; 2Industrial Technology Innovation Platform, Zhejiang Center for Safety Study of Drug Substances, Hangzhou, People’s Republic of ChinaCorrespondence: Zhenghong Wu; Xiaole Qi, Key Laboratory of Modern Chinese Medicines, China Pharmaceutical University, No. 639 Longmian Road, Jiangning District, Nanjing City, Jiangsu Province, 210009, People’s Republic of China, Tel +86 15062208341 ; +86 25 83179703, Email zhenghongwu66@cpu.edu.cn; qixiaole523@cpu.edu.cnBackground: Synergistic chemotherapy has been proved as an effective antitumor means in clinical practice. However, most co-administration treatment often lacks simultaneous control over the release of different chemotherapeutic agents.Materials and Methods: β-cyclodextrin modified hyaluronic acid was the “shell”, and the oxidized ferrocene-stearyl alcohol micelles served as the “core”, where doxorubicin (DOX) and curcumin (CUR) were loaded in shell and core of the bilayer nanoparticles (BNs), respectively. The pH- and glutathione (GSH)-responsive synchronized release behavior was evaluated in different mediums, and the in vitro and in vivo synergistic antitumor effect and CD44-mediated tumor targeting efficiency were further investigated.Results: These BNs had a spherical structure with the particle size of 299 ± 15.17 nm, while the synchronized release behaviour of those two drugs was proved in the medium with the pH value of 5.5 and 20 mM GSH. The co-delivery of DOX and CUR reduced the IC50 value by 21% compared to DOX alone, with a further 54% reduction after these BNs delivery measurements. In tumor-bearing mouse models, these drug-loaded BNs showed significant tumor targeting, enhanced antitumor activity and reduced systemic toxicity.Conclusion: The designed bilayer nanoparticle could be considered as potential chemotherapeutic co-delivery platform for efficient synchronized microenvironment respond and drug release. Furthermore, the simultaneous and synergistic drug release guaranteed the enhanced antitumor effects during the co-administration treatment.Graphical Abstract: Keywords: tumor microenvironment, combination chemotherapy, pH- and GSH-responsive, tumor targeting

Tian Zhang,1 Xiangxiu Qi2 1The First Internal Medicine Comprehensive Ward, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China; 2Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: Xiangxiu Qi, Department of Nursing, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Shenyang, 110004, People’s Republic of China, Email 492215122@qq.comBackground: Bladder cancer is the most predominant cancer of the lower urinary tract and is the most common cause for urostomy or urinary diversion. Urostomy immensely affect the patient’s everyday life from minor physical activity to social relations. Nurse-led interventions have been evaluated for improvement in quality of life in patients with urostomy.Objective: The main objective of this study was to review the medical literature in a systematic way to evaluate the nursing role in improving the health-related quality of life of patients undergoing urostomy.Methods: A systematic search of the PubMed, CINAHL, Embase, and Science Direct databases was carried out to identify studies that have evaluated the effect of nurse-led intervention on the self-efficacy and health-related quality of life in patients with urostomy. In addition, studies for factor affecting the quality of life were also investigated.Results: Overall, 10 studies were identified as suitable for inclusion in this review. Health-related quality of life was lower in these patients as compared to population norms and several factors such as age, employment, and living status were identified as the contributing factors. Preoperative education was critical in meeting the psychological needs while postoperative intervention was instrumental in improving the self-efficacy and health-related quality of life particularly when a continued nursing-patient interaction was existent.Conclusion: A comprehensive nurse-led intervention consisting of preoperative and postoperative components aimed at ostomy-related education, psychological counseling and compliant with patient factors is feasible and may result in greater improvement in self-efficacy and health-related quality of life in patients with urostomy. Larger clinical trials are warranted to validate these results.Keywords: bladder cancer, nursing, urostomy education, quality of life, perioperative care

Hao Tian,1,&ast; Tingting Zhao,1,&ast; Yanling Li,1,&ast; Na Sun,1 Dandan Ma,1 Qiyun Shi,1 Guozhi Zhang,1 Qingqiu Chen,1 Kongyong Zhang,1 Ceshi Chen,2,&ast; Yi Zhang,1 Xiaowei Qi1 1Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University, Chongqing, People’s Republic of China; 2Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaowei Qi; Yi Zhang, Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University, Gaotanyan Street 29, Chongqing, 400038, People’s Republic of China, Tel/Fax +86-23-68754160, Email qxw9908@foxmail.com; zhangyi1489@sina.comBackground: Epigenetic modification of chromatin is an important step in the regulation of gene expression. The chromobox family proteins (CBXs), as epigenetic modifier, may play a vital role in tumorigenesis and cancer progression. Herein we explored the correlation between CBXs and breast cancer (BC) via the bioinformatics approach and qRT-PCR validation.Methods: Several databases, including GEPIA, TCGA, GEO, K-M plotter, STRING, DAVID, cBioPortal, CIBERSORT, and HPA were employed to analyze the expression levels of CBXs and the correlations between CBXs and prognosis (overall and recurrence-free survival) in BC. We analyzed molecular functions, genetic variations, transcription factors of CBXs, and immune cell infiltration status. ROC curve analysis was performed to determine the predictive value of CBXs. RNA extracted from 11 human BC and paired adjacent normal tissues were subjected to qRT-PCR.Results: The mRNA expression level of CBX1– 5 was significantly upregulated, while that of CBX7 was significantly downregulated in BC; no expression disparities were observed in CBX6/8 expression. Further, high mRNA expression of CBX1/2/3/4/8 correlated with advanced BC, whereas high mRNA expression of CBX6/7 correlated with early BC. High mRNA expressions of CBX1/2/3/5 predict poor OS and RFS, while higher mRNA expressions of CBX6/7 predict better OS and RFS in patients with BC. ROC curve analysis revealed that CBX3 showed excellent discriminatory ability. Gene ontology enrichment analysis showed that CBXs primarily participated in SUMOylation and post-/transcriptional regulation. Moreover, they presented varying degrees of amplification in BC tissues and were related to the infiltration of various immune cells.Conclusion: CBXs can serve as putative biomarkers for BC. Further studies are warranted to determine the exact molecular mechanisms underlying the action of CBXs in BC, particularly CBX1/2/3/5/7.Keywords: chromobox family proteins, breast cancer, prognosis, bioinformatics, qRT-PCR

Kai Jiang,1,2 Jing Feng,2 Xia Qi,2 Lili Ran,2 Lixin Xie2 1Department of Ophthalmology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People’s Republic of China; 2Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of ChinaCorrespondence: Lixin Xie, Shandong Eye Institute, 5 Yan’erdao Road, Qingdao, 266071, Tel +8613335026472, Email Lixin_xie@hotmail.comPurpose: In search of new potent treatment of herpes simplex keratitis (HSK), inhibitory effect of oridonin (Ori) on herpes simplex virus type 1 (HSV-1) was validated by experiments.Methods: For evaluating inhibitory effect of oridonin on herpes simplex virus type 1, a series of in-vivo and in-vitro studies were carried out. Mouse HSV-1 infection model was used in the in-vivo experiments. Experimental mice were classified in five different groups: Mock (mock-infected), HSV-1+ DMSO, HSV-1+ Ori, HSV-1+ ACV, combined Ori and ACV+HSV-1. Corneas of Mock, HSV-1+ DMSO, HSV-1+ Ori group were sent for mRNA-sequencing after 3 days post infection (dpi). The expression of virus and host-related genes was evaluated by quantitative real-time polymerase chain reaction (qPCR). Vero cells HSV-1 infection models were used in the in-vitro experiments.Results: The application of ACV, Oridonin alone or a combination of both could alleviate HSV-1 severity and inhibit HSV-1 virus replication in C57BL/6 mice models. qPCR showed that compared with mock group, the expression of interleukin-6 (il-6), interleukin-1α (il-1α), and Tumor-necrosis factor-alpha (tnf-α) was up-regulated in DMSO+HSV-1 group and suppressed in other three group. Moreover, the expression of nod-like receptor protein (nlrp3), caspase 1 and interleukin-1β (il-1β) were depressed in the oridonin-treated group. Oridonin significantly inhibits HSV-1 replication, HSV-1 related gene expression, and the production of progeny HSV-1 viruses in vitro. Besides, oridonin affect the replication phase but not HSV-1 entry or penetration and cannot inactivate HSV-1.Conclusion: Oridonin alleviates herpes simplex keratitis infection in mouse, which may be attributed to inhibition of the NLRP3-inflammasome-IL-1β pathway. Our study illustrates that Oridonin has potential promise for application in treating HSK and other diseases caused by HSV-1 infection.Keywords: oridonin, HSV-1, herpes simplex keratitis, herb, nlrp3, inflammasome

PurposeTo develop and evaluate a fast patient localization tool using megavoltage (MV)-topogram on helical tomotherapy.Methods and materialsEighty-one MV-topogram pairs for 18 pelvis patients undergoing radiation were acquired weekly under an institutional review board-approved clinical trial. The MV-topogram imaging protocol requires 2 orthogonal acquisitions at static gantry angles of 0 degrees and 90 degrees for a programed scan length. A MATLAB based in-house software was developed to reconstruct the MV-topograms offline. Reference images (digitally reconstructed topograms, digitally reconstructed topograms) were generated using the planning computed tomography and tomotherapy geometry. The MV-topogram based alignment was determined by registering the MV-topograms to the digitally reconstructed topogram using bony landmark on commercial MIM software. The daily shifts in 3 translational directions determined from MV-topograms were compared with the megavoltage computed tomography (MVCT) based patient shifts. Linear-regression and two one-sided tests equivalence tests were performed to investigate the relation and equivalence between the 2 techniques. Seventy-eight MV-topogram pairs for 19 head and neck patients were included to validate the finding.ResultsThe magnitudes of alignment differences of (MVCT - MV-topogram) (and standard deviations) were -0.3 ± 2.1, -0.8 ± 2.4, and 1.6 ± 1.7 mm for pelvis and 0.6 ± 1.2, 0.8 ± 4.2, 1.6 ± 2.6 mm for head and neck; the linear-regression coefficients between 2 imaging techniques were 1.18, 1.10, 0.94, and 0.86, 0.63, 0.38 in the lateral, longitudinal, vertical directions for pelvis and head and neck, respectively. The acquisition time for a pair of MV-topograms was up to 12.7 times less than MVCT scans (coarse scan mode) while covering longer longitudinal length.ConclusionsMV-topograms showed equivalent clinical performance to the standard MVCT with significantly less acquisition time for pelvis and H&N patients. The MV-topogram can be used as an alternative or complimentary tool for bony landmark-based patient alignment on tomotherapy.