Enhanced Aggregation-Induced Delayed Electrochemiluminescence Triggered by Spatial Perturbation of Organic Dots.

Development of highly efficient, heavy-metal-free electrochemiluminescence (ECL) materials is attractive but still challenging. Herein, we report an aggregation-induced delayed ECL (AIDECL) active organic dot (OD) composed of a tert-butoxy-group-substituted benzophenone-dimethylacridine compound, which shows high ECL efficiency. The resultant ODs exhibit 2.1-fold higher ECL efficiency compared to control AIDECL-active ODs. Molecular stacking combined with theoretical calculations suggests that tert-butoxy groups effectively participate in the intermolecular interactions, further inhibiting the molecular motions in the aggregated states and thus accelerating radiative decay. On the basis of these ODs exhibiting excellent ECL performance, a proof-of-concept biosensor is constructed for the detection of miR-16 associated with Alzheimer's disease, which demonstrates excellent detection ability with the limit of detection of 1.7 fM. This work provides a new approach to improve the ECL efficiency and enriches the fundamental understanding of the structure-property relationship.

A Dual-Channel Ca2+ Nanomodulator Induces Intracellular Ca2+ Disorders via Endogenous Ca2+ Redistribution for Tumor Radiosensitization.

Tumor cells harness Ca2+ to maintain cellular homeostasis and withstand external stresses from various treatments. Here, a dual-channel Ca2+ nanomodulator (CAP-P-NO) is constructed that can induce irreversible intracellular Ca2+ disorders via the redistribution of tumor-inherent Ca2+ for disrupting cellular homeostasis and thus improving tumor radiosensitivity. Stimulated by tumor-overexpressed acid and glutathione, capsaicin and nitric oxide are successively escaped from CAP-P-NO to activate the transient receptor potential cation channel subfamily V member 1 and the ryanodine receptor for the influx of extracellular Ca2+ and the release of Ca2+ in the endoplasmic reticulum, respectively. The overwhelming level of Ca2+ in tumor cells not only impairs the function of organelles but also induces widespread changes in the gene transcriptome, including the downregulation of a set of radioresistance-associated genes. Combining CAP-P-NO treatment with radiotherapy achieves a significant suppression against both pancreatic and patient-derived hepatic tumors with negligible side effects. Together, the study provides a feasible approach for inducing tumor-specific intracellular Ca2+ overload via endogenous Ca2+ redistribution and demonstrates the great potential of Ca2+ disorder therapy in enhancing the sensitivity for tumor radiotherapy.

Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease.

Laryngopharyngeal reflux disease (LPRD) is an inflammatory condition in the laryngopharynx and upper aerodigestive tract mucosa caused by reflux of stomach contents beyond the esophagus. LPRD commonly presents with sym-ptoms such as hoarseness, cough, sore throat, a feeling of throat obstruction, excessive throat mucus. This complex condition is thought to involve both reflux and reflex mechanisms, but a clear understanding of its molecular mechanisms is still lacking. Currently, there is no standardized diagnosis or treatment protocol. Therapeutic strategies for LPRD mainly include lifestyle modifications, proton pump inhibitors and endoscopic surgery. This paper seeks to provide a comprehensive overview of the existing literature regarding the mechanisms, patho-physiology and treatment of LPRD. We also provide an in-depth exploration of the association between LPRD and gastroesophageal reflux disease.

Roles of different Ni-Si interactions in methane combustion under oscillating temperature conditions.

The silicon- modified nickel oxide catalysts with the same compositions but distinct Ni-Si interactions were obtained via different synthesis routes and utilized for methane combustion under conditions of oscillating temperatures. For catalysts prepared by co-grinding, amorphous SiO2 was dispersed on the surface of large NiO crystallites. During high-temperature calcination or reactions, the crystallization of SiO2, coupled with the sintering or decomposition of NiO crystallites, led to the inferior catalytic activity and stability. Interactions between Ni and Si species were enhanced in catalysts synthesized by precipitation. The Si species was incorporated into the NiO lattice to inhibit the growth of NiO crystallites and to generate nickel silicate species under thermal treatments. The small NiO crystallites provided more Ni3+ and active oxygen species for methane activation and oxidation, while the bulk nickel silicate species played a pivotal role in improving thermal stability, conjointly provoking excellent catalytic performance in cyclic heating-cooling tests between 180 and 800 °C. This study offers new insights into the design of metal oxide composites for catalytic applications.

Meibomian glands segmentation in infrared images with limited annotation.

AIM: To investigate a pioneering framework for the segmentation of meibomian glands (MGs), using limited annotations to reduce the workload on ophthalmologists and enhance the efficiency of clinical diagnosis. METHODS: Totally 203 infrared meibomian images from 138 patients with dry eye disease, accompanied by corresponding annotations, were gathered for the study. A rectified scribble-supervised gland segmentation (RSSGS) model, incorporating temporal ensemble prediction, uncertainty estimation, and a transformation equivariance constraint, was introduced to address constraints imposed by limited supervision information inherent in scribble annotations. The viability and efficacy of the proposed model were assessed based on accuracy, intersection over union (IoU), and dice coefficient. RESULTS: Using manual labels as the gold standard, RSSGS demonstrated outcomes with an accuracy of 93.54%, a dice coefficient of 78.02%, and an IoU of 64.18%. Notably, these performance metrics exceed the current weakly supervised state-of-the-art methods by 0.76%, 2.06%, and 2.69%, respectively. Furthermore, despite achieving a substantial 80% reduction in annotation costs, it only lags behind fully annotated methods by 0.72%, 1.51%, and 2.04%. CONCLUSION: An innovative automatic segmentation model is developed for MGs in infrared eyelid images, using scribble annotation for training. This model maintains an exceptionally high level of segmentation accuracy while substantially reducing training costs. It holds substantial utility for calculating clinical parameters, thereby greatly enhancing the diagnostic efficiency of ophthalmologists in evaluating meibomian gland dysfunction.

Comparison of outcomes between stent retriever combined with contact aspiration versus contact aspiration alone in patients without hyperdense artery sign/susceptibility vessel sign.

PURPOSE: To examine the relationship between hyperdense artery sign/susceptibility vessel sign (HAS/SVS) and thrombus composition, and evaluate the effect of HAS/SVS status on the association between first-line thrombectomy techniques and outcomes in patients with acute anterior-circulation large vessel occlusion (LVO). MATERIALS AND METHODS: From January 2018 to June 2021, 103 consecutive acute anterior-circulation LVO patients (75 [63.1%] male; median age, 66 years) who underwent thrombectomy, and for whom the removed clot was available for histological analyses were retrospectively reviewed. The presence of HAS and SVS was respectively assessed in noncontrast computed tomography (NCCT) and susceptibility-weighted imaging (SWI). Association of first-line thrombectomy techniques [stent retriever combined with contact aspiration (SR+CA) versus contact aspiration (CA)] with outcomes was assessed by the HAS/SVS status. RESULTS: Among the included patients, 55 (53.4%) were HAS/SVS(-), and 69 (67.0%) chose first-line SR+CA. Higher relative densities of fibrin/platelets (0.56 vs. 0.51, p<0.001) and lower relative densities of erythrocytes (0.32 vs. 0.42, p<0.001) were observed in HAS/SVS(-) than HAS/SVS(+) patients. First-line SR+CA was associated with reduced odds of distal embolization (aOR, 0.18; 95% CI, 0.04-0.83; p=0.027) and a more favorable 90-day functional outcome (aOR, 5.29; 95% CI, 1.06-26.34; p=0.042) in HAS/SVS(-) patients, and a longer recanalization time (53 min vs. 25 min, p=0.025) and higher risk of subarachnoid hemorrhage (24.2% vs. 0%, p=0.044) in HAS/SVS(+) patients. CONCLUSIONS: HAS/SVS(-) may indicate a higher density of fibrin/platelets in the thrombus, and first-line SR+CA may have a possible better performance than CA in acute LVO patients without HAS/SVS.

Comparison of indocyanine green and blue-stained glue for preoperative localization for pulmonary nodules.

Background: In patients with pulmonary nodules undergoing computed tomography (CT)-guided localization procedures, a range of liquid-based materials have been employed to date in an effort to guide video-assisted thoracoscopic surgery (VATS) procedures to resect target nodules. However, the relative performance of these different liquid-based localization strategies has yet to be systematically evaluated. Accordingly, this study was developed with the aim of examining the relative safety and efficacy of CT-guided indocyanine green (IG) and blue-stained glue (BSG) PN localization. Methods: Consecutive patients with PNs undergoing CT-guided localization prior to VATS from November 2021 - April 2022 were enrolled in this study. Safety and efficacy outcomes were compared between patients in which different localization materials were used. Results: In total, localization procedures were performed with IG for 121 patients (140 PNs), while BSG was used for localization procedures for 113 patients (153 PNs). Both of these materials achieved 100% technical success rates for localization, with no significant differences between groups with respect to the duration of localization (P = 0.074) or visual analog scale scores (P = 0.787). Pneumothorax affected 8 (6.6%) and 8 (7.1%) patients in the respective IG and BSG groups (P = 0.887), while 12 (9.9%) and 10 (8.8%) patients of these patients experienced pulmonary hemorrhage. IG was less expensive than BSG ($17.2 vs. $165). VATS sublobar resection procedure technical success rates were also 100% in both groups, with no instances of conversion to thoracotomy. Conclusions: IG and BSG both offer similarly high levels of clinical safety and efficacy when applied for preoperative CT-guided PN localization, with IG being less expensive than BSG.

Development and validation of a nomogram superior to CHADS2 and CHA2DS2-VASc models for predicting left atrial appendage dense spontaneous echo contrast/left atrial appendage thrombus.

Background: Atrial fibrillation (AF) is one of the most frequently encountered arrhythmias in clinical practice, with stroke triggered by detachment of left atrial appendage thrombus (LAAT) after AF being its most critical complication. The purpose of this study was to construct a nomogram model for forecasting left atrial appendage (LAA) dense spontaneous echo contrast (SEC) and LAAT to accurately identify patients at high risk for stroke. Methods: A retrospective analysis was conducted on 433 patients with AF receiving transesophageal echocardiography (TEE) in the First Affiliated Hospital of Soochow University from October 2019 to July 2022. These patients were assigned into a non-dense SEC/LAAT group or a dense SEC/LAAT group. We constructed a nomogram model dependent on the odds ratios (ORs) of logistic regression and subsequently compared its performance with two models, CHADS2 and CHA2DS2-VASc. Results: Female gender, high D-dimer level, low left ventricular ejection fraction, low left atrial ejection fraction, and low left atrial reservoir strain rate were found to be independent factors for predicting LAA SEC/LAAT, with OR values and 95% confidence intervals of 2.811 (1.445-5.469), 2.460 (1.230-4.921), 0.961 (0.927-0.996), 0.950 (0.932-0.967), and 0.173 (0.035-0.848), respectively. The consistency statistic of the nomogram based on these given predictive factors was 0.921, and the calibrated consistency statistic was 0.903. According to receiver operation curve analysis and decision curve analysis, the nomogram was demonstrated to be superior to the CHADS2 and CHA2DS2-VASc models in predicting LAA dense SEC/LAAT. The net reclassification improvement and integrated discrimination improvement of the nomogram were 0.449 (0.324-0.575) and 0.461 (0.408-0.515), when compared with the CHADS2 model, and were 0.521 (0.411-0.632), and 0.432 (0.400-0.504), respectively, when compared with the CHA2DS2-VASc models. Conclusions: The nomogram model constructed in this study demonstrated excellent performance in predicting LAA dense SEC/LAAT, displaying a superior ability to that of the CHADS2 and CHA2DS2-VASc models.

Intestinal microbiota via NLRP3 inflammasome dependent neuronal pyroptosis mediates anxiety-like behaviour in mice exposed to 3.5 GHz radiofrequency radiation.

The rapid development of 5G communication technology has increased public concern about the potential adverse effects on human health. Till now, the impacts of radiofrequency radiation (RFR) from 5G communication on the central nervous system and gut-brain axis are still unclear. Therefore, we investigated the effects of 3.5 GHz (a frequency commonly used in 5G communication) RFR on neurobehavior, gut microbiota, and gut-brain axis metabolites in mice. The results showed that exposure to 3.5 GHz RFR at 50 W/m2 for 1 h over 35 d induced anxiety-like behaviour in mice, accompanied by NLRP3-dependent neuronal pyroptosis in CA3 region of the dorsal hippocampus. In addition, the microbial composition was widely divergent between the sham and RFR groups. 3.5 GHz RFR also caused changes in metabolites of feces, serum, and brain. The differential metabolites were mainly enriched in glycerophospholipid metabolism, tryptophan metabolism, and arginine biosynthesis. Further correlation analysis showed that gut microbiota dysbiosis was associated with differential metabolites. Based on the above results, we speculate that dysfunctional intestinal flora and metabolites may be involved in RFR-induced anxiety-like behaviour in mice through neuronal pyroptosis in the brain. The findings provide novel insights into the mechanism of 5G RFR-induced neurotoxicity.

Oral Delivery of Photopolymerizable Nanogels Loaded with Gemcitabine for Pancreatic Cancer Therapy: Formulation Design, and in vitro and in vivo Evaluations.

Background: Gemcitabine (GEM) faces challenges of poor oral bioavailability and extensive first-pass metabolism. Currently, only injectable formulations are available for clinical use. Hence, there is an urgent demand for the development of advanced, efficacious, and user-friendly dosage forms to maintain its status as the primary treatment for pancreatic ductal adenocarcinoma (PDAC). Nanogels (NGs) offer a novel oral drug delivery system, ideal for hydrophilic compounds like GEM. This study aims to develop NGs tailored for GEM delivery, with the goal of enhancing cellular uptake and gastrointestinal permeability for improved administration in PDAC patients. Methods: We developed cross-linked NGs via photopolymerization of methacryloyl for drug delivery of GEM. We reveal characterization, cytotoxicity, and cellular uptake studies in Caco-2 and MIA PaCa-2 cells. In addition, studies of in vitro permeability and pharmacokinetics were carried out to evaluate the bioavailability of the drug. Results: Our results show NGs, formed via photopolymerization of methacryloyl, had a spherical shape with a size of 233.91±7.75 nm. Gemcitabine-loaded NGs (NGs-GEM) with 5% GelMA exhibited efficient drug loading (particle size: 244.07±19.52 nm). In vitro drug release from NGs-GEM was slower at pH 1.2 than pH 6.8. Cellular uptake studies indicated significantly enhanced uptake in both MIA PaCa-2 and Caco-2 cells. While there was no significant difference in GEM's AUC and Cmax between NGs-GEM and free-GEM groups, NGs-GEM showed markedly lower dFdU content (10.07 hr∙µg/mL) compared to oral free-GEM (19.04 hr∙µg/mL) after oral administration (p<0.01), highlighting NGs' efficacy in impeding rapid drug metabolism and enhancing retention. Conclusion: In summary, NGs enhance cellular uptake, inhibit rapid metabolic degradation of GEM, and prolong retention after oral administration. These findings suggest NGs-GEM as a promising candidate for clinical use in oral pancreatic cancer therapy.

Synergistic etching of nickel foam by Fe3+ and Cl- ions to synthesize nickel-iron-layered double hydroxide nanolayers with abundant oxygen vacancies for superior urea oxidation.

Urea electrolysis is an appealing topic for hydrogen production due to its ability to extract hydrogen at a lower potential. However, it is plagued by sluggish kinetics and noble-metal catalyst requirements. Herein, we developed nickel-iron-layered double hydroxide (NiFe-LDH) nanolayers with abundant oxygen vacancies (OV) via synergistically etching nickel foam with Fe3+ and Cl- ions, enabling the efficient conversion of urea into H2 and N2. The synthesized OV-NiFe-LDH exhibits a lower potential (1.30 vs. reversible hydrogen electrode, RHE) for achieving 10 mA cm-2 in the urea oxidation reaction (UOR), surpassing most recently reported Ni-based electrodes. OV provides favorable conductivity and a large surface area, which results in a 4.1-fold in electron transport and a 5.1-fold increase in catalyst reactive sites. Density Functional Theory (DFT) calculations indicate that OV can lower the adsorption energy of urea, and enhance the bonding strength of *CONHNH, giving rise to improved UOR. This study provides a viable path toward economical and efficient production of high-purity hydrogen.

Contrastive Multiview Attribute Graph Clustering With Adaptive Encoders.

Multiview attribute graph clustering aims to cluster nodes into disjoint categories by taking advantage of the multiview topological structures and the node attribute values. However, the existing works fail to explicitly discover the inherent relationships in multiview topological graph matrices while considering different properties between the graphs. Besides, they cannot well handle the sparse structure of some graphs in the learning procedure of graph embeddings. Therefore, in this article, we propose a novel contrastive multiview attribute graph clustering (CMAGC) with adaptive encoders method. Within this framework, the adaptive encoders concerning different properties of distinct topological graphs are chosen to integrate multiview attribute graph information by checking whether there exists high-order neighbor information or not. Meanwhile, the number of layers of the GCN encoders is selected according to the prior knowledge related to the characteristics of different topological graphs. In particular, the feature-level and cluster-level contrastive learning are conducted on the multiview soft assignment representations, where the union of the first-order neighbors from the corresponding graph pairs is regarded as the positive pairs for data augmentation and the sparse neighbor information problem in some graphs can be well dealt with. To the best of our knowledge, it is the first time to explicitly deal with the inherent relationships from the interview and intraview perspectives. Extensive experiments are conducted on several datasets to verify the superiority of the proposed CMAGC method compared with the state-of-the-art methods.

Hydrogen Source Tuned Regiodivergent Asymmetric Hydroalkylations of 2-Substituted 1,3-Dienes with Aldehydes by Cobalt-Catalysis.

Catalytic methods allowing for the reliable prediction and control of diverse regioselectivity along with the control of enantioselectivity to access different regio- and enantiomers by switching the least reaction parameters are one of the most attractive ways in organic synthesis, which provide access to diverse enantioenriched architectures from identical starting materials. Herein, a Co-catalyzed regiodivergent and enantioselective reductive hydroalkylation of 1,3-dienes with aldehydes has been achieved, furnishing different enantioenriched homoallylic alcohol architectures in good levels of enantioselectivity. The reaction features the switch of regioselectivity tuned by the selection of proton source. The use of an acid as proton source provided asymmetric 1,2-hydroalkylation products under reductive conditions, yet asymmetric 4,3-hydroalkylation products were obtained with silane as hydride source. This catalytic protocol allows for the access of homoallylic alcohols with two continuous saturated carbon centers in good levels of regio-, diastereo-, and enantioselectivity.

Work from home: Facilitators for an effective ergonomic work system.

Previous studies on Human Factors and Ergonomics (HFE) have primarily examined the impact of Work-From-Home (WFH) on worker health and well-being, yet little research has examined the optimal implementation process of WFH programs. Work systems perspective suggests that organizational policies, leadership, and psychological factors collectively influence the success of organizational change efforts. Our study explored the roles of managerial/supervisory, psychological, and organizational policy factors in facilitating the relationship between employees' HFE awareness and their acceptance and satisfaction with the WFH arrangement. Using data from 3195 knowledge workers in the US who use computers as their primary work tool and have worked from home at least one day in the past 30 days, we employed structural equation modeling to test our hypotheses. Transformational HFE leadership and employees' general self-efficacy are pivotal in implementing ergonomic WFH arrangements. The combination of employees' HFE awareness, transformational HFE leadership, and adequate levels of self-efficacy may foster positive process outcomes (e.g., readiness for WFH arrangement, workspace design satisfaction) in WFH arrangements. Efforts that are coordinated across organizational levels determine the effectiveness of organizational change.

The effect of commuting time on burnout: the mediation effect of musculoskeletal pain.

OBJECTIVES: This study explores the relationship among commuting, musculoskeletal (MS) pain, and burnout. METHODS: An observational and cross-sectional study was conducted at a medical university-affiliated hospital in Taichung, Taiwan in 2021. The two questionnaire was used and they included the Copenhagen Burnout Inventory (CBI) and the Nordic Musculoskeletal Questionnaire (NMQ). All participants were invited to complete the cross-sectional survey. A multiple linear regression was assessed correlations between commuting, MS pain, and burnout. RESULTS: After excluding those with missing data, 1,615 healthcare workers were deemed valid as research participants. In multiple linear regression, commuting time longer than 50 min was associated with personal burnout (PB) in the presence of adjusted confounders; however, long commuting time was not associated with work-related burnout (WB). Furthermore, the choice of commuting method did not affect PB or WB. Notably, both neck and shoulder pain (NBSP) and ankle pain (BAP) increase the risk of PB and WB. The mediation analysis demonstrated that NBSP is a mediating factor, increasing the level of PB and WB for commuting times longer than 50 min. CONCLUSIONS: Healthcare workers who commute for more than 50 min should be considered part of a high-risk group for burnout and musculoskeletal pain. They should also be provided with resources and programs focused on burnout prevention and MS pain relief.

Dbl family RhoGEFs in cancer: different roles and targeting strategies.

Small Ras homologous guanosine triphosphatase (Rho GTPase) family proteins are highly associated with tumorigenesis and development. As intrinsic exchange activity regulators of Rho GTPases, Rho guanine nucleotide exchange factors (RhoGEFs) have been demonstrated to be closely involved in tumor development and received increasing attention. They mainly contain two families: the diffuse B-cell lymphoma (Dbl) family and the dedicator of cytokinesis (Dock) family. More and more emphasis has been paid to the Dbl family members for their abnormally high expression in various cancers and their correlation to poor prognosis. In this review, the common and distinctive structures of Dbl family members are discussed, and their roles in cancer are summarized with a focus on Ect2, Tiam1/2, P-Rex1/2, Vav1/2/3, Trio, KALRN, and LARG. Significantly, the strategies targeting Dbl family RhoGEFs are highlighted as novel therapeutic opportunities for cancer.

The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: A systematic review and meta-analysis.

AIMS: To synthesize the available evidence to better understand the effectiveness of interventions to prevent or delay hyperglycaemia and Type 2 diabetes mellitus (T2DM) postnatally in women with current or previous gestational diabetes mellitus (GDM). METHODS: We searched five databases up to December 2020 for primary peer-reviewed articles reporting postpartum glycaemic outcomes in women with (previous) GDM following pharmacological or lifestyle intervention. Outcomes were relative risk of T2DM or continuous measures of glycaemia, change or at follow-up. A minimum of two studies evaluating the same intervention-outcome combination were needed to conduct meta-analyses, otherwise studies were described narratively. Meta-regression was used to evaluate whether associations varied by additional variables. We assessed risk of bias using the Critical Appraisal Skills Programme checklist. PROSPERO record CRD42018102380. RESULTS: We included 31 studies in the review with a total sample size of 8624 participants, and 26 studies in meta-analyses. Two-thirds of studies followed up participants at 1 year or less. Pharmacological interventions were associated with reduced risk of T2DM (0.80 [95% CI 0.64-1.00], n = 6 studies), as were lifestyle interventions albeit with a smaller effect size (0.88 [95% CI 0.76-1.01], n = 12 studies). Dietary and physical activity interventions were associated with a small reduction in fasting plasma glucose, particularly in longer interventions, but inconsistent effects were seen for other continuous outcomes. CONCLUSIONS: Although possibly due to chance, interventions to reduce hyperglycaemia after GDM may be effective. Future research should improve understanding of how interventions affect glucose control and how to optimise interventions for this population.

Radiotherapy alone versus concurrent chemoradiotherapy in patients with stage II and T3N0 nasopharyngeal carcinoma with adverse features: A propensity score-matched cohort study.

BACKGROUND AND PURPOSE: Whether concurrent chemoradiotherapy would provide survival benefits in patients with stage II and T3N0 NPC with adverse factors remains unclear in IMRT era. We aimed to assess the value of concurrent chemotherapy compared to IMRT alone in stage II and T3N0 NPC with adverse features. MATERIALS AND METHODS: 287 patients with stage II and T3N0 NPC with adverse factors were retrospectively analyzed, including 98 patients who received IMRT alone (IMRT alone group) and 189 patients who received cisplatin-based concurrent chemotherapy (CCRT group). The possible prognostic factors were balanced using propensity score matching (PSM). Kaplan-Meier analysis was used to evaluate the survival rates, and log-rank tests were employed to compare differences between groups. RESULTS: The median follow-up duration was 90.8 months (interquartile range = 75.6-114.7 months). The IMRT alone and the CCRT group were well matched; however, for all survival-related endpoints, there were no significant differences between them (5-year failure-free survival: 84.3% vs. 82.7%, P value = 0.68; 5-year overall survival: 87.3% vs. 90.6%, P value = 0.11; 5-year distant metastasis-free survival: 92.8% vs. 92.5%, P value = 0.97; 5-year locoregional relapse-free survival: 93.4% vs. 89.9%, P value = 0.30). The incidence of acute toxicities in the IMRT alone group was significantly lower than that in the CCRT group. CONCLUSION: For patients with stage II and T3N0 NPC with adverse features treated using IMRT, no improvement in survival was gained by adding concurrent chemotherapy; however, the occurrence of acute toxicities increased significantly. For those combined with non-single adverse factors, the comprehensive treatment strategy needs further exploration.