Abstract:Objective To explore the synergistic efficacy and safety of microwave ablation combined with bevacizumab in epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)-resistant advanced non-small cell lung cancer(NSCLC).Methods A retrospective analysis was performed on the clinical data of 82 patients with advanced non-squamous NSCLC who developed resistance to EGFR-TKI treatment and were admitted to Hainan Cancer Hospital from January 2022 to April 2025.According to the treatment regimens,the patients were divided into the combination group and the control group,with 41 cases in each group.The control group received pemetrexed/carboplatin chemotherapy,while the combination group was treated with microwave ablation plus bevacizumab combined with pemetrexed/carboplatin chemotherapy.The short-term efficacy,dynamic changes of serum tumor markers,long-term survival benefits and safety were compared between the two groups.Results The objective response rate and disease control rate in the combination group were significantly higher than those in the control group[65.8％(27/41)vs 34.2％(14/41),90.2％(37/41)vs 68.3％(28/41)](both P＜0.05).After treatment,the levels of carcinoembryonic antigen and cytokeratin 19 fragment in both groups were lower than those before treatment,and the levels in the combination group were significantly lower than those in the control group(all P＜0.05).The median progression-free survival(mPFS)in the combination group was 8.5 months(95％confidence interval:7.803-10.397),while that in the control group was 5.3 months(95％confidence interval:4.076-6.524).The mPFS in the combination group was significantly longer than that in the control group(hazard ratio=0.46,P＜0.01).There was no statistically significant difference in the incidence of grade 3 or above adverse reactions between the combination group and the control group(P＞0.05).Conclusion Microwave ablation combined with bevacizumab exerts a certain synergistic effect in patients with EGFR-TKI resistance,improves the response of tumor markers,prolongs PFS,and has a controllable safety profile,which provides a novel integrated treatment strategy for advanced NSCLC.

Abstract:Ankylosing spondylitis(AS)is an autoimmune disease characterized by immune disorder,chronic inflammation and abnormal bone metabolism,with the imbalance of T helper 17(Th17)/regulatory T(Treg)cells as the core,and its main clinical manifestations include inflammatory back pain and spinal ankylosis.This article systematically reviews relevant domestic and foreign literatures to explore the theoretical basis and mechanism of Duhuo Jisheng decoction in intervening AS.From the perspective of traditional Chinese medicine theory,this prescription is derived from Beiji Qianjin Yaofang,with the core effects of dispelling wind-dampness,relieving arthralgia,tonifying the liver and kidney,and nourishing Qi and blood,which is consistent with the pathogenesis of AS that"kidney deficiency and Du meridian insufficiency are the root cause,and wind-cold-dampness stasis are the superficial factors".From the perspective of modern mechanism,it repairs the Th17/Treg balance through the synergistic effect of multiple components and multiple targets:it not only downregulates the proportion of Th1 7 cells and the expression of retinoic acid receptor-related orphan receptor γt,and reduces the secretion of the proinflammatory factor interleukin-17(IL-17),but also upregulates the proportion of Treg cells and the expres-sion of forkhead box P3,and increases the release of the anti-inflammatory factor IL-10.Meanwhile,it targets and regulates upstream signaling pathways such as Janus kinase/signal transducer and activator of transcription and nuclear factor-κB,thereby inhibiting the inflammatory cascade reaction and improving pathological bone metabolism.However,current studies still have problems such as the disconnection between mechanism and clinical transformation and insufficient level of clinical evidence.In the future,it is necessary to promote its precise application through multi-center,large-sample randomized controlled trials and the construction of individualized diagnosis and treatment models,so as to provide a theoretical basis for the integrated Chinese and Western medicine treatment of AS.

Abstract:Objective To investigate the therapeutic effect of invasive-noninvasive sequential ventilation combined with bronchoscopic alveolar lavage on chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 58 patients with COPD complicated with respiratory failure admitted to the Department of Emergency and Department of Respiratory,the First Affiliated Hospital of Guilin Medical University from July 2021 to June 2023 were enrolled.The patients were divided into the control group and the observation group using the random number table method,with 29 cases in each group.The control group was treated with invasive-noninvasive sequential ventilation alone,while the observation group was treated with bronchoscopic alveolar lavage on the basis of the control group's regimen.Oxidative stress indexes,immune function indexes,pulmonary function indexes,diaphragmatic status,clinical efficacy and adverse reactions were compared between the two groups.Results After treatment,the levels of superoxide dismutase and glutathione in both groups were signifi-cantly higher than those before treatment,and the levels in the observation group were significantly higher than those in the control group;the malondialdehyde levels in both groups were significantly lower than those before treatment,and the level in the observation group was significantly lower than that in the control group(all P＜0.05).The levels of CD3+,CD4+,and the CD4+/CD8+ratio in both groups were higher than those before treatment,and the indexes in the observation group were significantly higher than those in the control group;the CD8+levels in both groups were lower than those before treatment,and the level in the observation group was significantly lower than that in the control group(all P＜0.05).The forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC ratio,diaphragm thickening fraction and diaphragm excursion in both groups were signifi-cantly higher than those before treatment,and the indexes in the observation group were significantly higher than those in the control group(all P＜0.05).The total effective rate of the observation group was significantly higher than that of the control group[86.2％(25/29)vs 62.1％(18/29)](P＜0.05).The time to respiratory failure correction,mechanical ventilation time and length of hospital stay in the observation group were significantly shorter than those in the control group(all P＜0.05).During treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Invasive-noninvasive sequential ventilation combined with bronchoscopic alveolar lavage can significantly improve the therapeutic effect in patients with COPD complicated with respiratory failure,ameliorate oxidative stress and immune indexes,promote the recovery of diaphragmatic function,with high safety.

Abstract:Objective To investigate the effects of Danicopan,a complement factor D(CFD)inhibitor,on cardiac function,myocardial hypertrophy and myocardial fibrosis in mice after myocardial infarction(MI).Methods C57BL/6 mice were randomly divided into sham operation group,MI control group and MI+Danicopan group.MI model was established by ligating the left anterior descending coronary artery.From the day of operation,mice in the MI+Danicopan group were intraperitoneally injected with Danicopan(10 mg/kg),while those in the MI control group were injected with an equal volume of phosphate-buffered saline,twice a week for 3 consecutive weeks.Mice in the sham operation group only received thoracotomy without ligation of the left anterior descending coronary artery and no drug administration.After the intervention,echocardiography was performed to evaluate cardiac function.Cardiac tissues were collected for wheat germ agglutinin staining to observe the cross-sectional area of cardiomyocytes,and Masson's trichrome staining to analyze collagen deposition and calculate the percentage of fibrotic area.Results The left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)in the MI control group were significantly lower than those in the sham operation group[(21.3±1.7)％vs(68.3±2.4)％,(9.5±1.0)％vs(40.7±3.9)％],while the LVEF and LVFS in the MI+Danicopan group[(46.2±12.3)％,(23.0±7.3)％]were significantly higher than those in the MI control group(all P＜0.05).Pathological observations showed that Danicopan administration could significantly alleviate the degree of cardiomyocyte hypertrophy induced by MI and reduce the overall collagen volume fraction of myocardial tissue.Conclusion Danicopan,a CFD inhibitor,can significantly improve cardiac function,and alleviate pathological cardiomyocyte hypertrophy and interstitial fibrosis in mice with MI,suggesting that it may serve as a potential drug for the treatment of ventricular remodeling after MI.

Abstract:Objective To investigate the predictive value of low triiodothyronine(T3)syndrome(LT3S)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score for the prognosis of patients with Klebsiella pneumoniae pneumonia.Methods The medical records of 63 patients with Klebsiella pneumoniae pneumonia admitted to Beijing Chao-Yang Hospital,Capital Medical University from January 2020 to December 2024 were retrospectively analyzed.The patients were divided into the survival group(26 cases)and the death group(37 cases)according to 30 d survival status.The clinical indicators were compared between the LT3S group(44 cases)and the normal T3 group(19 cases).The area under the receiver operating characteristic(ROC)curve(AUC)and Logistic regression analysis were used to evaluate the predictive value of LT3S and APACHE Ⅱscore for the prognosis of patients with Klebsiella pneumoniae pneumonia.Results The incidence of LT3 S in the death group was higher than that in the survival group[83.8％(31/37)vs 50.0％(13/26)](P=0.004).Logistic regression analysis showed that LT3 S and APACHE Ⅱ score were independent risk factors for 30 d death in patients with Klebsiella pneumoniae pneumonia(both P＜0.05).ROC curve analysis showed that the AUCs of T3 and APACHE Ⅱ score for predicting 30 d death were 0.930 and 0.858,respectively(P＞0.05).Conclusion The incidence of LT3S is high in patients with Klebsiella pneumoniae pneumonia.Both LT3S and APACHE Ⅱ score are independent risk factors for 30 d death in these patients,and there is no significant difference in their predictive efficacy.

Abstract:Objective To investigate the etiology,clinical characteristics,diagnosis and treatment of small intestinal diseases with chronic diarrhea as the main symptom,and to improve the understanding and timely diagnosis and treatment of related small intestinal diseases.Methods From January 2016 to January 2020,patients hospitalized in the Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences with chronic diarrhea as the first and main symptom,without evidence of esophageal,gastric or colorectal involvement by imaging and endoscopy,and with small intestinal lesions were retrospectively enrolled.The general information,etiology,clinical manifestations,nutritional and inflammatory status of the patients were analyzed.Results A total of 23 patients were enrolled,including 17 males and 6 females,with the most patients aged 19-44 years[12 cases(52.2％)].The median time from the onset of symptoms to the final diagnosis was 1 year.The main cause was immune-related diseases[17 cases(73.9％)],followed by small intestinal malabsorption syndrome[4 cases(17.4％)]and infectious diseases[2 cases(8.7％)].In addition to chronic diarrhea,the symptoms of digestive system were often accompanied by abdominal pain[17 cases(73.9％)],hematochezia[5 cases(21.7％)],nausea and vomiting[6 cases(26.1％)].Most patients were at risk of malnutrition,mainly manifested as emaciation,anemia and hypoalbuminemia.Conclusions There is a wide spectrum of diseases with chronic diarrhea as the main manifestation and small intestinal involvement alone.Most of them are rare small intestinal diseases,such as autoimmune enteritis,which are difficult to diagnose.For patients with unexplained chronic diarrhea,we should pay attention to the etiology of small intestinal diseases and make timely diagnosis and treatment.

Abstract:Objective To investigate the correlation between serum levels of endothelin-1(ET-1)and vascular endothelial growth factor A(VEGF-A)and reduced bone mass in patients with chronic kidney disease(CKD).Methods A total of 362 CKD patients admitted to the Affiliated Hospital of Shandong Second Medical University from January 2022 to January 2023 were retrospectively enrolled and divided into the reduced bone mass group(182 cases)and the osteoporosis group(180 cases)according to the diagnosis of reduced bone mass.Meanwhile,180 healthy subjects who underwent physical examination during the same period at this hospital were selected as the control group.Serum levels of ET-1 and VEGF-A were compared among the three groups.Multivariate Logistic regression analysis was used to identify the influencing factors of reduced bone mass in CKD patients,and Pearson correlation analysis was applied to analyze the correlation between serum ET-1 and VEGF-A levels and reduced bone mass in CKD patients.Results There were statistically significant differences in the proportions of hypertension and diabetes,fasting blood glucose,femoral neck T-score,average bone mineral density(BMD)of L1-4,serum calcium,femoral neck BMD,25-hydroxyvitamin D3[25-(OH)D3],24 h urinary protein excretion,estimated glomerular filtration rate(eGFR),serum phosphorus,parathyroid hormone(PTH),ET-1 and VEGF-A among the three groups(all P＜0.05).In reduced bone mass group,serum levels of ET-1 and VEGF-A were correlated with body mass index,hypertension,diabetes,cardiovascular disease,PTH and serum phosphorus(all P＜0.05).Multivariate Logistic regression analysis showed that diabetes,hypertension,serum calcium,serum phosphorus,25-(OH)D3,PTH,ET-1 and VEGF-A were all independent influencing factors for reduced bone mass in CKD patients(all P＜0.001).Pearson correlation analysis revealed that reduced bone mass in CKD patients was positively correlated with ET-1 and negatively correlated with VEGF-A levels(r=0.444,-0.502,both P＜0.001).Conclusion Serum levels of ET-1 and VEGF-A are abnormal in CKD patients and associated with reduced bone mass,early monitoring of these indicators has clinical significance.

Abstract:Objective To investigate the application effect of the multidrug-resistant organism(MDRO)early warning assessment scale in newly admitted patients to the intensive care unit(ICU).Methods A prospective observational study was conducted on 110 patients admitted to the Department of Critical Care Medicine,Guangdong Provincial Hospital of Traditional Chinese Medicine from August 2021 to February 2025,using a risk assessment scale containing five core indicators:patient source,length of hospital stay,age,duration of indwelling catheter,and high-risk factors.Receiver operating characteristic curve analysis was used to determine the optimal cut-off value of the assessment scale.Based on the principle of maximizing the Youden index,the optimal critical value was determined to be 9(the area under the curve was 0.78).Patients were divided into the high-risk group(≥9)and the low-risk group(≤8)according to the scores,and the difference in the MDRO detection rate between the two groups was compared.Results The MDRO detection rate in the high-risk group was significantly higher than that in the low-risk group[76.2％(32/42)vs 35.3％(24/68)](P＜0.001).A total of 194 pathogenic strains were isolated from all patients,among which 89 were MDRO strains(45.9％).The top four detected strains were Klebsiella pneumoniae(22 strains),Escherichia coli(15 strains),Staphylococcus aureus(12 strains)and Acinetobacter baumannii(12 strains).The rate of mixed infection was 30.9％(34/110).Conclusion The MDRO early warning assessment scale can effectively identify the high-risk population of MDRO among newly admitted ICU patients,and the implementation of pre-isolation measures for patients with a score of ≥9 points has important clinical value.

Abstract:Objective To analyze the expression of serum lipoprotein-associated phospholipase A2(Lp-PLA2),tissue inhibitor of matrix metalloproteinase 2(TIMP-2)and kidney injury molecule 1(KIM-1)in acute kidney injury(AKI)and their correlation with prognosis.Methods A total of 102 AKI patients admitted to the 908th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2023 to December 2024 were selected as the study group,and 100 healthy subjects who underwent physical examination during the same period at our hospital were enrolled as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of Lp-PLA2,TIMP-2 and KIM-1.The AKI patients were followed up for 6 months,and divided into the good prognosis group and poor prognosis group according to the recovery of renal function at the end of follow-up.The correlation between serum levels of Lp-PLA2,TIMP-2,KIM-1 and prognosis of AKI patients was analyzed.Results The serum levels of Lp-PLA2,TIMP-2 and KIM-1 in the study group were signifi-cantly higher than those in the control group[(357±52)μg/L vs(190±39)μg/L,(216±36)ng/L vs(98±21)ng/L,(186±21)ng/L vs(75±16)ng/L](all P＜0.05).With the increase of AKI stage,the serum levels of Lp-PLA2,TIMP-2 and KIM-1 gradually increasing,there were statistically significant differences between patients of different stages(all P＜0.05).The serum levels of Lp-PLA2,TIMP-2 and KIM-1 in the poor prognosis group were significantly higher than those in the good prognosis group[(421±55)μg/L vs(313±49)μg/L,(257±39)ng/L vs(186±33)ng/L,(226±36)ng/L vs(158±28)ng/L](all P＜0.05).Pearson correlation analysis showed that serum levels of Lp-PLA2,TIMP-2 and KIM-1 were positively correlated with poor prognosis(r=0.685,0.653,0.724,all P＜0.001).Conclusion The serum levels of Lp-PLA2,TIMP-2 and KIM-1 in AKI patients are significantly elevated and increase gradually with the progression of AKI stage.All the three indica-tors are positively correlated with the poor prognosis of AKI patients.

Abstract:Objective To investigate the relationship between C-reactive protein-albumin-lymphocyte(CALLY)index and disease activity in patients with Takayasu arteritis,and to evaluate its predictive value for disease activity.Methods Medical records of 92 hospitalized patients with Takayasu arteritis admitted to the Department of Rheumatology and Immunology,Beijing Anzhen Hospital,Capital Medical University from January 2016 to April 2024 were collected and retrospectively analyzed.Patients were divided into inactive group(41 cases)and active group(51 cases)according to the Indian Takayasu Arteritis Score 2010.Logistic regression model was used to analyze the relationship between CALLY index and disease activity,subgroup analysis was performed to assess the correlation in different populations,and the predictive ability of CALLY index was evaluated by restricted cubic spline(RCS)and receiver operating characteristic(ROC)curve analysis.Results The CALLY index in the active group was significantly lower than that in the inactive group[0.6(0.4,1.2)vs 2.2(0.8,5.3),P＜0.001].Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as smoking,drinking and erythrocyte sedimentation rate,the CALLY index was negatively correlated with disease activity risk(odds ratio=0.67,95％confidence interval:0.50-0.90,P=0.008).Analysis by CALLY tertile grouping showed that compared with Q,group(left interval of the lowest tertile),both Q2 and Q3 groups showed significant protective effects,with a trend test P＜0.001.RCS curve analysis showed a linear negative correlation between CALLY index and disease activity(P overall=0.013,P nonlinear=0.579).ROC curve analysis showed that the area under the curve(AUC)of CALLY index was 0.737(95％confidence interval:0.629-0.828),which was better than the controlling nutritional status score(AUC=0.631)and prognostic nutritional index(AUC=0.651).Subgroup analysis showed that the negative correlation between CALLY index and disease activity was more significant in female,non-hypertensive,non-diabetic,non-coronary heart disease,non-stroke,non-drinking,non-smoking patients,and those with body mass index＜25 kg/m2.In stratifications by different hypertension,diabetes,stroke states,drinking habit,age(cut-off at 45 years)and body mass index(cut-off at 25 kg/m2),the association between CALLY index and disease activity remained relatively consistent across subgroups,and no significant interaction effect was observed(all P for interaction＞0.05).Conclusion There is an independent negative correlation between CALLY index and disease activity in Takayasu arteritis,with good predictive value.It can be used as an effective and simple tool for clinical evaluation of disease activity in Takayasu arteritis.

Abstract:Comorbidity in the elderly is one of the global research hotspots at present.Respiratory sarcopenia comorbid with lung cancer in the elderly seriously impairs the therapeutic efficacy and tolerance of patients,exacerbates their quality of life and functional status,and even directly increases the risk of death.The demand for long-term medical and nursing management brings enormous pressure to the medical system.At present,the pathogenesis of the comorbidity of these two diseases remains unclear.This article introduces the epidemiological status of respiratory sarcopenia comorbid with lung cancer in the elderly,analyzes the pathogenesis of lung cancer complicated with respiratory sarcopenia and the common risk factors of the two diseases,and summarizes the intervention measures to improve respiratory muscle strength and increase muscle mass.It is expected to provide a reference for medical staff in the research and management of respiratory sarcopenia comorbid with lung cancer in the elderly,thereby improving the prognosis and optimizing the quality of life of elderly patients with lung cancer.

Abstract:Objective To explore the predictive value of serum heat shock protein 90α(HSP90α),annexin A3(ANXA3)combined with tumor-infiltrating lymphocytes(TILs)for the efficacy of neoadjuvant chemo-therapy(NAC)in breast cancer patients.Methods A total of 234 breast cancer patients(all receiving NAC)admitted to Qinghai Red Cross Hospital from April 2022 to February 2025 were prospectively enrolled.They were divided into an effective group and an ineffective group according to the efficacy of NAC.The serum levels of HSP90α and ANXA3 were detected by enzyme-linked immunosorbent assay,and the proportion of TILs was evaluated after hematoxylin-eosin staining.Logistic regression was used to analyze the influencing factors of NAC efficacy in breast cancer.Receiver operating characteristic curve was used to analyze the predictive value of serum HSP90α,ANXA3 combined with TILs for NAC efficacy in breast cancer.Results The serum levels of HSP90α and ANXA3 in the ineffective group were significantly higher than those in the effective group[(4.5±1.0)μg/L vs(2.9±1.0)μg/L,(6.0±1.1)μg/L vs(4.4±1.0)μg/L],while the TILs proportion was significantly lower than that in the effective group[(16.2±2.2)％vs(52.4±3.4)％](all P＜0.05).The areas under the curve(AUC)of serum HSP90α,ANXA3 and TILs for predicting NAC efficacy in breast cancer were 0.751,0.825 and 0.815,respectively,and the AUC of the combination of the three was 0.920,which was significantly higher than that of each single index(Z=2.701,2.742,2.757,all P＜0.05).HSP90α,ANXA3 and TILs were all correlated with molecular subtype,lymph node status and human epidermal growth factor receptor 2(HER-2)status of breast cancer patients(all P＜0.05).Logistic regression analysis showed that lymph node status,HER-2 status,HSP90α and ANXA3 were risk factors for NAC efficacy in breast cancer,while TILs was a protective factor(all P＜0.05).Conclusion The serum levels of HSP90α,ANXA3 and TILs in breast cancer patients show abnormal changes.Lymph node status,HER-2 status,HSP90α,ANXA3 and TILs are influencing factors of NAC efficacy in breast cancer,and the combination of HSP90α,ANXA3 and TILs has a certain predictive value for NAC efficacy in breast cancer patients.

Abstract:Knee osteoarthritis is a common chronic disease characterized by cartilage degeneration and synovial fibrosis,and its traditional Chinese medicine syndrome differentiation involves homeostasis imbalance of multiple Zang-Fu organs.The theory of"regulating the middle energizer and restoring balance"takes regulating the spleen and stomach of the middle energizer as the core,and restores the dynamic balance of human body functions by regulating Qi,blood,Yin,Yang,cold,heat,deficiency and excess of the body.The"gut-joint axis"theory mainly focuses on the intestinal flora imbalance that releases pro-inflammatory cytokines and produces inflammatory metabolites,leading to a state of systemic chronic inflammation,which in turn induces or aggravates knee osteoarthritis.This paper aims to discuss the consistency of the two theories and provide new ideas for the diagnosis and treatment of knee osteoarthritis.

Abstract:Spinocerebellar ataxia type 3(SCA3)is an autosomal dominant neurodegenerative disease and one of the most common neurogenetic degenerative disorders.The core pathogenic factor is the abnormal expansion of CAG trinucleotide repeat sequences in the ATXN3 gene,which leads to the accumulation of mutant ataxin-3 protein.Its pathogenesis has not been fully elucidated,and there is no effective therapeutic drug available.Mitochondrial dysfunction is a key pathological mechanism of SCA3.This article focuses on the role of mitochondrial dysfunction in SCA3.Mitochondrial dysfunction in SC A3 is characterized by bioenergetic defects such as decreased membrane potential,elevated reactive oxygen species and reduced adenosine triphosphate production.The underlying mechanisms involve the interference of mutant ataxin-3 with mitophagy by affecting the deubiquitination of voltage-dependent anion channel 1,a vicious cycle formed by oxidative stress and mitochondrial damage,imbalance of mitochondrial quality control,and tissue-specific susceptibility of apoptotic pathways.In-depth study of these mechanisms is of great significance for the development of therapeutic strategies.Future multi-dimensional target research focusing on mitochondrial protection and metabolic regulation may provide new translational directions for the treatment of SCA3.This article reviews the research progress on the role and underlying mechanisms of mitochondrial dysfunction in SC A3.

Abstract:Objective To investigate the correlation between C-reactive protein to albumin ratio(CAR),ferritin and clinicopathological features as well as prognosis in patients with B-cell non-Hodgkin lymphoma(B-NHL).Methods A total of 175 B-NHL patients diagnosed and treated standardizedly in the 980th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army from May 2021 to May 2023 were enrolled.Patients with CAR≥the optimal cut-off value were assigned to the high CAR group(82 cases),and those with CAR＜the optimal cut-off value were assigned to the low CAR group(93 cases).Patients with ferritin≥the optimal cut-off value were assigned to the high ferritin group(79 cases),and those with ferritin＜the optimal cut-off value were assigned to the low ferritin group(96 cases).Differences in clinicopathological features such as gender,age,pathological type and Ann Arbor stage were compared among patients in different CAR and ferritin groups.Kaplan-Meier method was used to plot survival curves,and Log-rank test was used to compare differences between groups.Cox proportional hazards regression analysis was used to evaluate whether CAR and ferritin were independent predictors of short-term prognosis in B-NHL patients.Results There were statistically significant differences in age,Ann Arbor stage,international prognostic index(IPI)score,B symptoms and lactate dehydrogenase(LDH)level between the high CAR group and the low CAR group(all P＜0.05).There were statistically significant differences in Ann Arbor stage,IPI score and hemoglobin level between the high ferritin group and the low ferritin group(all P＜0.05).Kaplan-Meier analysis showed that the 2-year cumulative progression-free survival rates of B-NHL patients in the high CAR group and high ferritin group after treatment were 58.5％and 55.7％respectively,which were lower than those in the low CAR group and low ferritin group(77.4％and 79.2％,P=0.007,0.001).Cox proportional hazards regression analysis showed that Ann Arbor stage Ⅲ-Ⅳ,IPI score 3-5,LDH ≥250 U/L,high CAR and high ferritin were all independent predictors of poor short-term prognosis in B-NHL patients(all P＜0.05).Conclusion High CAR and high ferritin are correlated with adverse clinicopathological features such as Ann Arbor stage Ⅲ-Ⅳ and high IPI score in B-NHL patients,and can also independently predict the risk of short-term recurrence in patients.

Abstract:Objective To investigate the effect of Netrin-1 overexpressing macrophage-derived exosomes(N-Exos)on angiogenesis and nerve repair after sciatic nerve injury in type 2 diabetes mellitus(T2DM)mice.Methods Bone marrow-derived macrophages(BMDMs)were isolated from the lower limb bone marrow of mice,and adenovirus transfection was used to induce Netrin-1 overexpression in BMDMs.The phenotype of macrophages after Netrin-1 overexpression was detected,and their exosomes were extracted and identified by transmission electron microscopy,nanoparticle tracking analysis and Western blot.Human umbilical vein endothelial cells(HUVECs)were co-cultured with N-Exos under high-glucose conditions in vitro to detect the effects of N-Exos on the proliferation,apoptosis,migration and tube formation abilities of HUVECs.Eighteen 8-week-old male C57BL/KsJ-db/db mice were randomly divided into three groups:the sciatic nerve injury group(control group),the exosome treatment group(Exos group),and the Netrin-1 overexpressing exosome treatment group(N-Exos group).A sciatic nerve injury model of T2DM mice was established to evaluate the effect of N-Exos on nerve repair after sciatic nerve injury in T2DM mice.Results The cell proliferation rate in the N-Exos group was higher than that in the Exos group and the control group,the 24 h scratch healing rate of HUVECs in the N-Exos group was higher than that in the Exos group and the control group,and the relative cumulative length of tube formation of HUVECs co-cultured with N-Exos was longer than that in the Exos group and the control group(all P＜0.05).TUNEL staining results showed that the number of apoptotic HUVECs was the largest in the control group and the smallest in the N-Exos group.In vivo experiments on T2DM mice confirmed that the relative fluorescence intensity of tumor necrosis factor-α in the injured sciatic nerve in the N-Exos group was lower than that in the control group and the Exos group,the relative fluorescence intensities of myelin basic protein and neurofilament protein were both higher than those in the control group and the Exos group,and the relative fluorescence intensity of CD31 in the injured nerve in the N-Exos group was higher than that in the control group and the Exos group.At 14 d after surgery,the gastrocnemius muscle atrophy index of mice in the N-Exos group was significantly lower than that in the Exos group and the control group[(15.7±1.0)％vs(20.5±0.8)％,(25.7±2.5)％](P=0.001).Conclusion N-Exos can promote angiogenesis and nerve repair after peripheral nerve injury in T2DM mice,which provides new ideas and a theoretical basis for the clinical treatment of peripheral nerve injury in diabetic patients.

Abstract:Objective To investigate the efficacy of vitamin D drops combined with cetirizine in the treatment of children with asthma in remission stage after acute exacerbation and its effect on immune function.Methods A total of 110 children with acute exacerbation of asthma admitted to Hebei Children's Hospital from January 2023 to January 2024 were enrolled and divided into the control group and the observation group according to the random number table method,with 55 cases in each group.At remission stage after acute exacerbation,on the basis of conventional treatment,the control group was treated with oral cetirizine,while the observation group was treated with vitamin D on the basis of control group.The general data,clinical efficacy,immune function indexes,pulmonary function-related indexes,serum 25-hydroxyvitamin D3 level,immunoglobulin E(IgE)level,remission of acute asthma exacerbation and asthma attacks and medical visits during treatment were compared between the two groups.Results There were no statistically significant differences in general data between the two groups(all P＞0.05).The total effective rate of the observation group was significantly higher than that of the control group[94.6％(52/55)vs 72.7％(40/55)](x2=9.565,P=0.002).After treatment,the levels of CD4+,CD4+/CD8+,forced expiratory volume in one second,forced vital capacity,peak expiratory flow,serum 25-hydroxyvitamin D3 and childhood asthma control test scores in both groups were significantly higher than those before treatment,and the above indexes in the observation group were significantly higher than those in the control group;the levels of CD8+and IgE in both groups were significantly lower than those before treatment,and the above indexes in the observation group were significantly lower than those in the control group(all P＜0.05).During the treatment period,the frequency of acute asthma exacerbation,unscheduled visits and hospitalization in the observation group were significantly lower than those in the control group(all P＜0.05).Conclusion Vitamin D combined with cetirizine has a significant therapeutic effect on children with asthma in remission stage after acute exacerbation,which can improve the immune function and pulmonary function of children.

Abstract:Against the background of deepening the reform of science and technology evaluation system,medical research institutes are in urgent need of establishing an evaluation system conforming to their own development rules.This paper analyzes the classified performance evaluation system for researchers.Through refined indicator design and salary linkage with strong incentives,the system effectively implements the strategies targeting the global scientific and technological frontiers,major economic fields,national major needs and people's life and health,as well as the principle of classified evaluation,and presents clear guidance for research activities.Nevertheless,it also faces potential challenges in supporting long-cycle research,balancing team and individual contributions,and guaranteeing the development of young scholars.This study puts forward systematic optimization suggestions including introducing milestone evaluation,setting up Annual Outstanding Team Award and establishing career pathways for young scholars,so as to provide theoretical reference and practical examples for similar medical research institutes to construct a dynamic,accurate and inclusive performance management system.

Abstract:Objective To compare and analyze the value of magnetic resonance hysterosalpingography(MR-HSG)and hysterosalpingo-contrast sonography(HyCoSy)in evaluating tubal patency.Methods A total of 165 infertility patients treated in Baishan Central Hospital,Jilin Province from March 2022 to December 2024 were retrospectively enrolled,including 76 cases in the MR-HSG group undergoing MR-HSG examination and 89 cases in the HyCoSy group undergoing HyCoSy examination.Tubal examination results and consistency with laparoscopic findings were compared between the two groups.Receiver operating characteristic(ROC)curves were drawn to compare the diagnostic efficacy of the two methods.Pain during contrast examination and incidence of intraoperative and postoperative adverse reactions were also evaluated.Results In the MR-HSG group(76 patients,152 fallopian tubes),51 tubes were patent,36 were partially obstructed,and 65 were obstructed,with a positive rate of 57.2％(87/152).In the HyCoSy group(89 patients,178 fallopian tubes),65 tubes were patent,44 were partially obstructed,and 69 were obstructed,with a positive rate of 61.2％(109/178).Taking laparoscopic chromopertubation as the gold standard,the sensitivity,specificity and Youden index of MR-HSG in judging tubal patency were 90.32％,94.92％and 0.852,respectively,with an AUC of 0.926(95％confidence interval:0.878-0.974,P＜0.001),showing good consistency with laparoscopic results(Kappa=0.837).The sensitivity,specificity and Youden index of HyCoSy were 90.18％,87.88％and 0.781,respectively,with an AUC of 0.890(95％confidence interval:0.835-0.946,P＜0.001),also showing good consistency(Kappa=0.773).The VAS score in the MR-HSG group was higher than that in the HyCoSy group[(2.1±0.5)vs(1.9±0.4),P＜0.05].The incidence of adverse reactions was 10.5％(8/76)in the MR-HSG group and 5.6％(5/89)in the HyCoSy group,with no statistically significant difference between groups(P=0.243).Conclusion Both MR-HSG and HyCoSy have high accuracy and reliability in evaluating tubal patency.MR-HSG has outstanding imaging advantages,while HyCoSy provides better patient experience.Appropriate examination methods should be selected clinically based on patient conditions.

Abstract:Objective To investigate the effect of awake prone position(APP)ventilation on clinical outcomes in patients with acute respiratory distress syndrome(ARDS).Methods Clinical data of 114 patients with ARDS admitted to Henan Provincial People's Hospital from January 2022 to January 2024 were retrospectively analyzed.Patients were divided into APP group(64 cases)receiving APP ventilation and supine position group(50 cases)receiving standard treatment.Endotracheal intubation rate and 28 d mortality were compared between the two groups.Furthermore,patients in the APP group were divided into early APP group(39 cases)and delayed APP group(25 cases)according to whether the initial time of APP was＞24 h after admission,to explore the effect of APP initiation timing on treatment outcomes.Results The endotracheal intubation rate in the APP group was lower than that in the supine position group[31.2％(20/64)vs 44.0％(22/50)](P＜0.05),but there was no significant difference in mortality between the two groups(P＞0.05).The respiratory rate-oxygenation index,oxygenation index,respiratory rate and diaphragm thickening fraction at the last hour of APP ventilation and 1 h af-ter restore supine position were all superior to those before the first APP ventilation,with statistically significant differences(all P＜0.05).The endotracheal intubation rate in the early APP group was lower than that in the delayed APP group[10.3％(4/39)vs 64.0％(16/25)](P＜0.001),but there was no significant difference in 28 d mortality between the two subgroups(P=0.221).Conclusions Early APP ventilation can effectively reduce the endotracheal intubation rate and improve clinical symptoms and physiological indicators in patients with ARDS.