Objective:To investigate the predictive effect of postoperative blood lipid metabolism and C-reactive protein/albumin ratio (CAR) on anastomotic fistula after radical resection of esophageal cancer.Methods:A retrospective case-control study was conducted on 256 patients with esophageal squamous cell carcinoma (all aged >50 years) who underwent radical esophagectomy in the thoracic surgery of the Second Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. Total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), ratio of C-reactive protein to albumin (CAR) and hemoglobin test index were collected. According to whether there was anastomotic fistula after operation, the patients were divided into anastomotic fistula group and non-anastomotic fistula group. The measurement data of normal distribution were compared by t-test, the measurement data of non-normal distribution were expressed by M( Q 1, Q 3), the comparison between groups was expressed by Mann-Whitney U test, and the counting data were expressed by (case(%)).The comparison between groups was performed by χ 2 test. Logistic regression model was used for multivariate analysis. ROC curve and Kappa value were used to evaluate the predictive value of total cholesterol and CAR in postoperative anastomotic fistula. Results:The preoperative body mass index (BMI) ((18.71±1.90) kg/m 2) in anastomotic fistula group was higher than that in non-anastomotic fistula group ((20.59±2.88) kg/m 2), and the difference was statistically significant ( t=3.48, P=0.001). The postoperative total cholesterol ((5.44±1.09) mmol/L), LDL-C ((3.82±1.15) mmol/L) and CAR(0.64(0.41, 0.95)) in anastomotic fistula group were higher than those in non-anastomotic fistula group ((4.54±0.94) mmol/L, (2.92±0.76) mmol/L, 0.27(0.13,0.45)). There were significant differences between the two groups (the statistical values were t=4.84, t=5.69, Z=5.16, all P<0.001)). The hemoglobin concentration of 103.20 (84.94,110.48) g/L was lower than that of non anastomotic fistula group (107.68 (99.20,125.20) g/L), the difference was statistically significant ( Z=2.82, P=0.005). Lower BMI( OR=0.652,95% CI 0.482-0.882), higher total cholesterol( OR=3.240,95% CI 1.430-7.340), lower hemoglobin ( OR=0.837,95% CI 0.777-0.902) and higher CAR( OR=2.161,95% CI 1.597-2.925) were the risk factors of anastomotic fistula in esophageal squamous cell carcinoma( P values were 0.006, 0.005, <0.001 and <0.001,respectively). ROC curve analysis showed that the areas under the curve of total cholesterol and CAR were 0.742 (95% CI:0.643-0.841, P<0.001) and 0.790 (95% CI:0.690-0.890, P<0.001) respectively. The cutoff values were 4.915 mmol/L and 0.605, the sensitivity were 80.0% and 80.0%, the specificity were 82.3% and 92.5%, respectively, and the Kappa values were 0.418 and 0.625 respectively (all P<0.001). Conclusion:Total cholesterol and CAR after radical resection of esophageal cancer have a certain predictive value for postoperative anastomotic fistula in patients with esophageal squamous cell carcinoma. The predictive result of CAR is better than that of total cholesterol.

Objective To explore the effectiveness evaluation and survival analysis of immune check-point inhibitors combined with anti-angiogenic therapy and chemotherapy as first-line treatment for extensive-stage small-cell lung cancer (ES-SCLC).Methods Thirty cases of EC-SCLC treated in department of Oncolo-gy,Inner Mongolia Autonomous Region People's Hospital from June 2020 to June 2021 were selected as the study subjects and treated by etoposide+lobaplatin+anlotinib+sintilimab firstline treatment,the therapeutic effect,improvement of living quality and adverse reactions were evaluated.Results The follow up was until August 2023.The median overall survival (OS) time was 17.3(15.1,19.4)months,the 1 year OS rate was 83.3% (95%CI:64.3%-94.1%).The median progression-free (PFS) time was 8.7(6.4,12.1)months,there was 1 case of complete remission (CR),24 cases of partial remission (PR),3 cases of stable disease (SD) and 2 cases of progress of disease (PD),the objective remission rate (ORR) was 83.3%,the disease con-trol rate (DCR) was 93.3%.Twenty-three cases (76.7%) developed different adverse reactions without more than grade three or above adverse reactions occurrence.Conclusion The etoposide+lobaplatin+anlotinib+si-ntilimab firstline treatment regimen obviously prolong median OS and PFS durations,moreover the adverse reactions are controlled.

Objective To systematically evaluate the efficacy and safety of trastuzumab deruxtecan(T-Dxd)in the treatment of breast cancer.Methods PubMed,Cochrane Library,Embase,Web of Science,SinoMed,CNKI,WanFang Data,and VIP databases were electronically searched to collect randomized controlled trials(RCTs)of T-Dxd(test group)versus chemotherapeutic agents or other antineoplastic agents(control group)from inception to February 15,2024.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias in the included studies.Meta-analysis was performed by using RevMan 5.3.1 software.Results A total of 3 RCTs involving 1 689 patients were included.The results of the Meta-analysis indicated that the progression-free survival(PFS)(HR=0.37,95％CI 0.27 to 0.51,P＜0.001),overall survival(OS)(HR=0.63,95％CI 0.53 to 0.75,P＜0.001),and objective response rate(ORR)(RR=2.52,95％CI 2.21 to 2.88,P＜0.001)in the test group were significantly superior to or higher than those of the control group.The incidence of drug-related interstitial lung disease(RR=10.82,95％CI 4.83 to 24.23,P＜0.001)and reduced ejection fraction(RR=5.05,95％CI 1.91 to 13.33,P=0.001)was significantly higher in patients in the test group than in the control group.Subgroup analysis showed that hormone receptor-positive and hormone receptor-negativity,brain metastasis,and no brain metastasis patients who received T-Dxd had longer PFS(P＜0.001).The results of sensitivity analysis showed that the results obtained were more robust when PFS,OS,and ORR were used as indicators.Conclusion Current evidence suggests that T-Dxd can prolong PFS and OS and improve ORR in breast cancer than chemotherapeutic agents or other antineoplastic agents,however,it may increase the risk of interstitial lung disease and reduce ejection fraction.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify the above conclusion.

Background and purpose:There is a consensus within the medical community regarding the perioperative treatment of locally advanced gastric cancer(LAGC),yet the selection of an efficient and safe treatment strategy remains a contentious issue.Previous studies have validated the effectiveness of chemotherapy in conjunction with immune checkpoint inhibitor(ICI)and anti-angiogenic agents in the perioperative treatment of LAGC.This study aimed to investigate the perioperative treatment regimen combining ICI,anti-angiogenic drugs and chemotherapy,in order to provide additional references for the selection of perioperative treatment strategies for patients with LAGC.Methods:This was a prospective,single-arm exploratory study designed to assess the efficacy and safety of perioperative treatment with penpulimab combined with anlotinib and chemotherapy for potentially resectable stage T3-4N+M0 LAGC.Patients diagnosed with LAGC at the Inner Mongolia Autonomous Region People's Hospital from January 2022 to December 2023 were enrolled in the study.The primary endpoints were pathological complete response(pCR)rate and major pathological remission(MPR)rate,while secondary endpoints included surgical conversion rate,objective response rate(ORR),disease-free survival(DFS),progression-free survival(PFS)and adverse reactions.Quality of life before and after treatment was evaluated using the European Organization for Research on Treatment of Cancer(EORTC)QLQ-STO22 Chinese version questionnaire.This study was reviewed and approved by the Ethics Committee of Inner Mongolia Autonomous Region People's Hospital(number:202404604L).Results:A total of 32 patients participated in the study,with an ORR of 78.1%(25/32).Of these,18 patients underwent surgical treatment,achieving a pCR rate of 22.2%(4/18)and a MPR rate of 38.9%(7/18).The median PFS for patients who did not undergo surgery was 9.8 months(95%CI:7.6-13.1),and the median follow-up duration was 16.4 months(95%CI:11.7-22.5).For patients who received radical surgical resection,the median DFS was not reached,and the 1-year DFS rate was 88.8%(16/18).Common adverse reactions following the treatment included myelosuppression,liver function abnormalities,diarrhea and neurotoxicity,with most adverse events being grade 1-2,a few grade 3 adverse events,and no grade 4 or 5 adverse events.According to the EORTC QLQ-STO22 Chinese version questionnaire,significant improvements were observed in the domains of difficulty swallowing,pain and eating restrictions.Additionally,improvements were noted in anxiety and reflux symptoms,while changes in body image were less pronounced.Conclusion:In the perioperative treatment of LAGC,the combination therapy of oxaliplatin,tegafur,anlotinib and penpulimab can improve the efficacy while ensuring safety,and is expected to become a new treatment for LAGC.

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot.Methods From March 2013 to December 2015,eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study.They were seven males and one female,with age range of 18-51 years (mean,34.5 years).The foot skin defect area ranged from 18 cm × 12 cm to 13 cm × 10 cm.All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively.The CTA data were entered into Mimics 15.0 software in DICOM format.Based on perforating condition of descending branch of lateral fenoral circunflex artery and the size of foot defect,one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap.The flap size ranged from 24 cm× 9 cm to 19 cm × 7 cm.All reconstructive surgeries were performed secondarily.Patients were all at Ⅱ stage recovery.The survival of flaps and healing status of flap donor sites were observed in one month after surgery.The number of debulking flaps was recorded.The appearance of flaps,shoe wearing,gait and related complications were recorded.Results The follow-up was 10-21 months (mean,15.5 months.All flaps survived uneventfully,and all donor sites were sutured directly.Three patients had twice debulking procedures,three patients had one debulking procedure,and two patients had no debulking.At the last visit in follow-up,the color and texture of flaps were good.All patients were able to wear shoes normally,two patients remained mild abnormal gait,and one patient presented superficial ulcer at the medial of the forefoot.Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications.Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot,which makes precise preoperative planning and intraoperative accurate cutting.

ObjectiveTo analyze the clinical characteristics of 151 local COVID-19 patients in Shanghai， 2022. MethodsThe clinical data of 151 COVID-19 patients admitted to a district-level designated hospital in Shanghai from April 13 to May 10， 2022 were reviewed， and their clinical manifestations， laboratory tests， lung imaging， treatment and outcomes were analyzed. ResultsThe 151 patients ranged from 3 to 97 years old， with a median age of 72 years. Most of them were clustered cases in the communities and families. The main clinical types were mild （95 cases， 62.9%） and general （47 cases， 31.1%）. Most of the 9 severe/critical patients （6.0%） were elderly and complicated with multiple comorbidities. The proportion of people who had not been vaccinated was as high as 66.9%， and the proportion of those among severe/critically ill patients who had not been vaccinated was even higher. The most common first symptoms were expectoration in 71 cases （47.0%）， fever in 51 cases （33.8%） and dry cough in 30 cases （19.9%）. The counts of white blood cells and neutrophils in mild or general group were mostly normal or decreased， and in the severe/critical group increased significantly （P<0.001）. Increase of troponin， D-dimer， creatinine， and myoglobin； and decrease of lymphocytes in severe/critical group were more common than the other clinical types （P<0.05）. The proportions of use of antibiotics， antiviral drugs， thymalfasin and heparin in severe/critical and general patients were significantly higher than those in mild patients （P<0.05）. Among the cured and discharged patients （138 cases， 91.4%）， the median number of days for COVID-19 viral nucleic acid to turn negative after treatment was 12 days. The negative conversion days of mild patients were significantly shorter than those of general patients and severe/critical patients （P<0.01）. Four （2.6%） death patients were all over 80 years old， unvaccinated， combined with multiple comorbidities， and eventually died of those serious comorbidities. ConclusionCOVID-19 patients at the district-level designated hospital are mainly clustered cases， and the proportion of patients who do not receive COVID-19 vaccine is high. Most of the hospitalized patients are mild， but advanced age， multiple underlying diseases， and lack of vaccination are high-risk factors for developing severe disease. Early assessment and comprehensive treatment are the key to improve prognosis.

Acute cerebral infarction （ACI）， also known as ischemic stroke， is a disease with a high disability rate， which brings heavy burdens to society and families. Its pathogenesis is related to many factors， of which the inflammatory theory is one of the important mechanisms. In the early stage of ACI， microglia are activated， and the inflammatory mediators， such as interleukins and tumor necrosis factor-α （TNF-α）， released by them induce vascular endothelial cells to express adhesion molecules. The circulating leukocytes （neutrophils， monocyte-macrophages， etc.） are promoted to roll and adhere to the injured vascular endothelium， migrate and cross the blood-brain barrier， penetrate and infiltrate the brain parenchyma， and further expand the local inflammatory response by releasing a variety of proinflammatory mediators， thus exacerbating the tissue injury at the injury site and ischemic penumbra. Traditional Chinese medicine （TCM） has advantages in treating the disease. TCM believes that the occurrence of stroke is related to blood stasis caused by various reasons， which block the brain vessel. This article reviewed the research progress on the effect of activating blood therapy on inflammatory factors in patients with ACI in recent years and discussed its regulation of inflammatory factors in ACI such as interleukin-1 （IL-1）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， interleukin-10 （IL-10）， TNF-α， C reactive protein （CRP）， and monocyte chemotactic protein-1 （MCP-1）， hoping to elucidate the scientific connotation of TCM treatment of ACI and lay the foundation for further research.