[摘 要] 目的：探讨复发/转移性鼻咽癌（NPC）接受含PD-1单抗免疫治疗的临床特征和预后影响因素。方法：回顾性分析2019年3月至2024年7月期间南部战区总医院确诊的95例NPC患者的临床资料和外周血生化及免疫学指标。预后分析采用Kaplan-Meier曲线，组间比较使用Log-rank检验，采用Cox比例风险模型进行单因素和多因素分析。结果：95例患者中男性81例，女性14例，中位年龄49.72岁（16~74岁），Ⅳ期91例（95.79%），所有患者均采用免疫治疗，联合或不联合化疗方案治疗，中位无进展生存期（mPFS）为10.5个月，客观缓解率（ORR）70.53%，疾病控制率（DCR）89.47%，接受含铂治疗方案患者PFS相对更长，且差异有统计学意义。紫杉醇 + 顺铂 + 氟尿嘧啶（TPF）对比吉西他滨 + 顺铂（GP）和紫杉醇 + 顺铂（TP）显示出更长的PFS，但差异无统计学意义。不同PD-1单抗治疗组间的PFS未显示出有统计学意义的差异。单因素及多因素Cox回归分析结果显示，肿瘤复发状态、初始血浆EBV感染状态、治疗周期数、基线外周血SII是复发/转移性NPC患者接受PD-1抑制剂治疗疗效预测的独立相关因素（均P < 0.05），并且非复发患者、初始血浆EBV DNA阳性、接受 ≥ 4治疗周期、基线外周血SII < 772.81的患者接受PD-1抑制剂治疗预后相对更好。结论：在接受PD-1抑制剂治疗的复发/转移性NPC患者中，非复发患者、初始血浆EBV DNA阳性、≥ 4治疗周期且外周血SII < 772.81者PFS相对更长，可早期识别免疫治疗效果不佳患者并精准干预。

High-throughput sequencing-based high-throughput screening （HTS²） technology， as a new advancement in the field of high-throughput biotechnology， is the world's first technology to integrate high-throughput sequencing into large-scale drug screening and target discovery. The artificially designed DNA probes were bound to the undetermined mRNAs of thousands of genes in cell lysates， and then the probes were ligated with ligases. The large-scale simultaneous detection of gene expression changes in thousands of drug-treated cell samples was performed using barcoding， automated operating platforms， and high-throughput sequencers. This technology enables high-throughput identification of drugs that significantly perturb the gene expression profiles characteristic of diseases. It can also take gene expression signature as the readout and exert great high-throughput advantages in the screening of multi-drug， multi-component， and multi-target drugs， as well as the research on complex mechanisms. Therefore， it is particularly suitable for elucidating the multi-target mechanisms of traditional Chinese medicine and identifying its multi-effective components. Its main technical advantages include high throughput， automation， and low cost. In recent years， HTS² technology has yielded important achievements in the elucidation of the mechanism of action of traditional Chinese medicine formulas， the scientific connotation analysis of the regional characteristics of traditional Chinese medicine， the targeted isolation of active compounds of traditional Chinese medicine， and the discovery of novel pharmacological functions of monomeric compounds of traditional Chinese medicine. In the era of artificial intelligence， HTS² technology will serve as a powerful tool for generating high-quality， original big data of traditional Chinese medicine， providing core data support and promoting AI-driven traditional Chinese medicine research. Ultimately， HTS² technology offers new strategies and critical data support for deeply analyzing the scientific connotation of traditional Chinese medicine and discovering novel traditional Chinese medicine-based drugs， thereby accelerating the modernization and internationalization of traditional Chinese medicine in China.

Objective:To analyze the clinical characteristics, treatment options, and prognosis of intranasal reactive hemangioma associated with camrelizumab therapy.Methods:Clinical data from patients with intranasal reactive hemangioma associated with camrelizumab treated at Nanfang Hospital of Southern Medical University from February 2021 to April 2022 were collected, including patients′ demographics, clinical symptoms, endoscopic lesion characteristics, enhanced MRI results of the sinuses, pathological examination results, treatment plans, and disease outcomes at the last follow-up.Results:A total of 5 patients with intranasal reactive hemangioma were included, comprising 3 males and 2 females, with ages ranging from 21 to 61 years. The primary diseases of these patients included advanced primary liver cancer and nasopharyngeal carcinoma with liver and lung metastases. All patients presented with recurrent nasal bleeding and progressively worsening nasal obstruction, rated as grade 2 adverse reactions. The onset of intranasal reactive hemangioma was observed after 2 to 15 cycles of camrelizumab injections, with lesions primarily located in the common nasal passage and nasopharynx. Endoscopically, intranasal reactive hemangiomas appeared as dark red, narrow-based, and easily bleeding tumor-like lesions. Enhanced MRI showed mild to moderate heterogeneous enhancement. All patients underwent endoscopic resection of hemangioma via a lesion-targeted technique, with the surgical procedure confined to the removal of the grossly visible tumor mass and 5 mm surrounding mucosal margins around the tumor bed. Postoperative pathological examination revealed hemangioma characteristics, including variably sized vascular lumens and endothelial cell proliferation. Follow-up duration ranged from 6 to 12 months, during which none of the patients experienced recurrence of intranasal reactive hemangioma.Conclusion:Prompt surgical excision of camrelizumab-induced intranasal reactive hemangioma is recommended upon diagnosis to mitigate bleeding complications.

Objective To investigate the mechanism of Fuzheng Yangxin Prescription in improving cardiac function in rats with heart failure with reduced ejection fraction(HFrEF)through regulation of AMPK/mTOR signaling pathway.Methods An HFrEF rat model was established via left anterior descending coronary artery ligation.Rats were randomized divided into sham-operation group,model group,Fuzheng Yangxin Prescription group and Entresto group,followed by 28 days of intervention.Echocardiography was used to measure left ventricular internal dimension at end-systole(LVIDs),left ventricular internal dimension at end-diastole(LVIDd),left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS),HE staining and Masson staining were used to observe myocardial morphology and fibrosis,serum contents of NT-proBNP and inflammatory factors(TNF-α,IL-1β,IL-6)were detected by ELISA,Western blot was performed to analyze p-AMPK,p-mTOR and protein expressions of autophagy markers(Beclin1,LC3,p62).Results Compared with sham-operation group,the LVIDs and LVIDd in model group significantly increased(P<0.05),while LVEF and LVFS significantly decreased(P<0.05),the structure of myocardial cells was disordered and arranged loosely,the deposition of collagen fibers in the infarct area was increased,and the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly increased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly decreased(P<0.05),while the protein expressions of p-mTOR and p62 significantly increased(P<0.05);compared with the model group,the LVIDs and LVIDd of rats in Fuzheng Yangxin Prescription group significantly decreased(P<0.05),the LVEF and LVFS were significantly increased(P<0.05),the disorder of myocardial cell arrangement and fibrosis were alleviated,the contents of NT-proBNP,TNF-α,IL-1β and IL-6 in serum significantly decreased(P<0.05),the protein expressions of p-AMPK,Beclin1 and LC3Ⅱ/LC3Ⅰ in myocardial tissue significantly increased(P<0.05),while the protein expressions of p-mTOR and p62 significantly decreased(P<0.05).Conclusion Fuzheng Yangxin Prescription may regulate autophagy by activating AMPK/mTOR pathway and improve cardiac function in HFrEF rats.

Objective To investigate the correlation between the levels of activated protein C(APC),thromboxane B2(TXB2),and soluble B7-H3(sB7-H3)in the peripheral blood of elderly patients with pneumonia and the severity as well as prognosis of the disease.Methods One hundred elderly pneumonia patients admitted to our hospital from March 2022 to June 2024 were enrolled as the study group,and 100 healthy volunteers during the same period were selected as the control group.The levels of APC,TXB2,and sB7-H3 in peripheral blood were com-pared between the two groups.Study group patients were further categorized into low-risk,medium-risk,and high-risk subgroups based on the CURB-65 score(Confusion,Uremia,Respiratory rate,Blood pressure,Age≥65 years).The levels of APC,TXB2,and sB7-H3 in peripheral blood were compared among patients with varying disease severities.Pearson correlation analysis was performed to evaluate the correlation between the levels of APC,TXB2,and sB7-H3 in peripheral blood and disease severity.The study group was followed up for 30 days and subsequently divided into good prognosis and poor prognosis subgroups according to their clinical outcomes.Clinical data and peripheral blood levels of APC,TXB2,and sB7-H3 were compared between patients with different prognoses.Partial correlation analysis was conducted to assess the relationship between peripheral blood levels of APC,TXB2,and sB7-H3 and prognosis.Finally,the predictive value of these biomarkers was evaluated using the Receiver Oper-ating Characteristic(ROC)curve.Results The level of APC in the peripheral blood of the study group was signifi-cantly lower than that of the control group,whereas the levels of TXB2 and sB7-H3 were significantly higher(P<0.05).The severity of the disease in the study group was assessed using the CURB-65 score,which categorized patients into 33 mild cases,39 moderate cases,and 28 severe cases.Severe patients exhibited a lower level of APC in peripheral blood compared to moderate and mild patients.Additionally,the levels of TXB2 and sB7-H3 in moderate patients were higher than those in mild patients,while severe patients demonstrated even higher levels of TXB2 and sB7-H3 compared to both moderate and mild patients(P<0.05).Pearson correlation analysis revealed that peripheral blood APC was negatively correlated with the CURB-65 score,whereas TXB2 and sB7-H3 were positively correlated with the CURB-65 score(P<0.05).During a 30-day follow-up period,the research team identified 79 patients with good prognoses and 21 patients with poor prognoses.Significant differences were observed in diabetes prevalence,disease severity,and APACHEⅡ scores between the poor prognosis subgroup and the good prognosis subgroup(P<0.05).The levels of APC in peripheral blood were significantly lower in the poor prognosis subgroup compared to the good prognosis subgroup,whereas the levels of TXB2 and sB7-H3 were significantly higher(P<0.05).Partial correlation analysis revealed that peripheral blood APC,TXB2,and sB7-H3 were significantly associ-ated with prognosis(P<0.05).The AUC values for predicting the prognosis of elderly pneumonia patients using peripheral blood APC,TXB2,and sB7-H3 were 0.752,0.738,and 0.761,respectively,with sensitivities of 66.67%,76.19%,and 66.67%,and specificities of 78.48%,67.09%,and 78.48%.When combining these three indicators for prognostic prediction,the AUC increased to 0.918,with a sensitivity of 85.71%and a specificity of 87.34%,demonstrating a significant improvement in predictive accuracy compared to each indicator used alone(Z=2.207,2.666,2.109,P=0.027,0.008,0.035).Conclusion The levels of APC,TXB2,and sB7-H3 in the peripheral blood of elderly patients with pneumonia are significantly associated with the severity and prognosis of the disease.Combined detection of these biomarkers can serve as a reliable predictor of clinical outcomes.

Purpose To evaluate the differential diagnostic value of 5.0T MRI susceptibility-weighted imaging(SWI)in hepatocellular carcinoma(HCC)and mass-forming intrahepatic cholangiocarcinoma(MICC).Materials and Methods A total of 56 patients with HCC and 36 patients with MICC confirmed by pathology from March 2023 to November 2024 in Anhui Provincial Hospital were retrospectively enrolled.Two radiologists independently analyzed three features of the lesions,including the low-signal rims around the lesion,hemorrhage within the lesion,and the relationship between lesions and adjacent vessels,on the SWI sequence between the two groups,respectively,via inter-rater consistency analysis.These above features between the two groups were compared and contrasted them with those obtained from conventional MR plain and enhanced scans,respectively.For intralesional hemorrhages,the diagnostic value was quantified by calculating the internal tissue susceptibility signal.Results The radiologists showed good consistency in the low-signal rims,intratumoral hemorrhage as well as the relationship between the lesion and the blood vessel on the SWI in the HCC group and the MICC group(Kappa=0.802-0.929,all P<0.001).Compared with conventional MR plain,SWI significantly enhanced the detection rates of perilesional low-signal rims and intratumoral hemorrhage(χ2=89.409,46.210,both P<0.001).These findings were more prevalent in HCC patients.The internal tissue susceptibility signal grading showed that HCC predominantly exhibited grade 3,whereas MICC predominantly exhibited grade 1,with statistically significant differences(Z=-4.059,P<0.05).Additionally,compared with enhanced MRI,SWI demonstrated higher accuracy in diagnosing the relationship between lesions and blood vessels in both groups;however,these differences were not statistically significant(χ2=0.275,0.247,P=0.871,0.619).In the HCC group,the relationship between tumors and blood vessels was primarily characterized by compression and tumor thrombus formation,while in the MICC group,it was predominantly marked by invasive changes,including vessel encasement,stenosis or occlusion,with a statistically significant difference between the two groups(Z=-6.809,P<0.001).Conclusion SWI sequence of 5.0T MRI provides clear visualization of the internal and peripheral structures of HCC and MICC.It can accurately delineate the relationship between lesions and blood vessels without the need for contrast agents,offering significant clinical utility in differentiating these two conditions.

Purpose To evaluate the differential diagnostic value of 5.0T MRI susceptibility-weighted imaging(SWI)in hepatocellular carcinoma(HCC)and mass-forming intrahepatic cholangiocarcinoma(MICC).Materials and Methods A total of 56 patients with HCC and 36 patients with MICC confirmed by pathology from March 2023 to November 2024 in Anhui Provincial Hospital were retrospectively enrolled.Two radiologists independently analyzed three features of the lesions,including the low-signal rims around the lesion,hemorrhage within the lesion,and the relationship between lesions and adjacent vessels,on the SWI sequence between the two groups,respectively,via inter-rater consistency analysis.These above features between the two groups were compared and contrasted them with those obtained from conventional MR plain and enhanced scans,respectively.For intralesional hemorrhages,the diagnostic value was quantified by calculating the internal tissue susceptibility signal.Results The radiologists showed good consistency in the low-signal rims,intratumoral hemorrhage as well as the relationship between the lesion and the blood vessel on the SWI in the HCC group and the MICC group(Kappa=0.802-0.929,all P<0.001).Compared with conventional MR plain,SWI significantly enhanced the detection rates of perilesional low-signal rims and intratumoral hemorrhage(χ2=89.409,46.210,both P<0.001).These findings were more prevalent in HCC patients.The internal tissue susceptibility signal grading showed that HCC predominantly exhibited grade 3,whereas MICC predominantly exhibited grade 1,with statistically significant differences(Z=-4.059,P<0.05).Additionally,compared with enhanced MRI,SWI demonstrated higher accuracy in diagnosing the relationship between lesions and blood vessels in both groups;however,these differences were not statistically significant(χ2=0.275,0.247,P=0.871,0.619).In the HCC group,the relationship between tumors and blood vessels was primarily characterized by compression and tumor thrombus formation,while in the MICC group,it was predominantly marked by invasive changes,including vessel encasement,stenosis or occlusion,with a statistically significant difference between the two groups(Z=-6.809,P<0.001).Conclusion SWI sequence of 5.0T MRI provides clear visualization of the internal and peripheral structures of HCC and MICC.It can accurately delineate the relationship between lesions and blood vessels without the need for contrast agents,offering significant clinical utility in differentiating these two conditions.

Objective To construct a predictive model for the 3-year recurrence-free survival(RFS)after total endoscopic resection of early and mid-stage esophageal cancer,and to test it,in order to provide decision support for standardized management after total endoscopic resection of early and mid-stage esophageal cancer.Methods A retrospective study was conducted to include 306 patients with early-to-mid stage esophageal cancer who underwent total endoscopic resection in our hospital from January 2018 to December 2020.The patients were divided into a modeling set(n=204)and a validation set(n=102)according to a 2∶1 ratio.Univariate analysis and random forest algorithm were used to screen variables,and Cox regression analysis was used to analyze the factors affecting the 3-year RFS after total endoscopic resection for early-to-mid stage esophageal cancer.The R language was used to construct a nomogram prediction model for model validation,and the receiver operating characteristic curve(ROC curve)was drawn to calculate the area under the curve(AUC).The discrimination of the prediction model was evaluated,and the calibration curve and decision curve(DCA curve)were used to evaluate the predictive performance and clinical applicability of the prediction model.Results Among the 306 patients with early and mid-stage esophageal cancer who underwent total endoscopic resection,18 died 3 years after the operation,55 relapsed,233 achieved RFS,and the 3-year RFS rate was 76.14％.Through univariate and random forest algorithm screening,seven factors were identified as being associated with the RFS of patients three years after surgery.These factors were entered into a Cox regression analysis,and the results showed that positive abdominal lymph nodes,vascular cancer thrombus,clinical stage Ⅲ,gross type of erosion,age ≥ 65 years,and tumor diameter＞3 cm were risk factors for RFS three years after surgery(P＜0.05).Based on this,a nomogram prediction model for RFS three years after full endoscopic resection for early-to-mid stage esophageal cancer was constructed.Internal and external validation showed that the consistency index of the prediction model in the modeling set was 0.881,and the consistency index in the validation set was 0.867.The ROC curve validation showed that the AUC of the prediction model in the modeling set and validation set were 0.855(95％CI:0.778-0.932)and 0.826(95％CI:0.763-0.890),respectively.The DCA curve validation showed that the risk threshold of the modeling set and validation set were 0-0.95 and 0-0.77,respectively,when the model could achieve high net benefits.Conclusion The 3-year RFS after total endoscopic resection for early and middle stage esophageal cancer is related to multiple factors.The nomogram model based on clinical stage Ⅲ,positive abdominal lymph nodes,vascular tumor thrombus,and gross type of erosion has good clinical utility for predicting the 3-year RFS of patients after surgery,and is of guiding significance for medical staff in making decisions about the management of early and middle stage esophageal cancer after surgery.

Objective To study the intervention effect of nursing staff's participation in antimicrobial stewardship(AMS)on the rational use of antimicrobial agents,and explore its role in constructing a scientific healthcare-associa-ted infection(HAI)control management.Methods The data on perioperative prophylactic use of antimicrobial agents,surgical-related HAI control,and pathogen detection before therapeutic use of antimicrobial agents among hospitalized patients in a hospital from January 2016 to December 2024 were collected.Relevant evaluation indica-tors before and after nursing staff participating in AMS were compared.2016-2018,2019-2021,and 2022-2024 were stages before intervention,during intervention,and after intervention,respectively.Results After nursing staff participated in AMS,the use rate of prophylactic antimicrobial agents 0.5-1 hour before surgery and discon-tinuation rate of antimicrobial agents within 24 hours after class Ⅰ incision surgery increased from 64.54％and 81.41％before intervention to 75.31％and 84.56％after intervention,respectively.Incidences of surgical-related HAI and surgical site infection in patients decreased from 3.11％and 0.96％before intervention to 1.37％and 0.17％after intervention,respectively.Pathogen detection rates before restricted-and special-grade antimicrobial agents treatment increased from 50.80％and 68.70％before intervention to 55.19％and 80.53％after interven-tion,respectively.Proportion of blood specimen from which coagulase-negative Staphylococcus was detected de-creased from 29.30％before intervention to 21.26％after intervention.Proportion of respiratory specimen from which Haemophilus influenzae was detected increased from 2.00％to 3.98％.Differences were all statistically sig-nificant(all P＜0.05).Conclusion As important members of the AMS team,nursing staff can effectively reduce irrational antimicrobial use,optimize medication timing and duration,and have a positive effect on ensuring patient safety through participating in the use and management of antimicrobial agents in hospitalized patients.

Objective To investigate the correlation between the levels of activated protein C(APC),thromboxane B2(TXB2),and soluble B7-H3(sB7-H3)in the peripheral blood of elderly patients with pneumonia and the severity as well as prognosis of the disease.Methods One hundred elderly pneumonia patients admitted to our hospital from March 2022 to June 2024 were enrolled as the study group,and 100 healthy volunteers during the same period were selected as the control group.The levels of APC,TXB2,and sB7-H3 in peripheral blood were com-pared between the two groups.Study group patients were further categorized into low-risk,medium-risk,and high-risk subgroups based on the CURB-65 score(Confusion,Uremia,Respiratory rate,Blood pressure,Age≥65 years).The levels of APC,TXB2,and sB7-H3 in peripheral blood were compared among patients with varying disease severities.Pearson correlation analysis was performed to evaluate the correlation between the levels of APC,TXB2,and sB7-H3 in peripheral blood and disease severity.The study group was followed up for 30 days and subsequently divided into good prognosis and poor prognosis subgroups according to their clinical outcomes.Clinical data and peripheral blood levels of APC,TXB2,and sB7-H3 were compared between patients with different prognoses.Partial correlation analysis was conducted to assess the relationship between peripheral blood levels of APC,TXB2,and sB7-H3 and prognosis.Finally,the predictive value of these biomarkers was evaluated using the Receiver Oper-ating Characteristic(ROC)curve.Results The level of APC in the peripheral blood of the study group was signifi-cantly lower than that of the control group,whereas the levels of TXB2 and sB7-H3 were significantly higher(P<0.05).The severity of the disease in the study group was assessed using the CURB-65 score,which categorized patients into 33 mild cases,39 moderate cases,and 28 severe cases.Severe patients exhibited a lower level of APC in peripheral blood compared to moderate and mild patients.Additionally,the levels of TXB2 and sB7-H3 in moderate patients were higher than those in mild patients,while severe patients demonstrated even higher levels of TXB2 and sB7-H3 compared to both moderate and mild patients(P<0.05).Pearson correlation analysis revealed that peripheral blood APC was negatively correlated with the CURB-65 score,whereas TXB2 and sB7-H3 were positively correlated with the CURB-65 score(P<0.05).During a 30-day follow-up period,the research team identified 79 patients with good prognoses and 21 patients with poor prognoses.Significant differences were observed in diabetes prevalence,disease severity,and APACHEⅡ scores between the poor prognosis subgroup and the good prognosis subgroup(P<0.05).The levels of APC in peripheral blood were significantly lower in the poor prognosis subgroup compared to the good prognosis subgroup,whereas the levels of TXB2 and sB7-H3 were significantly higher(P<0.05).Partial correlation analysis revealed that peripheral blood APC,TXB2,and sB7-H3 were significantly associ-ated with prognosis(P<0.05).The AUC values for predicting the prognosis of elderly pneumonia patients using peripheral blood APC,TXB2,and sB7-H3 were 0.752,0.738,and 0.761,respectively,with sensitivities of 66.67%,76.19%,and 66.67%,and specificities of 78.48%,67.09%,and 78.48%.When combining these three indicators for prognostic prediction,the AUC increased to 0.918,with a sensitivity of 85.71%and a specificity of 87.34%,demonstrating a significant improvement in predictive accuracy compared to each indicator used alone(Z=2.207,2.666,2.109,P=0.027,0.008,0.035).Conclusion The levels of APC,TXB2,and sB7-H3 in the peripheral blood of elderly patients with pneumonia are significantly associated with the severity and prognosis of the disease.Combined detection of these biomarkers can serve as a reliable predictor of clinical outcomes.