Pituitary metastasis(PM), a rare metastatic complication of malignant tumors most commonly seen in lung and breast cancers, exhibits subtle and nonspecific clinical manifestations that complicate its differentiation from other sellar lesions. Symptom development correlates with anatomical involvement: tumors often initially destroy the posterior pituitary, causing diabetes insipidus; subsequently, pituitary stalk compression may trigger hyperprolactinemia, while progressive anterior pituitary destruction ultimately leads to hormonal deficiencies. Additionally, mass effects from the tumor can result in optic chiasm compression, with specific neurological manifestations dependent on the invasion site. Nonspecific symptoms such as fatigue and headache are frequently observed. Pituitary MRI serves as a critical diagnostic tool for distinguishing sellar pathologies. As a distant metastatic event, PM portends a poor overall prognosis. This study presents two cases of lung adenocarcinoma with PM, supplemented by a comprehensive literature review, to summarize clinical characteristics and diagnostic/therapeutic strategies.

Objective To investigate the clinical diagnostic value of plasma RAS association domain family 1A(RASSF1A)gene methylation combined with tumor marker detection in non-small cell lung cancer(NSCLC).Methods A total of 98 NSCLC patients admitted to Qinhuangdao First Hospital from June 2023 to March 2024 were selected as the NSCLC group,and 95 patients who under-went pulmonary examinations during the same period but were not diagnosed with NSCLC were selected as the disease control group.Their general clinical data were collected.The correlations among plasma RASSF1A gene methylation,tumor markers,and clinicopatho-logical features were analyzed.The effects of RASSF1A gene methylation and tumor markers on the diagnosis of NSCLC were analyzed by the multivariate Logistic regression.A predictive model was constructed,and its effectiveness was evaluated by the receiver operating characteristics(ROC)curve and goodness of fit test.Results There were significant differences(P＜0.05)in smoking history,neu-ron specific enolase(NSE),carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),and RASSF1A methylation levels between the NSCLC group and non-NSCLC group.There were also significant differences(P＜0.05)in RASSF1A methylation levels,NSE,CEA,and CYFR21-1 levels among NSCLC patients with different clinical characteristics such as tumor diam-eter,differentiation degree,and growth type.The results of multivariate Logistic analysis showed that RASSF1A methylation levels(OR=1.071,95％CI:1.042-1.100),NSE(OR=1.168,95％CI:1.132-1.204),CEA(OR=1.154,95％CI:1.121-1.187),and CYFR21-1(OR=1.089,95％CI:1.023-1.195)were all independent risk factors for the diagnosis of NSCLC.A model predicting the occurrence of NSCLC was constructed using the principal component analysis(PCA)and partial least squares discriminant analysis(PLS-DA),and the ROC curve analysis results showed that the area under the ROC curve(AUCROC),sensitivity,and specificity of the prediction model for the RASSF1A methylation level combined with NSE,CEA,and CYFR21-1 were 0.922(95％CI:0.896-0.948),0.897,and 0.851,respectively,which were higher than those of the RASSF1A methylation level,NSE,CEA,and CYFR21-1 alone.Conclusion The prediction model of plasma RASSF1A gene methylation level combined with tumor markers has high diagnostic value for NSCLC and can be used for the clinical diagnosis of NSCLC.

Objective To investigate the clinical diagnostic value of plasma RAS association domain family 1A(RASSF1A)gene methylation combined with tumor marker detection in non-small cell lung cancer(NSCLC).Methods A total of 98 NSCLC patients admitted to Qinhuangdao First Hospital from June 2023 to March 2024 were selected as the NSCLC group,and 95 patients who under-went pulmonary examinations during the same period but were not diagnosed with NSCLC were selected as the disease control group.Their general clinical data were collected.The correlations among plasma RASSF1A gene methylation,tumor markers,and clinicopatho-logical features were analyzed.The effects of RASSF1A gene methylation and tumor markers on the diagnosis of NSCLC were analyzed by the multivariate Logistic regression.A predictive model was constructed,and its effectiveness was evaluated by the receiver operating characteristics(ROC)curve and goodness of fit test.Results There were significant differences(P＜0.05)in smoking history,neu-ron specific enolase(NSE),carcinoembryonic antigen(CEA),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),and RASSF1A methylation levels between the NSCLC group and non-NSCLC group.There were also significant differences(P＜0.05)in RASSF1A methylation levels,NSE,CEA,and CYFR21-1 levels among NSCLC patients with different clinical characteristics such as tumor diam-eter,differentiation degree,and growth type.The results of multivariate Logistic analysis showed that RASSF1A methylation levels(OR=1.071,95％CI:1.042-1.100),NSE(OR=1.168,95％CI:1.132-1.204),CEA(OR=1.154,95％CI:1.121-1.187),and CYFR21-1(OR=1.089,95％CI:1.023-1.195)were all independent risk factors for the diagnosis of NSCLC.A model predicting the occurrence of NSCLC was constructed using the principal component analysis(PCA)and partial least squares discriminant analysis(PLS-DA),and the ROC curve analysis results showed that the area under the ROC curve(AUCROC),sensitivity,and specificity of the prediction model for the RASSF1A methylation level combined with NSE,CEA,and CYFR21-1 were 0.922(95％CI:0.896-0.948),0.897,and 0.851,respectively,which were higher than those of the RASSF1A methylation level,NSE,CEA,and CYFR21-1 alone.Conclusion The prediction model of plasma RASSF1A gene methylation level combined with tumor markers has high diagnostic value for NSCLC and can be used for the clinical diagnosis of NSCLC.

Pituitary metastasis(PM), a rare metastatic complication of malignant tumors most commonly seen in lung and breast cancers, exhibits subtle and nonspecific clinical manifestations that complicate its differentiation from other sellar lesions. Symptom development correlates with anatomical involvement: tumors often initially destroy the posterior pituitary, causing diabetes insipidus; subsequently, pituitary stalk compression may trigger hyperprolactinemia, while progressive anterior pituitary destruction ultimately leads to hormonal deficiencies. Additionally, mass effects from the tumor can result in optic chiasm compression, with specific neurological manifestations dependent on the invasion site. Nonspecific symptoms such as fatigue and headache are frequently observed. Pituitary MRI serves as a critical diagnostic tool for distinguishing sellar pathologies. As a distant metastatic event, PM portends a poor overall prognosis. This study presents two cases of lung adenocarcinoma with PM, supplemented by a comprehensive literature review, to summarize clinical characteristics and diagnostic/therapeutic strategies.

Objective:To discuss the effect of asiatic acid(AA)on the inflammation and oxidative stress damage induced by lipopolysaccharide(LPS)in the primary cultured hippocampus neurons,and to clarify its mechanism.Methods:The primary cultured rat hippocampus neurons(cell purity identified by immunofluorescence staining)were divided into control group,LPS(10 mg·L-1)group,and LPS+AA group(10 mg·L-1 LPS+10,20,and 40 μmol·L-1 AA),AA group(20 μmol·L-1 AA),ML385 group[10 μmol·L-1 nuclear factor erythroid 2-related factor(Nrf2)inhibitor],and LPS+ML385+AA group(10mg·L-1 LPS+10 μmol·L-1 ML385+20 μmol·L-1 AA).After drug treatment,methylthiazolyldiphenyl-tetrazolium bromide(MTT)method was used to detect the survival rates of the hippocampus neurons in various groups;lactate dehydrogenase(LDH)kit was used to detect the LDH leakage rates of the hippocampus neurons in various groups;enzyme linked immunosorbent assay(ELISA)kit was used to detect the expression levels of inflammatory factors[interleukin(IL)-1β and tumor necrosis factor(TNF)-α]and the activities of superoxide dismutase(SOD)and malondialdehyde(MDA)levels in the hippocampus neurons in various groups;Griess method was used to detect the nitric oxide(NO)levels in supernatant of the hippocampus neurons in various groups;immunofluorescence staining was used to detect the expressions of Nrf2 and heme oxygenase-1(HO-1)proteins in the hippocampus neurons in various groups;Western blotting method was used to detect the expression levels of Nrf2,HO-1,nuclear factor-kappa B(NF-κB),and B-cell lymphoma 2(Bcl-2)proteins in the hippocampus neurons in various groups.Results:Compared with control group,the survival rate of the hippocampus neurons,SOD activity,and Bcl-2 expression level in the cells in LPS group were significantly decreased(P＜0.01),while the LDH leakage rate,expression levels of IL-1β and TNF-α,MDA level,and NO level,as well as the expression level of NF-κB protein,were significantly increased(P＜0.01);the fluorescence intensities and expression levels of Nrf2 and HO-1 proteins in hippocampus neurons were significantly decreased(P＜0.01).Compared with LPS group,the survival rates of hippocampus neurons,SOD activities,and expression levels of Bcl-2 in the cells in LPS+10 μmol·L-1 AA group and 20 μmol·L-1 AA group were significantly increased(P＜0.01),while the LDH leakage rates,expression levels of IL-1β and TNF-α,MDA levels,and NO levels,as well as expression levels of NF-κB protein,were significantly decreased(P＜0.05 or P＜0.01),and the fluorescence intensities and protein expression levels of Nrf2 and HO-1 in the cells were significantly increased(P＜0.01).Compared with LPS+20 μmol·L-1 AA group,the fluorescence intensities of Nrf2 and HO-1 in the cells in LPS+ML385+AA group were significantly decreased(P＜0.01),and the expression levels of Nrf2 protein in the nucleus and cytoplasm,the expression levels of HO-1 and Bcl-2 proteins in the cells were significantly decreased(P＜0.01),while the expression level of NF-κB protein was significantly increased(P＜0.01).Conclusion:AA can improve LPS-induced inflammation and oxidative stress damage in the primary cultured rat hippocampus neurons,and its mechanism may be related to the activation of the Nrf2/HO-1 signaling pathway.

Neuraxial labor analgesia effectively alleviates maternal pain and enhances pain control dur-ing delivery.However,breakthrough pain(BTP)following labor analgesia may occur in some parturients after neuraxial anesthesia,potentially prolonging labor progression,compromising maternal-fetal safety,and in-creasing the risk of cesarean delivery.Therefore,understanding and managing breakthrough pain are crucial in clinical practice.This review synthesizes current evidence on risk factors,neuraxial anesthesia modalities,ma-intenance techniques,and rational use of analgesic drugs to reduce BTP.

Objective To explore the application value of turbo spin echo-diffusion weighted imaging(TSE-DWI)sequences in 3.0 T rectal cancer MRI examination by comparing the image quality difference be-tween TSE-DWI and conventional echo planar imaging-diffusion weighted imaging(EPI-DWI)sequences.Methods The medical records of forty-two patients with newly diagnosed rectal cancer confirmed by colonos-copy were prospectively collected.All patients simultaneously underwent both TSE-DWI and EPI-DWI se-quence scans.The image quality of the two groups performed the subjective evaluation(lesion contrast,mag-netic susceptibility artifacts,geometric distortion)and objective evaluation[signal-to-noise ratio(SNR),con-trast-to-noise ratio(CNR),contrast,etc].Results In the subjective evaluation,compared with the conven-tional EPI-DWI sequences,the proportions of subjective score 3-5 points for the lesion contrast,magnetic susceptibility artifacts and geometric distortion in the TSE-DWI sequences lesions were over 95％,which all were higher the conventional EPI-DWI sequences;among them,the differences in the subjective scoring results of magnetic susceptibility artifacts and geometric deformation were statistically significant(x2=12.464,5.610,P＜0.05),while there was no statistical significance in lesion contrast(x2=2.363,P＞0.05).In the objective evaluation,SNR and CNR in the TSE-DWI sequences all were higher than those in the conventional EPI-DWI sequences,in which the difference in CNR was statistically significant(Z=—5.645,P＜0.05),while the difference in SNR was not statistically significant(Z=—1.057,P＞0.05).The contrast in the TSE-DWI sequences was lower than that in the conventional EPI-DWI sequences,and the difference was statistical-ly significant(t=3.012,P＜0.05).Conclusion The TSE-DWI sequence images have small geometric de-formation and few magnetic susceptibility artifacts,the image quality is superior to the EPI-DWI sequences.Especially in 3.0T rectal cancer MRI plain scan,the patients with gas accumulation in the intestinal lumen of rectal lesion could directly adopt the TSE-DWI sequences by replacing the conventional EPI-DWI sequences in order to increase the clinical application efficiency and image quality.

Objective:To improve the risk management process for clinical trial projects using healthcare failure mode and effect analysis(HFMEA), for references for enhancing the risk identification and preventing capabilities of drug clinical trial institutions.Methods:From June to December 2022, this study focused on the project management process of a clinical trial centre in a tertiary public hospital. Following HFMEA procedures, a research team was established. Core processes prone to failure modes in the drug clinical trial project management and their potential failure modes were identified through group discussions, literature analysis, the Delphi method, and decision tree analysis. High-risk failure modes were screened via risk assessment, corresponding improvement measures were formulated and performed, and their effectiveness was validated.Results:The study identified 6 main processes, 17 sub-processes, and 102 potential failure modes. Delphi analysis confirmed 88 failure modes, with 19 having a failure risk priority number(RPN)≥8.00. Decision tree analysis identified 16 high-risk failure modes, involving 5 main processes and 10 sub-processes. Targeted improvements, such as adopting standardized hospital contract templates and setting deadlines for final payment settlement, etc., were implemented. One year post-implementation(January 2024), the RPN for all 16 high-risk failure modes were<8.00.Conclusions:HFMEA could help hospital clinical trial institutions comprehensively and systematically identify high-risk failure modes in the project management process, develop targeted improvement measures, and improve the level of drug clinical trial project management.

Objective:To analyze the clinical characteristics and outcomes of Haemophilus influenzae (Hi) meningitis in children. Methods:This is a retrospective case series study. This study included 34 Hi meningitis patients who admitted to Beijing Children′s Hospital, Capital Medical University, from January 1, 2010, to December 31, 2023. Data on clinical presentations, laboratory tests, hearing assessment and outcomes at discharge were collected. Patients were divided into 2 groups according to the outcome at discharge: favorable outcome group and unfavorable outcome group. Mann-Whitney U test and Fisher exact test was used to estimate the risk factors for an unfavorable outcome at discharge. Results:Thirty-four patients were enrolled. There were 16 males and 18 females. The age at onset ranged from 3 months to 12 years. Fever (34 patients (100%)), convulsions (17 patients (50%)), and coma (21 patients (62%)) were the common clinical presentations. Twenty-four patients (71%) developed complications. There were 15 patients (44%) needed treatment in the intensive care unit, 5 patients (15%) received intubation, and 4 patients (12%) had developed shock. The favorable outcome group included 23 patients, and the unfavorable outcome group included 11 patients. Female, patients with limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L were risk factors of unfavorable outcome at discharge (all P<0.05). Among the 23 patients (68%) in favorable outcomes group, 13 patients (57%) had data available on their long-term follow-up results, including 12 patients with favorable long-term outcomes and 1 patient with unfavorable long-term outcome. Among the 11 patients (32%) in unfavorable outcomegroup, 1 patient died, the other 10 patients (91%) had data available on their long-term outcomes. Eight patients had unfavorable long-term outcomes and 2 patients with favorable long-term outcomes. Patients who had unfavorable outcomes at discharge were at a greater risk of experiencing unfavorable long-term outcomes ( P=0.001). Conclusions:It is common for patients with Hi meningitis to have intracranial complications or develop into critical conditions. Patients who have limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and who exhibit a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L tend to have unfavorable outcomes; they need to be assessed for sequelae.

Objective:To analyze the clinical characteristics and outcomes of Haemophilus influenzae (Hi) meningitis in children. Methods:This is a retrospective case series study. This study included 34 Hi meningitis patients who admitted to Beijing Children′s Hospital, Capital Medical University, from January 1, 2010, to December 31, 2023. Data on clinical presentations, laboratory tests, hearing assessment and outcomes at discharge were collected. Patients were divided into 2 groups according to the outcome at discharge: favorable outcome group and unfavorable outcome group. Mann-Whitney U test and Fisher exact test was used to estimate the risk factors for an unfavorable outcome at discharge. Results:Thirty-four patients were enrolled. There were 16 males and 18 females. The age at onset ranged from 3 months to 12 years. Fever (34 patients (100%)), convulsions (17 patients (50%)), and coma (21 patients (62%)) were the common clinical presentations. Twenty-four patients (71%) developed complications. There were 15 patients (44%) needed treatment in the intensive care unit, 5 patients (15%) received intubation, and 4 patients (12%) had developed shock. The favorable outcome group included 23 patients, and the unfavorable outcome group included 11 patients. Female, patients with limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L were risk factors of unfavorable outcome at discharge (all P<0.05). Among the 23 patients (68%) in favorable outcomes group, 13 patients (57%) had data available on their long-term follow-up results, including 12 patients with favorable long-term outcomes and 1 patient with unfavorable long-term outcome. Among the 11 patients (32%) in unfavorable outcomegroup, 1 patient died, the other 10 patients (91%) had data available on their long-term outcomes. Eight patients had unfavorable long-term outcomes and 2 patients with favorable long-term outcomes. Patients who had unfavorable outcomes at discharge were at a greater risk of experiencing unfavorable long-term outcomes ( P=0.001). Conclusions:It is common for patients with Hi meningitis to have intracranial complications or develop into critical conditions. Patients who have limb movement disability, dystonia, ventriculomegaly or hydrocephalus, and who exhibit a concentration of glucose in the initial cerebrospinal fluid lower than 1 mmol/L tend to have unfavorable outcomes; they need to be assessed for sequelae.