This review summarizes recent advances in neoadjuvant immunotherapy for advanced gastric cancer.Through literature search in PubMed,Web of Science,and CNKI databases from 2020 to 2023,we systematically analyzed the mechanisms,clinical applications,and bio-marker research.Programmed death-1(PD-1)inhibitors combined with chemotherapy significantly improve patient outcomes,while mi-crosatellite instability(MSI),programmed death-ligand 1(PD-L1)expression,and tumor mutational burden(TMB)have been identified as important predictive biomarkers.Multi-omics analysis shows great potential in identifying optimal responders,with pyroptosis-related gene scoring system(PRS)positively correlating with anti-tumor immune infiltration.Metabolic reprogramming and epigenetic regulation in the tumor microenvironment play key roles in immune evasion,while emerging targets such as Claudin 18.2 and combination targeting strategies further enhance therapeutic efficacy.Despite significant progress,precise patient selection and overcoming resistance mechan-isms remain major challenges.Future research should focus on biomarker validation,personalized treatment strategy development,tumor microenvironment dynamic analysis,and novel combination therapy exploration to improve clinical outcomes.

Objective:To explore the distribution and clearance of 99mTc labeled diethylenetriamine pentaacetic acid(99mTc-DTPA)in different brain regions of adult rats after administration through brain extracellular space(ECS)pathway.Methods:After the injection of a volume of 2 μL and radioactive activity of about 3.7 MBq(100 μCi)of 99mTc-DTPA into the caudate nucleus and thalamus of SD rats through stereotactic positioning of rat brain,the single photon emission computed tomography/computed tomography(SPECT/CT)for small animals was used for imaging at different time points,and the dyna-mic distribution and clearance of the tracer in the whole body were observed continuously.The SD rats were injected with 99mTc-DTPA into thalamus and caudate nucleus respectively for biological distribution in vivo.They were put to death 4 h later.Their blood and urine were collected.The brain,cerebellum,heart,liver,spleen,lung,and kidney were taken and weighed by γ counter to measure its radioactivity.Results:SPECT/CT imaging results showed that after 99mTc-DTPA was administered through brain ECS,the radioactivity was concentrated in the brain,kidney and bladder.The tracer administered to the left caudate nucleus was preferentially drained to the right cerebellum,while the tracer administered to the right caudate nucleus was preferentially drained to the left cerebellum.There was a phenomenon of"con-tralateral cerebellar dominant drainage"in the caudate nucleus.The thalamic area preferentially drained to the ipsilateral cerebellum after administration.Four hours after administration via ECS,high radioac-tive uptake appeared in urine,cerebellum and brain,followed by blood and kidney.The radioactive up-take values of heart,liver,spleen and lung were low,which were mainly excreted through urinary sys-tem.Conclusion:Intracerebral ECS administration is a promising method of administration,but there are significant differences in distribution and clearance in different brain regions.This study further ex-pands the content and significance of"ECS regions",and also provides an important theoretical founda-tion for the treatment of encephalopathy and the research of new drugs through brain ECS in the future.

Objective To analyze clinical characteristics affecting survival outcomes in gastric adenocarcinoma(GAC)patients with second primary malignancies(SPM)and construct a predictive model with a web-based calculator.Methods Patients diagnosed with GAC between January 2010 and December 2017 in the SEER database(n=24 085)were analyzed,comparing non-SPM(n=22 963)and SPM cohorts(n=1 122).SPM patients were randomized(3:1)into training(n=842)and internal validation cohorts(n=280).Univariate/multivariate Cox regression identified prognostic factors for model construction.Model performance was evaluated via ROC curves,calibration plots,and decision curve analysis(DCA).A web-based calculator was deployed using DynNom(https://kunma697.shinyapps.io/dynnomapp-1/).External validation used 192 SPM patients diagnosed at Yantai Yuhuangding Hospital(2010-2017).Results χ2 tests revealed SPM patients had higher age(56.3%),earlier T-stage(T1:29.2%;T2:10.5%),predominant gastric cardia involvement(43.7%),fewer distant metastases(12.3%),and higher rates of radiotherapy(32.5%)and surgery(77.2%)vs.non-SPM(P<0.05).Cox analyses identified GAC primary site,T-stage,SEER stage,radiotherapy/surgery history,plus SPM grade/stage/treatment history as significant predictors(P<0.05).AUCs in the training cohort were 0.771(95%CI:0.722～0.820),0.839(95%CI:0.796～0.882),and 0.836(95%CI:0.792～0.879)for 1-/3-/5-year survival;internal validation showed 0.751(95%CI:0.700～0.801),0.746(95%CI:0.695～0.797),and 0.772(95%CI:0.723～0.821);external validation yielded 0.713(95%CI:0.648～0.778),0.805(95%CI:0.749～0.861),and 0.851(95%CI:0.801～0.901).Calibration indicated high prediction-actuality concordance;DCA confirmed clinical utility.Conclusion The model and web calculator incorporating GAC/SPM characteristics effectively predict SPM patient prognosis.

OBJECTIVE To summarize the clinical features and treatment methods of subglottic cysts in infants.METHODS A single-center retrospective study was conducted,enrolling twelve pediatric patients with subglottic cysts who were treated at Beijing Children's Hospital,Affiliated to Capital Medical University,between December 2016 and October 2024.Clinical data were collected and analyzed,including patient age,body weight,perinatal history,presenting symptoms,findings from flexible laryngoscopy and imaging studies,as well as surgical treatment modalities.RESULTS Among the 12 patients,8 were male and 4 were female,with a median age of 7 months.Preterm infants accounted for 83.3%(10/12),low birth weight was observed in 58.3%(7/12),and 75%(9/12)had a history of tracheal intubation.The primary clinical manifestations included stridor,respiratory distress,and feeding difficulties.All patients were diagnosed by laryngoscopy and imaging studies,which confirmed the presence of subglottic cysts.Among these,9 were located on the right side and 3 on the left.All patients underwent subglottic cyst excision under general anesthesia using suspension laryngoscopy combined with endoscopy.Among them,two cases experienced recurrence and required a second surgical procedure three months postoperatively.Histopathological examination revealed a cyst wall lined by stratified squamous epithelium and pseudostratified ciliated columnar epithelium.All patients were followed up for a period ranging from 6 months to 6 years,with no recurrence observed during this time.CONCLUSION Infants presenting with stridor and dyspnea should undergo prompt laryngoscopy for definitive diagnosis.Subglottic cysts should be highly suspected in preterm,low-birth-weight infants with a history of intubation who develop stridor or respiratory distress during development.Once diagnosed,surgical intervention should be performed promptly to avoid the need for a tracheostomy.Surgical excision under general anesthesia using suspension laryngoscopy combined with endoscopy is an effective treatment for subglottic cysts.

Objective:To characterize the epidemiological features of hemorrhagic fever with renal syndrome (HFRS) in Jixi region, Heilongjiang Province, and to develop an autoregressive integrated moving average (ARIMA) model to predict the incidence trend of HFRS, thus to provide a scientific basis for targeted prevention and control.Methods:HFRS case data and host animals surveillance data from January 2013 to December 2024 in Jixi City were collected. Descriptive epidemiological methods were used to analyze the temporal, spatial, and population distribution characteristics of HFRS, with comparisons made using the chi-square test. ArcGIS10.8.2 software was employed for spatial clustering analysis. Moran I was used to assess the overall spatial trend of HFRS incidence. Getis-Ord Gi * analyses was used to identify the hotspots and coldspots. SaTScan v10.2 software was applied to detect spatiotemporal clusters. The Spearman correlation analysis was used to examine the relationship between rodent viral load index and HFRS incidence. ARIMA model was constructed and optimized using Bayesian information criterion (BIC) for short-term prediction of HFRS. Results:From January 2013 to December 2024, a total of 1 045 HFRS cases were reported in Jixi City, with an average annual incidence rate of 5.09/100 000. Three epidemic peaks were observed: 2014 (8.12/100 000), 2019 (7.22/100 000), and 2023 (3.86/100 000). The temporal distribution showed a bimodal pattern, with the autumn-winter peak (October to December) having more cases than the spring-summer peak (May to June). Geographically, cases were mainly concentrated in the central-eastern urban areas of Jixi City. The average annual incidence rate in males (7.89/100 000) was significantly higher than that in females (2.24/100 000), the difference was statistically significant ( χ2=322.15, P<0.001). The highest incidence rate was observed in the 50 to 59 age group (6.79/100 000), and farmers accounted for the largest proportion of cases (59.04% (617/1 045)). Spatial analysis revealed clustered distribution (Moran I=0.50, P<0.05), with hotspots in Hulin City and Mishan City. Spatiotemporal analysis identified one significant cluster (radius=89.2 km). No correlation was found between the rodent viral load index and HFRS incidence ( r=0.455, P=0.138). The optimal short-term prediction model was ARIMA (1, 0, 0) (0, 1, 1) (BIC=-3.24), which forecasted 38 HFRS cases in Jixi City in 2025. Conclusions:HFRS incidence in Jixi City exhibits periodicity, seasonality, and spatial clustering. The developed ARIMA model provides a valuable tool for predicting incidence trends, thus to optimize vaccination, rodent control, and surveillance measures in high-risk areas and populations.

MicroRNA(miRNA)serves as a novel regulatory factor in viral and bacterial co-infections,exhibiting dual regulatory roles during pathogen infections.On the one hand,it exerts protective effects by modulating viral replication cycles and host anti-infection immune responses.On the other hand,it can be exploited by pathogens to promote infection progression,including influencing viral replication,antiviral immune responses,and regulating bacterial adhesion and proliferation.Mixed viral and bacterial infections lead to high mortality rates.By binding to specific target gene mRNA,miRNA degrades or inhibits its translation,thereby regulating target gene expres-sion,which may ultimately serve as potential diagnostic and therapeutic targets.This paper reviews recent ad-vances in research on the role of miRNA in viral and bacterial infections,particularly its mechanisms in co-infec-tions,aiming to provide theoretical reference for further research on the infection mechanisms.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Men who have sex with men (MSM) represent a high-risk group for human papillomavirus (HPV) infection and transmission. HPV vaccination for MSM has been extensively explored in clinical trials and real-world settings in foreign countries, but it has not been widely promoted for MSM in the Chinese mainland. This article provides a comprehensive review of the HPV vaccination status among MSM, as well as the effectiveness, immunogenicity, safety, and cost-effectiveness of HPV vaccines, aiming to provide reference for the implementation and promotion of HPV vaccination among MSM in the Chinese mainland.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.