Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

Objective:To investigate the efficacy of radiotherapy in patients with advanced esophageal cancer receiving first-line chemoimmunotherapy.Methods:A retrospective analysis was conducted on the data of 137 patients with Stage Ⅳ esophageal squamous cell carcinoma (ESCC) treated at our hospital from January 2018 to May 2023. These patients were divided into two groups: a group treated with first-line chemoimmunotherapy combined with radiotherapy (chemoimmunotherapy + radiotherapy group, n = 43) and a group treated with only chemoimmunotherapy ( n = 94). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the groups. With overall survival (OS) and progression-free survival (PFS) as study endpoints, the survival data were analyzed using the Kaplan-Meier method, the log-rank test, and the Cox regression method. Results:Before calibration, the chemoimmunotherapy + radiotherapy group significantly outperformed the sole chemoimmunotherapy group in median PFS (13.6 months vs. 7.0 months; HR: 0.501, 95% CI: 0.309-0.811, P = 0.005). After calibration using the COX proportional-hazards model for age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, smoking history, T/N/M stage, and tumor location, the chemoimmunotherapy + radiotherapy group still had significant advantages in PFS (14.7 months vs. 7.0 months; HR: 0.441, 95% CI: 0.261-0.745, P = 0.002). IPTW analysis further confirmed this trend (13.9 months vs. 7.0 months; HR: 0.492, 95% CI: 0.304-0.795, P < 0.001). Specifically, the median OS of the chemoimmunotherapy + radiotherapy group demonstrated significant improvement in all analyses: pre-calibration (29.5 months vs. 18.0 months; HR: 0.507, 95% CI: 0.297-0.867, P = 0.013), after calibration using the Cox model (27.5 months vs. 16.7 months; HR: 0.470, 95% CI: 0.266-0.830, P = 0.009), and after calibration using IPTW (29.5 months vs. 16.9 months; HR: 0.448, 95% CI: 0.262-0.764, P < 0.001). Conclusions:The combination of radiotherapy and first-line chemoimmunotherapy can significantly improve survival outcomes of patients with advanced ESCC, suggesting its potential as a standard treatment strategy.

Objective:To compare the preliminary efficacy and adverse events of chemoradiotherapy (CRT) with or without immunotherapy in bladder preservation therapy for localized muscle-invasive bladder cancer (MIBC) confined to the pelvis.Methods:Clinical data of 60 patients with MIBC who received CRT with or without immunotherapy for bladder preservation at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to June 2024 were retrospectively analyzed. Patients were divided into CRT plus immunotherapy group and CRT-alone group. Survival outcomes, bladder function preservation, recurrence and metastasis, as well as early and late radiation toxicities were evaluated. The Mann-Whitney U test was used for between-group comparisons. Overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method, and survival rates were compared by the log-rank test. Results:In the CRT plus immunotherapy group ( n=23), the median follow-up was 20 months. The median OS and median PFS were not reached. The 2-year OS, PFS, LRFS, and DMFS rates were 95.7%, 70.7%, 70.7%, and 92.9%, respectively, and 22 patients (96%) preserved normal bladder function. Patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥1 had significantly higher 1-year PFS rate than those with CPS <1 (100% vs. 66.7%, P=0.004). In the CRT-alone group ( n=37), the median follow-up was 37 months, with median OS and PFS of 68 and 19 months, respectively. The 2-year OS, PFS, LRFS, and DMFS rates were 92.0%, 41.1%, 60.9% and 81.5%, respectively, and 33 patients (89%) preserved normal bladder function. Compared with the CRT-alone group, the CRT plus immunotherapy group showed a significant improvement in PFS ( χ2=4.38, P=0.036), while no significant differences were observed in OS, LRFS, or DMFS (all P>0.05). The incidence of acute hematologic toxicity in the CRT plus immunotherapy group and CRT-alone group were 52% (12/23), 27% (10/37) respectively, and late genitourinary toxicity was 22% (5/23), 8% (3/37), respectively, with no significant differences in overall acute or late toxicities (all P>0.05). Conclusions:For localized MIBC, bladder preservation with CRT combined with immunotherapy significantly improves PFS compared with CRT alone, while maintaining comparable safety. The PD-L1 status may serve as a favorable predictor for immunotherapy efficacy.

OBJECTIVE To further standardize the dispensing management standard of intravenous infusion drugs for clinical trials in pharmacy intravenous admixture services (PIVAS),and provide reference for medical institutions to provide high-quality pharmaceutical services.METHODS Initiated by PIVAS Group,Hospital Pharmacy Professional Committee,Shanghai Pharmaceutical Association,jointly led by Longhua Hospital,Shanghai University of Traditional Chinese Medicine and Shanghai Geriatric Medical Center,a writing group was established by PIVAS experts from multiple medical institutions to discuss the basic requirements and dispensing process of intravenous infusion drugs for clinical trials in PIVAS.The experts from the leading unit sorted out,summarized,analyzed,fed back and revised the opinions,and finally reached Expert Consensus on Dispensing Management of Intravenous Infusion Drugs for Clinical Trials in PIVAS.RESULTS & CONCLUSIONS The main contents of this consensus include information management,operation process,fund management and document management of intravenous infusion drugs for clinical trials in PIVAS.This consensus establishes a more standardized model for dispensing management of intravenous infusion drugs for clinical trials in PIVAS,by standardizing clinical trail drug management operational procedures,accurately recording and preserving drug-related information,with the aim of achieving standardized and meticulous management of PIVAS's receipt of clinical trial drugs.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To develop and validate a Self-care Ability Scale for Arteriovenous Fistula (AVF) in Maintenance Hemodialysis (MHD) patients.Methods:Guided by Orem's self-care theory, the initial item pool of the scale was developed through a literature review, semi-structured interviews, and group discussions. The initial scale was finalized after two rounds of expert consultation using the Delphi method. A convenience sampling method was used to recruit 418 MHD patients using AVF in January 2024 for item analysis, exploratory factor analysis and reliability testing. Another 293 MHD patients using AVF were recruited in March 2024 for confirmatory factor analysis.Results:The self-care ability scale for AVF in MHD patients included four dimensions: knowledge and skills of AVF self-care, willingness and attitude toward AVF self-care, recognition and prevention of AVF complications, and patient self-adjustment and adaptation, comprising 38 items. The content validity index at the scale level was 0.98. Exploratory factor analysis extracted four common factors with a cumulative variance contribution rate of 84.706%. Confirmatory factor analysis indicated good model fit, strong convergent validity, and ideal discriminant validity. The total Cronbach's α coefficient of the scale was 0.987; the split-half reliability coefficient was 0.902, and the test-retest reliability coefficient was 0.979.Conclusions:The Self-care Ability Scale for AVF in MHD patients demonstrates excellent reliability and validity, making it a suitable tool for assessing patients' ability to self-care for their AVF.

Objective To examine the expression levels of inflammatory factors,including IL-6,IL-10,MMP-9,IL-17A,and LDH,in the cerebrospinal fluid(CSF)of patients with spontaneous intracerebral hemor-rhage(sICH),and to investigate their associations with disease severity and clinical outcomes.Methods A total of 168 patients with sICH admitted to Tangshan GongRen Hospital between January 2023 and January 2025 were prospectively enrolled as the study group,while 30 non-sICH patients who underwent lumbar puncture during the same period served as the control group.Levels of inflammatory factors in CSF were compared between the two groups.Spearman's rank correlation analysis was performed to assess the association between inflammatory factor levels and clinical severity in sICH patients.Binary logistic regression analysis was conducted to identify independent predictors of sICH prognosis.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the prognostic value of these inflammatory factors in sICH.Results The levels of IL-6,IL-10,MMP-9,IL-17A,and LDH in the CSF of patients with sICH were significantly higher than those in non-sICH patients(all P<0.05).Furthermore,among sICH patients,these biomarker levels exhibited a graded increase according to disease severity:severe>moderate>mild(all P<0.05).Spearman correlation analysis revealed significant positive correlations between CSF levels of IL-6,IL-10,MMP-9,IL-17A,and LDH and the NIHSS scores,with correlation coefficients(r)of 0.686,0.553,0.685,0.593,and 0.695,respectively(all P<0.05).When comparing the prognoses of sICH patients,hematoma size,NIHSS score,and CSF levels of IL-6,IL-10,MMP-9,IL-17A,and LDH were significantly higher in the deceased group than in the survival group(P<0.05),whereas ApoA1 levels were lower in the deceased group(P<0.05).Logistic regression analysis revealed that hematoma size,NIHSS score,and elevated CSF levels of IL-6,IL-10,MMP-9,IL-17A,and LDH were independent risk factors for mortality in sICH patients(P<0.05).ROC curve analysis showed that the AUC values for CSF IL-6,IL-10,MMP-9,IL-17A,and LDH in predicting sICH prognosis were 0.794,0.754,0.670,0.717,and 0.683,respectively.Notably,the combination of CSF inflammatory markers with hematoma size and NIHSS score yielded an AUC of 0.993,demonstrating significantly greater predictive accuracy than CSF inflammatory markers alone(P<0.05).Conclusions The levels of inflammatory factors in the CSF,including IL-6,IL-10,MMP-9,IL-17A,and LDH,were elevated in patients with sICH and positively correlated with disease severity.Combining CSF inflammatory markers with the NIHSS score and hematoma size improved the predictive accuracy for sICH prognosis.

OBJECTIVE To explore the value of bronchoalveolar lavage fluid(BALF)metagenomic next generation sequencing(mNGS)technique in diagnosis of the pulmonary cryptococcosis patients with different clinical features so as to raise the clinicians' awareness of the diagnosis of pulmonary cryptococcosis with BALF-mNGS.METHODS Totally 73 patients with pulmonary cryptococcosis and 73 non-pulmonary cryptococcosis patients who were treated in Wenzhou People's Hospital from Jan.2021 to May 2024 were recruited as the research subjects.The clinical data including baseline data,complications,clinical manifestations,clinical laboratory test data,ima-ging findings and serological test data were collected from the patients.The sensitivity and specificity of BALF-mNGS in diagnosis of the pulmonary cryptococcosis were observed,and the difference in the sensitivity in diagno-sis of the patients with various clinical features was analyzed.RESULTS A total of 73 patients with pulmonary cryp-tococcosis were enrolled in the study,44 of whom were male,and 29 were female;62 were positive for BALF-mNGS,11 were negative;all of the 73 non-pulmonary cryptococcosis patients were tested negative for BALF-mNGS,the sensi-tivity of the BALF-mNGS test was 84.93％,with the specificity 100.00％,the positive predictive value 100.00％,the negative predictive value 86.95％.Totally 45 patients had the symptoms of cough and expectoration,42 of whom were positive for BALF-mNGS,the test sensitivity of the patients with the symptoms of cough and expectoration was 93.33％,higher than that of the patients without the symptoms of cough and expectoration(P＜0.05).Totally 31 pa-tients had the lesion site of right lung,30 of whom were positive for BALF-mNGS,and the test sensitivity of the patients with lesion site of right lung was 96.77％,higher than that of the patients with the lesion site of left lung or both lungs(P＜0.05).Totally 44 patients had multiple lesions,41 of whom were positive for BALF-mNGS,the test sensitivity of the patients with multiple lesions was 93.18％,higher than that of the patients with single lesion(P＜0.05).CONCLUSIONS The sensitivity of the BALF-mNGS is high in diagnosis of the patients with pulmonary cryptococ-cosis,especially for the patients with symptoms of cough and expectoration,lesion site of right lung and multiple lesions.It can be used for the early diagnosis of pulmonary cryptococcosis.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.