Objective:To establish and evaluate a confirmation method for hepatitis B surface antigen(HBsAg)based on chemiluminescent immunoassay and neutralization test.Methods:①Detection procedure of the confirmation method:Initially,optimal concentration of neutralizing antibody was determined through a preliminary trial.During the confirmation of HBsAg,in the detection cups and control cups already containing test serum,neutralizing antibody and pre-test four items(hepatitis B serological markers,HCV antibody,syphilis spiral body antibody,HIV antibody)negative serum were added in a 1∶1 ratio(100 μl∶100 μl),respectively.After thorough mixing,the mixture was incubated at 37℃for 30 min,and the pre-treated serum was tested using the Siemens Atellica IM HBsAg detection program.②Reliability evaluation of the confirmation method:Coincidence rate of the confirmation method results and the Siemens confirmation reagent test results for 64 serum samples with different concentrations of HBsAg reactivity was compared and analyzed.③Determination of the diagnostic value and positive judgment value of the confirmation method:Taking the Siemens confirmation reagent test results for 64 HBsAg reactive serum samples as"the gold standard",neutralization rate of the confirmation method test results was statistically analyzed using ROC curve.Results:①In the preliminary trial,when the concentration of HBsAb was≥1 285.12 mU/ml,neutralization rate of the test results was>50%,and the neutralization rate was increased with the concentra-tion of HBsAb.After the same concentration of HBsAb neutralized different concentrations of HBsAg,trend of the neutralization rate change was not significant.②Coincidence rate of the two methods was 100.00%.③Area under the curve(AUC)was 0.993 4,the pos-itive judgment value was neutralization rate≥47.93%,with a sensitivity of 98.15%and specificity of 100.00%.Conclusion:This de-tection method is simple,easy-to-use,cost-effective,and has high diagnostic value,suitable for confirming HBsAg at different con-centrations.

Objective:To explore the clinical characteristics, diagnostic difficulties and optimization direction of treatment strategies of ectopic varicose veins rupture and bleeding in the colon of cirrhotic portal hypertension.Methods:A retrospective analysis was conducted on the clinical data of a patient with cirrhotic portal hypertension and ectopic varicose rupture and bleeding of the colon diagnosed clinically in the Department of Gastroenterology of the Xin′an International Hospital Affiliated to Jiaxing University in February 2025. Combined with the review of relevant literature, the diagnosis and treatment experience was summarized.Results:The patient was diagnosed by colonoscopy with rupture and bleeding of varicose veins in the descending colon, and the blood vessels were exposed.After hemostasis with tissue clips under emergency colonoscopy and the bleeding stopped, drug treatment for bleeding prevention was continued. Sequential endoscopic EcV treatment was planned to be scheduled at an alternative time.Conclusions:The incidence of rupture and bleeding of ectopic varicose veins in the colon due to cirrhotic portal hypertension is relatively low. The diagnosis is difficult, the risk of bleeding is high, and the treatment strategies are controversial. It is necessary to further optimize the diagnosis and treatment strategies in order to improve the therapeutic effect of patients.

Objective:To establish and evaluate a confirmation method for hepatitis B surface antigen(HBsAg)based on chemiluminescent immunoassay and neutralization test.Methods:①Detection procedure of the confirmation method:Initially,optimal concentration of neutralizing antibody was determined through a preliminary trial.During the confirmation of HBsAg,in the detection cups and control cups already containing test serum,neutralizing antibody and pre-test four items(hepatitis B serological markers,HCV antibody,syphilis spiral body antibody,HIV antibody)negative serum were added in a 1∶1 ratio(100 μl∶100 μl),respectively.After thorough mixing,the mixture was incubated at 37℃for 30 min,and the pre-treated serum was tested using the Siemens Atellica IM HBsAg detection program.②Reliability evaluation of the confirmation method:Coincidence rate of the confirmation method results and the Siemens confirmation reagent test results for 64 serum samples with different concentrations of HBsAg reactivity was compared and analyzed.③Determination of the diagnostic value and positive judgment value of the confirmation method:Taking the Siemens confirmation reagent test results for 64 HBsAg reactive serum samples as"the gold standard",neutralization rate of the confirmation method test results was statistically analyzed using ROC curve.Results:①In the preliminary trial,when the concentration of HBsAb was≥1 285.12 mU/ml,neutralization rate of the test results was>50%,and the neutralization rate was increased with the concentra-tion of HBsAb.After the same concentration of HBsAb neutralized different concentrations of HBsAg,trend of the neutralization rate change was not significant.②Coincidence rate of the two methods was 100.00%.③Area under the curve(AUC)was 0.993 4,the pos-itive judgment value was neutralization rate≥47.93%,with a sensitivity of 98.15%and specificity of 100.00%.Conclusion:This de-tection method is simple,easy-to-use,cost-effective,and has high diagnostic value,suitable for confirming HBsAg at different con-centrations.

Objective:To explore the clinical characteristics, diagnostic difficulties and optimization direction of treatment strategies of ectopic varicose veins rupture and bleeding in the colon of cirrhotic portal hypertension.Methods:A retrospective analysis was conducted on the clinical data of a patient with cirrhotic portal hypertension and ectopic varicose rupture and bleeding of the colon diagnosed clinically in the Department of Gastroenterology of the Xin′an International Hospital Affiliated to Jiaxing University in February 2025. Combined with the review of relevant literature, the diagnosis and treatment experience was summarized.Results:The patient was diagnosed by colonoscopy with rupture and bleeding of varicose veins in the descending colon, and the blood vessels were exposed.After hemostasis with tissue clips under emergency colonoscopy and the bleeding stopped, drug treatment for bleeding prevention was continued. Sequential endoscopic EcV treatment was planned to be scheduled at an alternative time.Conclusions:The incidence of rupture and bleeding of ectopic varicose veins in the colon due to cirrhotic portal hypertension is relatively low. The diagnosis is difficult, the risk of bleeding is high, and the treatment strategies are controversial. It is necessary to further optimize the diagnosis and treatment strategies in order to improve the therapeutic effect of patients.

A 3-week practice-oriented training course on chronic obstructive pulmonary disease (COPD) management was conducted in December 2020, 34 primary care physicians from township or community health service centers attended the course. The impact of the training course on the knowledge levels of COPD management was evaluated with a questionnaire survey, the questionnaire contained the knowledge of COPD and its management. The survey showed that before the training, the participants had low knowledge levels on the definition of COPD and its risk factors; 67.6% (23/34) were not aware of COPD-related guidelines and new developments, and 17.6%(6/34) had conducted COPD follow-up assessments, pulmonary rehabilitation, and health education; only 8.8% (3/34) had used the improved British Medical Research Council Dyspnea Index (mMRC) and the chronic obstructive pulmonary disease assessment test (CAT) for patient self-assessment; there was no pulmonary function instrument in their units, and only 3 doctors (8.8%) had previously participated in pulmonary function training and knew indications and contraindications of the pulmonary function test, and complete report interpretation; all participants were unable to use common inhalation devices and master inhalation techniques completely and correctly; 11.8% (4/34) had assessed patients′ handling inhalation devices and performing inhalation. After the training, the knowledge levels of COPD clinical features, lung function and inhalation technique were significantly improved, and the scores were significantly increased compared with those before the training ( P<0.001). The study shows that primary care physicians have insufficient knowledge and management skill of COPD. The practice-oriented training can significantly improve the knowledge and skills of primary care physician for COPD management in the community.

Objective:To explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC).Methods:From December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People′s Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis.Results:The 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference ( χ2=31.27, P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference ( χ2=29.70, P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (all P<0.05). Furthermore, multivariate Cox regression analysis showed that T stage ( HR=1.46, 95% CI: 1.07-2.00, P=0.019), N stage ( HR=1.34, 95% CI: 1.02-1.76, P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.35, 95% CI: 1.58-7.11, P=0.002; NPS 3 or 4 group: HR=6.15, 95% CI: 2.89-13.11, P=0.001) were independent prognostic factors for PFS. Additionally, T stage ( HR=1.67, 95% CI: 1.01-2.77, P=0.046), N stage ( HR=1.44, 95% CI: 1.00-2.20, P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group: HR=3.10, 95% CI: 1.31-7.32, P=0.010; NPS 3 or 4 group: HR=5.09, 95% CI: 2.14-12.11, P=0.001) were independent prognostic factors for OS. Conclusion:Preoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Objective:To compare the differences in distribution and prognosis of cervical cancer patients in the 2009 and 2018 editions of International Federation of Gynecology and Obstetrics (FIGO) staging, and to analyze the prognostic factors of cervical cancer patients.Methods:The clinical data of 524 cervical cancer patients admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2018 were retrospectively analyzed. The cases were staged according to the 2009 and 2018 FIGO staging, and the Kendall τb coefficient was calculated to compare the consistency of the distribution of the two stages. Kaplan-Meier was used for survival analysis, and log-rank test was used to test the difference of prognosis in each stage. Cox-regression was used to analyze the prognostic factors of cervical cancer patients.Results:In the 2009 FIGO edition of staging, 1 case of stage ⅠB1 was reduced to stage ⅠA1 due to the microscopic infiltration depth <5 mm, 51 cases of stage ⅠB1 were raised to stage ⅠB2 due to 2 cm4 cm. A total of 119 cases raised to stage ⅢC1 due to pelvic lymph node metastasis, and 11 cases raised to stage ⅢC2 due to para-aortic lymph node metastasis. The distribution of cases in the two stages was consistent (τb=0.61, P<0.001). There were statistically significant differences in overall survival (OS) ( χ2=107.13, P<0.001; χ2=93.02, P<0.001; χ2=92.74, P<0.001) and progression-free survival (PFS) ( χ2=91.95, P<0.001; χ2=77.69, P<0.001; χ2=73.27, P<0.001) among patients with different stages of FIGO in 2018 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, ⅢC1, ⅢC2, Ⅳ) and 2009 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, Ⅳ) and patients with different T stages (T 1, T 2, T 3, T 4). There were statistically significant differences in OS ( χ2=20.71, P<0.001) and PFS ( χ2=24.25, P<0.001) in 2018 FIGOⅠB and ⅢC stages, and there was a statistically significant difference in OS between stage ⅢC1 and stage ⅠB2 ( χ2=6.18, P=0.013). Multivariate analysis showed that age ( HR=1.88, 95% CI: 1.08-3.28, P=0.026), pathological type ( HR=2.11, 95% CI: 1.04-4.27, P=0.038), lymph node metastasis ( HR=2.18, 95% CI: 1.34-3.56, P=0.002), parametrial spread ( HR=2.56, 95% CI: 1.52-4.29, P<0.001), maximum tumor diameter ( HR=1.98, 95% CI: 1.18-3.30, P=0.009), squamous cell carcinoma antigen (SCCA) positive after treatment ( HR=4.49, 95% CI: 2.09-9.68, P<0.001) and Hemoglobin (HB) level before treatment ( HR=0.58, 95% CI: 0.35-0.96, P=0.035) were independent risk factors for OS in patients with cervical cancer. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅠB1, ⅠB2, ⅠB3 were 100%, 97.1% and 87.9% respectively, with a statistically significant difference ( χ2=7.79, P=0.020), and there was a statistically significant difference between stage ⅠB1 and ⅠB3 ( χ2=5.55, P=0.019). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅠB1 and ⅠB2 were 95.7% and 84.3% respectively, with a statistically significant difference ( χ2=9.08, P=0.003). For patients with 2018 FIGO stage ⅠB, SCCA positive after treatment ( HR=1 172.50, 95% CI: 10.37-132 554.51, P=0.003) was an independent risk factor for OS, and differentiation degree ( HR=0.09, 95% CI: 0.01-0.81, P=0.032), treatment method ( HR=0.17, 95% CI: 0.04-0.71, P=0.015) and SCCA positive after treatment ( HR=190.68, 95% CI: 14.27-2 547.67, P<0.001) were independent risk factors for PFS. For patients with 2018 FIGO stage ⅠB, stage ( HR=9.56, 95% CI: 2.38-38.32, P=0.001), SCCA positive after treatment ( HR=126.32, 95% CI: 12.36-1 290.60, P<0.001) and lymph node metastasis ( HR=20.07, 95% CI: 3.63-111.11, P=0.001) were independent risk factors for OS, and differentiation degree ( HR=0.11, 95% CI: 0.02-0.63, P=0.013), treatment method ( HR=0.22, 95% CI: 0.06-0.75, P=0.015) and SCCA positive after treatment ( HR=43.83, 95% CI: 7.94-241.84, P<0.001) were independent risk factors for PFS. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 95.7% and 75.6% respectively, with a statistically significant difference ( χ2=13.96, P<0.001). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 83.1% and 67.1% respectively, with a statistically significant difference ( χ2=7.61, P=0.006). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 90.9% and 75.0% respectively, with a statistically significant difference ( χ2=8.85, P=0.003). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 75.7% and 66.7% respectively, with a statistically significant difference ( χ2=4.07, P=0.044). For patients with 2018 FIGO stage Ⅱ, pathological type ( HR=20.28, 95% CI: 2.93-140.32, P=0.002) and stage ( HR=4.35, 95% CI: 1.02-18.55, P=0.047) were independent risks factors for OS. For patients with 2009 FIGO stage Ⅱ, pathological type ( HR=5.82, 95% CI: 1.62-20.94, P=0.007) was an independent risk factor for OS, and pathological type ( HR=3.09, 95% CI: 1.22-7.85, P=0.017) and lymph node metastasis ( HR=2.07, 95% CI: 1.22-3.51, P=0.007) were independent risk factors for PFS. For patients with 2018 FIGO stage Ⅲ, maximum tumor diameter ( HR=3.31, 95% CI: 1.45-7.56, P=0.005) and SCCA positive after treatment ( HR=4.67, 95% CI: 1.22-17.86, P=0.024) were independent risk factors for OS, and pathological type ( HR=4.15, 95% CI: 1.47-11.77, P=0.007) and SCCA positive after treatment ( HR=3.96, 95% CI: 1.45-10.86, P=0.007) were independent risk factors for PFS. Conclusion:The 2018 and 2009 FIGO staging have a good distribution consistency in the cervical cancer patients, and the 2018 FIGO stage ⅠB has more advantages in judging the prognosis, but stage ⅢC cannot accurately judge the prognosis. Lymph node metastasis and maximum tumor diameter are more important prognostic factors.

Brain metastases are one of the most common distant metastases in patients with non-small cell lung cancer (NSCLC), and the prognosis will be extremely poor. The effect of chemotherapy and operation is limited. As a standard treatment, radiotherapy is widely used in clinical practice. Radiotherapy alone includes whole brain radiotherapy, stereotactic radiotherapy and whole brain radiotherapy combined with stereotactic radiotherapy. With the continuous development of radiotherapy and the progress of gene sequencing, radiotherapy has been combined with targeted drugs, anti-angiogenic drugs and immunodrugs in the treatment of NSCLC brain metastasis, which can improve the survival of patients with NSCLC brain metastasis.

Objective:To explore the impact of the number of pathological lymph node metastasis areas on the prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) after radical surgery.Methods:The clinicopathologic data of 153 patients with ESCC treated by radical surgery at the Department of Thoracic Surgery of the Affiliated Taixing People′s Hospital of Yangzhou University from January 2012 to December 2014 were retrospectively analyzed. Among these patients, 76 had no adjuvant therapy, and 77 received adjuvant radiotherapy or chemoradiotherapy after surgery. According to the lymph node classification criteria of American Thoracic Association and the number of pathological lymph node metastasis areas, the patients were divided into non-regional lymph node metastasis group ( n=68), oligo-regional lymph node metastasis group (1-2 regional lymph node metastasis, n=54) and multi-regional lymph node metastasis group (≥3 regional lymph node metastasis, n=31). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The Cox proportional hazards model was used to analyze prognostic factors, receiver operating characteristic (ROC) curve was used to analyze the predictive value of the number of lymph node metastasis areas. Results:The median overall survival (OS) was 37.0 months for the 153 patients, and the 1-, 3- and 5-year OS rates were 97.4%, 51.0% and 30.7% respectively. In the non-regional lymph node metastasis group, the median OS was 46.0 months, and the 1-, 3- and 5-year OS rates were 97.1%, 58.8% and 39.7% separately. In the oligo-regional lymph node metastasis group, the median OS was 39.0 months, and the 1-, 3- and 5-year OS rates were 94.4%, 55.6% and 35.2% respectively. In the multi-regional lymph node metastasis group, the median OS was 26.0 months, and the 1-, 3- and 5-year OS rates were 98.1%, 25.8% and 3.2% separately. There was a statistically significant difference among the three groups ( χ2=18.257, P<0.001). Among the 76 patients without adjuvant treatment, the 1-, 3- and 5-year OS rates were 94.7%, 50.0% and 34.2% in patients with non-regional lymph node metastasis, 90.9%, 36.4% and 9.1% in patients with oligo-regional lymph node metastasis, 97.4%, 18.8% and 0 in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=8.201, P=0.017). Among the 77 patients with adjuvant therapy, the 1-, 3- and 5-year OS rates were 97.7%, 66.7% and 46.7% in patients with non-regional lymph node metastasis, 96.9%, 68.8% and 53.1% in patients with oligo-regional lymph node metastasis, 93.3%, 26.7% and 6.7% in patients with multi-regional lymph node metastasis, and there was a statistically significant difference ( χ2=18.083, P<0.001). Univariate analysis showed that age ( HR=1.534, 95% CI: 1.041-2.260, P=0.030), T stage ( HR=1.757, 95% CI: 1.197-2.579, P=0.004), N stage ( HR=1.548, 95% CI: 1.043-2.297, P=0.030), TNM stage ( HR=1.392, 95% CI: 1.114-2.459, P=0.015), adjuvant therapy ( HR=0.545, 95% CI: 0.370-0.803, P=0.002) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.385, 95% CI: 0.238-0.624, P<0.001; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.442, 95% CI: 0.269-0.726, P=0.001) were closely related to OS in patients with ESCC after operation. Multivariate analysis showed that T stage ( HR=1.699, 95% CI: 1.143-2.525, P=0.009), adjuvant therapy ( HR=0.577, 95% CI: 0.386-0.864, P=0.008) and number of lymph node metastasis areas (multi-regional lymph node metastasis versus non-regional lymph node metastasis: HR=0.553, 95% CI: 0.411-0.996, P=0.011; multi-regional lymph node metastasis versus oligo-regional lymph node metastasis: HR=0.550, 95% CI: 0.328-0.924, P=0.024) were independent prognostic factors for OS. The number of lymph node metastasis areas (AUC=0.648, 95% CI: 0.560-0.735, P=0.004) was better than the number of lymph node metastasis (AUC=0.595, 95% CI: 0.497-0.694, P=0.061) in predicting OS of patients with ESCC after radical surgery. Conclusion:The number of postoperative pathological lymph node metastasis areas in thoracic ESCC has important value in predicting survival prognosis, and adjuvant therapy can significantly improve the OS of patients with oligo-regional lymph node metastasis.

Objective The purpose of this study was to investigate the influence of pre-treatment inflammatory markers on the therapeutic effect and survival outcome in patients with esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or radiotherapy (RT) alone.Methods A total of 107 patients who were diagnosed with ESCC were retrospectively analysed.They were treated with radical radiotherapy alone or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University between January 2013 and December 2014.According to the median values of neutrophil-lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR) and CRP/Alb ratio before treatment,the patients were divided into NLR＜3.06 group (54 cases) and NLR≥3.06 group (53 cases),PLR＜145.26 group (54 cases) and PLR≥ 145.26 (53 cases),CRP/Alb＜0.13 group (52 cases) and CRP/Alb≥0.13 (55 cases),respectively.The relationships between the response to treatment and these markers were analysed by univariate and multivariate logistic analyses.The Kaplan-Meier method and logrank test were adopted to calculate and compare associations of the progression-free survival (PFS) rates with these blood markers.Cox proportional hazards models were used for the univariate and multivariate analyses.Results The therapeutic effects of chemoradiotherapy,NLR＜3.06,PLR＜ 145.26 and CRP/ Alb＜ 0.13 were better than those of radiotherapy alone,NLR≥ 3.06,PLR≥ 145.26 and CRP/Alb ≥ 0.13,respectively,and the differences were statistically significant (HR=2.118,4.138,2.297,3.784,P＜0.05).Further analysis showed that chemoradiotherapy (HR =1.342,95％ CI 1.023 ～ 2.467,P＜ 0.05) and CRP/Alb ratio＜ 0.13 (HR =7.004,95％ CI 2.088 ～ 23.496,P＜0.05) were independent risk factors for good tumour response.In addition,TNM stage,treatment modality,NLR,PLR and CRP/Alb ratio were significantly associated with PFS by the univariate analysis (P＜0.05 for all).Furthermore,the multivariate Cox proportional hazard regression model analysis showed that only TNM stage (HR =1.326,95％ CI 1.070-1.833 P＜0.05),treatment modality (HR =0.400,95％ CI 0.230-0.694,P＜0.05) and CRP/Alb ratio (HR=3.518,95％ CI 1.975-6.266,P＜ 0.05) were considered independent prognostic factors for PFS.And according to TNM staging and treatment subgroup analysis,CRP/Alb＜0.13 had better progression-free survival time than CRP/Alb≥ 0.13 ESCC patients.Finally,the ROC curve also confirmed that CRP/Alb was superior to NLR and PLR in predicting short-term efficacy and progression-free survival in ESCC patients receiving chemoradiotherapy.Conclusions Our study demonstrated that CRP/Alb ratio was promising as a predictive marker for the therapeutic effect and survival outcome in ESCC patients receiving CRT or RT alone.