To summarize the distribution characteristics of human papillomavirus(HPV) infection types in patients with cervical squamous intraepithelial lesion(SIL) and cervical cancer(CC), and to explore the impact of HPV vaccination, HPV infection types, and general clinical data on different grades of cervical lesions.

Objective:To understand the current status of family resilience in children with autism and explore its influencing factors, providing a basis for developing intervention measures to improve family resilience in these families.Methods:Convenience sampling was used to select children with autism and their caregivers who underwent rehabilitation training at the Department of Child Developmental Behavior, Third Affiliated Hospital of Zhengzhou University from March to September 2023. A cross-sectional survey was conducted using a general information questionnaire, the Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Parenting Burnout Scale, and the Caregiver Stress Scale.Results:A total of 280 questionnaires were distributed, and 271 valid questionnaires were collected. Among the 271 children with autism, 210 were male and 61 were female, with the majority aged 3-5 years old (169 cases). Among the 271 caregivers, 21 were male and 250 were female, with the majority aged 30-39 years old (149 cases). The total score of the Chinese version of the Family Resilience Assessment Scale was (70.59 ± 14.08) points, with scores of (49.96 ± 10.23) points for family communication and problem-solving, (7.13 ± 1.62) points for social resource utilization, and (13.52 ± 3.31) points for maintaining a positive attitude. Multiple linear regression analysis showed that the child′s age, disease duration, reimbursement method, parenting burnout, and caregiver stress were influencing factors of family resilience in children with autism ( t values were -10.40-3.48, all P<0.05). Conclusions:The level of family resilience in children with autism needs improvement. Higher levels of parenting burnout and caregiver stress are associated with lower levels of family resilience. Future interventions should be developed based on these influencing factors to promote the physical and mental health of children with autism and their caregivers.

Objective:To explore the effect of Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) with chemotherapy on breast cancer patients who got agranulocytosis of 3 to 4 degree, agranulocytosis with fever (FN) and the influential factors of relative dose intensity (RDI) chemotherapy scheme. Meantime, the value of CD34 + and CD45 in peripheral blood on predicting agranulocytosis of 3-4 degree were investigated.Methods:A total of 104 women with breast cancer were treated at Huzhou Maternal and Child Health Hospital and Cancer Hospital of Zhejiang Province from Jan. 2022 to Sep. 2023. All subjects received primary prevention with PEG-rhG-CSF during chemotherapy. The clinical risk factors of agranulocytosis, FN and RDI were analyzed. The levels of CD34 + and CD45 in peripheral blood samples were analyzed by flow cytometry. Then the predictive value of the receiver characteristic curve (ROC) for Grade 3 to 4 agranulocytosis after primary prophylaxis with PEG-rhG-CSF for breast cancer chemotherapy was evaluated.Results:Among 104 breast cancer patients who received primary prevention of PEG-rhG-CSF during chemotherapy, 28 patients had agranulocytosis of 3 to 4 grade, 10 patients got FN, and 12 patients developed RDI<85%. The results of single factor analysis showed that CD34 +, CD45 and chemotherapy scheme were the influential factors of agranulocytosis of 3 to 4 degree, and low RDI of chemotherapy scheme ( OR=0.584, OR=0.999, OR=2.299, OR=0.100, OR=0.999, OR=3.088, P<0.05) . It also showed that CD34 + and chemotherapy scheme were the influential factors of FN ( OR=0.099, OR=2.667, P<0.05) . Multivariate Logistic regression analysis showed that CD34 +, CD45 and intensive chemotherapy were the independent risk factors of agranulocytosis of 3 to 4 degree after primary prevention with PEG-rhG-CSF ( OR=0.602, OR=0.999, OR=20.174, P<0.05) . CD34 + and intensive chemotherapy scheme were the independent influential factors of FN and RDI of chemotherapy scheme after primary prevention with PEG-RHG-CSF ( OR=0.072, OR=33.934, OR=0.086, OR=54.788, P<0.05) . The area under the curve (AUC) of CD34 + were 0.767 (95% CI:0.659-0.876) , AUC of CD45 were 0.743 (95% CI:0.644-0.842) , and the AUC of combined two indexes was 0.825 (95% CI:0.730-0.920) , which was higher than that of single index. So AUC of CD34 + and CD45 can be used for predicting agranulocytosis of grade 3 to 4 in breast cancer patients receiving primary prophylaxis with PEG-rhG-CSF. Conclusions:The levels of CD34 + and CD45 in peripheral blood of breast cancer patients with agranulocytosis of grade 3 to 4 receiving primary prevention with PEG-rhG-CSF during chemotherapy are lower. Combined detection of CD34 + and CD45 in peripheral blood can predict the occurrence of agranulocytosis of grade 3 to 4 in breast cancer patients after primary prevention with PEG-rhG-CSF. Also it can provide a reliable basis for assessing the risk of grade 3 to 4 agranulocytosis.

Objective To investigate the correlation between peripheral blood total bilirubin(TBIL)levels and the efficacy and prognosis of immunotherapy in advanced non-small cell lung cancer(NSCLC),as well as its relationship with immune inflammation.Methods A retrospective analysis was conducted on 246 patients with advanced NSCLC who received immunotherapy from June 2019 to June 2022.Pre-treatment TBIL levels were collected,and the optimal cutoff value for TBIL was determined using the"X-tile"software and the ROC curve.The impact of pre-treatment TBIL on the short-term efficacy and long-term prognosis of advanced NSCLC was an-alyzed.Results The optimal cutoff value for TBIL was identified as 10.5μmol/L using the"X-tile"software and the ROC curve.A-nalysis of short-term efficacy indicated that patients with higher TBIL levels had a significantly better objective response rate(ORR)compared to those with lower levels(51.3％vs 33.8％,P=0.006).The disease control rate(DCR)was also higher in the higher TBIL level group compared to the low level group(92.9％vs 81.2％,P=0.007).Kaplan-Meier survival analysis revealed that patients with elevated TBIL levels had a longer median progression-free survival(PFS)compared to those with lower TBIL levels,with 13.0 vs 7.0 months,respectively(P＜0.001).Similarly,the median overall survival(OS)was greater in the higher TBIL level group than in the lower TBIL level group,with 16.0 vs 12.0months,respectively(P＜0.001).Additionally,there were significant differences in neutro-phil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SII)between two groups of different TBIL levels(P＜0.05).Conclusion In immunotherapy for advanced non-small cell lung cancer,patients with higher baseline levels of TBIL exhibit a positive correlation with the efficacy and prognosis of immunotherapy.TBIL might be served as an important predictive marker for immunotherapy in patients with advanced NSCLC.

Objective:To compare knowledge graphs (KGs) constructed from standardized clinical pathways and actual examination records within 24 hours of emergency care for acute gastrointestinal hemorrhage (AGH), acute myocardial infarction (AMI), and intracerebral hemorrhage (ICH), and to visually analyze discrepancies between guideline recommendations and real-world practice, thereby exploring a novel methodology for clinical pathway optimization.Methods:KGs were developed using clinical pathway standards and actual examination data collected within the first 24 hours of emergency treatment for AGH, AMI, and ICH. Entity attributes were weighted to visually represent the frequency and extent of examination usage through variable node sizes in the KG. The constructed KGs were used to compare and analyze the differences in type and frequency of examinations performed relative to pathway standards.Results:The proportion of examination items with >50% adherence to clinical pathway standards within 24 hours was 76.92% for AGH, 44.44% for AMI, and 78.57% for ICH. Items from the clinical pathways that were not performed in over 50% of patients accounted for 15.38%, 27.78%, and 21.43% of cases, respectively. Non-pathway examinations increased by 9, 7, and 4 items for each condition, of which 17 items (85%) were performed at least once in more than half of the patients. Visualization via KGs revealed a reduction in redundant examinations by 38.64% between AGH and AMI, 35.00% between AGH and ICH, and 37.50% between AMI and ICH. Overall, a 54.84% reduction in redundant examinations was achieved across all three critical conditions.Conclusions:The visual KG approach effectively integrates both guideline-recommended and experience-driven examinations, serving as a correlational analysis tool to assess deviations between actual clinical practice and standardized pathways. It provides a quantitative foundation for optimizing clinical pathways, with potential for greater efficiency gains as more critical conditions are incorporated into the graph.

Objective To analyze the correlation of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)with short-term outcome and long-term prognosis in patients with advanced non-small cell lung cancer(NSCLC).Methods A retrospective study was conducted.A total of 215NSCLC patients who received a complete 4-cycle chemotherapy combined with immunotherapy or chemotherapy alone in the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University from January 2021 to January 2023 were selected as the research subjects.The patients were divided into remission group(n=97)and non-remission group(n=118)based on the efficacy of the treatments,and the differences in NLR,PLR,SII,and decline rate of each index were compared between the two groups.NLR,PLR,SII and decline rate before and after treatment were grouped by the best cut-off value or median,and the differences in progression-free survival and overall survival were analyzed by each index group.Results NLR and PLR in the remission group before each cycle of treatment were signifi-cantly lower than those in the non-remission group,and SII in the remission group before cycles 2nd,3rd,and 4th of treatment were sig-nificantly lower than those in the non-remission group(P＜0.05);From initial treatment to before the fourth treatment cycle,NLR and SII decline rates in the remission group were significantly higher than those in the non-remission group(P＜0.05);the tumor stage,NLR before cycle 4th of treatment were independent influencing factors of short-term efficacy in patients with advanced NSCLC(P＜0.05);patients with low NLR,PLR,SII and higher rates of decline in NLR and SII before cycle 4th treatment had longer progression-free survival and overall survival(P＜0.05).Conclusion Tumor stage and post-treatment NLR are significantly correlated with the short-term outcomes of patients with advanced NSCLC,and high post-treatment NLR often suggests a poorer response to treatment.The prognosis of advanced NSCLC patients with higher NLR decline rate and higher SII decline rate after treatment is better.

Objective To investigate the correlation between peripheral blood total bilirubin(TBIL)levels and the efficacy and prognosis of immunotherapy in advanced non-small cell lung cancer(NSCLC),as well as its relationship with immune inflammation.Methods A retrospective analysis was conducted on 246 patients with advanced NSCLC who received immunotherapy from June 2019 to June 2022.Pre-treatment TBIL levels were collected,and the optimal cutoff value for TBIL was determined using the"X-tile"software and the ROC curve.The impact of pre-treatment TBIL on the short-term efficacy and long-term prognosis of advanced NSCLC was an-alyzed.Results The optimal cutoff value for TBIL was identified as 10.5μmol/L using the"X-tile"software and the ROC curve.A-nalysis of short-term efficacy indicated that patients with higher TBIL levels had a significantly better objective response rate(ORR)compared to those with lower levels(51.3％vs 33.8％,P=0.006).The disease control rate(DCR)was also higher in the higher TBIL level group compared to the low level group(92.9％vs 81.2％,P=0.007).Kaplan-Meier survival analysis revealed that patients with elevated TBIL levels had a longer median progression-free survival(PFS)compared to those with lower TBIL levels,with 13.0 vs 7.0 months,respectively(P＜0.001).Similarly,the median overall survival(OS)was greater in the higher TBIL level group than in the lower TBIL level group,with 16.0 vs 12.0months,respectively(P＜0.001).Additionally,there were significant differences in neutro-phil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SII)between two groups of different TBIL levels(P＜0.05).Conclusion In immunotherapy for advanced non-small cell lung cancer,patients with higher baseline levels of TBIL exhibit a positive correlation with the efficacy and prognosis of immunotherapy.TBIL might be served as an important predictive marker for immunotherapy in patients with advanced NSCLC.

Objective To analyze the correlation of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)with short-term outcome and long-term prognosis in patients with advanced non-small cell lung cancer(NSCLC).Methods A retrospective study was conducted.A total of 215NSCLC patients who received a complete 4-cycle chemotherapy combined with immunotherapy or chemotherapy alone in the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University from January 2021 to January 2023 were selected as the research subjects.The patients were divided into remission group(n=97)and non-remission group(n=118)based on the efficacy of the treatments,and the differences in NLR,PLR,SII,and decline rate of each index were compared between the two groups.NLR,PLR,SII and decline rate before and after treatment were grouped by the best cut-off value or median,and the differences in progression-free survival and overall survival were analyzed by each index group.Results NLR and PLR in the remission group before each cycle of treatment were signifi-cantly lower than those in the non-remission group,and SII in the remission group before cycles 2nd,3rd,and 4th of treatment were sig-nificantly lower than those in the non-remission group(P＜0.05);From initial treatment to before the fourth treatment cycle,NLR and SII decline rates in the remission group were significantly higher than those in the non-remission group(P＜0.05);the tumor stage,NLR before cycle 4th of treatment were independent influencing factors of short-term efficacy in patients with advanced NSCLC(P＜0.05);patients with low NLR,PLR,SII and higher rates of decline in NLR and SII before cycle 4th treatment had longer progression-free survival and overall survival(P＜0.05).Conclusion Tumor stage and post-treatment NLR are significantly correlated with the short-term outcomes of patients with advanced NSCLC,and high post-treatment NLR often suggests a poorer response to treatment.The prognosis of advanced NSCLC patients with higher NLR decline rate and higher SII decline rate after treatment is better.

Objective:To explore the effect of Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) with chemotherapy on breast cancer patients who got agranulocytosis of 3 to 4 degree, agranulocytosis with fever (FN) and the influential factors of relative dose intensity (RDI) chemotherapy scheme. Meantime, the value of CD34 + and CD45 in peripheral blood on predicting agranulocytosis of 3-4 degree were investigated.Methods:A total of 104 women with breast cancer were treated at Huzhou Maternal and Child Health Hospital and Cancer Hospital of Zhejiang Province from Jan. 2022 to Sep. 2023. All subjects received primary prevention with PEG-rhG-CSF during chemotherapy. The clinical risk factors of agranulocytosis, FN and RDI were analyzed. The levels of CD34 + and CD45 in peripheral blood samples were analyzed by flow cytometry. Then the predictive value of the receiver characteristic curve (ROC) for Grade 3 to 4 agranulocytosis after primary prophylaxis with PEG-rhG-CSF for breast cancer chemotherapy was evaluated.Results:Among 104 breast cancer patients who received primary prevention of PEG-rhG-CSF during chemotherapy, 28 patients had agranulocytosis of 3 to 4 grade, 10 patients got FN, and 12 patients developed RDI<85%. The results of single factor analysis showed that CD34 +, CD45 and chemotherapy scheme were the influential factors of agranulocytosis of 3 to 4 degree, and low RDI of chemotherapy scheme ( OR=0.584, OR=0.999, OR=2.299, OR=0.100, OR=0.999, OR=3.088, P<0.05) . It also showed that CD34 + and chemotherapy scheme were the influential factors of FN ( OR=0.099, OR=2.667, P<0.05) . Multivariate Logistic regression analysis showed that CD34 +, CD45 and intensive chemotherapy were the independent risk factors of agranulocytosis of 3 to 4 degree after primary prevention with PEG-rhG-CSF ( OR=0.602, OR=0.999, OR=20.174, P<0.05) . CD34 + and intensive chemotherapy scheme were the independent influential factors of FN and RDI of chemotherapy scheme after primary prevention with PEG-RHG-CSF ( OR=0.072, OR=33.934, OR=0.086, OR=54.788, P<0.05) . The area under the curve (AUC) of CD34 + were 0.767 (95% CI:0.659-0.876) , AUC of CD45 were 0.743 (95% CI:0.644-0.842) , and the AUC of combined two indexes was 0.825 (95% CI:0.730-0.920) , which was higher than that of single index. So AUC of CD34 + and CD45 can be used for predicting agranulocytosis of grade 3 to 4 in breast cancer patients receiving primary prophylaxis with PEG-rhG-CSF. Conclusions:The levels of CD34 + and CD45 in peripheral blood of breast cancer patients with agranulocytosis of grade 3 to 4 receiving primary prevention with PEG-rhG-CSF during chemotherapy are lower. Combined detection of CD34 + and CD45 in peripheral blood can predict the occurrence of agranulocytosis of grade 3 to 4 in breast cancer patients after primary prevention with PEG-rhG-CSF. Also it can provide a reliable basis for assessing the risk of grade 3 to 4 agranulocytosis.

Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.