Objective:To analyze the relationship between the optimal surgical margin value and clinical prognosis of transoral robotic surgery（TORS） in treating human papillomavirus（HPV） -positive oropharyngeal squamous cell carcinoma. Methods:A single-center, prospective, observational cohort study was conducted, enrolling patients with early and moderated stage（≤T3 stage） oropharyngeal carcinoma undergoing TORS between July 2020 and April 2024. The proposed optimal surgical margin cutoff value for TORS was set as 2 mm. The primary objectives were to evaluate the optimal clear margin for TORS and its association with overall survival（OS） and progression-free survival（PFS）. Logistic regression was used to analyze correlations between surgical margins and clinical variables, while Cox regression models assessed the impact of surgical margins on OS and PFS. Results:A total of 90 patients（60 males, 66.7%） were included, all had squamous cell carcinoma, with a mean age of 58.0±9.0 years（range: 39-84 years） old. The 1, 2 and 3-year OS rates were 92.3%, 89.9% and 85.0%, respectively, while the 1, 2 and 3-year PFS rates were all 90.1%. For surgical margins ≤2 mm, the 1, 2 and 3-year OS rates were 80.8%, 69.3% and 69.3%, respectively, and PFS rates were 77.9% across three time points. For surgical margins>2 mm, the 1, 2 and 3-year OS rates were 96.5%, 96.5% and 90.6%, respectively, with PFS rates of 94.6%. Logistic regression showed no correlation between surgical margins and tumor type, T/N stage, smoking, alcohol use, or gender（P>0.05）. Cox analysis identified surgical margins>2 mm as a significant factor improving PFS（HR=0.14, 95%CI 0.02-0.90, P=0.038）. Conclusion:This systematic analysis suggests setting a 2 mm and longer as clear surgical margin for TORS. Margins>2 mm are associated with superior postoperative PFS rate and prolonged PFS time in HPV-positive oropharyngeal carcinoma patients.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Carcinoma, Squamous Cell/virology* ; Human Papillomavirus Viruses/isolation & purification* ; Margins of Excision ; Oropharyngeal Neoplasms/virology* ; Papillomavirus Infections/virology* ; Prognosis ; Prospective Studies ; Robotic Surgical Procedures/methods*

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To analyze the effects of paroxetine combined with aniracetam on the treatment of senile depression and the levels of 5-hydroxytryptamine (5-HT), cortisol and cystatin C(CysC).Methods:A total of 80 patients admitted to the psychiatric Department of Psychiatry, Suzhou City Guangji Hospital from January 2020 to January 2023 were selected and divided into two groups by random number table method: control group (40 cases) and observation group (40 cases). The control group was treated with oral paroxetine hydrochloride tablets, and the observation group was treated with oral paroxetine hydrochloride combined with aniracetam tablets. Negative emotions were assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before and after treatment, and sleep quality was assessed by Pittsburgh Sleep Quality Scale (PSQI). Serum levels of central neurotransmitters [norepinephrine (NE) and 5-HT], neurotrophic factor (BDNF), oxidative stress [cortisol and malondialdehyde (MDA)] and amino acid metabolism [cysteine (Hcy) and CysC] were measured before and after treatment.Results:After treatment, SAS and SDS scores in both groups were significantly decreased (all P<0.05), and SAS and SDS scores in the observation group were significantly lower than those in the control group (all P<0.05). After treatment, the sleep quality, sleep time, sleep time, sleep efficiency, sleep disorders, hypnotic drugs, daytime function scores and PSQI total scores of the two groups were significantly decreased (all P<0.05), and the above scores of the observation group were significantly lower than those of the control group ( P<0.05). After treatment, the serum levels of NE, 5-HT and BDNF in 2 groups were significantly increased, and the serum levels of NE, 5-HT and BDNF in the observation group were significantly higher than those in control group (all P<0.05). After treatment, the levels of serum cortisol and MDA in both groups were significantly decreased, and the levels of serum cortisol and MDA in the observation group were significantly lower than those in the control group (all P<0.05). After treatment, the serum Hcy and CysC levels in 2 groups were significantly decreased, and the serum Hcy and CysC levels in the observation group were significantly lower than those in the control group (all P<0.05). Conclusions:Paroxetine combined with aniracetam is more effective than paroxetine alone in the treatment of senile depression, which can effectively relieve anxiety and depression symptoms, improve sleep quality, and have positive effects on serum neurotransmitters, neurotrophic factors, oxidative stress and amino acid metabolism levels of patients.

Objective:To investigate the effects of bifidobacterium combined with salicylic acid on skin inflammation and intestinal microecology in acne patients with chloasma.Methods:Sixty acne patients with chloasma who received treatment in the Department of Cosmetic Dermatology, Wenzhou Heping Plastic Hospital from July 2020 to November 2021 were included in this study. They were randomly divided into three groups: lifestyle intervention group ( n = 20), bifidobacterium combined with salicylic acid intervention group ( n = 20), and isotretinoin intervention group ( n = 20). The lifestyle intervention group was treated by routine lifestyle care. The minocycline intervention group was administered with minocycline together with food based on lifestyle intervention. The bifidobacterium combined with salicylic acid intervention group was treated by bifidobacterium combined with salicylic acid based on lifestyle intervention. Clinical efficacy, skin condition score, changes in serum Toll like receptor 2 (TLR-2) and interleukin-17 (IL-17) levels after treatment relative to those before treatment, and the incidence of adverse reactions were compared among the three groups. Results:The response rate in the bifidobacterium combined with salicylic acid intervention group was 95.00% (19/20), which was higher than 55.00% (11/20) in the isotretinoin intervention group and significantly higher than 20.00% (4/20) in the lifestyle intervention group ( Z = 22.94, P < 0.05). After 14 weeks of treatment, the skin condition score in the bifidobacterium combined with salicylic acid intervention group was (53.15 ± 0.23) points, which was significantly higher than (32.95 ± 0.23) points in the isotretinoin intervention group and (10.18 ± 0.25) points in the lifestyle intervention group ( F = 164 761.37, P < 0.05). Serum levels of Toll-like receptor 2 and interleukin-17 in the bifidobacterium combined with salicylic acid intervention group were (35.31 ± 5.52) pg/mL and (164.23 ± 10.12) pg/mL, respectively, which were significantly lower than (52.13 ± 5.45) pg/mL and (198.32 ± 10.23) pg/mL in the isotretinoin intervention group and (62.56 ± 6.11) pg/mL and (245.23 ± 11.31) pg/mL in the lifestyle intervention group ( F = 116.33, 296.24, both P < 0.05). The incidence of adverse reactions in the bifidobacteria combined with salicylic acid intervention group was significantly lower than 65.00% (13/20) in the isotretinoin intervention group and 90.00% (18/20) in the lifestyle intervention group ( Z = 41.02, P < 0.05). Conclusion:Bifidobacterium combined with salicylic acid intervention for the treatment of acne complicated by chloasma can greatly improve skin conditions, alleviate skin inflammation, and reduce adverse reactions. Therefore, bifidobacterium combined with salicylic acid intervention is a safe and highly efficient method for the treatment of acne complicated by chloasma and deserves clinical promotion.

Objective: To understand the symptoms of depression and anxiety among rural returning adolescents and to analyze their association with physical activity related factors, so as to provide reference for interventions targeting depression and anxiety symtoms in the population. Methods: From April to June 2020, 3 495 middle school students were selected from 6 counties and districts of Shangrao City by random cluster stratified sampling sampling. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to evaluate the depressive and anxiety symptoms among middle school students. The International Physical Activity Questionnaire was used to assess their physical activity levels during the past week. Chi square test and Logistic regression analysis were used to determine the strength of the association between depression and anxiety symptoms and physical activity related factors in returning and non returning adolescents as well as the overall population. Results: Univariate analysis showed significant differences in the prevalence of depressive and anxiety symptoms between rural returning and non returning adolescents and the overall population in terms of "type of school" "family economic situation" "parental occupation" "number of sports classes per week" and "level of physical activity per week" ( χ 2=78.21, 16.56, 135.44, 107.75, 7.10, 8.62; 97.94, 24.26 , 124.07, 90.36, 9.60, 8.34, P <0.05). Multivariate regression analysis showed a correlation between the occurrence of depression and the number of sports classes per week for rural returning and non returning adolescents and the overall population (number of sports classes per week for non returning was 2 times, OR=1.22, 95%CI =1.01-1.49; returning adolescents for 1 time, OR=1.85, 95%CI =1.06-3.23; the overall population for 1 time, OR=1.34, 95%CI =1.01-1.77 and 2 times, OR=1.20, 95%CI =1.01-1.43, P <0.05). There was a correlation between anxiety symptoms and the number of sports classes per week for returning adolescents (number of sports classes per week for returning adolescents was 1 time, OR=2.10, 95%CI=1.21-3.63, P < 0.05 ). Conclusion A low frequency of weekly sports classes may be a risk factor for depressive or anxiety symptoms in rural and returning adolescents. Rural primary and secondary schools should appropriately increase the number of physical education courses or arrange sports extended classes to promote the development of adolescent mental health.

Objective:To explore the correlation of serum adiponectin (APN) , D-dimer (D-D) and neutrophil-to-lymphocyte ratio (NLR) levels with disease severity and prognosis in patients with diabetic foot ulcer infection.Methods:92 patients with diabetic foot ulcer infection in the Nantong Third Hospital Affiliated to Nantong University from Feb. 2020 to Feb. 2021 were selected, and they were divided into mild ( n=30) , moderate ( n=44) and severe ( n=18) patients according to the severity of the disease. The serum APN, D-D and NLR levels in patients with different severity were compared, the relationship between serum APN, D-D and NLR levels and disease severity in patients with diabetic foot ulcer infection were analyzed. Patients were followed up for 1 year, and the prognosis of the patients was counted. Factors affecting serum APN, D-D and NLR levels in patients with diabetic foot ulcer infection were analyzed, and the receiver operating curve (ROC) was used to analyze the value of serum APN, D-D and NLR levels in predicting poor prognosis of patients. Results:There were significant differences in serum APN, D-D and NLR levels in patients with different severity ( P<0.05) . APN level in severe patients was 5.35±0.98, in moderate patients was 7.64±1.25, both lower than that of the mild patients 9.19±1.73 ( P<0.05) . Serum APN level in severe patients was lower than that in moderate patients ( P<0.05) . Serum D-D and NLR levels were 3.49±0.72 and 2.86±0.58 in severe patients, respectively; and they were 3.02±0.63 and 2.24±0.46 in moderate patients, higher than that of mild patients 2.43±0.51; 1.71±0.33 ( P<0.05) . The levels of serum D-D and NLR in severe patients were higher than those in moderate patients ( P<0.05) . Spearman correlation analysis showed that the severity of the disease was negatively correlated with serum APN levels ( r=-0.414, P<0.001) , and positively correlated with serum D-D and NLR levels in patients with diabetic foot ulcer infection ( r=0.387, P<0.001; r=0.461, P<0.001) . Univariate analysis showed that the proportion of severe disease, serum fasting blood glucose, glycosylated hemoglobin, fibrinogen, D-D and NLR levels in patients with poor prognosis were higher than those in patients with good prognosis ( P<0.05) , and the APN level in patients with poor prognosis was lower than that in patients with good prognosis ( P<0.05) . Logistic multivariate regression analysis showed that severe disease, serum glycosylated hemoglobin, APN, D-D, and NLR levels were independent risk factors for poor prognosis in patients with diabetic foot ulcer infection ( P<0.05) . ROC analysis showed that the optimal cut-off points of serum APN, D-D and NLR levels for predicting poor prognosis of patients were 5.73 mg/L, 3.06 mg/L, 2.12, the sensitivity was 78.57%, 82.14%, 85.71%, the specificity was 76.56%, 67.19%, 73.44%, the area under the curve (AUC) was 0.793, 0.784, 0.818, the specificity and AUC of the three were 98.44 %, 0.918, respectively. Conclusions:Serum APN, D-D and NLR levels are related to the severity of the disease in patients with diabetic foot ulcer infection. Clinical detection of serum APN, D-D and NLR levels can be used as sensitive indicators to predict poor prognosis.

Objective:To explore the clinical efficacy of different doses of apatinib combined with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) and the adverse reactions.Methods:A total of 69 patients with NSCLC diagnosed in the No. 901 Hospital of the Chinese People′s Liberation Army Joint Logistics Support Force were selected from January 2018 to June 2020, and were divided into chemotherapy alone group (docetaxel+ cisplatin was used), apatinib group A [apatinib (0.25 g)+ docetaxel+ cisplatin was used] and apatinib group B [apatinib (0.50 g)+ docetaxel+ cisplatin was used] according to random number table method, with 23 cases in each group. The objective response rate (ORR), disease control rate (DCR), median overall survival (OS), median progression-free survival (PFS), and incidences of adverse reactions were compared between the three groups of patients.Results:One patients in the apatinib group B withdrew from the study due to acute myocardial infarction. After 4 cycless of treatment, the ORR of the patients in the chemotherapy alone group, apatinib group A and apatinib group B were 17.39% (4/23), 47.83% (11/23) and 54.55% (12/22) respectively, with a statistically significant difference ( χ2=7.41, P=0.024). The ORR of the apatinib group B was higher than that of the chemotherapy alone group, with a statistically significant difference ( χ2=6.77, P=0.009). There were no statistically significant differences in ORR between the apatinib group A and chemotherapy alone group, the apatinib group A and apatinib group B ( χ2=4.85, P=0.028; χ2=0.20, P=0.652). The DCR of the patients in the three groups were 47.83% (11/23), 78.26% (18/23) and 86.36% (19/22) respectively, with a statistically significant difference ( χ2=9.03, P=0.011). The DCR of the apatinib group B was higher than that of the chemotherapy alone group, with a statistically significant difference ( χ2=7.52, P=0.006). There were no statistically significant differences in DCR between the apatinib group A and the chemotherapy alone group, the apatinib group A and apatinib group B ( χ2=4.57, P=0.033; χ2=0.51, P=0.477). The median OS of the patients in the three groups were 6.8, 9.2 and 9.9 months respectively, with a statistically significant different ( χ2=8.91, P=0.022). Compared with the chemotherapy alone group, the median OS of the apatinib group A and apatinib group B were significantly prolonged, with statistically significant differences ( χ2=7.25, P=0.036; χ2=8.60, P=0.029). Compared with the apatinib group A, the median OS of the apatinib group B was prolonged, but there was no statistically significant different ( χ2=1.54, P=0.201). The median PFS of the patients in the three groups were 5.2, 7.7 and 8.2 months respectively, with a statistically significant different ( χ2=8.79, P=0.026). Compared with the chemotherapy alone group, the median PFS of the apatinib group A and apatinib group B were significantly prolonged, with statistically significant differences ( χ2=7.01, P=0.039; χ2=8.36, P=0.031). Compared with the apatinib A group, the median PFS of the apatinib group B was prolonged, but there was no statistically significant different ( χ2=1.68, P=0.186). There were statistically significant differences in the incidences of fatigue [34.78% (8/23) vs. 65.22% (15/23) vs. 72.73% (16/22), χ2=7.50, P=0.024], hypertension [4.35% (1/23) vs. 34.78% (8/23) vs. 68.18% (15/22), χ2=20.07, P<0.001], hand-foot syndrome [4.35% (1/23) vs. 43.48% (10/23) vs. 72.73% (16/22), χ2=22.28, P<0.001] and oral mucositis [8.70% (2/23) vs. 39.13% (9/23) vs. 72.73% (16/22), χ2=19.26, P<0.001] among the three groups. Compared with the chemotherapy alone group, the incidences of hypertension and hand-foot syndrome in the apatinib group A and the incidences of fatigue, hypertension, hand-foot syndrome and oral mucositis in the apatinib group B were increased, with statistically significant differences ( χ2=6.77, P=0.009; χ2=9.68, P=0.002; χ2=6.51, P=0.011; χ2=20.00, P<0.001; χ2=22.37, P<0.001; χ2=19.21, P<0.001). Conclusion:Apatinib (0.50 g) combined with chemotherapy has better short-term efficacy than chemotherapy alone in advanced NSCLC. Apatinib (0.25 g) and apatinib (0.50 g) can prolong the survival of patients, but increasing the treatment dose can not achieve longer survival benefit.

Objective:To investigate the causes of strong pathogenicity of Bacillus cereus ( B. cereus) in a mouse model of B. cereus endophthalmitis and the factors that might be related to the prognosis of the disease. Methods:C57BL/6J mice aged 6-8 weeks were injected with 1 μl PBS solution containing 100 CFU B. cereus into the vitreous cavity to construct traumatic endophthalmitis model, and a control group was set up by injecting the contralateral eyeball with 1 μl sterile PBS. A mouse model of Staphylococcus epidermidis ( S. epidermidis) endophthalmitis was constructed in the same way as disease control group. Real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) were used to detect the levels of inflammatory cytokines at different time points. Histology, electroretinogram and transmission electron microscopy were used to detect the progression of endophthalmitis and retinal function at different time points. Results:B. cereus grew significantly faster than S. epidermidis in the eyes of C57BL/6 mice and gradually moved to the cornea 12 h after infection. The results of transmission electron microscopy showed that many more B. cereus were found in the iris with sparse pigment particles, while S. epidermidis could not be detected in the anterior segment after infection. The electroretinogram results showed that the amplitude of A wave and B wave of mice with B. cereus endophthalmitis decreased significantly 6 h after infection, and the B wave could not be detected 12 h after infection. Moreover, the amplitude reduction at different time points was significantly larger than that in the S. epidermidis endophthalmitis group. Histological examination found that compared with the S. epidermidis endophthalmitis group, the mice with B. cereus endophthalmitis had significantly increased inflammatory cells in the anterior chamber and vitreous cavity with a higher degree of infiltration, which was more destructive to the tissue structure. ELISA results showed that the activity of myeloperoxidase (MPO) was significantly stronger in the B. cereus endophthalmitis group than in the S. epidermidis endophthalmitis group, suggesting that a much more severe inflammation was induced. The expression of IL-6, TNF-α and IL-1β at the transcription and protein levels in the mouse model of B. cereus endophthalmitis were significantly higher than those in the mice with S. epidermidis endophthalmitis. Conclusions:B. cereus could induce severe endophthalmitis and tissue destruction in the eye due to its rapid growth and migration ability, which was an important factor leading to vision loss.

[摘 要] 目的：探讨贝伐珠单抗联合多柔比星脂质体治疗铂类耐药复发性卵巢上皮性癌患者的近期疗效和不良反应，并随访生存情况。方法：选取中国人民解放军联勤保障部队第九〇一医院2018年1月至2019年12月收治的76例铂类耐药复发性卵巢上皮性癌患者，采用数字随机分组法分为对照组38例、观察组38例，对照组给予多柔比星脂质体单药化疗4个周期，观察组给予贝伐珠单抗联合多柔比星脂质体化疗4个周期，观察两组患者治疗后近期疗效和不良反应，以及血清肿瘤标志物人附睾蛋白4（human epididymis protein 4，HE4）、糖类抗原125（carbohydrate antigen 125，CA125）变化，并随访总生存期（OS）和无疾病进展生存期（PFS）。结果：对照组患者客观有效率（ORR）为40.54%、疾病控制率（DCR）为67.57%，观察组患者ORR为69.44%、DCR为88.89%，观察组ORR和DCR显著高于对照组（均P<0.05）。治疗后观察组患者血清HE4和CA125分别为（142.67±46.81）pmol/L、（31.79±11.65）U/L，显著低于对照组患者的（219.33±75.67）pmol/L、（57.05±17.85）U/L（均P<0.05）。两组患者的胃肠反应、骨髓抑制、肝肾功能损伤、心脏毒性、过敏反应、血栓栓塞和出血等不良反应相比较差异无统计学意义（均P>0.05）；观察组患者高血压发生率显著高于对照组（P<0.05），但可控、可耐受。观察组患者中位OS 和中位PFS分别分别为17.2个月和10.9个月，显著长于对照组患者的14.1个月和7.8个月（均P<0.05）。结论：对于铂类耐药复发性卵巢上皮性癌患者，贝伐珠单抗联合多柔比星脂质体近期疗效可靠、安全性好、不良反应可耐受，值得临床推广。

Objective To study the effects of melatonin (MT) on mitochondrial autophagy in neonatal rats with hypoxic-ischemic brain damage (HIBD).Method Animal model of HIBD was established.Forty-five 7-day-old Sprague-Dawley (SD) rats were randomly assigned to sham operation group and HIBD group.Brain tissue were taken at 0,2,4,6,8,12,24 and 48 h after model preparation,and the expressions of mitochondrial autophagy-related protein Bnip3 and autophagy-related protein LC3-Ⅱ were detected.Seventy-two 7-day-old SD rats were randomly assigned to sham operation group,HIBD group and post-HIBD treatment group (3-MA,Mdivi-I,Rapa,MT,3-MA + MT,Mdivi-1 + MT,Rapa + MT).The sizes of cerebral infarction after different treatment were detected using triphenyltetrazolium chloride staining (TIC).Primary cortical cells of fetal SD rats (embryonic day:17 ～ 19 d) were cultured.JC-I staining was used to detect mitochondrial membrane potential and immunofluorescence method was used to observe mitochondrial autophagy.The Oxygen glucose deprivation/reperfusion/R (OGD) model was prepared.Autophagy inhibitor 3-MA,mitochondrial autophagy inhibitor Mdivi-1,autophagy activator Rapa,and MT were applied and Bnip3 and LC3-Ⅱ expressions and CCK8 (Cell Counting Kit CCK 8) for cell viability assay were examined.Result TTC staining results showed significant white infarcts in the tissue of HIBD group after hypoxia-ischemia,especially in the 3-MA and Mdivi-1 groups,and the infarcts were smaller in Rapa group and groups with MT treatment,the differences were statistical significant (P ＜ 0.05).Compared with the sham operation group,the expressions of Bnip3 and LC3-Ⅱ in the HIBD group were significantly increased (P ＜ 0.05).Compared with the normal group,the expressions of Bnip3 and LC3-Ⅱ in the OGD/R group were increased (P ＜0.05).The activities of 3-MA and Mdivi-1 cells decreased significantly,the mitochondrial membrane potential decreased,and mitochondrial autophagy were decreased (P ＜ 0.05).The cell activity,mitochondrial membrane potential,and mitochondrial autophagy of Rapa group were increased (P ＜ 0.05).The cell viability,Bnip3 and LC3-Ⅱ expressions were increased in groups with MT intervention (P ＜ 0.05).Conclusion MT may play an important protective role in the early stage of brain injury by enhancing mitochondrial autophagy of HIBD,which provide a theoretical basis for the study of specific related mechanisms.