It is very limited that the benefit of perioperative chemotherapy in early non-small cell lung cancer (NSCLC), and the 5-year survival rate is only 5% higher than surgery. Antibodies that block programmed cell death protein 1/programmed death-ligand 1 significantly improve the survival of advanced NSCLC. The value of immunotherapy in early NSCLC is also being explored. This paper firstly summarized and analyzed the progress of immunotherapy in the perioperative period of NSCLC. Secondly, the safety and feasibility of surgical resection after neoadjuvant immunotherapy were discussed. Finally, the clinical value of different therapeutic efficacy prediction indicators was summarized, in order to clarify the current status of immunotherapy in the perioperative period, so as to improve the clinical benefits of early NSCLC patients.

INTRODUCTION: Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are used in the diagnosis and prognostication of rheumatoid arthritis (RA). We wanted to determine the specific contributions of RF and ACPA to the biological nature of RA and whether they act synergistically. METHODS: We identified 731 patients from our prospective multi-ethnic RA cohort and categorised them into four groups: ACPA-positive, RF-positive, doubly positive and doubly negative. We compared the demographics, Disease Activity Score-28, Health Assessment Questionnaire score, quality of life using Short Form 36 and the use of prednisolone and disease-modifying antirheumatic drugs (DMARDs) of these patient groups. RESULTS: Four hundred and ninety-one patients (67.2%) were ACPA+RF+, 54 (7.4%) were ACPA+RF-, 82 (11.2%) were ACPA-RF+ and 104 (14.2%) were ACPA-RF-. Mean disease duration before the study entry was not different in the four groups. Patients with older age of onset were less likely to be positive for RF and ACPA. Fewer ACPA+RF+ patients were in remission compared to those in the other groups ( P < 0.05). Erythrocyte sedimentation rate (ESR) was higher at study entry in the ACPA+RF+ group (40.4 mm/h vs. 30.6-30.9 mm/h, P < 0.05). Prednisolone and number of DMARDs used were higher in the ACPA+RF+ group compared to the doubly negative group. There were no differences in the functional status and quality of life. CONCLUSIONS RA patients who were positive for both ACPA and RF had lower remission rate, higher baseline ESR and required more corticosteroid and DMARD treatment compared to those who were singly positive or doubly negative. Being doubly positive confers a worse outcome to RA patients.
Humans ; Arthritis, Rheumatoid/diagnosis* ; Male ; Female ; Middle Aged ; Rheumatoid Factor/blood* ; Anti-Citrullinated Protein Antibodies/blood* ; Adult ; Quality of Life ; Prospective Studies ; Antirheumatic Agents/therapeutic use* ; Aged ; Peptides, Cyclic/immunology* ; Prednisolone/therapeutic use* ; Surveys and Questionnaires ; Severity of Illness Index ; Prognosis

Atherosclerosis is an arterial lesion involving abnor-mal lipid metabolism and an inflammatory response,and is the initiating factor of many cardiovascular and cerebrovascular dis-eases.Glycosylated ceramides are derivatives of ceramide mole-cules with a glycosylated group attached,which not only affect the structural integrity of cell membranes,but also regulate apop-tosis,inflammation and lipid metabolism,and disorders of glyco-sylated ceramide metabolism are closely related to the occurrence and progression of atherosclerosis.This review focuses on the specific functions of the glycosylated ceramide-related metabolic enzymes glucose ceramide synthetase,glucosylceramide syn-thetase,lactose ceramide synthetase,and galactosidase in athero-sclerosis,as well as their important effects on the development of atherosclerosis.Targeted therapeutic strategies for these meta-bolic enzymes,related drug development and significant potential in atherosclerosis prevention and treatment are also reviewed.

Aim To investigate the mechanism of 8-hydroxygenistein(8-OHG)in mitigating high-altitude induced heart injury(HAHI)via network pharmacolo-gy,molecular docking and animal experiment.Meth-ods 8-OHG-related targets were obtained from Swis-sTargetPrediction,Similarity ensemble approach,Su-perPred and PharmMapper databases.Genecards and OMIM databases were utilized for retrieving HAHI-re-lated targets.Venn diagram was drawn using R pack-age.STRING 11.5 and Cytoscape 3.9.1 were used to construct the protein-protein interaction network and screen core targets.GO and KEGG enrichment analysis were carried out using DAVID database.AutoDock Vi-na software was used for molecular docking.Visualiza-tion was performed using PyMOL 3.0.0 software.The HAHI model was established,and the the mice were randomly divided into the control group,model group and 8-OHG group.Hematoxylin-eosin(HE)staining was used to observe the pathological changes of myo-cardial tissue.Western blot was applied for detecting the expression levels of related proteins in myocardial tissue.Results A total of 73 overlapping targets be-tween 8-OHG and HAHI were screened,with ALB,AKT1,ESR1,HSP90AA1,NFKB1 and MMP9 were regarded as core targets.Molecular docking results in-dicated that 8-OHG had strong binding ability with these core targets.GO functional enrichment analysis obtained 185 biological processes,including negative regulation of apoptosis,response to hypoxia and in-flammatory response,38 cell compositions,including cytosol,cytoplasm,plasma membrane,as well as 71 molecular functions,including protein binding,metal ion binding,enzyme binding and so on.Altogether 55 signaling pathways were identified via KEGG enrich-ment analysis,including PI3 K/Akt signaling pathway,HIF-1 signaling pathway and MAPK signaling pathway.The results of animal experiments showed that 8-OHG could significantly improve the myocardial histopatho-logical change induced by high-altitude hypoxia expo-sure.Western blot results showed that compared with the normal group,the ratio of p-PI3K/PI3K and p-Akt/Akt in the myocardial tissue of mice in the model group significantly decreased,while the protein expres-sion of Beclin-1 and the ratio of LC3B-Ⅱ/LC3B-Ⅰsignificantly increased,while 8-OHG could reverse these changes.Conclusion The mechanism of 8-OHG in alleviating HAHI is related to its activation of PI3K/Akt signaling pathway,thereby inhibiting auto-phagy induced by high-altitude hypoxia exposure.

Objective Under the"Key Information Infrastructure Security Protection Requirements for Information Secu-rity Technology"(hereinafter referred to as"Security Protection Requirements"),this study aims to construct a security protec-tion system for medical information systems and improve their security protection capabilities.Methods Starting from the char-acteristics and security requirements of medical information systems,combined with the standard"Security Protection Require-ments",this study discusses and analyzes the construction of six aspects of security protection capabilities:identification,securi-ty protection,detection and evaluation,monitoring and warning,active defense,and event handling,and implements protection for key information infrastructure in medical institutions from both software and hardware aspects.Results A practical,system-atic,and normalized security protection system for medical information systems has been constructed to achieve comprehensive protection of medical information systems.Conclusion Under the requirements of"Security Protection Requirements",it is crucial to establish a comprehensive security protection system for medical information systems and implement the protection of key information infrastructure in medical institutions from both software and hardware aspects.This provides a scientific basis and practical guidance for network security protection in the medical industry.

Transcatheter aortic valve replacement(TAVR)is increasingly being applied in low-risk and younger patients.However,this trend necessitates that cardiac surgeons take on the responsibility of comprehensive lifetime management.This article explores three critical aspects of lifetime management,including the selection of the initial valve,the procedural success and the device success rates of TAVR,and the durability of the valve.Younger TAVR recipients require comprehensive lifetime management strategies,including the potential risk of reintervention.Improving TAVR's procedural and device success rates is the cornerstone of lifetime management,necessitating efforts in surgical strategy and operation to reduce complications.Valve durability is a key guarantee;current surgical bioprosthetic valves show good durability,but long-term data on TAVR valves'durability is still needed.Meanwhile,novel valves are being improved in durability,offering new directions for optimizing lifetime management in TAVR patients.

Objective:To explore the value of ultrasound imaging characteristics combined with clinical indicators in assessing the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).Methods:A retrospective analysis was conducted for patients who underwent pancreatic contrast-enhanced ultrasound (CEUS) from September 2017 to October 2023 at Peking Union Medical College Hospital and were diagnosed with PDAC based on pathological findings. Various parameters were recorded, including CA19-9 levels, tumor size, location, morphologic features, echogenicity, presence of internal cystic components, dilatation of the main pancreatic duct, peripheral vascular invasion, CEUS characteristics, presence or absence of liver metastasis, and treatment methods. In April 2024, patient survival information was obtained through telephone follow-up or review of medical records. Based on the results of the cox regression model analysis, a nomogram model of the risk of death was developed. The receiver operating characteristic (ROC) curves were applied to evaluate the predictive efficacy of the model. The calibration curves were plotted to evaluate the accuracy of the model, and clinical decision curves were used to evaluate the clinical benefit of the model.Results:This study included a total of 207 patients with PDAC. As of April 2024, 71 patients were alive and 136 died, with a median survival time of 14 months (95% CI: 12 -17). Multivariate analysis confirmed that the elevated CA19-9 ( HR=1.689, 95% CI: 1.102-2.588), tumor size >4 cm ( HR=1.641, 95% CI: 1.159-2.322), taller-than-wide shapes ( HR=1.450, 95% CI: 1.019-2.065), incomplete hypo-enhancement ( HR=1.618, 95% CI: 1.100-2.380), and liver metastasis ( HR=1.687, 95% CI: 1.175-2.423) were independent risk factors for survival in patients with PDAC. A nomogram model was further constructed for 6-month, 12-month and 3-year survival of patients with PDAC. The areas under the ROC curve were 0.679, 0.705 and 0.815, respectively. The calibration curves suggested that the model was more accurate, and the clinical decision curves showed that the model had a better clinical benefit. Conclusion:The combined use of ultrasound imaging characteristics and clinical indicators could effectively predict the prognosis of PDAC patients. Specifically, tumor size >4 cm, taller-than-wide shapes, incomplete hypo-enhancement, elevated CA19-9, and the presence of liver metastasis are correlated with poorer survival outcomes. The nomogram model constructed on the basis of these factors can be used to assess the survival of patients with PDAC.

Objective Under the"Key Information Infrastructure Security Protection Requirements for Information Secu-rity Technology"(hereinafter referred to as"Security Protection Requirements"),this study aims to construct a security protec-tion system for medical information systems and improve their security protection capabilities.Methods Starting from the char-acteristics and security requirements of medical information systems,combined with the standard"Security Protection Require-ments",this study discusses and analyzes the construction of six aspects of security protection capabilities:identification,securi-ty protection,detection and evaluation,monitoring and warning,active defense,and event handling,and implements protection for key information infrastructure in medical institutions from both software and hardware aspects.Results A practical,system-atic,and normalized security protection system for medical information systems has been constructed to achieve comprehensive protection of medical information systems.Conclusion Under the requirements of"Security Protection Requirements",it is crucial to establish a comprehensive security protection system for medical information systems and implement the protection of key information infrastructure in medical institutions from both software and hardware aspects.This provides a scientific basis and practical guidance for network security protection in the medical industry.

Transcatheter aortic valve replacement(TAVR)is increasingly being applied in low-risk and younger patients.However,this trend necessitates that cardiac surgeons take on the responsibility of comprehensive lifetime management.This article explores three critical aspects of lifetime management,including the selection of the initial valve,the procedural success and the device success rates of TAVR,and the durability of the valve.Younger TAVR recipients require comprehensive lifetime management strategies,including the potential risk of reintervention.Improving TAVR's procedural and device success rates is the cornerstone of lifetime management,necessitating efforts in surgical strategy and operation to reduce complications.Valve durability is a key guarantee;current surgical bioprosthetic valves show good durability,but long-term data on TAVR valves'durability is still needed.Meanwhile,novel valves are being improved in durability,offering new directions for optimizing lifetime management in TAVR patients.

Renal artery stenosis(RAS)is a common disease that endangers human health,usually caused by ath-erosclerosis or fibromuscular dyspalsia.RAS is also one of the most common causes of secondary hypertension,often leading to resistant hypertension with markedly elevated renin levels and early onset of progressive renal insufficiency.In addition,the activation of renin-angiotensin-aldosterone system(RAAS)caused by RAS and pathophysiological changes in-cluding glomerular sclerosis and atrophy,water and sodium retention can also lead to cardiovascular events such as heart failure,pulmonary edema,coronary heart disease and cerebral infarction.Therefore,early recognition of RAS and prompt revascularization in patients with severe stenosis are key to the treatment of RAS.Percutaneous renal artery stenting(PRAS)has become the preferred revascularization for patients with RAS due to its high response rate,minimally invasive-ness,fast recovery and low restenosis rate.However,there are still some unavoidable complications of PRAS,such as aortic dissection,renal artery rupture,puncture vascular aneurysm,contrast allergy and contrast-induced nephropathy.The occurrence of these complications may have adverse consequences for patients,and even death in severe cases.Renal arteriovenous fistula is a very rare complication of PRAS,and clinical experience in its recognition and management is very limited.Few cases that can be collected tend to favor re-surgical intervention.But surgical intervention undoubtedly in-creases the risk of patient suffering and mortality again.Thus,it is of great significance to summarize such complications and give a scientific recommendation to clinicians.This article reports a patient with resistant hypertension who underwent renal arteriography showing severe stenosis of renal vessels and developed a renal arteriovenous fistula after stent implanta-tion.Therefore,it is worth considering whether the renal arteriovenous fistula caused by PRAS should be treated with sur-gical intervention or conservative medical treatment.