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.

OBJECTIVE To explore the risk factors for serum COVID-19 antibodies in the population of Fuzhou to provide scientific basis for prevention and control strategies.METHODS The prospective study and the multi-stage stratified random sampling method were performed to select at least 200 subjects from each of the 12 counties(cit-ies)in Fuzhou.Questionnaires follow-ups and serum collections were conducted in Mar,Jun,Sep,and Dec.2024,respectively.The antibody levels in Dec.were divided into a high protective antibody group(IgG antibody≥50 AU/ml)and a low protective antibody group(IgG antibody≤20 AU/ml).The influencing factors of serum anti-body levels were analyzed by multivariate logistic regression model.RESULTS A total of 2816 subjects were en-rolled.In Mar,1454 subjects with high-protective antibodies were identified.After nine months of follow-up,of the 1454 subjects,344 had high protective antibodies and 369 had low protective antibodies in Dec..There were statistically significant differences in age,presence of typical symptoms after infection,underlying diseases,surgi-cal history,healing time,smoking and drinking histories between the high and low antibody groups(P<0.05).Multivariate logistic regression model showed that older age,underlying diseases,history of surgery,smoking and drinking were risk factors which could reduce antibody levels(P<0.05),while typical symptoms after infec-tion and longer recovery time were protective factors which could increase antibody levels(P<0.05).After the COVID-19 infection in spring of 2024,the serum antibody levels in Fuzhou residents showed the downward trend,especially after Sep.2024,with a more pronounced downward trend.CONCLUSIONS According to the risk factors of COVID-19 antibody levels,prevention and control efforts should be focused on the key population.It is necessa-ry to strengthen health education and carry out vaccination to maintain the levels of immunity to protect population from COVID-19 infection.

OBJECTIVE To explore the risk factors for serum COVID-19 antibodies in the population of Fuzhou to provide scientific basis for prevention and control strategies.METHODS The prospective study and the multi-stage stratified random sampling method were performed to select at least 200 subjects from each of the 12 counties(cit-ies)in Fuzhou.Questionnaires follow-ups and serum collections were conducted in Mar,Jun,Sep,and Dec.2024,respectively.The antibody levels in Dec.were divided into a high protective antibody group(IgG antibody≥50 AU/ml)and a low protective antibody group(IgG antibody≤20 AU/ml).The influencing factors of serum anti-body levels were analyzed by multivariate logistic regression model.RESULTS A total of 2816 subjects were en-rolled.In Mar,1454 subjects with high-protective antibodies were identified.After nine months of follow-up,of the 1454 subjects,344 had high protective antibodies and 369 had low protective antibodies in Dec..There were statistically significant differences in age,presence of typical symptoms after infection,underlying diseases,surgi-cal history,healing time,smoking and drinking histories between the high and low antibody groups(P<0.05).Multivariate logistic regression model showed that older age,underlying diseases,history of surgery,smoking and drinking were risk factors which could reduce antibody levels(P<0.05),while typical symptoms after infec-tion and longer recovery time were protective factors which could increase antibody levels(P<0.05).After the COVID-19 infection in spring of 2024,the serum antibody levels in Fuzhou residents showed the downward trend,especially after Sep.2024,with a more pronounced downward trend.CONCLUSIONS According to the risk factors of COVID-19 antibody levels,prevention and control efforts should be focused on the key population.It is necessa-ry to strengthen health education and carry out vaccination to maintain the levels of immunity to protect population from COVID-19 infection.

Objective To evaluate the dosimetric effect of three-dimensional(3D)printed headrests made of different materials in radiotherapy for head and neck tumor,and to evaluate whether the existence of customized 3D-printed headrest can be neglected during planning phase by comparing differences in target area doses,homogeneity index(HI),conformity index(CI),monitor units(MU),and organ-at-risk(OAR)dose.Methods Ten patients with head and neck tumors,including 5 cases with nasopharyngeal carcinoma and 5 with other head and neck tumors,were enrolled.The headrest contours were outlined using Monaco treatment planning system,and with the same calculation parameters,treatment plans were generated for scenarios without a headrest,with a standard headrest,and with 3D-printed headrests made of 10%filled polylactic acid and thermoplastic polyurethane.The target area doses,OAR dose,MU,and other results were recorded and subjected to statistical analysis.Results No significant differences were observed among the 4 groups(ignoring headrest,standard headrest,3D-printed headrests with 10%filled polylactic acid and thermoplastic polyurethane)in parameters such as D95,D5,Dmean,HI,CI,MU,and OAR dose(the maximum dose to the spinal cord)(P>0.05).Considering the presence of the headrest,significant differences were found in CI for nasopharyngeal carcinoma and other head and neck tumors(P<0.05).Conclusion During the planning phase,the existence of customized 3D-printed headrest can be ignored,but it should be noted that the presence of a headrest may reduce the MU in radiotherapy plans.When considering the headrest,the average CI of patients with other head and neck tumors is significantly higher than that with nasopharyngeal carcinoma.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective Using cochlear metabolomics to study the mechanisms underlying age-related hearing loss in rat.Methods A total of 30 rats with 2-month-old(young group)and 14-month-old(old group)were select-ed,with 15 rats in each group.The auditory function in each group was detected by auditory brainstem response(ABR),the morphology of cochlear tissue in both groups was observed using HE staining,and the oxidative stress status of cochlear tissue was detected by flow cytometry.Five rats/groups were selected for metabolomic examina-tion of cochlear tissue by untargeted ultra-high performance liquid chromatography-mass spectroscopy(LC-MS/MS)to analyze the metabolic differences in the aging cochlea.Results Compared with young group,ABR detection of tone burst at 8,16,and 32 kHz and click response thresholds were significantly higher in old group(P＜0.05),HE staining showed cochlear senescence-related vascular stripe atrophy(P＜0.05),and flow cytometric techniques suggested significantly higher levels of oxidative stress in old group(P＜0.05).Metabolomics detection revealed that a total of 124 differential metabolites were identified in the cochlea of the old group,of which 16 metabolites in-cluding sphingosine,all-trans-retinoic acid,and oleamide were significantly upregulated,while the levels of 108 me-tabolites such as purine,taurine,thiamine,and proline and its derivatives were significantly decreased.The results suggested that physiopathological mechanisms such as protein synthesis and catabolism,sphingolipid metabolism,purine metabolism,oxidative stress-related signaling,cell death,and coenzyme biosynthesis may be involved in co-chlear aging.Conclusion Cellular senescence and cochlear metabolic dysfunction may be important mechanisms of age-related hearing loss.

A 27-year-old female patient with AIDS received tenofovir alafenamide lamivudine and efavirenz(ART scheme). Because of the combined infection of talaromyces marneffei, she was given intravenous infusion of voriconazole 200 mg once per 12 hours. On the 4th day of medication, the valley blood concentration of voriconazole was 0.1 mg/L. The clinical pharmacist participated in the consultation and found that there was a drug interaction between efavirenz and voriconazole. The pharmacist recommended to discontinue efavirenz and switch to dolutegravir. After discontinuing efavirenz, the patient measured the blood trough concentration of voriconazole multiple times and adjusted the dose of voriconazole multiple times. Within 14 days of efavirenz discontinuation, the blood trough concentration of voriconazole changed slowly(0.1-0.4 mg/L), and after 14 days, the blood trough concentration remained basically stable. After increasing the dose of voriconazole to 300 mg once every 12 hours orally, the blood trough concentration of voriconazole increased to 1.8 mg/L, which was within the reference value range. This case suggests that when voriconazole is used in combination with efavirenz, even after discontinuing efavirenz, the metabolic induction effect of efavirenz still exists. Therefore, it is necessary to empirically increase the dose of voriconazole and dynamically adjust it based on therapeutic drug monitoring results.

Objective:To understand the occurrence of drug-drug interaction (DDI) in medical orders and the relevant common medications of hospitalized patients treated with voriconazole.Methods:The treatment information of hospitalized patients treated with voriconazole and had blood trough concentration ( Cmin) results in Quanzhou First Hospital, Fujian Province from May 2018 to August 2023 was collected through the hospital information system. Descriptive statistical analysis was conducted on the incidence of DDI medical orders, the drugs involved in DDI, the types and risk levels of DDI, the departments where DDI occurred, and the Cmin changes of voriconazole in patients with 1 or 2 type of voriconazole-related DDI medical orders (including drugs not recommended in combination with voriconazole or voriconazole dose needs to be adjusted when combined) during voriconazole treatment. Results:A total of 752 patients were included, of which 592 (78.7%) had 1 344 medical orders with voriconazole-related DDI, involving 28 drugs. Among them, 67.7% (401/592) of patients used 2 or more DDI drugs. Glucocorticoids [91.6% (542/592)], followed by proton pump inhibitors [87.8% (520/592)], were most frequently involved in the medical orders of DDI with voriconazole. Among the 28 voriconazole-related DDI drugs, 5 were involved in type 1 or 2 DDI, including rifampicin, nirmatrelvir/ritonavir, phenobarbital, phenytoin sodium, and rifabutin. The 5 drugs involved 33 patients, of whom 51.5% (17 patients) had voriconazole Cmi n<1.0 mg/L; rifampicin involved the most patients (17 patients), followed by nirmatrelvir/ritonavir (10 patients). When voriconazole was combined with rifampicin, rifabutin, phenobarbital and phenytoin sodium, its Cmin in most patients decreased significantly. The incidence of medical orders with voriconazole-related DDI was highest in the Intensive Care Unit, followed by the Department of Respiratory and Critical Care Medicine. Conclusions:Medical orders with DDI are very common in the clinical application of voriconazole, and most patients have used two or more DDI drugs, in which glucocorticoids and proton pump inhibitors appeared more common. It is necessary to be alert to the occurrence of DDI between voriconazole and rifampicin, rifabutin, phenobarbital and phenytoin sodium in clinic.

A 27-year-old female patient with AIDS received tenofovir alafenamide lamivudine and efavirenz(ART scheme). Because of the combined infection of talaromyces marneffei, she was given intravenous infusion of voriconazole 200 mg once per 12 hours. On the 4th day of medication, the valley blood concentration of voriconazole was 0.1 mg/L. The clinical pharmacist participated in the consultation and found that there was a drug interaction between efavirenz and voriconazole. The pharmacist recommended to discontinue efavirenz and switch to dolutegravir. After discontinuing efavirenz, the patient measured the blood trough concentration of voriconazole multiple times and adjusted the dose of voriconazole multiple times. Within 14 days of efavirenz discontinuation, the blood trough concentration of voriconazole changed slowly(0.1-0.4 mg/L), and after 14 days, the blood trough concentration remained basically stable. After increasing the dose of voriconazole to 300 mg once every 12 hours orally, the blood trough concentration of voriconazole increased to 1.8 mg/L, which was within the reference value range. This case suggests that when voriconazole is used in combination with efavirenz, even after discontinuing efavirenz, the metabolic induction effect of efavirenz still exists. Therefore, it is necessary to empirically increase the dose of voriconazole and dynamically adjust it based on therapeutic drug monitoring results.

Objective:To understand the occurrence of drug-drug interaction (DDI) in medical orders and the relevant common medications of hospitalized patients treated with voriconazole.Methods:The treatment information of hospitalized patients treated with voriconazole and had blood trough concentration ( Cmin) results in Quanzhou First Hospital, Fujian Province from May 2018 to August 2023 was collected through the hospital information system. Descriptive statistical analysis was conducted on the incidence of DDI medical orders, the drugs involved in DDI, the types and risk levels of DDI, the departments where DDI occurred, and the Cmin changes of voriconazole in patients with 1 or 2 type of voriconazole-related DDI medical orders (including drugs not recommended in combination with voriconazole or voriconazole dose needs to be adjusted when combined) during voriconazole treatment. Results:A total of 752 patients were included, of which 592 (78.7%) had 1 344 medical orders with voriconazole-related DDI, involving 28 drugs. Among them, 67.7% (401/592) of patients used 2 or more DDI drugs. Glucocorticoids [91.6% (542/592)], followed by proton pump inhibitors [87.8% (520/592)], were most frequently involved in the medical orders of DDI with voriconazole. Among the 28 voriconazole-related DDI drugs, 5 were involved in type 1 or 2 DDI, including rifampicin, nirmatrelvir/ritonavir, phenobarbital, phenytoin sodium, and rifabutin. The 5 drugs involved 33 patients, of whom 51.5% (17 patients) had voriconazole Cmi n<1.0 mg/L; rifampicin involved the most patients (17 patients), followed by nirmatrelvir/ritonavir (10 patients). When voriconazole was combined with rifampicin, rifabutin, phenobarbital and phenytoin sodium, its Cmin in most patients decreased significantly. The incidence of medical orders with voriconazole-related DDI was highest in the Intensive Care Unit, followed by the Department of Respiratory and Critical Care Medicine. Conclusions:Medical orders with DDI are very common in the clinical application of voriconazole, and most patients have used two or more DDI drugs, in which glucocorticoids and proton pump inhibitors appeared more common. It is necessary to be alert to the occurrence of DDI between voriconazole and rifampicin, rifabutin, phenobarbital and phenytoin sodium in clinic.