Owing to the insidious onset and limited awareness of early screening,many patients with esophageal squamous cell carcinoma(ESCC)are diagnosed at an advanced stage.Immunochemotherapy is the current standard first-line treatment for advanced ESCC;however,survival outcomes remain suboptimal.Radiotherapy,with its precise local control and potential immunomodulatory effects,is anticipated to act synergistically with immunochemotherapy,offering a novel direction for overcoming survival limitations.This review systematically sum-marizes the progress in the use of radiotherapy as a first-line treatment for advanced ESCC and discusses the synergistic mechanisms,clinical applications,and challenges associated with its combination with immunochemotherapy.

Objective To investigate the characteristics of the relative electroencephalogram(EEG)power spectrum in cerebral in-farction patients with different lesion locations and neurological deficit severities.Methods From February,2024 to May,2025,70 patients with cerebral infarction who completed EEG examinations at Shijiazhuang People's Hospital were enrolled.They were divided into cortical group(n=19)and subcortical group(n=51)based on admission MRI/CT imaging,and divided into mild group(n=53)and moderate-to-se-vere group(n=17)according to the scores of National Institutes of Health Stroke Scale(NIHSS)and Barthel In-dex.All patients underwent 32-channel video-EEG monitoring.The power spectral density of α and θ waves,and the(δ+θ)/(α+β)ratio(DTABR)were analyzed in eight electrodes of F3,F4,P3,P4,T3,T4,O1 and O2.Results DTABR was higher in the cortical group than in the subcortical group across all eight electrodes(|Z|≥2.047,P<0.05),while the relative power decreased in α waves(|Z|≥1.968,P<0.05),and increased in θ waves(|Z|≥1.988,P<0.05)in the cortical group.DTABR was higher in the moderate-to-severe group than in the mild group(|Z|≥2.263,P<0.05).Conclusion Elevated DTABR suggests cortical involvement or more severe neurological impairment,and decreased αwave and increased θ wave activity are primarily observed in patients with cortical lesions,potentially serving as EEG indicators for identifying cortical involvement.

Objective:To study the results of detection of pulmonary nodules among military flying personnel and analyze the contributors to pulmonary nodules so as to provide data for early prevention and interventions.Methods:The physical examination data of 1 465 military flying personnel was retrospectively analyzed who had received the annual health checkup and undergone chest CT examinations at Lintong Rehabilitation and Recuperation Center. They were grouped by age (<40 years and ≥40 years), flying hour (<1 000 h and ≥1 000 h) and type of personnel [pilots and air support (technical) personnel]. The detection rates of pulmonary nodules among flying personnel were compared across groups, and a multivariate Logistic regression analysis was conducted to analyze the contributing factors to pulmonary nodules.Results:Among the 1 465 military flying personnel, 212 cases (14.47%) with pulmonary nodules were detected. A total of 230 pulmonary nodules were detected, including 35 pulmonary nodules (15.22%) in the left upper lung, 42 pulmonary nodules (18.26%) in the left lower lung, 52 pulmonary nodules (22.61%) in the right upper lung, 47 pulmonary nodules (20.43%) in the right middle lung, and 54 pulmonary nodules (23.48%) in the right lower lung. The detection rate of pulmonary nodules among military flying personnel in the ≥1 000 h group was higher than in the <1 000 h group, and the difference was statistically significant ( χ2=4.14, P=0.042). More pulmonary nodules were detected among military flying personnel who smoked than among those who did not, and the difference was statistically significant ( χ2=9.34, P=0.002). Age, types of personnel, body mass index, and complications with other lung diseases made no significant difference in the detection rate of pulmonary nodules (all P>0.05). Multivariate Logistic regression analysis showed that smoking was a risk factor for pulmonary nodules ( OR=1.692, 95% CI: 1.217-2.351). Conclusions:Among military flying personnel, pulmonary nodules are more likely to occur in the right lung. Smoking is an independent risk factor for pulmonary nodules, suggesting that routine chest CT screening should be carried out during the annual physical examinations of military flying personnel in order to exercise early interventions.

Objective To investigate the characteristics of the relative electroencephalogram(EEG)power spectrum in cerebral in-farction patients with different lesion locations and neurological deficit severities.Methods From February,2024 to May,2025,70 patients with cerebral infarction who completed EEG examinations at Shijiazhuang People's Hospital were enrolled.They were divided into cortical group(n=19)and subcortical group(n=51)based on admission MRI/CT imaging,and divided into mild group(n=53)and moderate-to-se-vere group(n=17)according to the scores of National Institutes of Health Stroke Scale(NIHSS)and Barthel In-dex.All patients underwent 32-channel video-EEG monitoring.The power spectral density of α and θ waves,and the(δ+θ)/(α+β)ratio(DTABR)were analyzed in eight electrodes of F3,F4,P3,P4,T3,T4,O1 and O2.Results DTABR was higher in the cortical group than in the subcortical group across all eight electrodes(|Z|≥2.047,P<0.05),while the relative power decreased in α waves(|Z|≥1.968,P<0.05),and increased in θ waves(|Z|≥1.988,P<0.05)in the cortical group.DTABR was higher in the moderate-to-severe group than in the mild group(|Z|≥2.263,P<0.05).Conclusion Elevated DTABR suggests cortical involvement or more severe neurological impairment,and decreased αwave and increased θ wave activity are primarily observed in patients with cortical lesions,potentially serving as EEG indicators for identifying cortical involvement.

Owing to the insidious onset and limited awareness of early screening,many patients with esophageal squamous cell carcinoma(ESCC)are diagnosed at an advanced stage.Immunochemotherapy is the current standard first-line treatment for advanced ESCC;however,survival outcomes remain suboptimal.Radiotherapy,with its precise local control and potential immunomodulatory effects,is anticipated to act synergistically with immunochemotherapy,offering a novel direction for overcoming survival limitations.This review systematically sum-marizes the progress in the use of radiotherapy as a first-line treatment for advanced ESCC and discusses the synergistic mechanisms,clinical applications,and challenges associated with its combination with immunochemotherapy.

Objective:To study the results of detection of pulmonary nodules among military flying personnel and analyze the contributors to pulmonary nodules so as to provide data for early prevention and interventions.Methods:The physical examination data of 1 465 military flying personnel was retrospectively analyzed who had received the annual health checkup and undergone chest CT examinations at Lintong Rehabilitation and Recuperation Center. They were grouped by age (<40 years and ≥40 years), flying hour (<1 000 h and ≥1 000 h) and type of personnel [pilots and air support (technical) personnel]. The detection rates of pulmonary nodules among flying personnel were compared across groups, and a multivariate Logistic regression analysis was conducted to analyze the contributing factors to pulmonary nodules.Results:Among the 1 465 military flying personnel, 212 cases (14.47%) with pulmonary nodules were detected. A total of 230 pulmonary nodules were detected, including 35 pulmonary nodules (15.22%) in the left upper lung, 42 pulmonary nodules (18.26%) in the left lower lung, 52 pulmonary nodules (22.61%) in the right upper lung, 47 pulmonary nodules (20.43%) in the right middle lung, and 54 pulmonary nodules (23.48%) in the right lower lung. The detection rate of pulmonary nodules among military flying personnel in the ≥1 000 h group was higher than in the <1 000 h group, and the difference was statistically significant ( χ2=4.14, P=0.042). More pulmonary nodules were detected among military flying personnel who smoked than among those who did not, and the difference was statistically significant ( χ2=9.34, P=0.002). Age, types of personnel, body mass index, and complications with other lung diseases made no significant difference in the detection rate of pulmonary nodules (all P>0.05). Multivariate Logistic regression analysis showed that smoking was a risk factor for pulmonary nodules ( OR=1.692, 95% CI: 1.217-2.351). Conclusions:Among military flying personnel, pulmonary nodules are more likely to occur in the right lung. Smoking is an independent risk factor for pulmonary nodules, suggesting that routine chest CT screening should be carried out during the annual physical examinations of military flying personnel in order to exercise early interventions.

OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica(Abbreviated as HSH)on rheumatoid arthritis(RA)based on cluster of differentiation 4/lymphocyte cell-specific protein-tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17(CD4/LCK/ZAP70/IL-17)signaling pathway.METHODS The rats were divided into normal group,model group,HSH low-dose,medium-dose and high-dose groups(2.7,10.8,21.6 mg/kg)and positive control group(Tripterygium glycosides tablet,6.3 mg/kg),with 10 rats in each group.Except for normal group,RA rat model was induced by complete Freund's adjuvant in other groups.After modeling,each group was given relevant medicine or normal saline intragastrically,once a day,for 28 consecutive days.The changes in ankle joint swelling and arthritis index in rats were determined;the pathological changes of ankle joint tissue were observed;the levels of inflammatory factors[IL-1β,IL-21,IL-17A,IL-2,interferon-γ(IFN-γ)and IL-6]in serum and joint fluid of rats were determined;the levels of Th1,Th17 and Treg cells in the whole blood and spleen of rats were detected;protein and mRNA expressions of LCK,proto-oncogene tyrosine-protein kinase Fyn(Fyn),ZAP70,CD45,RAR-related orphan receptor γt(RORγt),and forkhead box protein 3(Foxp3)in ankle synovial tissue were determined.RESULTS Compared with normal group,the changes in ankle joint swelling,arthritis index,the levels of IL-1β,IL-21,IL-17A,IL-2,IFN-γ and IL-6 in serum and joint fluid,the levels of Th1,Th17 cells and Th17/Treg value in whole blood and spleen,and the protein and mRNA expression levels of LCK,Fyn,ZAP70,CD45,and RORγt in ankle joint synovium were all significantly increased/elevated(P＜0.05).The level of Treg cells in the spleen,as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased(P＜0.05).Compared with model group,most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH(P＜0.05).The degree of pathological changes in ankle joint tissues was markedly improved,and inflammation was alleviated.CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway,thereby modulating the Th17/Treg balance.This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

Objective:To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma.Methods:This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of ( M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) μmol/L(range: 5.4 to 722.8 μmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 μmol/L to 85.5 μmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results:Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ ( P=0.009), hemi-hepatectomy and extended resection ( P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1: OR=1.43 (0.61-3.35), P=0.413;T3 vs. T1: OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions:Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

In order to understand the potential target and related mechanism of action of Termina-lia Chebula treatment,network pharmacology and molecular docking methods were used in this experiment,and the challenge test of Salmonella from yak was performed.The active ingredients and potential targets of Terminalia Chebula were screened through HERB cluster identification database,TCMSP database and SwissTargetPrediction web page tool,and"gastroenteritis"was searched through OMIM and GeneCards database.Cytoscape and STRING databases were used to construct the Terminalia Chebula PPI network to screen out key targets,the intersection targets between Terminalia Chebula and enteritis were obtained through Venny platform,and gene ontol-ogy(GO)and Kyoto encyclopedia database of genes and genomics(KEGG)were enriched through DAVID database.The core target of screening was verified by molecular docking.After that,the gastrointestinal inflammation model of mice was established,the pathological changes of gastroin-testinal tract were observed,and the effect of Terminalia Chebula on the target protein was veri-fied by Western blot test.The results showed that:after analyzing and sorting out 8 main active in-gredients of Terminalia Chebula,118 targets of Terminalia Chebula were screened,11 161 targets of gastroenteritis and 100 targets of intersection were obtained;the core targets of PTGS2,CASP3,SLC3A2,Bax,Bcl-2 and TP53 of Terminalia Chebula and enteritis were obtained through PPI network.GO and KEGG enrichment analysis collected 337 items and 138 items,respectively,mainly related to chemokine pathway,PI3K-Akt signaling pathway,apoptosis related pathway,i-ron ion transport related pathway,NF-κB signaling pathway,etc.The results of molecular docking showed that chebulidic acid,the first active component of chebulidic acid,can bind to Bax,Bcl-2,PTGS2 and SLC3A2 through hydrogen bonding,hydrophobic action,π-π packing force and other intermolecular forces.The pathological tissue sections showed that Terminalia Chebula could sig-nificantly recover gastrointestinal tissue injury.Western blot test results showed that Terminalia Chebula can regulate the process of apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways to achieve the effect of treating intestinal inflammatory damage.The results showed that Terminalia Chebula can regulate the occurrence and development of enteritis by regu-lating apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways.Terminalia Chebula has the characteristics of multi-target and multi-pathway in the treatment of enteritis.

Objective:To investigate the effects of radiation dose to the host immune system during radiotherapy on disease progression and survival in patients with peripheral early-stage non-small cell lung cancer (ES-NSCLC) receiving stereotactic body radiation therapy (SBRT).Methods:Clinical data of pathologically confirmed ES-NSCLC patients who were treated with SBRT at Tianjin Medical University Cancer Institute and Hospital between January 2007 and December 2020 were retrospectively analyzed. The prognostic significance of the estimated dose of radiation to immune cells (EDRIC) in ES-NSCLC patients undergoing SBRT was cited and validated. EDRIC was calculated using the model developed by Kong et al. and improved by Ladbury et al. Kaplan-Meier method and Cox proportional hazards regression were adopted to estimate cancer-specific survival (CSS), progression-free survival (PFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS). Pearson's correlation was used to assess the correlation between variables. Results:The median prescription dose/fraction was 60 Gy/5 fractions (range: 48-60 Gy in 3-10 fractions). The median follow-up time was 52.17 (1.17-154.77) months. The median gross tumor volume (GTV) and EDRIC were 10.98 (0.91-120.34) cm 3 and 2.064 (0.426-6.015) Gy, respectively. Person's correlation analysis showed that GTV was positively correlated with EDRIC ( r=0.712, P<0.001). In multivariate analysis, EDRIC was an important prognostic variable of CSS and DMFS. Higher EDRIC was significantly associated with worse CSS ( HR=1.763, P=0.004) and DMFS ( HR=1.902, P=0.004). Compared to patients with EDRIC ≤ 1.56 Gy, those with EDRIC > 2.64 Gy and EDRIC between <2.06-2.64 Gy exhibited significantly lower CSS ( P<0.001, P=0.049). There were significant differences in DMFS among the groups divided by quartiles of EDRIC (compared to EDRIC ≤1.56 Gy, the P values were <0.001, 0.004, and 0.022 respectively). Conclusions:EDRIC is an important predictor of CSS and DMFS in ES-NSCLC patients treated with SBRT, suggesting that radiation dose to the immune system is a critical determinant of treatment outcomes. EDRIC can be used to quantify the effects of radiation therapy on the host immune system.