ObjectiveTo identify and validate the optimal compatibility dosage of astragaloside Ⅰ （ASⅠ） and calycosin （CY） in the treatment of cholestatic liver fibrosis. MethodsA 3，5-diethoxycarbonyl-1，4-dihydrocollidine （DDC） diet was used to establish a mouse model of liver fibrosis， and the uniform design method was used to identify the optimal combination ratio of the saponin component ASⅠ and the flavonoid component CY in Astragalus membranaceus. In the uniform design experiment， 80 male C57/BL6J mice were divided into normal group， model group， total astragalosides （TAS） group， groups A — F with a uniform design， and obeticholic acid （OCA） group using a random number table， with 8 mice in each group. The multiple regression analysis was used to establish the optimal regression equation and obtain the potential optimal combination ratio. The in vivo efficacy of the empirically optimal combination identified in the uniform design and the optimal dose combination predicted by the regression equation were compared for validation. A one-way analysis of variance was used for comparison of continuous data between multiple groups； the Levene test was used to determine the homogeneity of variance， and the least significant difference t-test was used for comparison of data with homogeneity of variance between two groups， while the Dunnett T3 test was used for comparison of data with heterogeneity of variance. ResultsIn the uniform design regimen， the JYB combination （3.125 mg/kg ASI+50 mg/kg CY） significantly reduced the serum levels of alanine aminotransferase （ALT）， aspartate transaminase （AST）， alkaline phosphatase （ALP）， total bile acid （TBA）， total bilirubin （TBil）， and indirect bilirubin （IBil） in mice with DDC-induced cholestatic liver fibrosis （all P<0.05）， and it also reduced hepatic Hyp content （P<0.01）， semi-quantified collagen deposition area （P<0.001）， and the mRNA expression levels of Acta2， Col1a1， Ck7， Ck19， Adgre1， TLR4， TNF-α， and CCL5 in liver tissue （all P<0.05）. The regression equation showed that 50 mg/kg ASⅠ+50 mg/kg CY was the potential optimal combination， which was named as P1 combination. However， subsequent validation experiments showed that P1 combination only significantly improved the serum levels of AST and IBil and hepatic Hyp content in DDC mice （all P<0.05）， with no significant impact on hepatic collagen deposition and the mRNA expression levels of Acta2， Ck7， Ck19， Adgre1， and CCL5 （all P>0.05）. In contrast， the JYB combination significantly improved the serum levels of ALP， ALT， AST， TBA， TBil， and IBil， hepatic collagen deposition， hepatic Hyp content， and the mRNA expression levels of Acta2， Col1a1， Ck7， Ck19， Adgre1， TLR4， TNF-α， and CCL5 （all P<0.05）. ConclusionThis study shows that the JYB combination （3.125 mg/kg ASⅠ+50 mg/kg CY） can significantly alleviate DDC-induced liver fibrosis， with comparable efficacy to total saponins from Astragalus membranaceus， and compared with ASⅠ or CY administered alone， the JYB combination has a significantly better regulatory effect on the serum levels of ALP and TBA.

This paper presents a case of interstitial lung disease(ILD)during anti-tumor therapy in an elderly breast cancer patient,along with the subsequent glucocorticoid treatment course.Based on the patient's symptoms,signs and comprehensive evaluation of laboratory and imaging findings,and review of relevant literature,the ILD was suspected to be associated with abemaciclib.The causal relationship was determined as highly likely,according to the Common Terminology Criteria for Adverse Events,the severity of the ILD was evaluated as grade 2.The abemaciclib were discontinued and glucocorticoids were administered for anti-inflammation,supplemented with rabeprazole for gastric protection.During the treatment,disease recurrence occurred,which was considered related to overly rapid tapering of glucocorticoid dosage,prompting subsequent dose adjustment and slow reduction of glucocorticoids.Follow-up showed that the patient's ILD had improved.Clinical pharmacists assisted physicians in the differential diagnosis of adverse drug reactions and provided pharmaceutical care,participated in adjusting treatment plans,delivered medication education to patients,and ensured the safety and effectiveness of drug therapy.

Objective To develop a multimodal nomogram for predicting the risk of postoperative metastasis and recurrence in patients with stage Ⅱ colorectal cancer(CRC)who do not receive adjuvant therapy.Methods A total of 424 patients with stage Ⅱ CRC who underwent radical resection without adjuvant therapy at our institution between January 2016 and December 2021 were retrospectively enrolled.Clinicopathological characteristics[including T stage,carcinoembryonic antigen(CEA)levels,and tumor differentiation],inflammatory markers(preoperative neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio),radiomic features(MRI texture entropy),and molecular biomarkers(KRAS mutation status)were collected.Radiologically confirmed metastasis or recurrence was defined as the primary endpoint.Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors and construct a predictive nomogram.The model's discriminatory performance was assessed using receiver operating characteristic(ROC)curve analysis.Internal validation was conducted via bootstrapping,and model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis was applied to assess the clinical utility of the nomogram,and risk stratification was subsequently performed.Results Among the patients,104(24.53%)developed metastasis or recurrence within three years after surgery.Multivariate analysis revealed the following independent risk factors(all P<0.05):CEA>5 μg/L,moderate to poor differentiation,presence of lymphovascular invasion,perineural invasion,elevated neutrophil-to-lymphocyte ratio(NLR),increased radiomic entropy,and KRAS mutation.The nomogram demonstrated strong predictive accuracy(AUC=0.870,95%CI:0.850～0.930),and the calibration curve indicated excellent agreement between predicted and observed outcomes.Following risk stratification,the recurrence rate was only 6.1%in the low-risk group,compared to 74.2%in the high-risk group(P<0.05).Conclusions This study develops a clinical-inflammatory-radiomic integrated prediction model specifically for stage Ⅱ colorectal cancer patients who do not receive adjuvant therapy.The model effectively identifies the risk of postoperative metastasis and recurrence,enabling the establishment of a risk stratification system to guide subsequent treatment decisions.

The aging trend is intensifying currently,but there is still a lack of standardized diagnosis and treat-ment schemes for severe infections in elderly people.This paper focuses on the recommendations for immune-related clinical diagnosis and treatment routes as well as the idea of risk stratified diagnosis and treatment for elderly peo-ple,aiming to effectively prevent infectious diseases in elderly people and perform stratified management through systematic and scientific means of immune function monitoring and regulation,so as to enhance the standardized level of diagnosis and treatment as well as clinical treatment effect of infection in elderly people.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

A 71-year-old man with undifferentiated sarcoma was treated with palliative first-line regimen(epirubicin,anlotinib and penpulimab)for 6 cycles and maintained with anlotinib and penpulimab for 30 cycles.He was admitted to the hospital due to chest pain 25 months after the first treatment.The laboratory examination showed cardiac troponin T 1.26 ng·mL-1,N terminal pro B type natriuretic peptide 8,545 pg·mL-1,coronary computed tomography angiography(CTA)showed non-calcified plaque in the left proximal anterior descending branch,severe lumen stenosis,nearly complete occlusion.Emergency CTA was performed on the same day,showing 50％stenosis of the distal left main coronary artery(LMCA);95％stenosis of the left anterior descending(LAD)branch ostium,the LAD branch was medium-sized and showed no stenosis;50％stenosis of the left circumflex branch(LCx),and a cardiac stent was implanted into the LAD branch.The patient has recovered after coronary artery stent implantation.Naranjo's Assessment Scale was used to evaluate the association of suspected drugs,the acute myocardial infarction of this patient was likely associated with the combination of penpulimab and anlotinib.Myocardial infarction is a rare but severe adverse drug reaction of anti-tumor treatment.This article summarizes the related risks and treatment measures to provide a reference for clinical medication safety.

Objective To develop a multimodal nomogram for predicting the risk of postoperative metastasis and recurrence in patients with stage Ⅱ colorectal cancer(CRC)who do not receive adjuvant therapy.Methods A total of 424 patients with stage Ⅱ CRC who underwent radical resection without adjuvant therapy at our institution between January 2016 and December 2021 were retrospectively enrolled.Clinicopathological characteristics[including T stage,carcinoembryonic antigen(CEA)levels,and tumor differentiation],inflammatory markers(preoperative neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio),radiomic features(MRI texture entropy),and molecular biomarkers(KRAS mutation status)were collected.Radiologically confirmed metastasis or recurrence was defined as the primary endpoint.Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors and construct a predictive nomogram.The model's discriminatory performance was assessed using receiver operating characteristic(ROC)curve analysis.Internal validation was conducted via bootstrapping,and model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis was applied to assess the clinical utility of the nomogram,and risk stratification was subsequently performed.Results Among the patients,104(24.53%)developed metastasis or recurrence within three years after surgery.Multivariate analysis revealed the following independent risk factors(all P<0.05):CEA>5 μg/L,moderate to poor differentiation,presence of lymphovascular invasion,perineural invasion,elevated neutrophil-to-lymphocyte ratio(NLR),increased radiomic entropy,and KRAS mutation.The nomogram demonstrated strong predictive accuracy(AUC=0.870,95%CI:0.850～0.930),and the calibration curve indicated excellent agreement between predicted and observed outcomes.Following risk stratification,the recurrence rate was only 6.1%in the low-risk group,compared to 74.2%in the high-risk group(P<0.05).Conclusions This study develops a clinical-inflammatory-radiomic integrated prediction model specifically for stage Ⅱ colorectal cancer patients who do not receive adjuvant therapy.The model effectively identifies the risk of postoperative metastasis and recurrence,enabling the establishment of a risk stratification system to guide subsequent treatment decisions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.