Objective:To investigate the dynamic changes of cytokine levels in patients with sepsis and to identify potential biomarkers for evaluating the prognosis of the disease.Methods:A total of 195 patients with sepsis hospitalized at the Department of Infectious Diseases and the Department of Critical Care Medicine of the First Affiliated Hospital of Soochow University from August 2022 to October 2024 were recruited, and 70 healthy individuals undergoing physical examinations were recruited as the healthy control group. The levels of 11 cytokines, including interferon γ (IFN-γ), interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17A, tumor necrosis factor α (TNF-α) and C-reactive protein (CRP) were compared between the sepsis patients and the healthy controls. Spearman correlation analysis was used to assess the correlation between cytokine levels and sequential organ failure assessment (SOFA) scores in sepsis patients. Receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated to evaluate the diagnostic value of cytokines for sepsis. Delong test was used to compare AUC. Based on the 28-day survival outcomes, the sepsis patients were categorized into non-survival group and survival group. The levels of the 11 cytokines in patients on the 1st, 3rd, 7th, 14th, 21st and 28th days after confirmed sepsis were dynamically monitored, and their change characteristics were analyzed. Mann-Whitney U test was used for statistical comparison. Results:The age of the 195 patients with sepsis was 68.0 (55.0, 76.0) years old, including 124 males (63.6%), 64 died and 131 survived.The levels of IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17A, TNF-α, CRP in the sepsis group were all higher than those in the healthy control group ( Z=-2.99, -5.42, -4.95, -4.09, -5.05, -11.30, -8.66, -8.23, -5.64, -4.75, -2.12 and -10.75, respectively, all P<0.05). The differences were statistical significance. The levels of IL-2 ( r=0.149, P=0.037), IL-6 ( r=0.223, P=0.002), IL-8 ( r=0.159, P=0.026), and IL-10 ( r=0.188, P=0.009) in patients with sepsis were positively correlated with SOFA scores. The AUC of CRP in diagnosing sepsis was 0.989 with the sensitivity of 97.4% and the specificity of 100.0%. The AUC of IL-6 in diagnosing sepsis was 0.953, with the sensitivity of 93.3% and the specificity of 97.1%, and the AUC of IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-8, IL-10, IL-12P70, IL-17A, and TNF-α were 0.620, 0.718, 0.699, 0.665, 0.703, 0.850, 0.836, 0.727, 0.691, and 0.574, respectively.The AUC of the 11 cytokines were all lower than that of CRP, and the differences were all statistically significant ( Z=2.34, 10.24, 8.03, 8.08, 10.64, 8.70, 5.91, 5.17, 8.91, 9.25 and 4.10, respectively, all P<0.05).During the dynamic monitoring, the IFN-γ and IL-1β levels in the non-survival group increased gradually. The IFN-γ levels on the 14th and 21st day in the non-survival group were higher than those in the survival group ( Z=0.53 and 0.08, respectively, both P<0.05), and IL-1β levels on the 14th, 21st, and 28th days were also higher than those in the survival group ( Z=0.03, 0.26 and 0.31, respectively, all P<0.05). IL-6 and IL-8 levels reached their peaks on the 14th day, which were significantly higher than those in the survival group ( Z=0.01 and 0.02, respectively, both P<0.05), and then decreased, and the differences were all statistically significant. Conclusions:The levels of IFN-γ and IL-1β in the non-survival sepsis patients show a gradually increasing trend. The dynamic changes of IL-6 have certain significance for the prediction of disease severity and prognosis evaluation in sepsis.

Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)and lymphocyte to monocyte ratio(LMR)in the diagnosis and prognosis of patients with sepsis.Methods From January 2022 to December 2022,patients in the First Affiliated Hospital of Soochow University were recruited in this study,including 47 patients with sepsis(sepsis group),31 with infection but not diagnosed as sepsis(infection group),and 25 healthy individuals(control group)were simultaneously chosen.Patients with sepsis were assigned to non-shock group(32 cases)or shock group(15 cases),survivors group(38 cases)or deaths group(9 cases).Procalcitonin(PCT),C-reactive protein(CRP)and routine blood tests were analyzed and compared between groups.Spearman's correlation test was used to analyze the correlation among NLR,LMR and PCT,PCR,lymphocyte,monocyte,neutrophil,platelet and SOFA scores,the diagnostic value of NLR and LMR in sepsis was evaluated by plotting the receiver operating characteristic(ROC)curve.Results The NLR was 12.54(7.53,23.42)in sepsis group,3.85(1.83,5.64)in infection group,and 1.71(1.39,2.20)in normal control group.The corresponding LMR was 1.58(1.07,3.03),2.81(1.53,4.76),and 5.16(4.04,6.59),respectively.NLR was negatively correlated with LMR(rs=-0.469,P＜0.05).The NLR on day 7(NLR7)was 6.56(3.90,10.72)in the non-shock group and 15.20(7.53,27.31)in shock group.The corresponding △NLR7 was-1.64(-5.75,0.41)and 1.98(-0.48,13.79)in the two groups.The shock group had significantly higher △NLR7 than the non-shock group(P＜0.05).NLR7 was 7.10(4.09,12.96)in the survivors and 15.20(10.45,32.82)in the deaths group.The corresponding △NLR7 was-0.65(-5.58,1.58)and 5.02(-1.12,17.06)in the two groups.The deaths group had significantly higher △NLR7 than the survivors group(P＜0.05).The LMR on day 7(LMR7)was 2.22(1.64,3.78)in the non-shock group and 1.29(0.66,2.03)in shock group.The corresponding △LMR7 was 0.38(-0.37,1.17)and-0.19(-0.78,0.25)in the two groups.The shock group had significantly lower △LMR7 than the non-shock group(P＜0.05).LMR7 was 2.12(1.49,3.42)in the survivors group and 1.09(0.53,1.78)in the deaths group.The deaths group had significantly lower LMR7 than the survivors group(P＜0.05).The AUC of NLR was 0.959 1(95％CI:0.910 5-1.000 0)in diagnosis of sepsis.The best cut-off value was 4.16.The A UC of LMR was 0.913 6(95％CI:0.846 4-0.980 8)in diagnosis of sepsis.The best cut-off value was 3.21.Conclusions NLR and LMR can be used to evaluate the severity and prognosis of patients with sepsis.These two markers may play a role in the diagnosis of sepsis.

Factitious Disorder is a chronic and difficult-to-diagnose artificial illness characterized by the in-dividual's recurrent simulation of symptoms,deliberate self-harm to produce signs or symptoms,and a high likeli-hood of misdiagnosis and mistreatment in clinical settings.This article introduces a case of a 10-year-old girl with factitious disorder who was misdiagnosed as Henoch-Schonlein purpura in 4 medical institutions,which was the first simulated case of Henoch-Schonlein purpura in China.Based on the literature analysis of factitious disorder,the au-thor combed and analyzed the literature in order to improve clinicians'awareness of the disease and reduce misdiag-nosis and mistreatment.

Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)and lymphocyte to monocyte ratio(LMR)in the diagnosis and prognosis of patients with sepsis.Methods From January 2022 to December 2022,patients in the First Affiliated Hospital of Soochow University were recruited in this study,including 47 patients with sepsis(sepsis group),31 with infection but not diagnosed as sepsis(infection group),and 25 healthy individuals(control group)were simultaneously chosen.Patients with sepsis were assigned to non-shock group(32 cases)or shock group(15 cases),survivors group(38 cases)or deaths group(9 cases).Procalcitonin(PCT),C-reactive protein(CRP)and routine blood tests were analyzed and compared between groups.Spearman's correlation test was used to analyze the correlation among NLR,LMR and PCT,PCR,lymphocyte,monocyte,neutrophil,platelet and SOFA scores,the diagnostic value of NLR and LMR in sepsis was evaluated by plotting the receiver operating characteristic(ROC)curve.Results The NLR was 12.54(7.53,23.42)in sepsis group,3.85(1.83,5.64)in infection group,and 1.71(1.39,2.20)in normal control group.The corresponding LMR was 1.58(1.07,3.03),2.81(1.53,4.76),and 5.16(4.04,6.59),respectively.NLR was negatively correlated with LMR(rs=-0.469,P＜0.05).The NLR on day 7(NLR7)was 6.56(3.90,10.72)in the non-shock group and 15.20(7.53,27.31)in shock group.The corresponding △NLR7 was-1.64(-5.75,0.41)and 1.98(-0.48,13.79)in the two groups.The shock group had significantly higher △NLR7 than the non-shock group(P＜0.05).NLR7 was 7.10(4.09,12.96)in the survivors and 15.20(10.45,32.82)in the deaths group.The corresponding △NLR7 was-0.65(-5.58,1.58)and 5.02(-1.12,17.06)in the two groups.The deaths group had significantly higher △NLR7 than the survivors group(P＜0.05).The LMR on day 7(LMR7)was 2.22(1.64,3.78)in the non-shock group and 1.29(0.66,2.03)in shock group.The corresponding △LMR7 was 0.38(-0.37,1.17)and-0.19(-0.78,0.25)in the two groups.The shock group had significantly lower △LMR7 than the non-shock group(P＜0.05).LMR7 was 2.12(1.49,3.42)in the survivors group and 1.09(0.53,1.78)in the deaths group.The deaths group had significantly lower LMR7 than the survivors group(P＜0.05).The AUC of NLR was 0.959 1(95％CI:0.910 5-1.000 0)in diagnosis of sepsis.The best cut-off value was 4.16.The A UC of LMR was 0.913 6(95％CI:0.846 4-0.980 8)in diagnosis of sepsis.The best cut-off value was 3.21.Conclusions NLR and LMR can be used to evaluate the severity and prognosis of patients with sepsis.These two markers may play a role in the diagnosis of sepsis.

Objective:To investigate the dynamic changes of cytokine levels in patients with sepsis and to identify potential biomarkers for evaluating the prognosis of the disease.Methods:A total of 195 patients with sepsis hospitalized at the Department of Infectious Diseases and the Department of Critical Care Medicine of the First Affiliated Hospital of Soochow University from August 2022 to October 2024 were recruited, and 70 healthy individuals undergoing physical examinations were recruited as the healthy control group. The levels of 11 cytokines, including interferon γ (IFN-γ), interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17A, tumor necrosis factor α (TNF-α) and C-reactive protein (CRP) were compared between the sepsis patients and the healthy controls. Spearman correlation analysis was used to assess the correlation between cytokine levels and sequential organ failure assessment (SOFA) scores in sepsis patients. Receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated to evaluate the diagnostic value of cytokines for sepsis. Delong test was used to compare AUC. Based on the 28-day survival outcomes, the sepsis patients were categorized into non-survival group and survival group. The levels of the 11 cytokines in patients on the 1st, 3rd, 7th, 14th, 21st and 28th days after confirmed sepsis were dynamically monitored, and their change characteristics were analyzed. Mann-Whitney U test was used for statistical comparison. Results:The age of the 195 patients with sepsis was 68.0 (55.0, 76.0) years old, including 124 males (63.6%), 64 died and 131 survived.The levels of IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12P70, IL-17A, TNF-α, CRP in the sepsis group were all higher than those in the healthy control group ( Z=-2.99, -5.42, -4.95, -4.09, -5.05, -11.30, -8.66, -8.23, -5.64, -4.75, -2.12 and -10.75, respectively, all P<0.05). The differences were statistical significance. The levels of IL-2 ( r=0.149, P=0.037), IL-6 ( r=0.223, P=0.002), IL-8 ( r=0.159, P=0.026), and IL-10 ( r=0.188, P=0.009) in patients with sepsis were positively correlated with SOFA scores. The AUC of CRP in diagnosing sepsis was 0.989 with the sensitivity of 97.4% and the specificity of 100.0%. The AUC of IL-6 in diagnosing sepsis was 0.953, with the sensitivity of 93.3% and the specificity of 97.1%, and the AUC of IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-8, IL-10, IL-12P70, IL-17A, and TNF-α were 0.620, 0.718, 0.699, 0.665, 0.703, 0.850, 0.836, 0.727, 0.691, and 0.574, respectively.The AUC of the 11 cytokines were all lower than that of CRP, and the differences were all statistically significant ( Z=2.34, 10.24, 8.03, 8.08, 10.64, 8.70, 5.91, 5.17, 8.91, 9.25 and 4.10, respectively, all P<0.05).During the dynamic monitoring, the IFN-γ and IL-1β levels in the non-survival group increased gradually. The IFN-γ levels on the 14th and 21st day in the non-survival group were higher than those in the survival group ( Z=0.53 and 0.08, respectively, both P<0.05), and IL-1β levels on the 14th, 21st, and 28th days were also higher than those in the survival group ( Z=0.03, 0.26 and 0.31, respectively, all P<0.05). IL-6 and IL-8 levels reached their peaks on the 14th day, which were significantly higher than those in the survival group ( Z=0.01 and 0.02, respectively, both P<0.05), and then decreased, and the differences were all statistically significant. Conclusions:The levels of IFN-γ and IL-1β in the non-survival sepsis patients show a gradually increasing trend. The dynamic changes of IL-6 have certain significance for the prediction of disease severity and prognosis evaluation in sepsis.

Objective:To study the relationships between host immune function in the tumor microenvironment (TME) and early-stage lung cancer progression. Methods:A total of 216 patients with early-stage lung cancer admitted to Zhumadian Central Hospital between Febru-ary 2020 and April 2023 were included to analyze immune cell presence in cancer and adjacent tissues. The patients were assigned into a re-lapse group (41 cases) and a non-recurrence group (175 cases) based on their relapse status. Baseline data and immune cell expression in the two groups were compared to analyze the influence and predictive value of immune cell prevalence on lung cancer recurrence. Results:The proportion of CD56+natural killer (NK) cells was lower in cancer tissues than that in adjacent tissues. The infiltration rates of CD68+tu-mor-associated macrophages (TAMs) and CD163+TAMs,as well as the proportions of CD4+and CD8+T cells,were higher in adjacent tissues than in cancerous tissues (P<0.05). In the recurrence group,the maximum tumor diameter,proportion of patients with micro-papillary struc-tures,CD68+TAM and CD163+TAM infiltration rates,and CD8+T cell proportion were higher than those in the non-recurrent group,while the CD56+NK cell positive rate was lower (P<0.05). After correction,CD56+NK positivity,elevated CD68+TAM and CD163+TAM infiltration,and CD8+T cell proportion were independent factors associated with early-stage lung cancer recurrence (P<0.05). The AUC for predicting early-stage lung cancer recurrence using CD56+NK positivity+high CD68+TAM and CD163+TAM infiltration+proportion of CD8+T cells was 0.949,which was higher than that of each individual immune marker (P<0.05). Conclusions:Host immune function in the TME in patients with early lung cancer correlates with disease progression. The combination of high CD56+NK+,CD68+TAM infiltration,high CD163+TAM infiltration,and CD8+T-cell ratio can improve prediction efficiency for early lung cancer recurrence.

Objective:To evaluate the prognostic value of the lung immune prognostic index (LIPI) combined with the prognostic nutritional index (PNI) for predicting immunotherapy response in patients with non-small cell lung cancer (NSCLC). Methods:A total of 106 patients with NSCLC who received immunotherapy in Zhumadian Central Hospital from January 2022 to December 2023 were selected and assigned into a response group (n=72) and non-response group (n=34) according to their response after immunotherapy. Clinical data,LIPI,and PNI of the two groups were compared to analyze the relationship between LIPI and PNI with clinicopathological features and treatment response and to analyze the predictive value of LIPI and PNI in the immunotherapy response of patients with NSCLC. The precision-recall (PR) curve was used to evaluate combined predictive values. Results:The TNM stage,lymph node metastasis,and distant metastasis were significantly different between the two groups (P<0.05). The proportion of patients with good LIPI in the non-response group was lower than that in the response group,the proportion of patients with poor LIPI was higher than that in the response group (P<0.05),and the PNI in the non-re-sponse group was lower than that in the response group (P<0.05). LIPI positively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response,whereas PNI negatively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response (P<0.05). Logistic regression analysis showed that LIPI and PNI were still significantly correlated with immunotherapy re-sponse in patients with NSCLC (P<0.05). The area under the curve (AUC) of the combined prediction of LIPI and PNI was 0.936,which was significantly higher than that of LIPI and PNI alone (P<0.05). The PR curve showed an AUC of 0.852,indicating that the combined prediction had high recall and accuracy rates. Conclusions:LIPI and PNI are closely related to TNM stage,lymph node metastasis,distant metastasis,and treatment response in patients with NSCLC. The combination of LIPI and PNI has a high reference value for predicting immunotherapy response in patients with NSCLC.

Objective:To study the relationships between host immune function in the tumor microenvironment (TME) and early-stage lung cancer progression. Methods:A total of 216 patients with early-stage lung cancer admitted to Zhumadian Central Hospital between Febru-ary 2020 and April 2023 were included to analyze immune cell presence in cancer and adjacent tissues. The patients were assigned into a re-lapse group (41 cases) and a non-recurrence group (175 cases) based on their relapse status. Baseline data and immune cell expression in the two groups were compared to analyze the influence and predictive value of immune cell prevalence on lung cancer recurrence. Results:The proportion of CD56+natural killer (NK) cells was lower in cancer tissues than that in adjacent tissues. The infiltration rates of CD68+tu-mor-associated macrophages (TAMs) and CD163+TAMs,as well as the proportions of CD4+and CD8+T cells,were higher in adjacent tissues than in cancerous tissues (P<0.05). In the recurrence group,the maximum tumor diameter,proportion of patients with micro-papillary struc-tures,CD68+TAM and CD163+TAM infiltration rates,and CD8+T cell proportion were higher than those in the non-recurrent group,while the CD56+NK cell positive rate was lower (P<0.05). After correction,CD56+NK positivity,elevated CD68+TAM and CD163+TAM infiltration,and CD8+T cell proportion were independent factors associated with early-stage lung cancer recurrence (P<0.05). The AUC for predicting early-stage lung cancer recurrence using CD56+NK positivity+high CD68+TAM and CD163+TAM infiltration+proportion of CD8+T cells was 0.949,which was higher than that of each individual immune marker (P<0.05). Conclusions:Host immune function in the TME in patients with early lung cancer correlates with disease progression. The combination of high CD56+NK+,CD68+TAM infiltration,high CD163+TAM infiltration,and CD8+T-cell ratio can improve prediction efficiency for early lung cancer recurrence.

Objective:To evaluate the prognostic value of the lung immune prognostic index (LIPI) combined with the prognostic nutritional index (PNI) for predicting immunotherapy response in patients with non-small cell lung cancer (NSCLC). Methods:A total of 106 patients with NSCLC who received immunotherapy in Zhumadian Central Hospital from January 2022 to December 2023 were selected and assigned into a response group (n=72) and non-response group (n=34) according to their response after immunotherapy. Clinical data,LIPI,and PNI of the two groups were compared to analyze the relationship between LIPI and PNI with clinicopathological features and treatment response and to analyze the predictive value of LIPI and PNI in the immunotherapy response of patients with NSCLC. The precision-recall (PR) curve was used to evaluate combined predictive values. Results:The TNM stage,lymph node metastasis,and distant metastasis were significantly different between the two groups (P<0.05). The proportion of patients with good LIPI in the non-response group was lower than that in the response group,the proportion of patients with poor LIPI was higher than that in the response group (P<0.05),and the PNI in the non-re-sponse group was lower than that in the response group (P<0.05). LIPI positively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response,whereas PNI negatively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response (P<0.05). Logistic regression analysis showed that LIPI and PNI were still significantly correlated with immunotherapy re-sponse in patients with NSCLC (P<0.05). The area under the curve (AUC) of the combined prediction of LIPI and PNI was 0.936,which was significantly higher than that of LIPI and PNI alone (P<0.05). The PR curve showed an AUC of 0.852,indicating that the combined prediction had high recall and accuracy rates. Conclusions:LIPI and PNI are closely related to TNM stage,lymph node metastasis,distant metastasis,and treatment response in patients with NSCLC. The combination of LIPI and PNI has a high reference value for predicting immunotherapy response in patients with NSCLC.