[摘 要] 目的：探讨复发/转移性鼻咽癌（NPC）接受含PD-1单抗免疫治疗的临床特征和预后影响因素。方法：回顾性分析2019年3月至2024年7月期间南部战区总医院确诊的95例NPC患者的临床资料和外周血生化及免疫学指标。预后分析采用Kaplan-Meier曲线，组间比较使用Log-rank检验，采用Cox比例风险模型进行单因素和多因素分析。结果：95例患者中男性81例，女性14例，中位年龄49.72岁（16~74岁），Ⅳ期91例（95.79%），所有患者均采用免疫治疗，联合或不联合化疗方案治疗，中位无进展生存期（mPFS）为10.5个月，客观缓解率（ORR）70.53%，疾病控制率（DCR）89.47%，接受含铂治疗方案患者PFS相对更长，且差异有统计学意义。紫杉醇 + 顺铂 + 氟尿嘧啶（TPF）对比吉西他滨 + 顺铂（GP）和紫杉醇 + 顺铂（TP）显示出更长的PFS，但差异无统计学意义。不同PD-1单抗治疗组间的PFS未显示出有统计学意义的差异。单因素及多因素Cox回归分析结果显示，肿瘤复发状态、初始血浆EBV感染状态、治疗周期数、基线外周血SII是复发/转移性NPC患者接受PD-1抑制剂治疗疗效预测的独立相关因素（均P < 0.05），并且非复发患者、初始血浆EBV DNA阳性、接受 ≥ 4治疗周期、基线外周血SII < 772.81的患者接受PD-1抑制剂治疗预后相对更好。结论：在接受PD-1抑制剂治疗的复发/转移性NPC患者中，非复发患者、初始血浆EBV DNA阳性、≥ 4治疗周期且外周血SII < 772.81者PFS相对更长，可早期识别免疫治疗效果不佳患者并精准干预。

OBJECTIVE: The self-defined multidisciplinary (endocrinology, vascular surgery, and orthopedics) scoring system (EMO scoring system for short) was designed. The feasibility of the EMO scoring system to guide the proximal tibial transverse transport (TTT) for diabetic foot wounds was preliminarily explored. METHODS: Based on the current commonly used clinical criteria for diabetic foot judgment, expert consensus, guidelines, and related research progress in the treatment of diabetic foot wounds, combined with clinical experience, a set of EMO scoring systems including endocrinology, vascular surgery, and orthopedics was formulated. The criteria for selecting conservative treatment, TTT after baseline improvement, and TTT based on scoring results was proposed. A total of 56 patients with diabetic foot wounds who were admitted between September 2017 and July 2022 and met the selection criteria was taken as the study subjects. Among them, 28 patients were treated with TTT and 28 patients were treated conservatively. The patients were graded according to the EMO scoring system, the corresponding treatment methods were selected, and the actual treatment methods and results of the patients were compared. RESULTS: The EMO scoring system was formed through literature retrieval and clinical experiences. The system included three criteria, namely endocrinology (E), macrovascular disease (M), and orthopedics (O), which were divided into multiple subtypes according to the relevant evaluation items, and finally the diabetic foot wound was divided into 8 types, which correspondingly selected TTT, TTT after baseline improvement, and conservative treatment. All 56 patients were followed up 12 months after treatment. Among them, the wound healing rate of the TTT group was 85.71% (24/28), which was higher than that of the conservative treatment group [53.57% (15/28)]. At 12 week after treatment, CT angiography showed that there were more small blood vessels in the wound and ipsilateral limb in TTT group than in the conservative treatment group. Based on the EMO scoring system, 14 of the 56 patients needed conservative treatment, 29 patients needed TTT, and 13 patients needed TTT after baseline improvement. Compared with the clinical data of the patients, the wound healing rate of the patients judged to be TTT was 75.86% (22/29), of which 21 cases were actually treated with TTT, and the healing rate was 90.48%; 8 patients were treated conservatively, and the healing rate was 37.50%. The wound healing rate of the patients judged to be conservative treatment was 92.86% (13/14), of which 1 case was actually treated with TTT, and the healing rate was 100%; 13 cases were treated conservatively, and the healing rate was 92.31%; 1 case experienced minor amputation. The wound healing rate of the patients judged to TTT after baseline improvement was only 30.77% (4/13), of which 6 cases were actually treated with TTT, and the healing rate was 66.67%; 7 cases were treated conservatively, and the healing rate was 0. CONCLUSION EMO scoring system can comprehensively evaluate the diabetic foot wounds, and make personalized judgment on whether TTT treatment is feasible, so as to improve the level of diabetic foot wound treatment and the prognosis of patients.
Humans ; Diabetic Foot/therapy* ; Feasibility Studies ; Male ; Female ; Middle Aged ; Aged ; Tibia/surgery* ; Wound Healing ; Adult ; Treatment Outcome ; Conservative Treatment

Objective Methyltransferase 3(METTL3)mediated N6-methyladenosine(m6A)methylation modifica-tion of transient receptor potential cation channel subfamily M member 7(TRPM7)regulates ferroptosis and malig-nant progression in cervical cancer(CESC).Methods Totally 40 patients with cervical cancer were collected.Cer-vical cancer tissues and adjacent normal tissues(≥3 cm from the edge of the tumor tissue)were sampled at opera-tion and then divided into experimental group and control group,respectively.RT-qPCR and Western blot were used to detect the differences in TRPM7 mRNA and protein expression between the two groups.TRPM7-interfering cell lines were constructed to investigate the effects of TRPM7 on CESC cells.Cell proliferation and apoptosis were assessed using 5-ethynyl-2'-deoxyuridine(EdU)assay and flow cytometry,respectively.Transwell chamber assays were employed to evaluate cell invasion and migration capabilities.The levels of ferroptosis in CESC cells were measured using kits for reactive oxygen species(ROS),malondialdehyde(MDA),glutathione(GSH),and Fe2+.Bioinformatics tools were utilized to predict methyltransferases associated with TRPM7.The interaction between METTL3 and TRPM7 was examined through RNA immunoprecipitation(RIP)and methylated RNA immunoprecip-itation quantitative PCR(Me-RIP qPCR).The effect of METTL3 on the stability of TRPM7 expression was assessed using actinomycin D assay.Results TRPM7 was highly expressed in CESC tissue and cells.Knockdown of TRPM7 significantly inhibited cell proliferation,promoted cell apoptosis,suppressed cell migration and invasion capabilities,and enhanced ferroptosis levels(P＜0.05).Bioinformatics predictions suggested that METTL3 might act as a methyltransferase for TRPM7.Interference with METTL3 gene expression significantly reduced TRPM7 pro-tein levels,decreased TRPM7 m6A modification levels,and impaired TRPM7 gene stability(P＜0.05).Conclusions METTL3 regulates CESC proliferation,apoptosis,migration,invasion,and ferroptosis by m6A meth-ylation modification of the TRPM7 gene.

BACKGROUND:The regulatory mechanisms of acupotomy intervention for knee osteoarthritis at a transcriptome level are not well understood despite its proven clinical efficacy.OBJECTIVE:Using acupotomy therapy in a rat model of knee osteoarthritis,to conduct transcriptome sequencing and bioinformatics analysis on cartilage samples,along with validation,and to reveal the molecular regulatory mechanisms involved in this therapy for knee osteoarthritis in rats.METHODS:Forty-eight Sprague-Dawley rats were selected and divided into three groups by random number table method,acupotomy group,model group,and sham operation group,with 16 rats in each group.Osteoarthritis models were induced by medial meniscus instability in the acupotomy group and model group.After successful modeling,acupotomy group rats were treated with acupotomy once a week,for 4 weeks in total.After the intervention,cartilage samples from the rat's knee joint were stained with hematoxylin-eosin staining and safranin O-fast green staining,evaluated by Mankin scores,and underwent MicroCT scanning.Serum inflammatory factor levels were detected by Elisa.Transcriptome sequencing was performed on the remaining cartilage samples,and the data were analyzed using R software to identify differential gene expression levels among the groups.Core targets were screened through protein-protein interaction network and Cytoscape and validated using RT-qPCR.RESULTS AND CONCLUSION:Compared with the sham operation group,rats in the model group had rough and uneven articular cartilage surfaces,narrowed joint spaces,destroyed articular surface structures,elevated Mankin scores,and significant increases in serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase 13(P<0.05).Compared with the model group,rats in the acupotomy group had smoother articular cartilage surfaces,wider joint spaces,slightly irregular articular surfaces,lower Mankin scores,and significantly lower serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase-13(P<0.05).Gene ontology and Kyoto genome and genome encyclopedia analyses involved proteolytic metabolism,autophagy,mitogen-activated protein kinase,nuclear factor kB,and Wnt signaling pathways.Protein-protein interaction network and Cytoscape screened for four key genes,including ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.The mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the model group was lower than that of the sham operation group(P<0.05),while the mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the acupotomy group was higher than that in the model group(P<0.05).To conclude,acupotomy treatment of knee osteoarthritis in rats may act on signaling pathways such as MAPK,nuclear factor kB,and Wnt to promote cartilage repair,and is closely related to the expression of genes associated with ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.

BACKGROUND:The regulatory mechanisms of acupotomy intervention for knee osteoarthritis at a transcriptome level are not well understood despite its proven clinical efficacy.OBJECTIVE:Using acupotomy therapy in a rat model of knee osteoarthritis,to conduct transcriptome sequencing and bioinformatics analysis on cartilage samples,along with validation,and to reveal the molecular regulatory mechanisms involved in this therapy for knee osteoarthritis in rats.METHODS:Forty-eight Sprague-Dawley rats were selected and divided into three groups by random number table method,acupotomy group,model group,and sham operation group,with 16 rats in each group.Osteoarthritis models were induced by medial meniscus instability in the acupotomy group and model group.After successful modeling,acupotomy group rats were treated with acupotomy once a week,for 4 weeks in total.After the intervention,cartilage samples from the rat's knee joint were stained with hematoxylin-eosin staining and safranin O-fast green staining,evaluated by Mankin scores,and underwent MicroCT scanning.Serum inflammatory factor levels were detected by Elisa.Transcriptome sequencing was performed on the remaining cartilage samples,and the data were analyzed using R software to identify differential gene expression levels among the groups.Core targets were screened through protein-protein interaction network and Cytoscape and validated using RT-qPCR.RESULTS AND CONCLUSION:Compared with the sham operation group,rats in the model group had rough and uneven articular cartilage surfaces,narrowed joint spaces,destroyed articular surface structures,elevated Mankin scores,and significant increases in serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase 13(P<0.05).Compared with the model group,rats in the acupotomy group had smoother articular cartilage surfaces,wider joint spaces,slightly irregular articular surfaces,lower Mankin scores,and significantly lower serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase-13(P<0.05).Gene ontology and Kyoto genome and genome encyclopedia analyses involved proteolytic metabolism,autophagy,mitogen-activated protein kinase,nuclear factor kB,and Wnt signaling pathways.Protein-protein interaction network and Cytoscape screened for four key genes,including ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.The mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the model group was lower than that of the sham operation group(P<0.05),while the mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the acupotomy group was higher than that in the model group(P<0.05).To conclude,acupotomy treatment of knee osteoarthritis in rats may act on signaling pathways such as MAPK,nuclear factor kB,and Wnt to promote cartilage repair,and is closely related to the expression of genes associated with ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.

ObjectiveTo investigate the application of endoscopy in obtaining the great saphenous vein （GSV） during coronary artery bypass grafting （CABG） and explore the learning curve， with a particular focus on common challenges encountered during the learning process and their impact on early clinical outcomes. MethodsA retrospective analysis was conducted on clinical data from 83 patients who underwent off-pump CABG with endoscopic GSV harvesting at the First Affiliated Hospital of Zhengzhou University from July 2013 to April 2014. Patients were categorized into four groups based on the chronological order of their hospitalization： Group A （novice group， n=20）， Group B （proficient group， n=20）， Group C （progressive group， n=20）， and Group D （mature group， n=23）. Differences in perioperative and midterm follow-up outcomes among the groups were analyzed to determine the learning curve period. ResultsThe study population had a mean age of （60.22±8.06） years and a mean body weight of （69.77±11.66） kg. Comorbidities included hypertension （24 cases）， diabetes （26 cases）， and subacute cerebral infarction （14 cases）. The novice group exhibited significantly shorter GSV length-to-harvest time ratio relative to the other three groups （P<0.001） and a significantly higher incidence of main vein damage （P=0.006）. However， there was no statistically significant difference in graft patency at the 1-year follow-up. ConclusionThorough and reliable technical training in endoscopic GSV harvesting is essential to minimize vascular injury caused by novice operators. Approximately 20 cases of hands-on experience and a careful self-analysis of procedural challenges are likely required to achieve proficiency in GSV harvesting.

Objective To understand the reliability of caloric test results through the analysis of the pod shape dia-gram types of caloric test and to provide a more accurate and reliable basis for vestibular system function evaluation.Meth-ods The results of caloric test in 528 patients from July 2021 to May 2022 in vertigo diagnosis and treatment center were analyzed.According to pod pattern and unilateral weakness(UW),the patients were divided into five groups:cold and warm test symmetrical group,left and right side asymmetry group,single value significant abnormal group,bilateral hypo-plasia group and pod morphology unable to be classified group.Unreliable data can be identified by comparing,explaining,and summarizing the results of UW of different groups,so as to reduce the interference of unreliable data to clinical diagno-sis and treatment.Results Cold and warm test symmetric group(n=439)included patients with symmetry of bilateral vestibular function(n=273)and decreased vestibular function of one side(n=166).Left and right symmetrical groups in-eluded pationts with bilateral symmetric vestibular function(n=11)and unilateral reduction(n=13).Single value signifi-cant abnormal group showed cases with unilateral vestibular function reduction(n=25)and bilateral symmetric vestibular function(n=11).Bilateral hypolasion group showed cases with bilateral symmetric vestibular function(n=25)and unilat-eral reduction(n=9).Pod morphology unclassified group(n=5)suggested varions interference factors.Conduson When the function of the peripheral vestibular is symmetrical and normal,we should be alert to the existence of temperature effect,and should consider the inspection of the perfusion apparatus and the calibration of the irrigation temperature.When the function of the peripheral vestibular shows unilateral weakness,repeating the irrigation is recommended when the single value of the caloric test significantly increases or decreases.If there is no change,repeating the irrigation at the same tem-perature in the other ear or even repeating the whole caloric test are recommended.The UW value could not truly reflect the state of peripheral vestibular function when the caoric test produces bilateral weakness.Therefore,water irrigation could be used to make a correct judgment based on the medical history and other auxiliary examinations.It is of great significance to judge the effectiveness of caloric test comprehensively by combining the morphology of pod diagram with UW value.

Objectives: . Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system. Methods: . We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables. Results: . The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16–2.57); were older (MD, 5.47 years, 95% CI, 2.44–8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33–2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56–3.44 cm); exhibited limited mouth opening (MD, −0.52 cm; 95% CI, −0.88 to −0.15 cm); had limited neck flexibility (MD, −10.05 cm; 95% CI, −14.10 to −6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07–5.48). Conclusion . We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Purpose/Significance To investigate and analyze the current situation of health industry network security in Shandong province,to pinpoint the network security weaknesses,and to improve the decision-making capacity of risk management.Method/Process Based on the data collected by questionnaires,the gap analysis of network security is conducted from the two dimensions of the level and regional distribution of medical institutions.Result/Conclusion In view of the problems faced by the informatization construction of primary medical and health institutions at the management level and the technical protection level,the specific solutions to the network security governance of health industry are put forward.