This paper summarizes Professor WANG Xixing's clinical experience in treating immune checkpoint inhibitor-related pneumonitis （CIP） based on the theory of "cough attributed to the five zang （脏） organs". Cough is a common predominant symptom of CIP. According to the theory of "cough attributed to the five zang organs"， drug toxicity triggers cancer toxin， leading to disharmony among the five zang organs， and then lung failing to diffuse and govern descent as the core pathogenesis. Therefore， treatment should focus on harmonizing the five zang organs to restore the normal function of lung qi to diffuse and govern descent. In clinical practice， CIP can be classified into four syndrome patterns， including lung yin depletion， deficiency of both the lung and the spleen with phlegm-dampness， liver fire harassing the lung， and lung-kidney yin deficiency. Correspondingly， Chaimai Jinluo Runfei Decoction （柴麦金络润肺汤） is used to nourish yin and moisten the lung； Qigui Peitu Huayin Decoction （芪桂培土化饮汤） is used to fortify the spleen and tonify the lung， resolve dampness and dispel phlegm； Chaidan Shuyu Runjin Decoction （柴丹疏郁润金汤） is used to drain liver and clear the lung； and Dimai Jinshui Xiangsheng Decoction （地脉金水相生汤） is used to nourish the kidney and moisten the lung.

ObjectiveTo investigate the current awareness and optimization recommendations on pneumonia with unknown etiology (PUE) surveillance among Shanghai healthcare professionals, and to provide evidence for the improvement of the surveillance system. MethodsIn December 2024, healthcare professional participants from diverse medical and health institutions were randomly selected within each stratum using a stratified cluster sampling method in all 16 districts of Shanghai for questionnaire surveys on their knowledge and suggestions for optimization of the PUE surveillance system. Descriptive statistics analyses, multivariate logistic regressions, and content analyses were used for data analyses. ResultsA total of 385 survey subjects were involved in the study, including 119 professional staffs from disease prevention and control centers and 266 from medical institutions. Those who understood the case definition for PUE correctly accounted for 67.01% (258/385). Multivariate regression model analyses showed that female gender (aOR=2.22, 95%CI: 1.36‒3.66), professionals from disease control institutions (aOR=2.02, 95%CI: 1.12‒3.72), and those who self-assessed as being familiar with the monitoring system (aOR=2.18, 95%CI:1.23‒3.89) had better understanding of the definition. Overall, 89.61% (345/385) of the survey subjects acknowledged the necessity of the surveillance system. Small number of cases meeting the case definition (54.46%, 214/379), insufficient diagnostic awareness (39.84%, 151/379), and lack of incentives for case reporting (29.29%, 111/379) were major problems for the current surveillance system, with variations observed across different types of institutions. Suggested segments for optimizing the surveillance system included monitoring purpose, case definition, form of monitoring and reporting procedure, organization mechanism, and epidemiological investigation and response. ConclusionThe necessity of PUE surveillance is commonly recognized among healthcare workers. However, the existing system falls short in terms of mastery of case definition and overall surveillance adaptability. There is an urgent need for optimization and improvement to enhance the capacity for preventing and controlling emerging and sudden respiratory infectious diseases.

Objective To explore the materials and embolization technique employed in precision superselective transarterial embolization for the treatment of acute renal hemorrhage.Methods The data of 50 patients with acute renal hemorrhage who underwent precision superselective transarterial embolization were retrospectively analyzed.The angiographic findings,embolic materials and embolization methods were collected.The main outcome measures were technical success rate,clinical efficacy and renal function.Results In this study,44 patients had positive angiographic findings.The clinical success rate was 90.9%(40/44)after first precision superselective transarterial embolization.In patients of failure of first embolization,3 patients underwent successful repeated embolization and 1 patient refused repeat embolization.Empirical embolization was carried out among the 6 patients with negative angiographic findings.In 32 patients with complete data for estimated glomerular filtration rate(eGFR),there was no statistical difference before and those measured 7 d after precision superselective transarterial embolization.Conclusion Precision superselective transarterial embolization technique is an effective method for the treatment of acute renal hemorrhage,preserving renal function.

Objective To evaluate the safety and efficacy of valve-in-valve transcatheter mitral valve replacement(ViV-TMVR)in patients with bioprosthetic valve degeneration who are at high surgical risk.Methods This study is a multi-center,retrospective cohort analysis of 20 consecutive patients who underwent transseptal ViV-TMVR using the Edwards SAPIEN 3 transcatheter heart valve(THV).The primary endpoints include technical success and procedural success,both defined according to the Mitral Valve Academic Research Consortium(MVARC)criteria,as well as mortality and functional change assessed based on New York Heart Association(NYHA)classification at 30-days and six months post-procedure.Clinical follow-up assessments are conducted at 30-days and six months.Results From February 2021 to October 2022,a total of 20 patients with symptoms of bioprosthetic valve degeneration were enrolled across nine sites in China.The patients had a mean age of(73.5±5.5)years,with 85.0％being females and 70.0％classified as NYHA class Ⅲ/Ⅳ.The study achieved a 100.0％technical success rate and a 90.0％procedural success rate finally.All patients remained alive during the 30-day follow-up period.However,six months post-intervention,two patients(10.0％)were re-hospitalized due to heart failure,and sadly,one of them(5.0％)died.None of the patients reported any adverse events related to ViV-TMVR during the follow-up period.Notably,there was a significant improvement in NYHA class compared to baseline(P=0.0004)at six-month follow-ups.Conclusions The transseptal ViV-TMVR technique proved to be highly successful and was associated with significant improvement in NYHA class function.These findings strongly suggest that it serves as a safe and efficient treatment alternative for high-risk patients suffering from bioprosthetic valve degeneration.

Objective:To explore the learning patterns of resident physicians in anesthesiology when performing tracheal intubation guided by Shikani laryngoscope, and provide a reference for the skill training of clinical anesthesiologists.Methods:From August 2023 to December 2024, a total of 19 resident physicians specializing in anesthesiology participated in this study at Peking University Third Hospital. All resident physicians received standardized training on clinical skills. None of them had received specialized training in Shikani laryngoscope-guided tracheal intubation. The relevant theoretical teaching and practical guidance were provided by the same senior attending physician throughout the study. A flipped-classroom teaching model was adopted, and each student was instructed by the teaching physician to perform the procedure on 15 cases in chronological order, resulting in a total of 285 cases. The cumulative sum (CUSUM) value for each tracheal intubation was calculated, and the learning curve was plotted using R software. A fourth-order polynomial nonlinear regression model was used to fit the curve and estimate the 95% confidence interval of the learning curve. The first-order derivative function of the regression model was further analyzed to reveal the dynamic changes in proficiency with the number of training sessions. The CUSUM curve was segmented using the maximum statistics test to identify the optimal breakpoint.Results:The maximum selection test revealed that the breakpoint for the increase in CUSUM level was at the eighth attempt.Conclusions:Resident physicians in anesthesiology can master Shikani laryngoscope-guided tracheal intubation after eight standardized training sessions. Moreover, the participants showed high satisfaction with the flipped-classroom teaching model.

Objective To explore the materials and embolization technique employed in precision superselective transarterial embolization for the treatment of acute renal hemorrhage.Methods The data of 50 patients with acute renal hemorrhage who underwent precision superselective transarterial embolization were retrospectively analyzed.The angiographic findings,embolic materials and embolization methods were collected.The main outcome measures were technical success rate,clinical efficacy and renal function.Results In this study,44 patients had positive angiographic findings.The clinical success rate was 90.9%(40/44)after first precision superselective transarterial embolization.In patients of failure of first embolization,3 patients underwent successful repeated embolization and 1 patient refused repeat embolization.Empirical embolization was carried out among the 6 patients with negative angiographic findings.In 32 patients with complete data for estimated glomerular filtration rate(eGFR),there was no statistical difference before and those measured 7 d after precision superselective transarterial embolization.Conclusion Precision superselective transarterial embolization technique is an effective method for the treatment of acute renal hemorrhage,preserving renal function.

Objective To evaluate the safety and efficacy of valve-in-valve transcatheter mitral valve replacement(ViV-TMVR)in patients with bioprosthetic valve degeneration who are at high surgical risk.Methods This study is a multi-center,retrospective cohort analysis of 20 consecutive patients who underwent transseptal ViV-TMVR using the Edwards SAPIEN 3 transcatheter heart valve(THV).The primary endpoints include technical success and procedural success,both defined according to the Mitral Valve Academic Research Consortium(MVARC)criteria,as well as mortality and functional change assessed based on New York Heart Association(NYHA)classification at 30-days and six months post-procedure.Clinical follow-up assessments are conducted at 30-days and six months.Results From February 2021 to October 2022,a total of 20 patients with symptoms of bioprosthetic valve degeneration were enrolled across nine sites in China.The patients had a mean age of(73.5±5.5)years,with 85.0％being females and 70.0％classified as NYHA class Ⅲ/Ⅳ.The study achieved a 100.0％technical success rate and a 90.0％procedural success rate finally.All patients remained alive during the 30-day follow-up period.However,six months post-intervention,two patients(10.0％)were re-hospitalized due to heart failure,and sadly,one of them(5.0％)died.None of the patients reported any adverse events related to ViV-TMVR during the follow-up period.Notably,there was a significant improvement in NYHA class compared to baseline(P=0.0004)at six-month follow-ups.Conclusions The transseptal ViV-TMVR technique proved to be highly successful and was associated with significant improvement in NYHA class function.These findings strongly suggest that it serves as a safe and efficient treatment alternative for high-risk patients suffering from bioprosthetic valve degeneration.

The accelerated advancement of medical informatization has increasingly highlighted the limitations of tradi-tional PC terminals in terms of data security,operational efficiency,and resource integration.Cloud desktop technology has e-merged as a viable solution for hospital informatization,offering both cost-effectiveness and operational efficiency while fulfilling domestic substitution requirements.This study implemented a comprehensive cloud desktop management system by utilizing exist-ing hospital IT infrastructure supplemented with newly deployed cloud desktop servers and terminal devices.The system signifi-cantly improved hardware/software resource utilization and management efficiency,delivering stable and high-performance cloud desktop services to meet growing clinical and administrative demands.This study showcased a hospital cloud desktop deployment as a case study,exploring healthcare informatization solutions based on cloud desktop technology.The technical architecture,de-ployment strategy,implementation pathway,and effectiveness evaluation were analyzed to investigate the application of cloud desktop technology in healthcare settings.The results indicate that cloud desktop technology can significantly improve operational efficiency,reduce maintenance costs,and provide foundational support for smart hospital construction.

Objective To investigate the value of multimodal model integrating digital mammography(MG)and MRI radiomics features for preoperative prediction of lymphovascular invasion(LVI)status in breast cancer.Methods The clinical and imaging data from 336 patients with pathologically confirmed invasive breast cancer were retrospectively analyzed and randomly divided into a training group(235 cases)and a test group(101 cases)according to the ratio of 7∶3.Feature dimensionality reduction was carried out by Pearson correlation analysis followed by least absolute shrinkage and selection operator(LASSO)regression.Radiomics models were constructed based on MG craniocaudal(CC),dynamic contrast enhancement(DCE),T2 WI,and integrated MRI sequences;a multimodal model was further developed by incorporating clinical high-risk factors.The predictive efficiency of each model was evaluated by plotting receiver operating characteristic(ROC)curve.Results The ROC curve analysis showed that the multimodal model performed the best predictive efficiency,with area under the curve(AUC)of 0.989 and 0.861,accuracy of 0.949 and 0.782,sensitivity of 0.923 and 0.828,and specificity of 0.962 and 0.764 in the training group and test group respectively.Conclusion The multimodal model,integrating MG and MRI radiomics features,show optimal performance and can be served as a preoperative prediction of LVI status in breast cancer.

Objective:To investigate the clinicopathological and genetic features of infantile rhabdomyofibrosarcoma (IRFS) with EGFR kinase domain duplication (EGFR-KDD).Methods:The clinical, morphological and immunohistochemical features of three IRFS with EGFR-KDD diagnosed from January 2022 to January 2024 at Department of Pathology, Foshan Traditional Chinese Medicine Hospital, Foshan, China were retrospectively analyzed using PCR or next generation sequencing technique; and related literature was reviewed.Results:There were 1 male and 2 females, aged at presentation ranging from 1 to 4 years. The tumor occurred in the left thigh, right maxillofacial region, and right popliteal space. The presenting symptom was a painless mass which was accidentally discovered. The maximum diameter of tumors ranged from 3 to 5 cm. Microscopically, the tumors were poorly defined and composed of relatively monomorphic spindle cells, arranged in diffuse, fascicular growth patterns, with moderate pale eosinophilic cytoplasm. Mitoses were abundant. A few round rhabdomyoblastic tumor cells with abundant eosinophilic cytoplasm were found. There was no evidence of hemorrhage or necrosis. The tumor cells expressed vimentin, SMA, MSA, desmin, MyoD1 and myogenin; and the Ki-67 proliferation index was 10%-60%. RT-PCR showed EGFR-KDD in all three cases. Gene fusion was detected in three cases based on next generation sequencing, but only one case had EGFR-KDD. Follow-up data for 12 to 36 months showed two patients died of the disease and one patient was alive without recurrences and metastasis.Conclusions:IRFS is a rare soft tissue tumor that resembles infantile fibrosarcoma but has immunohistochemical evidence of rhabdomyoblastic differentiation. It more commonly occurs in infants and tends to appear in limbs and torso with poor prognosis. Aggressive multimodality treatment is recommended for these patients. EGFR-KDD may be a genetic driver to IRFS. Clinical response to EGFR targeted therapy might be promising in the future.