Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

Objective To construct a machine learning algorithm using biomarkers to predict the risk of sepsis-induced respiratory tract infection in order to assist clinicians in making decisions.Methods Based on the diagnostic criteria of the research subjects,and the basic clinical data of the participants were collected.The data set was randomly split into a training set(80％)and a validation set(20％).Use feature filtering algorithms to select the best subset of variables from the training set,and use this subset to construct random forest(RF),extreme gradient boosting(XGBoost),adaptive boosting(AdaBoost),Logistic regression(LR),ridge regression(Ridge),and support vector machine(SVM)classifiers.Then,evaluate the model's generalization ability using a validation dataset.Evaluate the performance of the model comprehensively through accuracy,precision,recall,and area under the curve.Results A total of 377 patients with sepsis-induced respiratory tract infection(case group)and 564 patients with respiratory tract infection(control group)were included,and 17 variables were found to be suitable for the initial model construction.Using feature screening algorithm,we found that the predictive performance of tree models(RF,XGboost,and AdaBoost)was better than that of linear models(LR,SVM,and Ridge).The AdaBoost model included 14 biomarkers,and its prediction accuracy was better than RF,XGBoost,LR,SVM,Ridge models,its precision,recall,accuracy and area under the curve were 0.90,0.84,91.75％and 0.950,respectively.The Ridge model had the worst prediction performance,with an accuracy of 82.97％,its precision,recall and area under the curve were 0.90,0.72 and 0.835 respectively.Conclusion In this study,six predictive models of sepsis-induced respiratory tract infection were developed,among which AdaBoost model could more accurately predict the risk of sepsis-induced respiratory tract infection and help to assist clinical decision-making.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

This review summarizes recent advances in neoadjuvant immunotherapy for advanced gastric cancer.Through literature search in PubMed,Web of Science,and CNKI databases from 2020 to 2023,we systematically analyzed the mechanisms,clinical applications,and bio-marker research.Programmed death-1(PD-1)inhibitors combined with chemotherapy significantly improve patient outcomes,while mi-crosatellite instability(MSI),programmed death-ligand 1(PD-L1)expression,and tumor mutational burden(TMB)have been identified as important predictive biomarkers.Multi-omics analysis shows great potential in identifying optimal responders,with pyroptosis-related gene scoring system(PRS)positively correlating with anti-tumor immune infiltration.Metabolic reprogramming and epigenetic regulation in the tumor microenvironment play key roles in immune evasion,while emerging targets such as Claudin 18.2 and combination targeting strategies further enhance therapeutic efficacy.Despite significant progress,precise patient selection and overcoming resistance mechan-isms remain major challenges.Future research should focus on biomarker validation,personalized treatment strategy development,tumor microenvironment dynamic analysis,and novel combination therapy exploration to improve clinical outcomes.

Objective To construct a machine learning algorithm using biomarkers to predict the risk of sepsis-induced respiratory tract infection in order to assist clinicians in making decisions.Methods Based on the diagnostic criteria of the research subjects,and the basic clinical data of the participants were collected.The data set was randomly split into a training set(80％)and a validation set(20％).Use feature filtering algorithms to select the best subset of variables from the training set,and use this subset to construct random forest(RF),extreme gradient boosting(XGBoost),adaptive boosting(AdaBoost),Logistic regression(LR),ridge regression(Ridge),and support vector machine(SVM)classifiers.Then,evaluate the model's generalization ability using a validation dataset.Evaluate the performance of the model comprehensively through accuracy,precision,recall,and area under the curve.Results A total of 377 patients with sepsis-induced respiratory tract infection(case group)and 564 patients with respiratory tract infection(control group)were included,and 17 variables were found to be suitable for the initial model construction.Using feature screening algorithm,we found that the predictive performance of tree models(RF,XGboost,and AdaBoost)was better than that of linear models(LR,SVM,and Ridge).The AdaBoost model included 14 biomarkers,and its prediction accuracy was better than RF,XGBoost,LR,SVM,Ridge models,its precision,recall,accuracy and area under the curve were 0.90,0.84,91.75％and 0.950,respectively.The Ridge model had the worst prediction performance,with an accuracy of 82.97％,its precision,recall and area under the curve were 0.90,0.72 and 0.835 respectively.Conclusion In this study,six predictive models of sepsis-induced respiratory tract infection were developed,among which AdaBoost model could more accurately predict the risk of sepsis-induced respiratory tract infection and help to assist clinical decision-making.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

This review summarizes recent advances in neoadjuvant immunotherapy for advanced gastric cancer.Through literature search in PubMed,Web of Science,and CNKI databases from 2020 to 2023,we systematically analyzed the mechanisms,clinical applications,and bio-marker research.Programmed death-1(PD-1)inhibitors combined with chemotherapy significantly improve patient outcomes,while mi-crosatellite instability(MSI),programmed death-ligand 1(PD-L1)expression,and tumor mutational burden(TMB)have been identified as important predictive biomarkers.Multi-omics analysis shows great potential in identifying optimal responders,with pyroptosis-related gene scoring system(PRS)positively correlating with anti-tumor immune infiltration.Metabolic reprogramming and epigenetic regulation in the tumor microenvironment play key roles in immune evasion,while emerging targets such as Claudin 18.2 and combination targeting strategies further enhance therapeutic efficacy.Despite significant progress,precise patient selection and overcoming resistance mechan-isms remain major challenges.Future research should focus on biomarker validation,personalized treatment strategy development,tumor microenvironment dynamic analysis,and novel combination therapy exploration to improve clinical outcomes.

Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Objective:To explore the efficacy and adverse reactions of nimotuzumab combined with induction chemotherapy (IC) based on albumin-bound paclitaxel plus cisplatin (TP regimen) for patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:Clinical data were collected from 65 patients with LA-HNSCC (stages Ⅲ/Ⅳ A/Ⅳ B; excluding nasopharyngeal carcinoma) who received 2-3 cycles of IC followed by concurrent chemoradiotherapy (CRT) in the Second Hospital of Dalian Medical University from January 2018 to June 2022. Based on the IC regimen, these patients were categorized into a nimotuzumab combined with TP (Nimo-TP) group ( n = 34) and a TP group ( n = 31), and their short-term efficacy [i.e., the objective response rate (ORR)], survival outcomes [e.g., overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS)], and adverse reactions were compared. Additionally, factors affecting their survival outcomes were analyzed. Results:There were statistically significant differences in 1- and 2-year DMFS between both groups (90.4% vs. 69.5%, 90.4% vs. 66.0%, χ2=1.81, P < 0.05), so did the ORRs after IC and CRT of both groups (after IC: 67.6% vs. 41.9%, χ2=4.34, P = 0.037; after CRT: 88.2% vs. 67.7%, χ2=4.03, P = 0.045). However, there was no statistically significant difference in the 2-year OS, PFS, and LRFS between both groups ( P > 0.05). Multivariate analysis revealed that nimotuzumab combined with TP-based IC served as an independent prognostic factor for DMFS ( HR = 0.27, 95% CI: 0.07-0.97, P = 0.045), while complete/partial response after IC acted as an independent prognostic factor for both PFS and local relapse-free survival ( HR = 0.36, 95% CI: 0.17-0.76, P = 0.008; HR = 0.28, 95% CI: 0.11-0.69, P = 0.006). Notably, adding nimotuzumab did not aggravate the adverse reactions in the patients during IC and CRT( P > 0.05). Conclusions:Nimotuzumab combined with TP-based induction chemotherapy followed by CRT significantly improved the DMFS of LA-HNSCC patients, exhibiting high safety. However, such therapy failed to significantly improve their OS, PFS, and LRRFS, and, thus, further research is required.