Objective:To investigate the effect of trastuzumab deruxtecan (T-DXd) in the treatment of metastatic breast cancer (MBC) patients with different expression levels of human epidermal growth factor receptor 2 (HER2) and the influencing factors of prognosis.Methods:The retrospective case series analysis and cohort study were conducted. Clinical data of 20 MBC patients with different expression levels of HER2 treated with T-DXd at Xi'an International Medical Center Hospital from August 2021 to August 2023 were retrospectively collected to analyze the efficacy and safety of T-DXd. The Cox proportional hazards model was used for multivariate analysis of prognostic factors.Results:All 20 patients were female, with a median age [ M ( Q1, Q3)] of 49 years old (40 years old, 58 years old). Of the 20 cases, 12 had low expression of HER2 [immunohistochemistry HER2+, or immunohistochemistry ++ and fluorescence in situ hybridization (FISH)-negative], and 8 had overexpression of HER2 (immunohistochemistry HER2+++, or immunohistochemistry ++ and FISH-positive); median number of lines of treatment with T-DXd was 6 lines (3 lines, 7 lines); 14 patients had partial remission, 3 patients had stable disease, and 3 patients had disease progression, with an objective remission rate (ORR) of 70% (14/20) and a disease control rate of 85% (17/20). Eight patients with overexpression of HER2 had objective remission in 6 cases, and 12 patients with low expression of HER2 had objective remission in 8 cases, and the ORR difference between the two groups was not statistically significant ( P = 1.000). The main adverse reactions of the patients were nausea (14 cases), vomiting (12 cases), leukopenia (10 cases), elevated aspartate aminotransferase (10 cases), elevated alanine aminotransferase (9 cases), anemia (8 cases), fatigue (8 cases), alopecia (8 cases), neutropenia (6 cases), and thrombocytopenia (5 cases); ≥ grade 3 adverse reactions were bone marrow suppression and gastrointestinal reactions, all with an incidence of ≤10%. The median follow-up time was 7.1 months (1.9 months, 11.5 months). The median progression-free survival (PFS) time was 6.5 months (95% CI: 3.9-9.1 months), and the median PFS time of patients with overexpression of HER2 was longer than that of patients with low expression of HER2 [7.0 months (95% CI: 6.4- 7.6 months) vs. 4.0 months (95% CI: 1.7-6.3 months)], and the difference in PFS between the two groups was statistically significant ( P = 0.025). Multivariate Cox regression analysis showed that overexpression of HER2 was an independent protective factor for PFS in MBC patients treated with T-DXd ( HR = 0.265, 95% CI: 0.075-0.945, P = 0.041). Conclusions:MBC patients with overexpression or low expression of HER2 have a good therapeutic effect and safety profile when treated with T-DXd. The overexpression of HER2 may predict good PFS in MBC patients treated with T-DXd, and may serve as a biomarker for predicting PFS in such patients, but it may not affect the ORR.

Objective:To investigate the levels of serum high mobility group box (HMGB) 2 and HMGB3 and clinical significance in patients with non-small cell lung cancer (NSCLC) .Methods:A total of 137 NSCLC patients admitted to the First Affiliated Hospital of Xi'an Medical University from January 2020 to January 2022 were selected as the NSCLC group, and another 90 cases who underwent healthy medical checkups during the same period were selected as the healthy group. Serum HMGB2 and HMGB3 levels were compared between the two groups. The relationship between serum HMGB2 and HMGB3 levels and the clinical and pathological characteristics of NSCLC patients was analyzed. NSCLC patients were divided into a good prognosis group ( n=86) and a poor prognosis group ( n=51) according to the prognosis, and the clinical data of the two groups were compared. Multivariate logistic regression was used to analyze the influencing factors of the prognosis of NSCLC patients. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum HMGB2 and HMGB3 on the prognosis of NSCLC patients. Results:Serum HMGB2 [ (6.35±1.66) ng/ml vs. (2.58±0.76) ng/ml, t=20.19, P<0.001] and HMGB3 [ (2.48±0.56) ng/ml vs. (1.09±0.13) ng/ml, t=23.13, P<0.001] levels in NSCLC group were higher than those in healthy group. Serum HMGB2 and HMGB3 levels of NSCLC patients with a history of smoking ( t=2.80, P=0.006; t=5.04, P<0.001), lymph node metastasis ( t=3.53, P=0.001; t=4.02, P<0.001), and TNM stage Ⅲ-Ⅳ ( t=2.58, P=0.011; t=3.82, P<0.001) were significantly higher than those of patients with no history of smoking, no lymph node metastasis, and TNM stage Ⅰ-Ⅱ. The serum levels of HMGB2 [ (7.80±1.83) ng/ml vs. (5.49±1.56) ng/ml, t=7.85, P<0.001] and HMGB3 [ (2.91±0.78) ng/ml vs. (2.23±0.43) ng/ml, t=6.58, P<0.001) ] in the poor prognosis group were higher than those in the good prognosis group, and the proportion of patients with lymph node metastasis ( χ2=4.81, P=0.028), history of smoking ( χ2=11.67, P=0.001), and TNM stage Ⅲ-Ⅳ ( χ2=6.18, P=0.013) was significantly higher than that in the good prognosis group. Multivariate logistic regression analysis showed that lymph node metastasis ( OR=1.96, 95% CI: 1.14-3.36, P=0.015), smoking history ( OR=2.02, 95% CI: 1.33-3.06, P=0.001), TNM stage ( OR=2.28, 95% CI: 1.35-3.86, P=0.002), HMGB2 ( OR=2.01, 95% CI: 1.40-2.91, P<0.001), and HMGB3 ( OR=1.99, 95% CI: 1.25-3.15, P=0.003) levels were independent influencing factors of prognosis of NSCLC patients. ROC curve analysis showed that the area under the curve (AUC) of serum HMGB2 and HMGB3 alone and in combination to predict the prognosis of NSCLC patients were 0.833, 0.862 and 0.922, respectively, and the AUC predicted by the combination was significantly higher than that predicted by serum HMGB2 ( Z=2.44, P=0.015) and HMGB3 ( Z=2.54, P=0.011) alone. Conclusion:Serum HMGB2 and HMGB3 levels are up-regulated in NSCLC patients and are closely associated with poor prognosis, and the combined detection of the two has certain predictive efficacy for prognosis of NSCLC patients.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

A colon-specific drug delivery system has great potential for the oral administration of colorectal cancer. However, the uncontrollable in vivo fate of liposomes makes their effectiveness for colonic location, and intratumoral accumulation remains unsatisfactory. Here, an oral colon-specific drug delivery system (CBS-CS@Lipo/Oxp/MTZ) was constructed by covalently conjugating Clostridium butyricum spores (CBS) with drugs loaded chitosan (CS)-coated liposomes, where the model chemotherapy drug oxaliplatin (Oxp) and anti-anaerobic bacteria agent metronidazole (MTZ) were loaded. Following oral administration, CBS germinated into Clostridium butyricum (CB) and colonized in the colon. Combined with colonic specifically β-glucosidase responsive degrading of CS, dual colon-specific release of liposomes was achieved. And the accumulation of liposomes at the CRC site furtherly increased by 2.68-fold. Simultaneously, the released liposomes penetrated deep tumor tissue via the permeation enhancement effect of CS to kill localized intratumoral bacteria. Collaborating with blocking the translocation of intestinal pathogenic bacteria from lumen to tumor with the gut microbiota modulation of CB, the intratumoral pathogenic bacteria were eliminated fundamentally, blocking their recruitment to immunosuppressive cells. Furtherly, synchronized with lipopolysaccharide (LPS) released from MTZ-induced dead Fusobacterium nucleatum and the tumor-associated antigens produced by Oxp-caused immunogenic dead cells, they jointly enhanced tumor infiltration of CD8⁺ T cells and reactivated robust antitumor immunity.

Mendelian Randomization Analysis ; Bone Density ; Genome-Wide Association Study ; Minerals ; Life Expectancy ; Polymorphism, Single Nucleotide

OBJECTIVES: Nasopharyngeal carcinoma (NPC) is a highly invasive epithelial malignant tumor with unique geographical and ethnic distribution characteristics. NPC is mostly found in south China and Southeast Asia, and its treatment mainly depends on radiotherapy and chemotherapy. However, NPC is usually found in the late stage, and local recurrence and distant metastasis are common, leading to poor prognosis. The receptor tyrosine kinase AXL is up-regulated in various tumors and it is involved in tumor proliferation, migration, invasion, and other processes, which are associated with poor prognosis of tumors. This study aims to detect the expression of AXL in NPC cell lines and tissues, and to investigate its biological function of AXL and the underlying molecular mechanisms in regulation of NPC. METHODS: The expression levels of AXL in normal nasopharyngeal epithelial tissues and NPC tissues were analyzed by GSE68799, GSE12452, and GSE53819 data sets based on Gene Expression Omnibus (GEO) database. The Cancer Genome Atlas (TCGA) database was used to analyze the relationship between AXL and prognosis of head and neck squamous cell carcinoma (HNSC). The indicators of prognosis included overall survival (OS), disease-free interval (DFI), disease-specific survival (DSS), and progression-free interval (PFI). Western blotting assay was used to detect the AXL protein expression levels in normal nasopharyngeal epithelial cell line and NPC cell lines. Immunohistochemical method was used to detect AXL expression levels in normal nasopharyngeal epithelial tissues and NPC tissues. Cell lines with stable AXL knockdown were established by infecting 5-8F and Fadu cells with lentivirus interference vector, and cell lines with stable AXL overexpression were established by infecting C666-1 and HK-1 cells with lentivirus expression vector. Real-time PCR and Western blotting were used to detect the efficiency of knockdown and overexpression in stable cell lines. The effects of AXL knockdown or overexpression on proliferation, migration, and invasion of NPC cells were detected by CCK-8, plate colony formation, and Transwell assays, and the effect of AXL knockdown on tumor growth in nude mice was detected by subcutaneous tumor formation assay. The sequence of AXL upstream 2.0 kb promoter region was obtained by UCSC online database. The PROMO online database was used to predict AXL transcription factors with 0% fault tolerance, and the JASPAR online database was used to predict the binding sites of ETS1 to AXL. Real-time PCR and Western blotting were used to detect the effect of ETS1 on AXL protein and mRNA expression. The AXL upstream 2.0 kb promoter region was divided into 8 fragments, each of which was 250 bp in length. Primers were designed for 8 fragments. The binding of ETS1 to AXL promoter region was detected by chromatin immuno-precipitation (ChIP) assay to determine the direct regulatory relationship between ETS1 and AXL. Rescue assay was used to determine whether ETS1 affected the proliferation, migration, and invasion of NPC cells through AXL. RESULTS: Bioinformatics analysis showed that AXL was highly expressed in NPC tissues (P<0.05), and AXL expression was positively correlated with OS, DFI, DSS, and PFI in HNSC patients. Western blotting and immunohistochemical results showed that AXL was highly expressed in NPC cell lines and tissues compared with the normal nasopharyngeal epithelial cell line and tissues. Real-time PCR and Western blotting results showed that knockdown and overexpression efficiency in the stable cell lines met the requirements of subsequent experiments. The results of CCK-8, plate colony formation, Transwell assays and subcutaneous tumor formation in nude mice showed that down-regulation of AXL significantly inhibited the proliferation, migration, invasion of NPC cells and tumor growth (all P<0.05), and the up-regulation of AXL significantly promoted the proliferation, migration, and invasion of NPC cells (all P<0.05).As predicted by PROMO and JASPAR online databases, ETS1 was a transcription factor of AXL and had multiple binding sites in the AXL promoter region. Real-time PCR and Western blotting results showed that knockdown or overexpression of ETS1 down-regulated or up-regulated AXL protein and mRNA expression levels. ChIP assay result showed that ETS1 bound to AXL promoter region and directly regulate AXL expression. Rescue assay showed that AXL rescued the effects of ETS1 on proliferation, migration and invasion of NPC cells (P<0.05). CONCLUSIONS AXL is highly expressed in NPC cell lines and tissues, which can promote the malignant progression of NPC, and its expression is regulated by transcription factor ETS1.
Animals ; Cell Line, Tumor ; Cell Movement/genetics* ; Cell Proliferation/genetics* ; Gene Expression Regulation, Neoplastic ; Mice ; Mice, Nude ; Nasopharyngeal Carcinoma/genetics* ; Nasopharyngeal Neoplasms/metabolism* ; RNA, Messenger/genetics* ; Sincalide/metabolism* ; Transcription Factors/genetics*

Objective:To apply the best evidence of exercise rehabilitation during hospitalization for patients with acute myocardial infarction after percutaneous coronary intervention (PCI) in clinical practice, in order to standardize the management of exercise rehabilitation of patients by medical staff and promote the practice of cardiac rehabilitation.Methods:By using the clinical evidence practice application system of Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, the literatures related to the subject were systematically retrieved and quality evaluation was conducted. A total of 20 best evidences were collected, and 16 evidence-based quality review standards were developed in combination with the clinical context. The implementation of nurses' review indicators, the score of Cardiac Rehabilitation Knowledge Test and the score of Exercise Fear Scale before and after the application of evidence were compared respectively on the nurses and patients with acute myocardial infarction after PCI from February 1 to March 30, 2020 and from May 1 to July 3, 2020.Results:Except for index 1 and index 2, the implementation rates of all review indexes before and after the application of evidence were all increased, and the differences were statistically significant ( P<0.01) . The score of Cardiac Rehabilitation Knowledge Test was (91.14±14.05) after the application of evidence, which was higher than (80.00±10.41) before the application of evidence, and the difference was statistically significant ( t=-2.682, P<0.05) . After the application of evidence, the score of Exercise Fear Scale for Patients with Heart Disease was (43.43±10.93) , which was not statistically significantly different from the score (44.19±8.58) before the application of the evidence ( t=0.280, P>0.05) . Conclusions:The application of the best evidence of exercise rehabilitation during hospitalization in patients with acute myocardial infarction after PCI can improve the management and cognition of medical staff on exercise rehabilitation of patients and reduce the influence of exercise fear avoidance of patients.

We report the diagnosis and treatment of a neonate with primary pulmonary hypertension. The full-term baby was delivered vaginally in good condition at birth and admitted eight days after birth due to intermittent cyanosis. The chest X-ray showed a scattered sheet-like shadow in both lungs, and the cardiac color doppler studies suggested patent ductus arteriosus. Following admission, the neonate was given three days of anti-infection and headbox oxygen treatment. Despite subsequent high-frequency ventilator assisted ventilation combined with nitric oxide inhalation and continuous intravenous milrinone and oral sildenafil, the baby's condition worsened, and she died fifteen minutes after withdrawing resuscitation. Genetic studies revealed a chr13:37446983 mutation in SMAD9.

We reported the diagnosis and treatment of a male infant with congenital tuberculosis. He was a small for gestational age (SGA) and formula-fed baby born virginally at the gestational age of 36 weeks. He was admitted to hospital at the age of 28 days for fever. His mother experienced untreated low fever and cough at 24-28 gestational weeks and was postnatally diagnosed as having pulmonary tuberculosis and tuberculosis encephalitis. Physical examination of the baby found hepatomegaly and splenomegaly on admission and the lab results indicated anaemia, elevated C-reactive protein (CRP) and impaired liver function. Acid-fast Bacillus was detected in gastric fluid smear test using acid-fast staining. The detection of T-cell ELIspots in tuberculosis infection (T-SPOT.TB) test was positive. Chest/abdominal X-rays showed multiple nodular and linear shadows in both lungs. Abdominal MRI revealed abnormal signals of diffuse nodular lesions in the liver and spleen. X-rays of the long bones showed few periosteal reactions in both femurs. Quadruple anti-tuberculosis therapy with isoniazid, rifampicin, pyrazinamide and amikacin was initiated on admission and the patient experienced fluctuating body temperature, poor weight gain and CRP level ranging from 15 to 22 mg/L. Though the pulmonary lesion subsided after the treatment, no significant change occured in hepatic or splenic lesions. The baby boy was discharged from the hospital at the request of his parents on 39 d and lost to follow-up.

Objective To analyze the reasonable and suitable level of serum 25 hydroxy vitamin D [25 (OH) D] and Vitamin D(Vit D) supplement of premature infants born less than 32 weeks in the neo-natal intensive care unit. Methods For eligible premature infants hospitalized in our department from March 2016 to December 2017,Vit D 900 IU/d was supplemented one week after birth under the conditions of es-tablishing enteral feeding. The selected cases were divided into two groups based on different blood concentra-tion of serum 25(OH)D at four weeks after birth,for 38 cases≥25 ng/ml as group A and 24 cases 15 to 25 ng/ml as group B. Their bone mass density( BMD) were tested at correct gestational age of 40 weeks and compared with 40 term infants as control group at the same period. Results The serum concentrations of 25(OH) D in group A were (29.23 ±3.08)ng/ml at 4 weeks and (35.13 ±4.67)ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,13. 2％(5/38) cases demonstrated the lower BMD. The serum concentrations of 25(OH) D in group B were (20. 12 ± 3. 95)ng/ml at 4 weeks and (22. 36 ± 4. 82)ng/ml at 8 weeks after birth respectively. At correct gestational age of 40 weeks,75. 0％(18/24) cases demonstrated the lower BMD. The differences between group A and control group were not statistically sig-nificant(χ2 =0. 06,P>0. 05),and differences between group B and control group were statistically signifi-cant(χ2 =25. 45,P<0. 001). Conclusion Premature should be given Vit D 900 IU/day or more with rea-sonable and sufficient calcium and phosphorus to maintain their concentration of serum 25(OH)D at about 29. 23 ng/ml and re-check their concentration of serum 25 ( OH) D every four weeks.