Esophageal cancer （EC） is a highly prevalent malignant tumor in China. The phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway， as one of the key oncogenic pathways， can promote the cell cycle progression， proliferation， migration， and invasion， induce chemoresistance， and inhibit apoptosis and autophagy of EC cells. Traditional Chinese medicine （TCM）， with the advantages of targeting multiple points with multiple components to delay cancer progression， can target the PI3K/Akt signaling pathway for EC treatment. This article preliminarily discusses the molecular mechanism and role of the PI3K/Akt signaling pathway in EC and elaborates on the specific targets and efficacy of TCM in treating EC through intervention in the PI3K/Akt signaling pathway in the past five years. TCM materials and extracts inhibiting the PI3K/Akt signaling pathway in EC include Borneolum， spore powder of Ganoderma lucidum without spore coat， extract of Celastrus orbiculatus， root extract of Taraxacum， and Bruceae Fructus oil emulsion. TCM active ingredients exerting the effect include flavonoids， terpenoids， saponins， phenols， polysaccharides， alkaloids， and other compounds. TCM compound prescriptions with such effect include Qige San， Huqi San， Xuanfu Daizhetang， Tongyoutang and its decomposed prescriptions， Liujunzi Tang， and Xishenzhi Formula. In addition， TCM injections such as Compound Kushen Injection and Kang'ai injection also inhibit the PI3K/Akt signaling pathway in EC. This paper summarizes the role of the PI3K/Akt signaling pathway in EC and the TCM interventions， aiming to provide reference for the research and clinical application of new drugs for EC.

OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors （ICIs） combined with neoadjuvant chemotherapy in the treatment of early triple-negative breast cancer （TNBC）. METHODS Randomized controlled trials （RCTs） comparing ICIs combined with neoadjuvant chemotherapy （experimental group） versus neoadjuvant chemotherapy alone （control group） were retrieved from PubMed， Cochrane Library， Embase， Web of Science， CNKI， Wanfang Data， and VIP databases， as well as relevant studies published at oncology academic conferences. The search period was from database inception to June 30， 2025. After literature screening， data extraction， and quality assessment， a meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 6 RCTs involving 3 786 patients were finally included. The meta-analysis results showed that the experimental group had superior event-free survival [HR＝0.73， 95%CI （0.62， 0.85）， P＜0.000 1]， overall survival [HR＝0.69， 95%CI （0.57， 0.84）， P＝0.000 3]， and pathological complete response （pCR） [OR＝1.57， 95%CI （1.37， 1.80）， P＜0.000 01] compared to the control group. The incidence of ≥grade 3 adverse event （AE）， severe AE （SAE）， and ≥ grade 3 immune-related adverse event （irAE） in the experimental group was significantly higher than that in the control group. There was no statistically significant difference between the two groups in the incidence of any AE or any irAE （P＞0.05）. Subgroup analysis revealed that， regardless of programmed cell death ligand 1 expression status （negative or positive），the pCR in the experimental group was significantly higher than that in the control group （P＜0.05）. Additionally， the pCR of the patients with positive lymph nodes in the experimental group was significantly higher to that in the ontrol group （P＜0.05）. There was no statistically significant difference in pCR between the two groups with negative lymph nodes （P＝0.09）. CONCLUSIONS ICIs combined with neoadjuvant chemotherapy can significantly improve event-free survival and overall survival in patients with TNBC， providing patients with long-term survival benefits. However， the risk of ≥ grade 3 AE， SAE and ≥ grade 3 irAE has increased.

In order to meet the demand for high-quality medical professionals,it is an important goal of higher medical education to cultivate a compound medical professional degree postgraduate with both clinical and research capabilities.This study aims to investigate the current status of research ability training for medical postgraduate students in our university and analyze the main problems.Through designing and distributing questionnaires,feedback data from medical postgraduate students in our uni-versity were collected.The results show that some students lack research experience,have limited research output,and do not have the habit of independent literature reading.In response to the needs of training medical professional degree postgraduate students,this study proposes improvement suggestions.On one hand,optimizing the curriculum and using a closed-loop teaching mode with interactive discussions.On the other hand,strengthening mentor responsibilities and creating a good research atmos-phere.These measures can help improve the research ability of medical postgraduate students and better meet the demand for high-quality medical professionals.

Objective:To investigate the effects of different plasma/red blood cell suspension ratios on prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (Fb) level in patients with postpartum hemorrhage, providing evidence for rational blood transfusion in clinical practice.Methods:This study used a retrospective design. The clinical data of 128 patients with postpartum hemorrhage admitted to Jinan Central Hospital from January 2020 to December 2023 were analyzed. The patients were divided into a control group and an observation group, with 64 patients in each group, based on different transfusion protocols. The control group received transfusion therapy using a conventional plasma/red blood cell suspension ratio, while the observation group was treated with an optimized ratio scheme. The PT, APTT, and Fb levels were compared between the two groups before and after blood transfusion. The amount of bleeding, the volume of blood transfused, and the incidence of complications were recorded and compared between the two groups.Results:Before transfusion, there were no statistically significant differences in PT, APTT, or Fb levels between the two groups (all P>0.05). After transfusion, PT and APTT in the observation group were (11.53 ± 1.08) seconds and (32.00 ± 3.00) seconds, respectively, which were significantly shorter than those in the control group [(13.02 ± 1.57) seconds, (35.00 ± 4.00) seconds, t = 8.01, 6.01, both P<0.001]. Fb levels in the observation group were significantly higher than those in the control group [(2.24 ± 0.37) g/L vs. (1.83 ± 0.47) g/L, t = 5.48, P<0.001]. The amount of bleeding and the volume of red blood cell suspension transfused in the observation group were (800 ± 150) mL and (600 ± 80) mL, respectively, which were significantly lower than those in the control group [ (1 200 ± 200) mL, (800 ± 100) mL, t = 12.01, 10.01, both P<0.001]. There was no statistically significant difference in the volume of blood transfused between the two groups ( t = 0.00, P = 1.000). The incidence of complications in the observation group was significantly lower than that in the control group [10.94% (7/64) vs. 20.31% (13/64), χ2 = 4.60, P = 0.032]. Conclusions:The optimized plasma/red blood cell suspension ratio can effectively improve the coagulation function of patients with postpartum hemorrhage, reduce bleeding and transfusion-related complications.

Objective:To investigate the mechanism of ursolic acid regulating HMGB1/TLR4 pathway in reducing intestinal barrier injury in a rat model of ulcerative colitis(UC).Methods:Rats were randomly divided into control group,model group,glycyr-rhizic acid(HMGB1 inhibitor)group,ursolic acid group and glycyrrhizic acid+ursolic acid group,with 12 rats in each group.UC rat model was induced by tritrobenzene sulfonate enema.After drug administration,body weight and disease activity index(DAI)score were performed of rats in each group;pathological morphology of colonic mucosa was detected by HE staining,the thickness of mucosa and height of villi were compared;levels of catalase(CAT),superoxide dismutase(SOD),malondialdehyde(MDA)in colon tissue,levels of serum diamine oxidase(DAO),and intestinal fatty acid binding protein(I-FABP),TNF-α,IL-18,IL-6 were detected by kits;expression levels of tight junction proteins(Claudin-1,ZO-1,Occludin)and HMGB1/TLR4 pathway proteins(HMGB1,TLR4,MyD88)in colon tissues were detected by Western blotting.Expression levels of HMGB1,TLR4 and MyD88 in colonic tissue were detected by immunohistochemistry.Results:Compared with control group,colonic mucosal tissue of model group had severe pathological injury,the body weight,mucosal thickness,villus height,CAT,SOD,Claudin-1,ZO-1 and Occludin levels in colon tis-sue were significantly reduced,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly increased(P<0.05);compared with model group,pathological injury of colonic mucosal tissue of rats in ursolic acid group,glycyrrhizic acid group and glycyrrhizic acid+ursolic acid group were reduced,body weight,muco-sal thickness,villus height,colon tissue CAT,SOD,Claudin-1,ZO-1 and Occludin levels were significantly increased,while DAI score,serum DAO,I-FABP,TNF-α,IL-18 and IL-6 levels,colon tissue MDA,HMGB1,TLR4 and MyD88 levels were significantly reduced(P<0.05);combined intervention of glycyrrhizic acid and ursolic acid could enhance the influence of ursolic acid on the above indexes(P<0.05).Conclusion:Ursolic acid can inhibit inflammation,reduce the level of oxidative stress,reduce the colonic mucosal injury of UC rats,repair the intestinal mucosal barrier function,and improve the clinical symptoms of rats,which may be achieved by down-regulating the HMGB1/TLR4 pathway.

OBJECTIVE To analyze the risk factors of neonatal pneumonia(NP)and construct the risk prediction model for NP.METHODS A total of 60 cases of neonatal pneumonia admitted to neonatology department of Chan-gzhou Children's Hospital from Dec.2022 to Dec.2023 were selected in the study group,and another 60 healthy neonates during the same period were randomly selected as the healthy group.The risk factors of neonatal pneu-monia were summarized by logistic regression analysis,the prediction model was established,the discrimination of the model was evaluated by receiver's operating characteristic(ROC)curves,and the correction capability was as-sessed by Hosmer-Lemeshow test.RESULTS Birth 1 min Apgar score＜7 points(OR=5.930,95％CI:2.877-12.222,P＜0.001)and amniotic fluid pollution(OR=4.175,95％CI:1.251-13.935,P=0.021)were the risk factors for neonatal pneumonia,while prophylactic antimicrobial drug application(OR=0.471,95％CI:0.226-0.982,P=0.044)was a protective factor(P＜0.05).Based on the results of Logistic regression analysis,the formula of the relevant risk prediction model was established as logit(P)=20.780×1 min Apgar score-23.429 × amniotic fluid pollution+3.024 × prophylactic use of antibiotics+1.056.The results of ROC curves analysis showed that AUC of the risk prediction model was 0.774(95％CI:0.691-0.857),suggesting that the risk pre-diction model had a good discrimination,and Hosmer-Lemeshow x2=7.028,P=0.941,and there was good cali-bration degree of the model.CONCLUSION Birth 1 min Apgar score＜7 points and amniotic fluid pollution are in-dependent risk factors of NP,while prophylactic antimicrobial drug application is a protective factor,and the risk prediction model for the development of NP based on logistic regression analysis had good predictive efficiency and accuracy.

Objective To evaluate the efficacy,safety and cost-effectiveness of dorzagliatin in the treatment of type 2 diabetes mellitus using a rapid health technology assessment,and to provide medical evidence for clinical decision-making.Methods PubMed,Embase,Cochrane Library,CNKI,Wanfang Data,SinoMed and relevant health technology assessment(HTA)websites and databases were searched to collect systematic reviews/Meta-analysis,pharmacoeconomic literature and HTA reports of dorzagliatin in the treatment of type 2 diabetes from inception to July 20,2024.Two reviewers independently screened literature,extracted date and assessed quality.The results were qualitatively described and analyzed.Results A total of 6 studies were included,including 5 systematic reviews/Meta-analysis and a pharmacoeconomic study.In terms of efficacy compared with placebo,dorzagliatin significantly reduced glycated hemoglobin(HbA1c),fasting plasma glucose,2-hour postprandial blood glucose and insulin resistance index(P＜0.05),improved HbA1c compliance rate in terms of safety,dorzagliatin,and enhanced homeostasis model assessment-β(P＜0.05),significantly increased total cholesterol,triglyceride,body weight and body mass index(P＜0.05).In terms of safety,the total incidence of adverse reactions of dorzagliatin was slightly higher than that of the placebo group(P＜0.05).However,there was no significant difference in the incidence of severe adverse reactions between the two groups(P＞0.05),and there was no significant increase in the incidence of hyperlipidemia and hypoglycemia(P＞0.05).In terms of economy,the treatment of dorzagliatin combined with metformin has a long-term cost-utility advantage,with an economic probability of nearly 70％.Conclusion Compared with placebo,dorzagliatin has a good overall efficacy and safety in the treatment of type 2 diabetes.In terms of safety,the total incidence of adverse reactions of dorzagliatin was slightly higher than that of placebo.In terms of economy,compared with metformin alone,dorzagliatin combined with metformin has economic advantages.However,there is a lack of head-to-head comparisons of doxorubicin with other classes of glucose-lowering medications,and none of the included studies described long-term cardiac,cerebral,or renal benefits,which limits the comprehensive evaluation of the efficacy and safety of dorzagliatin.

OBJECTIVE To assess the current status of hospital-acquired infections and their economic burden in or-thopedic patients based on diagnosis-related groups(DRG).METHOD Based on the National Health Insurance dis-ease diagnosis-related groups,32 413 orthopedic patients from a tertiary care hospital in Beijing in 2021 were grouped,hospital-acquired infections were retrospectively analyzed,and the direct and indirect economic burdens of different DRG groups were assess using indictors such as hospitalization time and cost,bed turnover loss,and labor time loss.RESULTS A total of 32 413 patients were included,the incidence of hospital-acquired infection was 0.47％(153/32 413),the site of infection was predominantly the surgical site(57.99％),and hospital-acquired infections in the hematologic system had a greater impact on cost-consumption indices and time-consumption indi-ces.The infection cases were concentrated in 19.58％of the DRGs groups.The IF23 group(lower limb bone sur-gery with complications and comorbidities)had the highest direct economic burden(24 010 yuan/case)due to hos-pital-acquired infections,and the increase in the cost of consumables and medication was the main factor causing the direct economic burden.At both the hospital level and family-society level,the top three DRG groups in terms of indirect economic burden due to hospital-acquired infections were IB15,IB13 and IF23.CONCLUSION Hospital-acquired infections in orthopedic patients have a tendency to be concentrated,quantitatively assessment of their e-conomic burden based on DRGs not only illustrates the importance of hospital-acquired infection prevention and control,but also accurately identifies the disease groups that require focused management,providing an evidence-based basis for precise prevention and control of hospital-acquired infections.

Objective:To evaluate the changes in brain network function indicators in premature infants with language developmental disorders by resting state functional magnetic resonance imaging (rs-fMRI).Methods:Premature infants admitted to Changzhou Children's Hospital Affiliated to Nantong University from January 2021 to December 2023 were selected as the study subjects to evaluate language development. Language development assessment was conducted using the Gesell developmental scales during follow-up until 12 months of corrected gestational age. According to the evaluation results, the subjects were divided into language development disorders group (31 cases) and normal language development group (19 cases). rs-fMRI was performed on all premature infants with corrected gestational age of 40-42 weeks. The amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo) analysis were performed on MRI data. Regions of interest (ROI) were obtained as seed points based on previous literature, then functional connectivity (FC) was extracted between these ROIs for inter-group comparison. Independent sample t-test, non parametric test, chi-square test, and Fisher's exact test were performed on the data using SPSS 23.0 software. Results:(1)There were statistically significant differences in birth weight, gestational age, moderate to severe respiratory distress syndrome, sepsis, and maternal education level between the two groups of premature infants (all P<0.05).(2)The FC values of left temporal gyrus-left angular gyrus (1.220±0.155, 1.139±0.118), left insula-left trigone (0.520±0.199, 0.411±0.152), and left angular gyrus-left marginal gyrus (1.588±0.333, 1.330±0.437) in language development disorders group were higher than those in normal language development group ( t=-2.089, -2.186, -2.359, all P<0.05). There was no statistically significant difference in the FC values of ROI-ROI between the two groups in the right hemisphere of the brain (all P>0.05). The FC values of left superior temporal gyrus-right insula (0.588±0.257, 0.398±0.305) and left superior temporal gyrus-right marginal gyrus (1.550±0.393, 1.374±0.213) in language development disorders group were higher than those in the normal language development group ( t=-2.363, 2.057, both P<0.05). Conclusions:Functional connectivity between local brain regions in preterm infants with language development is significantly enhanced. The change of local brain network functional connectivity has certain predictive value for the language developmental outcome of preterm infants.

Objective To evaluate the safety and efficacy of ciprofol in the anesthesia of elderly patients undergoing bronchoscopy.Methods A total of 96 elderly patients(≥65 years old)undergoing fiberoptic bronchos-copy under sedation and anesthesia were randomly assigned to either the ciprofol group(Group C,n=48)or the propofol group(Group P,n=48).In Group C,anesthesia was induced with an intravenous injection of sufentanil at 0.1 μg/kg and ciprofol at 0.3 mg/kg.In Group P,anesthesia was induced with an intravenous injection of sufent-anil at 0.1 μg/kg and propofol medium/long-chain fat emulsion at 1.5 mg/kg.Hemodynamic parameters,including heart rate(HR),mean arterial pressure(MAP),and peripheral oxygen saturation(SpO2),were recorded at five time points:before anesthesia induction(T1),immediately after the bronchoscope passed through the glottis(T2),immediately after it reached the carina(T3),immediately after the bronchoscope was withdrawn from the nostril post-procedure(T4),and upon full consciousness after leaving the recovery room(T5).Additionally,the success rate of sedation and anesthesia,cough severity scores,induction time(t1),bronchoscopy duration(t2),recovery time(t3),and orientation recovery time(t4)were documented for both groups.Intraoperative complications,such as hypotension,hypoxemia(SpO2<90%),injection pain during induction,airway interventions(e.g.,jaw support,mask ventilation),and the number of additional sedative doses administered,were also recorded.Results Compared with T1,MAP in both groups decreased at T2 and T3(P<0.05).Compared with group P,group C exhibited a higher MAP at T2 and T3(P<0.05).between the two groups in terms of sedation success rate,induction time,cough score,examination time,recovery time,and orientation recovery time(P>0.05).Compared with group P,group C demonstrated lower incidences of hypotension,hypoxemia,injection pain,and fewer airway intervention events(P<0.05).Conclusions Compared with propofol,ciprofol in combination with sufentanil demonstrates superior circulatory stability,a lower incidence of respiratory system-related adverse reactions,and reduced injection pain.Therefore,it can be safely and effectively utilized for painless bronchoscopic diagnosis and treatment in elderly patients.