Objective:Exploring the efficacy and safety of the combination of programmed cell death protein 1 (PD-1) inhibitors with chemotherapy for the treatment of local recurrence at the primary tumor site of esophageal squamous cell carcinoma (ESCC) following definitive chemoradiotherapy.Methods:Seventy-six patients with local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy, who were treated at the Cancer Hospital Affiliated with Nanjing Medical University from January 2019 to January 2024. All patients received treatment with a PD-1 inhibitor combined with chemotherapy, and the short-term efficacy, long-term efficacy, and adverse reactions were observed. Univariate and multivariate Cox regression models were employed to identify the factors influencing overall survival (OS) and after-recurrence survival (ARS).Results:Among the 76 patients, 7 achieved partial response, 35 had stable disease, and 34 experienced progressive disease. The objective response rate was 9.2% (7/76), and the disease control rate was 55.3% (42/76). With a median follow-up time of 23.1 months, 33 out of 76 patients died. The median survival time was 38.5 months (95% CI: 29.6-47.3 months); the 1-year, 2-year, and 3-year OS were 94.5%, 66.6%, and 51.7%, respectively. The median ARS was 14.7 months (95% CI: 10.4-19.1 months); the 6-month, 12-month, and 24-month ARS were 85.8%, 59.6%, and 25.7%, respectively. Univariate analysis showed that the initial radiation dose, the Eastern Cooperative Oncology Group (ECOG) performance status of patients after recurrence, the recurrence-free interval (RFI), and the approach to chemotherapy treatment following local esophageal recurrence were factors affecting OS and ARS ( P＜0.05). Multivariate analysis showed that initial radiotherapy dose ( HR=0.268, 95% CI: 0.100-0.720), the ECOG performance status after recurrence ( HR=4.106, 95% CI: 1.228-13.728), and RFI ( HR=0.248, 95% CI: 0.106-0.582) were independent prognostic factors for OS. Additionally, the initial radiation dose ( HR=0.289, 95% CI: 0.098-0.853) and the ECOG performance status after recurrence ( HR=5.143,95% CI:1.404-18.838) were independent prognostic factors for ARS. The incidence of treatment-related adverse-reactions was 85.5% (65/76). Grade 3 or higher treatment-related adverse reactions primarily included anemia in 4 cases, leukopenia in 8 cases, neutropenia in 9 cases, thrombocytopenia in 2 cases, liver function abnormalities in 4 cases, and elevated troponin T in 2 cases. There were no cases of treatment-related mortality. Conclusions:The combination of PD-1 inhibitors with chemotherapy is safe and effective for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy and can provide survival benefits for patients. This approach can be considered as a therapeutic option for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy.

Objective:Exploring the efficacy and safety of the combination of programmed cell death protein 1 (PD-1) inhibitors with chemotherapy for the treatment of local recurrence at the primary tumor site of esophageal squamous cell carcinoma (ESCC) following definitive chemoradiotherapy.Methods:Seventy-six patients with local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy, who were treated at the Cancer Hospital Affiliated with Nanjing Medical University from January 2019 to January 2024. All patients received treatment with a PD-1 inhibitor combined with chemotherapy, and the short-term efficacy, long-term efficacy, and adverse reactions were observed. Univariate and multivariate Cox regression models were employed to identify the factors influencing overall survival (OS) and after-recurrence survival (ARS).Results:Among the 76 patients, 7 achieved partial response, 35 had stable disease, and 34 experienced progressive disease. The objective response rate was 9.2% (7/76), and the disease control rate was 55.3% (42/76). With a median follow-up time of 23.1 months, 33 out of 76 patients died. The median survival time was 38.5 months (95% CI: 29.6-47.3 months); the 1-year, 2-year, and 3-year OS were 94.5%, 66.6%, and 51.7%, respectively. The median ARS was 14.7 months (95% CI: 10.4-19.1 months); the 6-month, 12-month, and 24-month ARS were 85.8%, 59.6%, and 25.7%, respectively. Univariate analysis showed that the initial radiation dose, the Eastern Cooperative Oncology Group (ECOG) performance status of patients after recurrence, the recurrence-free interval (RFI), and the approach to chemotherapy treatment following local esophageal recurrence were factors affecting OS and ARS ( P＜0.05). Multivariate analysis showed that initial radiotherapy dose ( HR=0.268, 95% CI: 0.100-0.720), the ECOG performance status after recurrence ( HR=4.106, 95% CI: 1.228-13.728), and RFI ( HR=0.248, 95% CI: 0.106-0.582) were independent prognostic factors for OS. Additionally, the initial radiation dose ( HR=0.289, 95% CI: 0.098-0.853) and the ECOG performance status after recurrence ( HR=5.143,95% CI:1.404-18.838) were independent prognostic factors for ARS. The incidence of treatment-related adverse-reactions was 85.5% (65/76). Grade 3 or higher treatment-related adverse reactions primarily included anemia in 4 cases, leukopenia in 8 cases, neutropenia in 9 cases, thrombocytopenia in 2 cases, liver function abnormalities in 4 cases, and elevated troponin T in 2 cases. There were no cases of treatment-related mortality. Conclusions:The combination of PD-1 inhibitors with chemotherapy is safe and effective for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy and can provide survival benefits for patients. This approach can be considered as a therapeutic option for local recurrence at the primary tumor site of ESCC following definitive chemoradiotherapy.

OBJECTIVE To investigate the therapeutic effect of Huashi Baidu Granules on respiratory syncytial virus(RSV)pneumonia model mice and its effect on lung lipid metabolism.METHODS BALB/c mice were randomly divided into control group,model group,Ribavirin group,Dexamethasone group,low dose group of Huashi Baidu Granules and high dose group of Huashi Baidu Granules.Lung tissue samples of mice in each group were collected to observe pathological changes and detect mRNA expression levels of RSV-F,RSV-G,IL-1β,IL-6 and TNF-α genes.The lipid components of lung tissue were extracted and analyzed by ultra-high performance liquid chromatography-quadrupole-electrostatic field orbital trap high-resolution mass spectrometry(UPLC-Q Exactive Orbitrap MS)to find the changes in lipid metabolism.RESULTS The model group exhibited pulmonary interstitial thickening and in-flammatory infiltration compared to the control group,the mRNA levels of viral load and inflammatory factors in lung tissue such as IL-1β and TNF-α were significantly increased(P<0.001).Moreover,the model group exhibited significant abnormalities in lipid metabo-lism,including disorders in phosphatidylserine(PS),phosphatidylglycerol(PG),sphingomyelin(SM),ceramide(Cer),triglyceride(TG),diglyceride(DG),fatty acid(FA),ether phosphatidylcholine(PC O),ether lysophosphatidylcholine(LPC O).However,af-ter the treatment of Huashi Baidu Granules(25.12 g·kg-1·d-1),the above indexes showed a significant improvement.CONCLU-SION Huashi Baidu Granules can treat RSV pneumonia by regulating lipid metabolism,reducing viral load and alleviating inflamma-tory response in lung tissue.

Objective:To measure the skin thickness in patients with erysipelas by high-frequency ultrasonography (HF-USG), and to compare the clinical efficacy of systemic antibiotics alone versus their combination with glucocorticoids in the treatment of erysipelas.Methods:Hospitalized patients with erysipelas were enrolled from Zhongda Hospital, Southeast University from January to December in 2021, and randomly divided into the study group and control group according to the order of visits. The study group was treated with systemic cefathiamidine for 7 days followed by oral methylprednisolone at a dose of 0.4 mg·kg -1·d -1, while the control group was treated with cefathiamidine alone. Before and after the treatment for 10 days, the thicknesses of the epidermis-dermis layers and subcutaneous tissues were measured by HF-USG at the sites of the most severe skin lesions on the affected limbs and at the corresponding sites on the healthy limbs, and white blood cell (WBC) counts, neutrophil (NEU) counts, as well as C-reaction protein (CRP) levels were determined. The t test and non-parametric test were used to compare the efficacy between two groups. Results:A total of 23 patients with erysipelas were enrolled. Among the 12 patients in the study group, 8 were males and 4 were females, and their age was 71.4 ± 11.4 years. Among the 11 patients in the control group, 7 were males and 4 were females, and their age was 67.4 ± 11.1 years. Before treatment, the thicknesses of the epidermis-dermis layers (0.33 ± 0.12 cm) and subcutaneous tissues (1.08 ± 0.49 cm) in the study group were not significantly different from those in the control group (0.25 ± 0.09 cm, 0.98 ± 0.46 cm; t = -1.83, -0.49, P = 0.081, 0.626, respectively). After the 10-day treatment, the thicknesses of the epidermis-dermis layers and subcutaneous tissues of the skin lesions on the affected limbs significantly decreased in both groups compared with those before treatment (both P < 0.05), and the decrease in the thicknesses of subcutaneous tissues was significantly stronger in the study group (0.32 ± 0.33 cm) than in the control group (0.10 ± 0.07 cm; t = 2.20, P = 0.039). Before treatment, the WBC counts ([11.16 ± 4.42] × 10 9/L), NEU counts ([8.26 ± 4.16] × 10 9/L) and CRP levels (median [ Q1, Q3]: 72.20 [19.28, 140.50] mg/L) in the study group were not significantly different from those in the control group ([10.10 ± 4.53] × 10 9/L, [7.21 ± 3.00] × 10 9/L, 34.40 [8.00, 74.20] mg/L, respectively; t or Z = 0.60, 0.71, -0.85, P = 0.578, 0.496, 0.196, respectively). After the 10-day treatment, the WBC counts, NEU counts, and CRP levels significantly decreased in both groups compared with those before treatment (all P < 0.05) . Conclusion:The combined treatment with systemic antibiotics and glucocorticoids could effectively alleviate skin inflammation, and more rapidly reduce the thicknesses of inflamed subcutaneous tissues in patients with erysipelas compared with systemic antibiotics alone.

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

Objective:To explore the changing track of cancer-related fatigue in patients with lung cancer during perioperative period and analyze its influencing factors.Methods:From December 2020 to May 2021, 162 eligible patients with lung cancer were selected in the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital by convenient sampling method. Mental resilience and social support were investigated before operation (T0);and cancer-related fatigue was investigated before operation (T0),3 days after operation (T1), 1 week after operation (T2), 2 weeks after operation (T3) and 1 month after operation (T4), and Latent Class Growth Model was used to identify the track categories. Logistic regression analysis was used to analyze the influencing factors.Results:Three cancer-related fatigue tracks were fitted in this study, which were no fatigue group (31.7%), increased fatigue group (36.0%) and sustained fatigue group (32.3%). Univariate analysis showed that smoking history ( χ2=14.83, P<0.05), BMI ( χ2=29.67, P<0.05), hemoglobin count ( F=4.57, P<0.05), mental resilience ( F=35.53, P<0.05), social support ( F=47.53, P<0.05) were related to the track category of cancer-related fatigue. Logistic regression analysis showed that smoking history, over weight/obesity, resilience and social support were the predictors of cancer-related fatigue locus ( P<0.05). Conclusions:Perioperative cancer-related fatigue of patients with lung cancer has different change trajectories, patients with higher BMI and lower resilience are more likely to have a tendency of persistent fatigue. Patients with smoking history and lower social support are more likely to have an upward trend of fatigue. For this kind of lung cancer patients, medical staff should take timely and effective intervention measures to improve their cancer-related fatigue.

Objective:To evaluate the sternocleidomastoid muscle hardness in patients with tension-type headache (TTH) by acoustic radiation force impulse (ARFI), and to explore its clinical value in evaluating TTH.Methods:Thirty-five patients with TTH admitted to our hospital from March 2019 to March 2020 and 35 subjects accepted physical examination at the same time period were enrolled in this study. The thicknesses of sternocleidomastoid muscles were measured by two-dimensional ultrasound. On this basis, shear wave velocity (SWV) of sternocleidomastoid muscles was quantitatively evaluated by ARFI. The correlation between thicknesses of sternocleidomastoid muscles and headache was further analyzed.Results:The thickness of sternocleidomastoid muscles, SWV in transverse and longitudinal sections, visual analogue scale (VAS) scores in patients with TTH during headache and after massage were significantly higher than those in the heathy subjects ( P<0.05). Meanwhile, SWV in transverse and longitudinal sections, VAS scores decreased significantly in TTH after massage, which showed significant difference as compared with those during headache ( P<0.05). During headache, the thickness of sternocleidomastoid muscles was negatively correlated with VAS scores ( r=-0.397, P=0.002), SWV in longitudinal section of sternocleidomastoid muscles was positively correlated with VAS scores ( r=0.643, P=0.000). Conclusions:The thickness and hardness of sternocleidomastoid muscle are closely related with TTH. ARFI can quantitatively evaluate the thickness and hardness of sternocleidomastoid muscle.

Objective To investigate the efficacy and safety of gastric peroral endoscopic myotomy ( G-POEM) for postsurgical gastroparesis. Methods A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. Results All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9. 8±5. 8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1. 6±0. 5, 1. 2±0. 4, 1. 1±0. 6, 1. 4±0. 3 and 1. 7±0. 3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3. 8±1. 1, all P<0. 01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23. 8±8. 8 min, 21. 2±9. 5 min, 20. 9±8. 3 min and 26. 4±7. 8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67. 8±12. 5 min, all P<0. 01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26. 4 (21. 8, 40. 3) min, 22. 6 (13. 9, 32. 7) min, 24. 3 (18. 2, 36. 5) min and 26. 8 (16. 4, 38. 5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [ 72. 5 ( 48. 3, 108. 6 ) min, all P<0. 01 ] . Conclusion G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety.

Objective:To understand the spatial distribution of mushroom poisoning in Hunan Province and its influential factors,and to provide the evidence for control of the mushroom poisoning.Methods:The surveillance data for mushroom poisoning cases from 122 counties in Hunan Province in 2015 were collected.Based on geographical information system database,spatial autocorrelation analysis and spatial regression analysis (via OpenGeoDa) was conducted.Results:The incidence of mushroom poisoning in Hunan Province in 2015 was 2.94/100 000.Global Moran's I values was 0.315 (P＜0.05).Local spatial autocorrelation analysis indicated that Ningxiang,Xiangtan,Shaoyang,Lingling,Jiahe,and Linwu districts et al were "positive hotspot" regions.Guzhang,Hecheng,Dingcheng,Yueyang districts et al were "negative hotspot" regions.Spatial regression analysis revealed that the reported incidence of mushroom poisoning was positively correlated with the annual average temperate (Z=2.145,P=0.032),the number of health care institutions per capita (Z=2.352,P=0.019),and the number of students enrollment in secondary schools (Z=4.309,P＜0.001).It was negatively associated with the number of school staff and workers of secondary schools (Z=-2.626,P=0.009).Conclusion:The spatial distribution of mushroom poisoning cases in Hunan Province in 2015 is highly clustered.Mushroom poisoning cases are more prevalent in the middle and southern regions and less prevalent in the northern areas of the province.The annual average temperate and the number of students enrollment in secondary schools demonstrate a certain positive influence on the distribution of mushroom poisoning in Hunan.

Objective: To investigate the changes of cardiac sympathetic nerve function and susceptibility of ventricular arrhythmia at chronic stress condition in experimental rats.
Methods: A total of 30 SD rats were randomly assigned into two groups: Control group, the rats were fed with normal condition and Chronic stress group, the rats were fed with unpredictable chronic stimulus program.n=15 in each group and all animals were treated for 4 weeks. The behavior of rats was assessed by open ifeld test and sucrose intake test, the susceptibility of ventricular arrhythmia was measured by Burst stimulus program under narcosis condition, and the sign of cardiac sympathetic nerve reconstruction, tyrosine hydroxylase content was examined by immunohistochemistry.
Results: Compared with Control group, Chronic stress group had decreased ratio of sucrose favorite/open field test, P<0.05 and increased susceptibility of ventricular arrhythmia,P<0.05. Masson staining showed that the ventricular collagen score was similar between 2 groups,P>0.05. Immunohistochemistry presented that Chronic stress group had much higher tyrosine hydroxylase content (1397.8 ± 268.8) um2/mm2 than Control group (995 ± 232.3) um2/mm2,P<0.05.
Conclusion: Chronic stress may increase the susceptibility of ventricular arrhythmia in experimental rats, and the cardiac sympathetic nerve reconstruction might be an important mechanism.