OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment.

Objective To evaluate the image quality of abdominal dual-energy CT virtual monoenergetic imaging (VMI) in patients with early gastric cancer using titanium alloy clips and assess its effectiveness on reducing metal artifacts. Methods A retrospective study was conducted, including 31 patients with gastric cancer who underwent abdominal dual-energy CT scans with titanium clips inserted in the gastric cavity. Each scan was reconstructed into mixed images (simulated 120 kVp CT) and VMIs with energy levels ranging from 40 keV to 140 keV. Metal artifacts were quantitatively evaluated by measuring the noise values in the lesion and perigastric regions. The contrast-noise ratio (CNR) of the lesion and the corresponding liver tissue was calculated to assess the image quality. Two radiologists independently evaluated the images, considering overall quality, artifact severity, lesion conspicuity, perigastric clarity, and vascular contrast. Results Quantitative analysis revealed that metal artifacts in both the lesion and perigastric regions decreased as the energy level increased. VMIs at 80-140 keV (lesion site) and 90-140 keV (perigastric space) showed significantly fewer artifacts compared to mixed images (P＜0.05). The CNR of lesions remained stable across VMIs at 50-140 keV, while the CNR of normal liver tissue decreased significantly with increasing energy (P＜0.05). In the subjective assessment, VMIs at 80-140 keV had higher artifact scores than mixed images (P＜0.05). VMIs at 70-90 keV provided better lesion conspicuity and perigastric clarity, although vascular contrast decreased significantly with increasing energy (P＜0.05). VMIs at 70-90 keV showed better overall quality (P＜0.05), though not significantly different from mixed images. Conclusions VMIs at 80 keV and 90 keV improve the visibility of lesions and perigastric regions affected by metallic clips, which combined with mixed images can enhance radiologists’ diagnostic accuracy.

OBJECTIVE To analyze the correlation of the peak blood concentration （cmax） of compound sulfamethoxazole （TMP/SMZ） and its metabolite N-acetyl sulfamethoxazole （NSMZ） with clinical efficacy and adverse reactions in critically ill patients. METHODS The data of critically ill patients treated with TMP/SMZ in various ICU of Hainan General Hospital from December 2023 to January 2025 were retrospectively collected. The patients were divided into success group and failure group based on the treatment outcome. Simple linear regression and Spearman correlation analysis were used to analyze the correlation of TMP cmax， SMZ cmax， and NSMZ cmax with clinical efficacy and adverse reactions. The receiver operating characteristic curve （ROC） was used to determine the cutoff values of cmax for predicting the occurrence of adverse reactions. RESULTS Among critically ill patients with an acute physiology and chronic health evaluation Ⅱ （APACHE-Ⅱ） ≥15 points 24 h of check-in at ICU， SMZ cmax of success group was significantly higher than failure group （P＜0.05）. The daily total dose of TMP/SMZ was positively correlated with TMP cmax and SMZ cmax（ P＜0.05）. TMP cmax was significantly correlated with hepatotoxicity and nephrotoxicity， SMZ cmax with hepatotoxicity， and NSMZ cmax with nephrotoxicity （P＜0.05）. The cutoff values of TMP cmax for predicting nephrotoxicity and hepatotoxicity were 7.25 μg/mL and 6.63 μg/mL， respectively. The cutoff value of SMZ cmax for predicting hepatotoxicity was 138.00 μg/mL， and that of NSMZ cmax for predicting nephrotoxicity was 60.76 μg/mL. CONCLUSIONS Among critically ill patients with an APACHE-Ⅱ ≥15 points 24 h of check-in at ICU， SMZ cmax is associated with treatment success. Hepatotoxicity risk significantly increases when TMP cmax ≥6.63 μg/mL or SMZ cmax ≥138.00 μg/mL； nephrotoxicity risk significantly increases when TMP cmax ≥7.25 μg/mL or NSMZ cmax ≥60.76 μg/mL.

AIM: To investigate timing of glucocorticoids use in the treatment of syphilitic uveitis.METHODS: A retrospective study was conducted in 110 patients(134 eyes)with syphilitic uveitis diagnosed from January 2008 to January 2021, of whom 24 were binocular. The time from onset to treatment was 1 d to 3 mo. They were divided into three groups according to the treatment, including 98 eyes with completed clearely fundus lesions and no abnormalities in fundus fluorescein angiography(FFA)+ indocyanine green angiography(ICGA)+ optical coherence tomography(OCT)after treated with antibiotics alone for 1 to 2 wk in single antibiotics group, 26 eyes with in completely cleared fundus lesions and retinal vessels wall staining observed by FFA or choroidal weak fluorescence observed by ICGA after standard antisyphilitic treatments for 1 to 2 wk in first antibiotics followed by hormones group, and 10 eyes treated according to uveitis at other hospital in the absence of a clear cause of disease, that was intravenously dripped with 250 mL of normal saline and 10 mg of dexamethasone once a day for 7 to 10 d in total, then clearly diagnosed as syphilitic uveitis by Treponema pallidum particle agglutination(TPPA)test after receiving treatment for 10 to 14 d in hormones followed by antibiotics group. The best corrected visual acuity, slit-lamp examination, fundus photography, OCT, FFA, ICGA and prognosis of the three groups of patients were compared.RESULTS: There were statistically significant difference in the best corrected visual acuity, optic disc, retinal vasculitis, choroidal weak fluorescence, and RPR titer before and after treatment of the three groups of patients. The prognosis of the hormones followed by antibiotics group was lower than that in the single antibiotics group and antibiotics followed by hormones group, and the proportion of “good” prognosis in the antibiotics followed by hormones group was larger than that in other groups.CONCLUSION: Early diagnosis and regular treatment of syphilitic uveitis has a good overall prognosis, and giving large doses of glucocorticoids before thorough antisyphilitic treatments is not conducive to the recovery of disease. In patients with residual lesions after standard antisyphilitic, the application of small doses of glucocorticoids is helpful for the recovery of the disease.

Objective To evaluate the clinical efficacy of Targeted Ⅱ Formula(composed of Astragali Radix,Pseudostellariae Radix,Ophiopogonis Radix,Asparagi Radix,Glehniae Radix,Rehmanniae Radix,Ligustri Lucidi Fructus,Ecliptae Herba,Polygonati Rhizoma,Polygonati Odorati Rhizoma,etc.)in delaying epidermal growth factor receptor(EGFR)tyrosine kinase inhibitors(TKIs)resistance in EGFR mutation-positive non-small cell lung cancer(NSCLC)patients with.Methods Between January 1,2019 and June 30,2023,64 NSCLC patients with qi-yin deficiency syndrome treated at Shanghai Pulmonary Hospital(affiliated to Tongji University)were stratified based on their 1-month post-targeted therapy response and then were randomized into a treatment group(receiving Icotinib plus Targeted Ⅱ Formula decoction)or a control group(receiving Icotinib alone).Patients were followed-up until disease progression.Progression-free survival(PFS),adverse events,quality of life,and immune function were assessed.Results(1)In terms of PFS,the mean PFS in the treatment group was(18.78±7.17)months,while that in the control group was(11.76±4.26)months.The PFS in the treatment group was significantly longer than that in the control group,with a statistically significant difference(P＜0.001);the 1-year PFS rate in the treatment group was 87.50％(28/32),significantly higher than the 38.71％(12/31)in the control group,with a statistically significant difference(P＜0.001).(2)In terms of adverse reactions,the incidence of targeted drug-related rash in the treatment group was 68.75％(22/32),lower than that of the control group(80.65％,25/31),but the difference between the two groups was not statistically significant(P＞0.05).In terms of rash grading,both groups primarily had Grade 1 rashes,and the treatment group had fewer Grade 2 and 3 rashes than the control group,indicating that the severity of rashes was more pronounced in the control group.(3)In terms of quality of life,after treatment,the Karnofsky Performance Status(KPS)score in the treatment group significantly increased compared to before treatment(P＜0.05),while the control group showed no significant increase compared to before treatment(P＞0.05).The intergroup comparison revealed that the increase of KPS scores in the treatment group was significantly greater than that in the control group,with a statistically significant difference(P＜0.05).(4)In terms of immune function,after treatment,the levels of CD8+T lymphocytes and interferon-γ(IFN-γ)in peripheral blood were significantly higher in the treatment group than before treatment(P＜0.05),while those in the control group were significantly lower than before treatment(P＜0.05);Intergroup comparisons revealed that the treatment group exhibited a significantly greater reduction in peripheral blood CD8+T lymphocyte and IFN-γ expression levels compared to the control group,with statistically significant differences(P＜0.05).Conclusion This study employed an innovative stratified randomization design to eliminate bias in Icotinib efficacy.The results demonstrate that Targeted Ⅱ Formula effectively delays EGFR-TKI resistance,mitigates adverse events,and improves quality of life in EGFR mutation-positive NSCLC patients with qi-yin deficiency syndrome,supporting its role as an adjuvant therapy in targeted lung cancer treatment.

Objective: To investigate the value of decreased carbohydrate antigen 19-9(CA19-9) kinetics in predicting short-term outcomes and determining prognosis among advanced biliary or pancreatic cancer patients receiving first-or second-line therapy in the real world. Methods : Eighty-nine patients were retrospectively collected with advanced biliary or pancreatic cancer, especially on the CA19-9 dynamics and decline rates at different time points. This study evaluated the association of CA19-9 changes with clinicopathological features, short-term response to antitumor therapy, and survival outcomes. Results : The enrolled patients recorded baseline CA19-9 levels ranging from 1.20 to 65 706.40 U/ml, with a median of 303.11 U/ml. There was no statistical correlation between baseline CA19-9 levels and gender, age, body mass index, primary tumor site, hepatic metastases, pulmonary metastases, lymph node metastases, peritoneal metastases, performance status, treatment lines, and combinations of drug types. Baseline CA19-9 levels were not associated with systemic immunoinflammatory index, prognostic nutritional index, and total bilirubin. A 25% or 50% decrease in CA19-9 after 2-3 therapy courses indicated short-term efficacy in reaching tumor objective remission or disease control. Both combinations of multiple drug types and a 25% decline in CA19-9 after one course of treatment were independent prognostic factors that affected the longer progression-free survival of patients receiving first or second line of treatment. Conclusion Decreased CA19-9 kinetics has specific values in predicting the efficacy and prognosis of advanced biliary or pancreatic cancer.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

Objective:To investigate the clinical manifestations, pathological features, treatment methods and prognosis of primary renal synovial sarcoma (PRSS) in order to improve the clinical understanding and treatment level of the disease.Methods:The clinical data, pathological features, immunohistochemical indexes, SYT gene detection, treatment and follow-up results of 21 patients with PRSS reported in the First Affiliated Hospital of Soochow University from 2018 to 2023 were retrospectively analyzed. Kaplan-Meier method was used to calculate the relationship between age and cumulative survival rate. Results:The male to female ratio of PRSS patients was 16∶5, the ratio of left and right kidneys was 7∶14, the median age was 50 years old, the mean age was 44.5 years old, the median tumor length diameter was 9.7 cm, and the mean tumor length diameter was 6.7 cm. 57%(12/21) reported low back pain and 48%(10/21) reported gross hematuria. Immunohistochemical examination showed 100% positive for Vimentin(16/16), BCL-2(18/18) and TLE-1(10/10), 69%(9/13) and 85%(6/7) positive for CD99 and CD56, respectively. Genetic testing found SYT translocation signal in 92% of cases (12/13). Next generation sequencing (NGS) detected SS18- SSX1 fusion in 2 cases and SS18- SSX2 fusion in 1 case. SS18- SSX1+ S18- SSX2 fusion was found in 1 case, and one case of SS18- NEDD4 fusion occurred. Preoperative neoadjuvant chemotherapy was performed in 2 cases, postoperative chemotherapy in 11 cases, postoperative chemoradiotherapy in 2 cases, and surgery only in 5 cases. All patients were followed up for 3 to 42 months, and 4 cases were lost to follow-up. Patients with younger onset had a longer cumulative survival time. Patients had a median survival time of 13 months and a mean survival time of 15.4 months. Conclusions:PRSS is more common in middle-aged men, the right kidney is easy to occur, the length of the mass is usually >7 cm, most cases can be initially diagnosed by pathologic morphology, immunophenotype, fluorescence in situ hybridization or NGS STY gene detection can provide accurate diagnosis. The prognosis of PRSS is very poor, and the cumulative survival rate is negatively correlated with the age of onset. Surgical resection combined with chemotherapy is the main treatment for PRSS.

Objective To investigate the correlation of SII with occurrence of short-term MI in eld-erly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with con-comitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atheroscle-rosis were risk factors for MI occurrence(OR=1.001,95％CI:1.000-1.001,P=0.001;OR=1.106,95％CI:1.016-1.203,P=0.020;OR=4.798,95％CI:2.621-8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95％CI:0.073-0.895,P=0.033;OR=0.474,95％CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P＜0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the high-level group was significantly lower than that in the low-level group(Plog rank＜0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independ-ent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

Objective:To investigate the clinical manifestations, pathological features, treatment methods and prognosis of primary renal synovial sarcoma (PRSS) in order to improve the clinical understanding and treatment level of the disease.Methods:The clinical data, pathological features, immunohistochemical indexes, SYT gene detection, treatment and follow-up results of 21 patients with PRSS reported in the First Affiliated Hospital of Soochow University from 2018 to 2023 were retrospectively analyzed. Kaplan-Meier method was used to calculate the relationship between age and cumulative survival rate. Results:The male to female ratio of PRSS patients was 16∶5, the ratio of left and right kidneys was 7∶14, the median age was 50 years old, the mean age was 44.5 years old, the median tumor length diameter was 9.7 cm, and the mean tumor length diameter was 6.7 cm. 57%(12/21) reported low back pain and 48%(10/21) reported gross hematuria. Immunohistochemical examination showed 100% positive for Vimentin(16/16), BCL-2(18/18) and TLE-1(10/10), 69%(9/13) and 85%(6/7) positive for CD99 and CD56, respectively. Genetic testing found SYT translocation signal in 92% of cases (12/13). Next generation sequencing (NGS) detected SS18- SSX1 fusion in 2 cases and SS18- SSX2 fusion in 1 case. SS18- SSX1+ S18- SSX2 fusion was found in 1 case, and one case of SS18- NEDD4 fusion occurred. Preoperative neoadjuvant chemotherapy was performed in 2 cases, postoperative chemotherapy in 11 cases, postoperative chemoradiotherapy in 2 cases, and surgery only in 5 cases. All patients were followed up for 3 to 42 months, and 4 cases were lost to follow-up. Patients with younger onset had a longer cumulative survival time. Patients had a median survival time of 13 months and a mean survival time of 15.4 months. Conclusions:PRSS is more common in middle-aged men, the right kidney is easy to occur, the length of the mass is usually >7 cm, most cases can be initially diagnosed by pathologic morphology, immunophenotype, fluorescence in situ hybridization or NGS STY gene detection can provide accurate diagnosis. The prognosis of PRSS is very poor, and the cumulative survival rate is negatively correlated with the age of onset. Surgical resection combined with chemotherapy is the main treatment for PRSS.