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.

AIM:To analyze the influencing factors of visual outcome after vitrectomy for polypoidal choroidal vasculopathy(PCV)combined with vitreous hemorrhage and establish a predictive model.METHODS: A retrospective analysis was conducted on the clinical data of 129 cases(129 eyes)of patients who underwent vitrectomy for PCV combined with vitreous hemorrhage from June 2021 to January 2024 in our hospital. They were divided into elevated group(71 eyes)and non-elevated group(58 eyes)according to visual outcome at early posoperative stage(within 24 mo). Another 30 cases(30 eyes)of PCV with vitreous hemorrhage undergoing vitrectomy were selected as external validation data. The predictive value of the model for the postoperative visual outcomes of both internal and external populations was evaluated.RESULTS: The non-elevated group had a higher proportion of patients aged ≥60 years, diabetes, continuous abnormalities of the ellipsoid zone(EZ)during surgery, bleeding involving the macular fovea, and postoperative retinal scar formation than the elevated group were independent factors affecting postoperative visual acuity(all P<0.05). The AUC of the predictive model for predicting the postoperative visual outcomes of internal and external populations was 0.824(95%CI: 0.750-0.898)and 0.809(95%CI: 0.723-0.865), respectively.CONCLUSION:Patients aged ≥60 years, diabetes, intraoperative continuous abnormalities of EZ, bleeding involving the macular fovea, and postoperative retinal scar formation are influencing factors for visual outcome after vitrectomy in patients with PCV combined with vitreous hemorrhage. A predictive model based on those factors has been established, which has a certain predictive value for postoperative visual outcome.

OBJECTIVE To explore the clinical characteristics of cardiotoxicity caused by lidocaine， and provide a reference for the safe use of drug in clinical practice. METHODS Chinese and English search terms， such as “lidocaine”“ cardiotoxicity”， were used to search for literature related to lidocaine-induced cardiac toxicity from CNKI， Wanfang Data， VIP， PubMed and Embase， and conduct descriptive analysis. RESULTS A total of 31 papers were included， with 40 patients. Of the 40 patients， 23 were male and 17 were female； ages ranged from 5 months to 73 years， with 4 patients≤18 years old， 17 patients 19-59 years old， and 19 patients≥60 years old. The main indications for medication were surgical anesthesia （26 cases）， and the main routes of administration were intravenous administration， nerve block anesthesia and local infiltration anesthesia （15， 6， 6 cases）； the dosage of medication for 34 patients complied with the instructions； the most of cardiotoxicity occurred 1 min-1 h after medication （19 cases）， and the main symptoms were bradycardia， atrial conduction slowing， atrioventricular block， sinus arrest， etc. Thirty- four patients improved after resuscitation and symptomatic treatment， and six patients died. CONCLUSIONS Lidocaine-induced cardiotoxicity can occur in all ages， mainly within 1 h after administration， and is manifested as arrhythmia， tachycardia or tachycardia， atrioventricular block， etc.， which is severe. When using it clinically， it is necessary to strengthen pharmaceutical monitoring of medication dosage， administration route， toxic reactions， etc.； when relevant symptoms appear， medication should be stopped promptly and symptomatic treatment should be carried out， to protect the safety of drug use.

OBJECTIVE To explore the clinical characteristics of cardiotoxicity caused by lidocaine， and provide a reference for the safe use of drug in clinical practice. METHODS Chinese and English search terms， such as “lidocaine”“ cardiotoxicity”， were used to search for literature related to lidocaine-induced cardiac toxicity from CNKI， Wanfang Data， VIP， PubMed and Embase， and conduct descriptive analysis. RESULTS A total of 31 papers were included， with 40 patients. Of the 40 patients， 23 were male and 17 were female； ages ranged from 5 months to 73 years， with 4 patients≤18 years old， 17 patients 19-59 years old， and 19 patients≥60 years old. The main indications for medication were surgical anesthesia （26 cases）， and the main routes of administration were intravenous administration， nerve block anesthesia and local infiltration anesthesia （15， 6， 6 cases）； the dosage of medication for 34 patients complied with the instructions； the most of cardiotoxicity occurred 1 min-1 h after medication （19 cases）， and the main symptoms were bradycardia， atrial conduction slowing， atrioventricular block， sinus arrest， etc. Thirty- four patients improved after resuscitation and symptomatic treatment， and six patients died. CONCLUSIONS Lidocaine-induced cardiotoxicity can occur in all ages， mainly within 1 h after administration， and is manifested as arrhythmia， tachycardia or tachycardia， atrioventricular block， etc.， which is severe. When using it clinically， it is necessary to strengthen pharmaceutical monitoring of medication dosage， administration route， toxic reactions， etc.； when relevant symptoms appear， medication should be stopped promptly and symptomatic treatment should be carried out， to protect the safety of drug use.

OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica（Abbreviated as HSH） on rheumatoid arthritis （RA） based on cluster of differentiation 4/lymphocyte cell-specific protein- tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17（CD4/LCK/ZAP70/IL-17） signaling pathway. METHODS The rats were divided into normal group， model group， HSH low-dose， medium-dose and high-dose groups （2.7， 10.8， 21.6 mg/kg） and positive control group （Tripterygium glycosides tablet， 6.3 mg/kg）， with 10 rats in each group. Except for normal group， RA rat model was induced by complete Freund’s adjuvant in other groups. After modeling， each group was given relevant medicine or normal saline intragastrically， once a day， for 28 consecutive days. The changes in ankle joint swelling and arthritis index in rats were determined； the pathological changes of ankle joint tissue were observed； the levels of inflammatory factors [IL-1β， IL-21， IL-17A， IL-2， interferon-γ （IFN-γ） and IL-6] in serum and joint fluid of rats were determined； the levels of Th1， Th17 and Treg cells in the whole blood and spleen of rats were detected； protein and mRNA expressions of LCK， proto-oncogene tyrosine-protein kinase Fyn （Fyn）， ZAP70， CD45， RAR-related orphan receptor γt （RORγt）， and forkhead box protein 3 （Foxp3） in ankle synovial tissue were determined. RESULTS Compared with normal group， the changes in ankle joint swelling， arthritis index， the levels of IL-1β， IL-21， IL-17A， IL-2， IFN-γ and IL-6 in serum and joint fluid， the levels of Th1， Th17 cells and Th17/Treg value in whole blood and spleen， and the protein and mRNA expression levels of LCK， Fyn， ZAP70， CD45， and RORγt in ankle joint synovium were all significantly increased/elevated （P＜0.05）. The level of Treg cells in the spleen， as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased （P＜0.05）. Compared with model group， most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH （P＜0.05）. The degree of pathological changes in ankle joint tissues was markedly improved， and inflammation was alleviated. CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway， thereby modulating the Th17/Treg balance. This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

Objective: To analyze the implementation status and challenges of sex education in special education schools, so as to provide a scientific basis for formulating effective promotion strategies. Methods: From November 2023 to January 2024, a census survey was conducted among 120 in service teachers from 7 special education schools in Luzhou. The questionnaire covered the current status of sex education in schools, teachers attitudes and knowledge toward sex education, and their coping methods for students inappropriate sexual behaviors. Results: About 77.5% of teachers reported having provided sex education to students, but 93.2% indicated a lack of specialized sex education textbooks for special children, 90.4% reported no full time teachers for sex education, and the methods of sex education were relatively limited (50.0% mainly based on lecture method). Nearly 95.8% of teachers held a positive attitude toward sex education, with 98.3% supporting its implementation. Only 26.7% of teachers demonstrated a good grasp of sex education knowledge, with the best understood topic being "recognition and protection of private parts" (21.6%). When dealing with students inappropriate sexual behaviors, the active response rate of teachers was 23.9%, with the highest active response rate observed for "intentionally hugging or kissing the opposite sex" (39.7%). Conclusions The special education schools in Luzhou lack comprehensive sex education curricula, teaching materials and full time teachers, sufficient knowledge among teachers, and adequate proactive responses to students inappropriate sexual behaviors. Greater emphasis should be placed on sex education for special children, including the training of dedicated teachers, to provide comprehensive and high quality sex education services for special children.

OBJECTIVE To explore the effect of Jinkui shenqi pill and its potential mechanism on diabetic nephropathy-related osteoporosis （DNOP） in rats. METHODS The rats were randomly divided into blank control group， control group， model group， Jingui shenqi pill low-， medium- and high-dose groups （0.62， 1.24， 2.48 g/kg）， and positive control group （denosumab 3 mg/ kg）， with 12 cases in each group. Except for the blank control group and the control group， models of DNOP were constructed in the remaining groups by high-glucose and high-fat forage， 3% fructose solution for feeding+intraperitoneal injection of streptozotocin solution. At 2 d after successful molding， Jingui shenqi pill low-， medium- and high-dose groups， and positive control group were given intragastric administration or subcutaneous injection of the corresponding drugs， once a day， for consecutive 8 weeks. After the last administration， bone mineral density （BMD） and serum bone metabolism-related indexes [osteocalcin （OC）， calcium， phosphorus， alkaline phosphatase （ALP）， tartrate-resistant acid phosphatase （TRAP）] were detected. The pathological changes of right femoral tissues were observed， and the expressions of receptor activator of NF-κB ligand （RANKL）/receptor activator of NF-κB （RANK）/osteoprotegerin （OPG） pathway-related mRNAs and proteins in left femoral tissues were detected. RESULTS Compared with the blank control group and the control group， there was rupture of bone trabecula and severe structural damage in the model group， and tissue space was obvious. BMD and ALP activities， mRNA and protein expressions of OPG were significantly decreased or down-regulated， while the levels of OC， calcium and phosphorus， TRAP activity， mRNA and protein expressions of RANKL and RANK were significantly increased or up-regulated （P＜0.05）. Compared with the model group， the number of bone trabeculae was increased in all Jingui shenqi pill groups， and the arrangement of bone trabeculae was more regular and dense. The above indexes generally were improved in a certain dose-dependent manner （P＜0.05）. CONCLUSIONS Jingui shenqi pill can promote osteogenesis and regulate the balance of bone metabolism in DNOP rats， which may be related to down-regulating the expressions of RANKL and RANK， and up-regulating the expression of OPG.

Objective: To investigate the changing trends for associations of anxiety and depressive symptoms with smartphone addiction among middle school students, so as to provide a scientific basis for preventing smartphone addiction in middle school students. Methods: From 2022 to 2023, a method of combining convenient sampling with cluster sampling was used to select 8 923 middle school students from 27 junior high schools and 3 senior high schools in a district of Shenzhen City between September 2022 (baseline, T1) and September 2023 (follow up, T2). The Smartphone Addiction Scale-Short Version (SAS-SV), Patients Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder 7-item Scale (GAD-7) were administered to assess smartphone addiction, anxiety and depressive symptoms. Mixed effects models were used to analyze the association of anxiety and depressive symptoms with smartphone addiction among middle school students. Results: From September 2022 to September 2023, the reported prevalence of smartphone addiction increased from 24.22% to 25.25% ( χ 2=45.71); and smartphone addiction scores [ 24.00 (16.00, 32.00),25.00(16.00, 33.00)], anxiety symptom scores [2.00(0.00, 7.00),3.00(0.00, 7.00)] and depressive symptom scores[3.00(0.00, 8.00),5.00(0.00, 9.00)] all significantly increased ( Z =-17.43, -42.38, -41.57) (all P <0.05). There were statistically significant difference in the distribution of anxiety and depression symptom levels among middle school students in 2022 and 2023 ( χ 2=85.15, 106.85, both P <0.05). After adjusting for covariates such as age, gender and family background, mixed effects models revealed dose response associations of anxiety and depressive symptoms with smartphone addiction among middle school students:mild anxiety symptom( OR =3.22), moderate to severe anxiety symptom ( OR =5.36), mild depressive symptom ( OR =3.32) and moderate to severe depressive symptom ( OR =6.13) were significantly associated with higher risks of smartphone addiction (all P <0.05). Interaction effect analysis found that co existing anxiety and depressive symptoms synergistically increased addiction risk by 5.60 times ( OR =5.60) compared to the asymptomatic group, with 32% of the combined risk attributable to their interaction ( S=1.64, AP =0.32)(both P < 0.05 ). Conclusions Anxiety and depressive symptoms are significantly associated with smartphone addiction, exhibiting a synergistic effect. Attention should be paid to emotional issues and smartphone addiction among middle school students.

ObjectiveTo analyze the correlation between the clinical symptoms， signs， syndrome characteristics and laboratory indicators of cough variant asthma （CVA） and deepen the understanding of the treatment of this disease based on the theory of "Fu Feng". MethodsAn observational study was conducted. A total of 207 CVA patients who visited the respiratory department of the Third Affiliated Hospital of Beijing University of Chinese Medicine from September 2022 to November 2023 were included. The information from the four diagnostic methods and the laboratory test results of patients were collected. Factor analysis was conducted on the information obtained through the four diagnostic methods in TCM， and the nature and location of CVA were extracted. Sample cluster analysis （Q clustering） and the K-means method were used for data clustering analysis to determine the syndrome types of CVA and analyze the syndrome characteristics and differences in laboratory indicators among different syndrome types. ResultsThe main symptom of CVA patients was cough， accompanied by symptoms such as itchy throat， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， chest tightness， hoarseness， bitter mouth， poor appetite， and skin itching. Factor analysis showed that the disease was located in the lung， involving the liver， spleen， and kidney. The pathological factors involved Yin deficiency， Yang deficiency， wind factor， dampness factor， Yin factor， and Qi stagnation. Cluster analysis revealed four syndrome types： Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. Fengfu Yinshang syndrome accounted for the highest proportion， followed by Tanyin Zufei syndrome. There were no significant differences in eosinophil count and percentage， fractional nasal nitric oxide （FnNO） level， and pulmonary function indexes among the four syndromes. The levels of serum total IgE and fractional exhaled nitric oxide （FeNO） in patients with Fengfu Yinshang syndrome were significantly higher than those in patients with Shixie Neiyun syndrome and Tanyin Zufeisyndrome. ConclusionCough is the main symptom of CVA， accompanied by pharyngeal itching， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， and allergic manifestations. The disease involves the lung， liver， spleen， and kidneys. The essence of the pathogenesis lies in a latent dormant pathogen and a disorder of the pivot mechanism. The four common syndrome types are Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. The TCM syndrome types are correlated with laboratory indexes. The serum total IgE and FeNO of patients with Fengfu Yinshang syndrome are worse.

ObjectiveTo observe the regulation effect of Sangmei Zhike granules on airway inflammation and cyclic adenosine monophosphate （cAMP）-protein kinase A （PKA）-cAMP response element binding protein （CREB） pathway in cough variant asthma （CVA） rats with Fengfu Yinshang syndrome. MethodsEight-week-old male rats were randomly divided into a blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group. Except for the blank group， Fengfu Yinshang models of CVA were established in the other groups. On the 16th day of the experiment， the western medicine group was treated with budesonide aerosol inhalation （dosage of 0.5 g·L^-1）， and the TCM group was given Sangmei Zhike granules by gavage （dosage of 4.19 g·kg^-1·d^-1）， with each group treated once daily for 14 days. On the 30^th day of the experiment， lung function parameters were determined. Whole blood inflammatory cell detection， hematoxylin-eosin （HE） staining of lung tissue， and immunohistochemistry were used to detect the expression of CREB， phosphorylated CREB （pCREB）， and phosphorylated vasodilator-stimulated phosphoprotein （pVASP） proteins in rat lung tissue， and Reverse transcription quantitative polymerase chain reaction （Real-time PCR） was used to determine the protein expressions of cAMP， CREB， and PKA in rat lung tissue. Western blot （WB） was used to detect the expression of PKA， VASP， p-VASP， CREB， and p-CREB proteins. ResultsCompared with the model group， the average dynamic lung compliance （CDyn_average） in the TCM group increased （P0.05）. Compared with the model group， the TCM group showed a decrease in absolute and percentage values of neutrophils （NEUT%）， absolute values of lymphocytes （LYMPH）， absolute and percentage values of basophils （BASO%）， absolute values of monocytes （MONO）， absolute and percentage values of eosinophils （EOS%）， and white blood cells （WBC） （P0.05）. Compared with the western medicine group， the TCM group showed a decrease in MONO， EOS%， and LYMPH% and an increase in MONO% （P0.05）. ELISA results showed that compared with the model group， the TCM group had increased interferon-gamma （IFN-γ） and decreased interleukins （IL）-4， IL-5， IL-13， and total serum IgE， while the Western medicine group had increased IFN-γ and decreased IL-5， IL-13， and total serum IgE （P0.05）. Compared with the western medicine group， the TCM group had decreased IL-5 （P0.05）. HE staining results of rat lung tissue showed that the ciliated epithelium of the D bronchi in the TCM group recovered well. Mucous edema secretion decreased， and a small number of bronchiolar epithelial cells were shed， with reduced infiltration of inflammatory cells and the degree of epithelial injury. Immunohistochemical （IHC） results showed that compared with the model group， positive expressions of CREB， pCREB， and pVASP （brownish-yellow） were significantly increased in the TCM and western medicine groups. Real-time PCR results showed that compared with the model group， the relative expression levels of cAMP， CREB， and PKA in the TCM group were significantly increased （P0.05）， and compared with the western medicine group， the TCM group also showed significantly increased relative expression levels of cAMP， CREB， and PKA （P0.05）. WB results showed that compared with the model group， the expressions of PKA， VASP， p-VASP， CREB， p-CREB， and p-CREB/CREB proteins were increased in the TCM group， while p-VASP/VASP protein expression decreased （P0.05）. Compared with the western medicine group， the TCM group had increased expressions of PKA， VASP， and p-CREB proteins and decreased p-VASP/VASP expression （P0.05）. ConclusionSangmei Zhike granules have the effect of improving lung function and inhibiting airway inflammation in rats with CVA due to Fengfu Yinshang syndrome， possibly related to the activation of the cAMP/PKA/CREB pathway.