The number of pertussis cases reported through hospital-based passive surveillance severely underestimated the actual disease incidence. This may be due to factors such as atypical symptoms in the vaccine era, limited diagnostic criteria, insufficient clinician awareness, poor access to diagnostic technologies, and problems in monitoring and reporting management. Atypical pertussis often lacks specific symptoms or signs, making it prone to underdiagnosis or missed diagnosis in clinical practice. As a result, patients are not managed or treated effectively. This enables the pathogen to continue spreading. This is an important reason for the difficulty in accurately assessing the actual prevalence of pertussis. This study reviews the global understanding and evolving perspectives of atypical pertussis. It also examines the challenges this condition poses to prevention and control efforts. These challenges include low consultation rates, frequent underdiagnosis or missed diagnoses, limited laboratory testing access, and insufficiently targeted prevention strategies. The study also proposes countermeasures to optimize diagnosis, surveillance, and overall prevention and control efforts.

The contents of Zhang Zhongjing's works Treatise on Exogenous Febrile Disease,the Jade Case Classic of the Golden Cabinet,and Essentials from the Golden Cabinet(collectively known as the three classical medical books of Zhang Zhongjing),as well as Important Formulas Worth A Thousand Gold Pieces and Supplement to"Important Formulas Worth a Thousand Gold Pieces",which were cited in the Arcane Essentials from the Imperial Library(Wai Tai Mi Yao Fang)during comparative proofreading were analyzed.Wai Tai Mi Yao Fang is a book edited and public by the Bureau of Revising Medical Books in Northern Song Dynasty.The contents in the collation records for Wai Tai Mi Yao Fang were compared to the original text of the above five classical medical books proofread in Song Dynasty.The results showed that:(1)the ministers of Song Dynasty which were in charge of the proofreading mainly took the previously-proofread books as references,and widely referenced to the other editions of Wai Tai Mi Yao Fang,which reflected the proofreading principles of the Bureau of Revising Medical Books in Northern Song Dynasty,i.e.,collecting various editions widely and then identifying similarities and differences;(2)the analysis of the collation record in Zhongjing's Treatise on Exogenous Febrile Disease by using comparative proofreading method plus reasoning proofreading method showed that,the medical knowledge of the ministers of Song Dynasty had some limitations;(3)some of the medical terminology used by the ministers of Song Dynasty in their collation record influenced the naming convention of later generations of medical science,for example,making the Piyue Pills be the synonym of the Maziren Wan(Maren Wan).The results indicated that the complexity and uncertainty of the textual content of the popular edition of Wai Tai Mi Yao Fang should deserve the attention,and their influences on the development of later generations'scholarship need further in-depth study.

Objective To explore the value of dynamic contrast-enhanced MRI radiomics in predicting androgen receptor(AR)expression in breast cancer.Methods A total of 166 patients with pathological confirmed breast cancer and underwent dynamic con-trast-enhanced MRI were selected.All patients were randomly divided into training set(n=116)and test set(n=50)in a ratio of 7∶3.The 116 patients in the training set were divided into AR positive group(n=71)and AR negative group(n=45)according to the results of AR immunohistochemical.The clinical and radiomics prediction models were established by using the clinical data and radiomics characteristics of the patients,respectively.The combined prediction model was constructed by integrative both the Radiomics score(Radscore)and relevant clinical factors,and the prediction performance of the models was evaluated.Results The clinical model was 1.255+1.109×tumor diameter+0.801×lymph node metastasis+0.255×histological grade+0.215×TNM stage+0.226×estro-gen receptor(ER)+0.359×human epidermal growth factor receptor 2(HER-2)+0.311×Ki-67.The radiomics model was constructed based on the 5 potential predictors screened by least absolute shrinkage and selection operator(LASSO)model,Radscore=1.342+1.393×Orig_Shape_MAL+1.248×Wave_LHH_GLSZM_GLNU+0.888×Wave_HHH_GLDM_DE+0.714×Wave_HLL_FO_Minimum+1.138×Wave_HHH_FO_TE.The combined prediction model was 1.928+1.043×tumor diameter+1.012×lymph node metasta-sis+0.332×histological grade+0.309×TNM stage+1.059×ER+1.017×HER-2+0.893×Ki-67+1.259×Radscore.The receiver operating characteristic(ROC)curves showed that all of the three models had good prediction performance in both the training set and the test set.DeLong test showed that the area under the curve(AUC)of the combine model was significantly higher than that of the clinical and radiomics models in the training set and test set(P＜0.05).Calibration curve showed that the three models had good fitting effect in the training and test sets.The clinical deci-sion curve showed that the combine model had higher clinical practical value than the other two models both in the training set and test set.Conclusion The combined prediction model constructed by dynamic contrast-enhanced MRI radiomics and clinical characteristic can be used to predict AR expression and has high clinical application value.

In July 2024,the Diagnosis Related Groups(DRG)2.0 is released based on the Notice from the National Healthcare Security Administration on Issuing the DRG 2.0 and Deepening the Relevant Work.Compared with DRG 1.1,version 2.0 was established based on a wider range of suggestions regarding the Adjacent Diagnosis Related Groups(ADRG),Major Comorbidity or Complication(MCC),and Comorbidity or Complication(CC)from various institutions.A list of disease diagnoses and surgical operations that are not used as grouping rules was compiled,and grouping efficacy was further improved by upgrading the algorithms for MCC and CC with the help of AI.Meanwhile,it is necessary to pay more attention to the number of cases of ADRG,the better methods to list the MCC/CC,the suggestions of various doctors and continuously standardize the data and update the grouping scheme of DRG.

The number of pertussis cases reported through hospital-based passive surveillance severely underestimated the actual disease incidence. This may be due to factors such as atypical symptoms in the vaccine era, limited diagnostic criteria, insufficient clinician awareness, poor access to diagnostic technologies, and problems in monitoring and reporting management. Atypical pertussis often lacks specific symptoms or signs, making it prone to underdiagnosis or missed diagnosis in clinical practice. As a result, patients are not managed or treated effectively. This enables the pathogen to continue spreading. This is an important reason for the difficulty in accurately assessing the actual prevalence of pertussis. This study reviews the global understanding and evolving perspectives of atypical pertussis. It also examines the challenges this condition poses to prevention and control efforts. These challenges include low consultation rates, frequent underdiagnosis or missed diagnoses, limited laboratory testing access, and insufficiently targeted prevention strategies. The study also proposes countermeasures to optimize diagnosis, surveillance, and overall prevention and control efforts.

In July 2024,the Diagnosis Related Groups(DRG)2.0 is released based on the Notice from the National Healthcare Security Administration on Issuing the DRG 2.0 and Deepening the Relevant Work.Compared with DRG 1.1,version 2.0 was established based on a wider range of suggestions regarding the Adjacent Diagnosis Related Groups(ADRG),Major Comorbidity or Complication(MCC),and Comorbidity or Complication(CC)from various institutions.A list of disease diagnoses and surgical operations that are not used as grouping rules was compiled,and grouping efficacy was further improved by upgrading the algorithms for MCC and CC with the help of AI.Meanwhile,it is necessary to pay more attention to the number of cases of ADRG,the better methods to list the MCC/CC,the suggestions of various doctors and continuously standardize the data and update the grouping scheme of DRG.

Objective To explore the value of dynamic contrast-enhanced MRI radiomics in predicting androgen receptor(AR)expression in breast cancer.Methods A total of 166 patients with pathological confirmed breast cancer and underwent dynamic con-trast-enhanced MRI were selected.All patients were randomly divided into training set(n=116)and test set(n=50)in a ratio of 7∶3.The 116 patients in the training set were divided into AR positive group(n=71)and AR negative group(n=45)according to the results of AR immunohistochemical.The clinical and radiomics prediction models were established by using the clinical data and radiomics characteristics of the patients,respectively.The combined prediction model was constructed by integrative both the Radiomics score(Radscore)and relevant clinical factors,and the prediction performance of the models was evaluated.Results The clinical model was 1.255+1.109×tumor diameter+0.801×lymph node metastasis+0.255×histological grade+0.215×TNM stage+0.226×estro-gen receptor(ER)+0.359×human epidermal growth factor receptor 2(HER-2)+0.311×Ki-67.The radiomics model was constructed based on the 5 potential predictors screened by least absolute shrinkage and selection operator(LASSO)model,Radscore=1.342+1.393×Orig_Shape_MAL+1.248×Wave_LHH_GLSZM_GLNU+0.888×Wave_HHH_GLDM_DE+0.714×Wave_HLL_FO_Minimum+1.138×Wave_HHH_FO_TE.The combined prediction model was 1.928+1.043×tumor diameter+1.012×lymph node metasta-sis+0.332×histological grade+0.309×TNM stage+1.059×ER+1.017×HER-2+0.893×Ki-67+1.259×Radscore.The receiver operating characteristic(ROC)curves showed that all of the three models had good prediction performance in both the training set and the test set.DeLong test showed that the area under the curve(AUC)of the combine model was significantly higher than that of the clinical and radiomics models in the training set and test set(P＜0.05).Calibration curve showed that the three models had good fitting effect in the training and test sets.The clinical deci-sion curve showed that the combine model had higher clinical practical value than the other two models both in the training set and test set.Conclusion The combined prediction model constructed by dynamic contrast-enhanced MRI radiomics and clinical characteristic can be used to predict AR expression and has high clinical application value.

For a long time, macrolides have been the first choice for the antibacterial treatment for pertussis.However, in the past decade, resistance to macrolide antimicrobials has been common in clinically isolated Bordetella pertussis in China, which is in contradiction with the recommended macrolide treatment.Therefore, Trimethoprim-Sulfamethoxazole (TMP-SMZ) is suggested as the first choice for antibacterial treatment for pertussis in China, with a dosage determined according to age and body weight, lasting 14 days.If TMP-SMZ cannot be used, full-dose and full-course β-lactam antimicrobials may be used, of which the effects should be assessed carefully.The impact of other antibacterial drugs, such as quinolones and tetracyclines, on the elimination of Bordetella pertussis should also be evaluated as soon as possible to treat adult pertussis and potential cases caused by drug-resistant bacteria in future.

Objective:To evaluate the effectiveness and safety of concurrent chemoradiotherapy combined with nimotuzumab in the treatment of patients with inoperable esophageal squamous cell carcinoma (ESCC).Methods:A retrospective analysis was conducted on the clinical data of 503 patients with inoperable ESCC who underwent concurrent chemoradiotherapy in the Department of Radiation Oncology, Changzhou No. 2 People′s Hospital Affiliated to Nanjing Medical University and Department of Radiation Oncology, Affiliated Hospital of Jiangnan University from 2014 to 2020. Among these patients, 69 received concurrent chemoradiotherapy combined with nimotuzumab (the combined therapy group) and 434 received concurrent chemoradiotherapy alone (the concurrent chemoradiotherapy group). Patients of both groups were matched at a ratio of 1∶2 using the propensity score matching (PSM) method. As a result, 168 patients were determined for clinical analysis, including 61 in the combined therapy group and 107 in the concurrent chemoradiotherapy group. The short-term efficacy and adverse reactions of both groups were compared. The overall survival (OS) curves and progression-free survival (PFS) curves were plotted using the Kaplan-Meier method for the Log-rank test.Results:The two groups showed no statistical difference ( P > 0.05) in clinical baseline characteristics after the PSM. The objective response rate (ORR) of the combined therapy group was significantly higher than that of the concurrent chemoradiotherapy group with statistically significant differences (85.2% vs. 71.0%, χ2 = 4.33, P = 0.037). There was no statistical difference (98.4% vs. 91.6%, P > 0.05) in the disease control rate (DCR) between the two groups. The combined therapy group had median PFS of 28.07 months and 1-, 3-, and 5-year PFS ratios of 78.2%, 37.5% and 29.1%, respectively. The concurrent chemoradiotherapy group had mPFS of 19.54 months and 1-, 3-, and 5-year PFS ratios of 72.9%, 28.3% and 21.3%, respectively. Both groups showed statistically significant differences in PFS ( χ2 = 4.49, P = 0.034). The combined group had median OS of 34.93 months and 1-, 3-, and 5-year OS ratios of 88.5%, 46.8% and 37.4%, respectively. The concurrent chemoradiotherapy group had mOS of 24.30 months and 1-, 3-, and 5-year OS ratios of 81.3%, 35.2% and 28.0%, respectively. Both groups showed statistically significant differences in OS (χ 2= 5.11, P = 0.024), but did not show statistical differences ( P > 0.05) in the severity degree of each adverse effect during the treatment. Conclusions:Concurrent chemoradiotherapy combined with nimotuzumab can improve the ORR and prolong the PFS and OS of patients with inoperable ESCC compared with concurrent chemoradiotherapy alone. Furthermore, combining with nimotuzumab does not increase adverse effects and can be tolerated by patients with high safety.

Objective:To study the effects of poly adenosine diphosphate ribose polymerase (PARP) inhibitors niraparib and pamiparib on the radiosensitivity of breast cancer cell lines MCF-7 and MDA-MB-436, and to explore its mechanism.Methods:MCF-7 and MDA-MB-436 cells were divided into control group, niraparib group, pamiparib group, radiation group, combination group treated with niraparib and radiation, and combination group treated with pamiparib and radiation, respectively. The effects of drugs on cell proliferation and radiosensitivity were measured by CCK-8 assay and colony formation assay, respectively. The effect of drugs combined with radiation on cell cycle and apoptosis were detected by flow cytometry. Immunofluorescence method was used to detect the changes of γ-H2AX focal number of cells. The expressions of FANCG, Bax and Bcl-2 mRNA and protein were detected by qPCR and Western blot, respectively.Results:Both niraparib and pamiparib inhibited the proliferation of breast cancer cells MCF-7 and MDA-MB-436 in a time-dose dependent manner. With the increase of irradiation dose, D0, Dq, SF2 value of MCF-7 and MDA-MB-436 cells decreased, and SER D0 and SER Dq value increased. Compared with control group, the percentages of cells in G 2/M phase were increased ( tMCF-7=41.66, 44.08, P<0.05; t436=24.69, 18.91, P<0.05), the percentage of cells in G 0/G 1 phase were decreased ( tMCF-7=8.67, 29.61, P<0.05; t436=26.39, 29.12, P<0.05), and the cell apoptosis rate was significantly increased ( tMCF-7=11.17, 11.71, P<0.05; t436=42.68, 15.89, P<0.05) in the combination group. Compared with control group, the number of γ-H2AX foci of MCF-7 cells in the radiation group and combination group treated with niraparib and radiation increased significantly at 2 h after irradiation ( t=8.89, 21.72, P<0.05). At 24 h after irradiation, the number of γ-H2AX foci basically returned to normal level in the radiation group but remained at a higher level in the combination group ( t=8.82, P<0.05). Compared with control group, the expressions of FANCG and Bcl-2 mRNA decreased ( tFANCG=14.07, P<0.05; tBcl-2=29.21, P<0.05), the expression of Bax mRNA increased ( t=8.90, P<0.05), and the expression of FANCG and Bcl-2 proteins decreased ( tFANCG=7.09, P<0.05; tBcl-2=10.24, P<0.05), while the expression of Bax protein increased ( t=2.90, P<0.05) in the combination group. Conclusions:PARP inhibitors niraparib and pamiparib can increase the radiosensitivity of breast cancer MCF-7 and MDA-MB-436 cells probably through down-regulating the expression of FANCG in FA-BRCA pathway, up-regulating apoptosis-related genes and inhibiting DNA damage repair.