This paper reports a 45-year-old female patient with lung squamous cell carcinoma who received chemotherapy for multiple systemic metastases,and then 171 mg of the immune checkpoint inhibitor serplulimab was added,ivd,d1(21 d as a cycle).After 2 cycles of treatment,the patient developed dizziness and nausea,and tumor brain metastasis was considered.The lung CT showed that the irregular mass shadow in the anterior segment of the upper lobe of the right lung was enlarged compared with the previous one,and MRI of the liver showed patchy abnormal signal in the liver segment Ⅳ.PET-CT showed that the lung,liver,adrenal gland,left groin and multiple bones were all progressed compared with the previous progress.It was considered to be tumor hyperprogression caused by serplulimab.Serplulimab was immediately discontinued and methylprednisolone was given for symptomatic treatment,but the patient still died due to overprogression.The Naranjo's Assessment Scale was used to evaluate the correlation between the tumor progression and serplulimab in this case,and the result was' likely to be related'.This case suggested that,the prognosis of tumor hyperprogression caused by immune checkpoint inhibitors has a poor prognosis,the clinical use of immune checkpoint inhibitors should be alert to this situation,and pay attention to early differential diagnosis and timely treatment to avoid serious consequences.

This paper reports a 45-year-old female patient with lung squamous cell carcinoma who received chemotherapy for multiple systemic metastases,and then 171 mg of the immune checkpoint inhibitor serplulimab was added,ivd,d1(21 d as a cycle).After 2 cycles of treatment,the patient developed dizziness and nausea,and tumor brain metastasis was considered.The lung CT showed that the irregular mass shadow in the anterior segment of the upper lobe of the right lung was enlarged compared with the previous one,and MRI of the liver showed patchy abnormal signal in the liver segment Ⅳ.PET-CT showed that the lung,liver,adrenal gland,left groin and multiple bones were all progressed compared with the previous progress.It was considered to be tumor hyperprogression caused by serplulimab.Serplulimab was immediately discontinued and methylprednisolone was given for symptomatic treatment,but the patient still died due to overprogression.The Naranjo's Assessment Scale was used to evaluate the correlation between the tumor progression and serplulimab in this case,and the result was' likely to be related'.This case suggested that,the prognosis of tumor hyperprogression caused by immune checkpoint inhibitors has a poor prognosis,the clinical use of immune checkpoint inhibitors should be alert to this situation,and pay attention to early differential diagnosis and timely treatment to avoid serious consequences.

Objective To evaluate the nutritional status in maintenance hemodialysis patients using objective score of nutrition on dialysis.Methods Patients on maintenance hemodialysis were randomly selected and divided into three groups based on objective score of nutrition on dialysis:normal nutritional status group,moderate nutritional status group,and low nutritional status group.Logistic regression analysis was performed to identify factors of malnutrition.Furthermore,the results were compared with those of subjective global assessment.Results Totally 75 patients(male:female =1.13∶1)with a mean age of(54.90 ± 12.10)years and a mean vintage of (85.37 ± 54.17)months were enrolled.As determined by objective score of nutrition on dialysis,15 patients (20％)were divided into normal nutritional status group,42(56％)into moderate nutritional status group,and 18(24％)into low nutritional status group.Compared with the normal nutritional status group,the low nutritional status group had significantly different body mass index[(19.81 ± 2.22)vs(23.90 ± 2.44)kg/m2,P =0.030]and dry weight[(50.85 ± 7.60)vs(59.94 ± 10.89)kg,P =0.020].In addition,compared with normal nutritional status group,the moderate nutritional status group and low nutritional status group had significantly different total cholesterol[(4.60 ± 0.84)and(3.73 ± 0.68)mmol/L vs(5.71 ± 1.64)mmol/L,P =0.011,P =0.000],normalized protein catabolic rate[1.17 and 1.15 g/(kg · d)vs 1.45 g/(kg · d),P =0.030,P =0.010],triceps skinfold thickness[(1.44±0.77)and(1.00±0.41)cmvs(1.80±0.63)cm,P=0.032,P=0.020],mid-ann circumference[(24.85±1.48)and(21.66±1.48)cmvs(24.99 ±2.30)cm,P=0.046,P =0.037].Logistic regression analysis indicated C-reactive protein(OR =12.482,95％ CI =0.190-130.928,P =0.035)and normalized protein catabolic rate(OR =0.128,95％ CI =0.022-0.736,P =0.021)were significantly correlated with malnutrition.Conclusion Malnutrition is common in hemodialysis patients,with inflammation and low protein intake being its independent factors.