Rheumatoid arthritis （RA） is a common chronic systemic autoimmune disease with synovitis as the main manifestation， which often causes joint swelling and pain or even deformity. It is considered to be an incurable lifelong disease. Although the current Western medicine treatment can alleviate the progression of the disease， it has the clinical limitations of liver injury， cardiovascular complications， and other adverse reactions， along with easy recurrence. Traditional Chinese medicine （TCM） has a long history and has the advantages of individualized treatment and fewer adverse reactions. It can effectively relieve the symptoms of joint swelling and pain in RA patients and slow down the progression of bone destruction， which has attracted wide concern in the medical community. Janus kinase （JAK）/signal transducer and activator of transcription （STAT） signaling pathway is an important intracellular pathway involved in cell proliferation， differentiation， apoptosis， immune regulation， and other biological behaviors， and plays an important role in the pathophysiological process of RA. In recent years， many studies have confirmed that TCM monomers and compounds can inhibit inflammation and angiogenesis by regulating the JAK/STAT signaling pathway， induce apoptosis and inhibit proliferation of fibroblast-like synoviocytes （FLS）， regulate immune response， and thus exert an effect in the treatment of RA. However， there is still a lack of comprehensive and systematic induction and overview. Therefore， by searching the relevant literature in China National Knowledge Infrastructure （CNKI） and PubMed databases from 2009 to 2024， this study described the mechanism of the JAK/STAT signaling pathway in the occurrence and development of RA and summarized the research progress of TCM monomers and compounds in regulating the JAK/STAT signaling pathway in RA intervention. The study aims to provide new ideas and strategies for the clinical treatment of RA with TCM and the research and development of new drugs.

OBJECTIVE To investigate the application status of prescription pre-review systems in healthcare institutions of Yunnan province， evaluate their system functions and management capabilities， and provide a practical basis for promoting rational drug use. METHODS A questionnaire survey was conducted among public healthcare institutions at or above the secondary level in Yunnan province to investigate the deployment status of the systems. A capability maturity assessment framework was constructed， encompassing 6 dimensions and 39 indicators， including real-time prescription review， prescription correlation review， rule setting， evidence-based information support， prescription authority management， and system operation management. This framework was then used to evaluate the institutions that had implemented the pre-review systems. RESULTS A total of 100 valid questionnaires were collected， with 37 institutions having adopted prescription pre-review systems， mainly tertiary hospitals. The system predominantly adopted a modular architecture and was embedded into the hospital information system through application programming interfaces and middleware， providing certain capabilities for real-time prescription risk identification. Evaluation results indicated that basic functions such as reviewing indications， contraindications， and drug compatibility performed well， while deficiencies remained in functions related to parenteral nutrition prescription， review of drug dosage for specific diseases， individual patient characteristic recognition， and rule setting. Moreover， the construction of review centers and establishment of management systems were also not well-developed. CONCLUSIONS The overall application rate of prescription pre-review systems in Yunnan province remains low. System functions and management mechanisms require further improvement. It is recommended to enhance information infrastructure in lower-level institutions and explore regionally unified review models to promote standardized and intelligent development of prescription review practices.

Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.

Objective:To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus.Methods:This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age ( M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results:Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy ( P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively ( P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively ( P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions:HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients′ survival.

Objective To evaluate the intra-rater and inter-rater consistency of GRBAS and CAPE-V in Chi-nese context.Methods Five experts used the"Voice Assessment Assistant"APP to evaluate voice samples extrac-ted from The Sixth Medical Center of Chinese PLA General Hospital Pathological Voice Database V1.0.Fifty-two cases were used for inter-rater consistency analysis,and 38 cases were used for intra-rater consistency assessment.Intraclass correlation coefficient(ICC)was used for intra-rater and inter-rater consistency analysis of CAPE-V,while Cohen's Kappa method was applied for intra-rater consistency analysis of the five features of GRBAS.Inter-rater consistency analysis for GRBAS used Fleiss Kappa method,and Spearman's correlation analysis was conducted for the same features in both scales.Results The results of intra-rater consistency analysis showed that all six fea-tures of CAPE-V exhibited high consistency,with ICC coefficients of overall severity(OS)=0.80,roughness(R)=0.69,breathiness(B)=0.77,strain(S)=0.75,pitch(P)=0.74,and loudness(L)=0.78.For GRBAS,ex-cept for the features G(0.48)and S(0.45)which showed weaker intra-rater consistency,the rest of the features had poor intra-rater consistency.The results of inter-rater consistency analysis showed that the ICC correlation coef-ficients for all features of CAPE-V were greater than 0.85,indicating a high degree of consistency in the scoring of each feature by different raters.For GRBAS,except for the feature G(correlation coefficient=0.48),the rest of the features had correlation coefficients less than 0.40,indicating that the inter-rater consistency was poor for all features except G.When evaluating the same sample with both GRBAS and CAPE-V,the Spearman correlation co-efficients for the overall voice quality OS/G,roughness R,breathiness B,and strain S were 0.89,0.85,0.91,and 0.91,respectively,suggesting a high degree of correlation between the scoring results of the four features in the two scales.Conclusion In the auditory perceptual assessment of Chinese voice samples,the CAPE-V scale has higher intra-rater and inter-rater consistency compared to the GRBAS scale and is more suitable for clinical practice.

Objective To evaluate the intra-rater and inter-rater consistency of GRBAS and CAPE-V in Chi-nese context.Methods Five experts used the"Voice Assessment Assistant"APP to evaluate voice samples extrac-ted from The Sixth Medical Center of Chinese PLA General Hospital Pathological Voice Database V1.0.Fifty-two cases were used for inter-rater consistency analysis,and 38 cases were used for intra-rater consistency assessment.Intraclass correlation coefficient(ICC)was used for intra-rater and inter-rater consistency analysis of CAPE-V,while Cohen's Kappa method was applied for intra-rater consistency analysis of the five features of GRBAS.Inter-rater consistency analysis for GRBAS used Fleiss Kappa method,and Spearman's correlation analysis was conducted for the same features in both scales.Results The results of intra-rater consistency analysis showed that all six fea-tures of CAPE-V exhibited high consistency,with ICC coefficients of overall severity(OS)=0.80,roughness(R)=0.69,breathiness(B)=0.77,strain(S)=0.75,pitch(P)=0.74,and loudness(L)=0.78.For GRBAS,ex-cept for the features G(0.48)and S(0.45)which showed weaker intra-rater consistency,the rest of the features had poor intra-rater consistency.The results of inter-rater consistency analysis showed that the ICC correlation coef-ficients for all features of CAPE-V were greater than 0.85,indicating a high degree of consistency in the scoring of each feature by different raters.For GRBAS,except for the feature G(correlation coefficient=0.48),the rest of the features had correlation coefficients less than 0.40,indicating that the inter-rater consistency was poor for all features except G.When evaluating the same sample with both GRBAS and CAPE-V,the Spearman correlation co-efficients for the overall voice quality OS/G,roughness R,breathiness B,and strain S were 0.89,0.85,0.91,and 0.91,respectively,suggesting a high degree of correlation between the scoring results of the four features in the two scales.Conclusion In the auditory perceptual assessment of Chinese voice samples,the CAPE-V scale has higher intra-rater and inter-rater consistency compared to the GRBAS scale and is more suitable for clinical practice.

Objective:To evaluate the clinical outcomes of radical resection and perioperative management strategies in hepatocellular carcinoma (HCC) patients with major vascular invasion and tumor thrombus.Methods:This is a retrospective case series study. From January 2010 to December 2022,clinicopathological data of 387 HCC patients who underwent liver resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. In the cohort,there were 326 males (84.2%) and 61 females (15.8%),with an age ( M(IQR)) of 54(16) years (range: 16 to 82 years). One hundred and nineteen patients (30.7%) had macrovascular invasion without thrombus and 268 patients(69.3%) had macrovascular thrombus. Categorical variables were presented as frequencies (percentages). Survival rates were calculated using life-table analysis,and Kaplan-Meier curves were employed to depict overall survival(OS) and recurrence-free survival (RFS). Independent prognostic factors were identified by univariate and multivariate Cox regression. Results:Among 387 patients,R0 resection was achieved in 359 cases (92.8%),with R1 or R2 resection in 28 cases (7.2%). Excluding in-hospital deaths,the 354 R0-resected patients had a median OS of 19.8 months, with 1-, 3-, and 5-year OS rates were 63.3%, 35.1%, and 22.4%, respectively; median RFS was 5.6 months,and 1-, 3-, and 5-year RFS was 34.0%,18.0%,and 14.4%, respectively. Patients receiving preoperative therapy showed a median OS of 26.0 months,1-, 3-, and 5-year OS rates were 75.5%, 48.4%, and 32.5%, respectively. There was no significant difference in the OS of patients with or without preoperative therapy ( P>0.05). The median OS time of patients who received postoperative adjuvant therapy was 53.0 months, and the 1-, 3-, and 5-year OS rates were 87.9%, 59.2%, and 34.8%, respectively. The median OS time of patients who did not receive postoperative adjuvant therapy was 13.7 months, and 1-, 3-, and 5-year OS rates were 56.7%, 31.7%, and 22.4%, respectively ( P<0.01). The median RFS of patients who received postoperative adjuvant therapy was 11.6 months, and the 1-, 3-, and 5-year RFS rates were 49.6%, 29.8%, and 26.8%, respectively. The median RFS of patients who did not receive postoperative adjuvant therapy was 4.2 months, and the 1-,3-,and 5-year RFS rates were 29.2%, 16.1%, and 12.5%, respectively ( P<0.01). Multivariate analysis identified that maximum tumor diameter,postoperative adjuvant therapy,and treatment after recurrence were the independent predictors of the OS of patients with major vascular invasion and tumor thrombus (all P<0.05),while age,surgical approach,and postoperative adjuvant therapy independently influenced the RFS of patients with major vascular invasion and tumor thrombus(all P<0.05). Conclusions:HCC patients with vascular invasion/thrombus could benefit from surgery-based multimodal therapy after careful evaluation. Postoperative adjuvant therapy significantly reduces recurrence and prolongs patients′ survival.

Objective To explore the effects of Zengye Runzao Decoction on mRNAs and proteins related to submandibular gland tissue and the expression of Th17/Treg in peripheral blood of Sj?gren syndrome(SS)model mice.Methods SPF Balb/c mice were randomly divided into control group and modeling group,the modeling group established an SS mouse model through immune induction,while the control group was not treated.The modeled mice were randomly divided into model group,total glucosides of Paeoniae Radix Alba group and Zengye Runzao Decoction low-,medium-and high-dosage groups,with 3 mice in each group.The total glucosides of Paeoniae Radix Alba group was given 0.234 mg/g total glucosides of Paeoniae Radix Alba solution by gavage,Zengye Runzao Decoction low-,medium-and high-dosage groups were given 4,8,12 mg/g Zengye Runzao Decoction by gavage,and the control group and model group were given the same volume of distilled water by gavage,once a day for 60 consecutive days.The daily water intake,salivary flow rate and submandibular index were calculated,the tissue morphology of submandibular gland was observed by HE staining,the expressions of HOXA1,STAT3,IL-17,FOXP3 mRNA and miR-181c-3p in submandibular gland tissue were detected by qPCR,Western blot was used to detect the expressions of HOXA1,STAT3,p-STAT3,IL-17 and FOXP3 protein in submandibular gland tissue,the proportion of Th17 and Treg cells in peripheral blood was detected by flow cytometer.Results Compared with the control group,the daily water intake of the model group mice increased,saliva flow rate and submandibular gland index decreased,lymphocyte infiltration in submandibular gland tissue was significant,the expressions of HOXA1,STAT3,IL-17 mRNA increased,the expressions of FOXP3 mRNA and miR-181c-3p decreased,the expressions of HOXA1,STAT3,p-STAT3,IL-17 protein increased,FOXP3 protein expression decreased,Th17 ratio and Th17/Treg increased,and Treg ratio decreased,with statistical significance(P<0.05).Compared with the model group,the daily water intake of Zengye Runzao Decoction groups decreased,the saliva flow rate increased,and the infiltration of lymphocytes in the submandibular gland tissue was reduced to varying degrees,the expressions of HOXA1 and IL-17 mRNA decreased,while the expressions of FOXP3 mRNA and miR-181c-3p increased,the expression of HOXA1 protein decreased,while the expression of FOXP3 protein increased,the ratio of Th17 and Th17/Treg decreased,and the Treg ratio increased.The submandibular gland index increased in Zengye Runzao Decoction high-dosage group,and the expressions of STAT3 mRNA and protein,as well as p-STAT3 and IL-17 protein decreased,with statistical significance(P<0.05).Conclusion Zengye Runzao Decoction may regulate Th17/Treg cell imbalance by up-regulating the expressions of miR-181c-3p,FOXP3 and down-regulating the expressions of HOXA1,p-STAT3,STAT3 and IL-17,and then improve the function and tissue injury of submandibular gland caused by SS.

Objective:To investigate the value of mean platelet volume-to-lymphocyte ratio (MPVLR) in assessing the prognosis of elderly patients treated with radiotherapy for esophageal cancer.Methods:A retrospective case series study was conducted. The clinical data of 102 elderly esophageal cancer patients who received radiotherapy from September 2015 to September 2020 in Zhongshan Hospital Affiliated to Xiamen University were retrospectively analyzed. After admission, all patients were tested for serum mean platelet volume and lymphocyte levels by using a fully automated hematology analyzer, and MPVLR was calculated. The optimal cut-off value of MPVLR was determined based on the receiver operating characteristic (ROC) curve. The patients were grouped according to the optimal cut-off value of MPVLR, and clinicopathological characteristics of the two groups were compared. The Kaplan-Meier method was used to analyze the overall survival of patients after radiotherapy, and the multivariate Cox proportional risk model was used to analyze the factors affecting the overall survival of patients after radiotherapy.Results:The age of 102 patients was (77±3) years; there were 58 male cases, 44 female cases; 67 cases of middle and high differentiation, 35 cases of low differentiation; 65 cases of TNM stage Ⅰ-Ⅱ, 37 cases of stage Ⅲ-Ⅳ. ROC curve analysis showed that the area under the curve of MPVLR predicting the overall survival of esophageal cancer patients after radiotherapy was 0.905 (95% CI: 0.855-0.955). The optimal cut-off value of MPVLR was 5.442. All patients were divided into the low MPVLR group (MPVLR ≤ 5.442, 60 cases) and the high MPVLR group (MPVLR > 5.442, 42 cases) according to the optimal cut-off value of MPVLR. The proportion of patients with low differentiation and stage Ⅲ-Ⅳ in the high MPVLR group was higher than that in the low MPVLR group (all P < 0.001). The 3-year overall survival rate after radiotherapy in the high-MPVLR group was lower than that in the low-MPVLR group (23.81% vs. 51.67%), and the difference in the overall survival of both groups was statistically significant ( P < 0.05). The differences in the overall survival of elderly esophageal cancer patients with different differentiation and TNM staging after radiotherapy were statistically significant (all P < 0.05). Univariate Cox regression analysis showed that TNM stage Ⅲ-Ⅳ ( HR = 3.034, 95% CI: 1.805-5.101), low differentiation ( HR = 2.872, 95% CI: 1.791-4.606), and MPVLR > 5.442 ( HR = 3.789, 95% CI: 2.000-7.178) were independent risk factors for overall survival in elderly patients with esophageal cancer after radiotherapy (all P < 0.001). Conclusions:MPVLR before radiotherapy is closely related to the prognosis of elderly patients with esophageal cancer, and patients with MPVLR > 5.442 may have poorer overall survival after radiotherapy.

Robotic surgery is applied in gastrointestinal surgery for their flexible and safe operation, especially in the narrow space of the pelvic cavity for radical surgery of rectal cancer, which has obvious advantages. Natural orifice specimen extraction surgery (NOSES) is a hot surgical technique that has developed rapidly in gastrointestinal surgery in recent years. The integration of robotic surgery and NOSES surgery has pushed minimally invasive surgery for rectal cancer to a new level. Robotic NOSES surgery for rectal cancer can be divided into two types based on the different extraction methods: transrectal and transvaginal specimen extraction. The selection and flexibility of surgical procedures are the keys to the standardized, healthy, and orderly development of robotic NOSES for rectal cancer. Based on domestic and foreign literature and guidelines and combined with the team′s practical experience, the authors elaborate on the selection strategy of robotic NOSES for rectal cancer, in order to provide reference for more scientific and safe implementation of robotic NOSES for rectal cancer.