[摘 要] 目的：探讨嗜酸性粒细胞（Eos）和其他循环血细胞和炎症指标在预测小细胞肺癌（SCLC）免疫治疗疗效和免疫相关不良反应（irAE）中的价值。方法:回顾分析2013年8月至2023年7月期间海军军医大学第一附属医院呼吸科收治的410例SCLC患者临床信息；在化疗或免疫治疗前，以及治疗后的3个周期，分别检测患者全血细胞计数和细胞因子等指标；记录irAE的发生时间、类型、分级，以及随访情况。结果: 接受化疗联合免疫检查点抑制剂（ICI）治疗（简称联合治疗）的患者116例，其中一线联合治疗患者91例、后线联合治疗25例。联合组患者的总有效率（ORR）为44.8%，疾病控制率（DCR）为90.5%，单用化疗（单化）组患者的ORR为38.4%，DCR为85.0%。联合组中位PFS为8.9（7.2～10.5）个月，中位OS为17.7（13.9～21.5）个月。将联合组与单化组行倾向得分匹配（PSM）法配对，对比二组治疗后3周期的绝对嗜酸性粒细胞计数（AEC）水平、相对嗜酸性粒细胞计数（REC）水平；计算历次复查Eos水平与基线Eos水平的比值（AECT1/0、AECT2/0、AECT3/0、RECT1/0、RECT2/0、RECT3/0），联合组的AECT3/0和RECT3/0显著高于单化组。单因素分析表明，基线AEC和REC的升高与较好的治疗至失败时间（TTF）和OS显著相关（P < 0.05）；治疗后Eos水平与基线水平的比例（AECT3/0、RECT3/0）与较好的PFS和TTF显著相关（P < 0.05）；RECT3/0升高同样与OS改善显著相关（P < 0.05）。多因素分析提示，AECT3/0 > 0.41与较好的PFS和TTF显著相关（P < 0.05）；当RECT3/0 > 0.32时，与较好的PFS、TTF、OS均显著相关（P < 0.05）；RECT3/0 > 0.27仅与较好的TTF、OS显著相关（P < 0.05）。亚组分析发现，缓解组的RECT3/0显著高于非缓解组（P < 0.05）。一线应用ICI与二线/后线应用ICI患者的PFS、TTF、OS无统计学差异，但一线应用ICI时ORR（50% vs 25%，P < 0.05）和DCR（93.48% vs 79.17%，P < 0.05）显著优于二线/后线。116例联合治疗患者发生43例irAE（35.34%）, 最常见的为免疫相关性皮炎8.62%；Ⅲ级以上的irAE共17例（14.66%）；因irAE停药10例（8.62%），死亡2例;发生irAE的患者PFS较未发生irAE的患者显著延长（P < 0.05），而TTF和OS无统计学差异。发生irAE患者的RECT3较未发生irAE患者显著升高（P < 0.05），AECT3/0 > 0.29的患者irAE发生率显著增高（P < 0.05）。结论: Eos是SCLC接受ICI治疗的保护性因素，通过监测AECT3/0、RECT3/0，并结合患者的临床病理生理特征、细胞因子和炎症标志物水平进行综合评估，可有效预测SCLC患者的免疫治疗疗效和irAE的发生。

PURPOSE: To investigate the incidence and influencing factors of bone loss in patients with spinal cord injury (SCI). METHODS: A retrospective case-control study was conducted. Patients with SCI in our hospital from January 2019 to March 2023 were collected. According to the correlation between bone mineral density (BMD) at different sites, the patients were divided into the lumbar spine group and the hip joint group. According to the BMD value, the patients were divided into the normal bone mass group (t > -1.0 standard deviation) and the osteopenia group (t ≤ -1.0 standard deviation). The influencing factors accumulated as follows: gender, age, height, weight, cause of injury, injury segment, injury degree, time after injury, start time of rehabilitation, motor score, sensory score, spasticity, serum value of alkaline phosphatase, calcium, and phosphorus. The trend chart was drawn and the influencing factors were analyzed. SPSS 26.0 was used for statistical analysis. Correlation analysis was used to test the correlation between the BMD values of the lumbar spine and bilateral hips. Binary logistic regression analysis was used to explore the influencing factors of osteoporosis after SCI. p < 0.05 was considered statistically significant. RESULTS: The incidence of bone loss in patients with SCI was 66.3%. There was a low concordance between bone loss in the lumbar spine and the hip, and the hip was particularly susceptible to bone loss after SCI, with an upward trend in incidence (36% - 82%). In this study, patients with SCI were divided into the lumbar spine group (n = 100) and the hip group (n = 185) according to the BMD values of different sites. Then, the lumbar spine group was divided into the normal bone mass group (n = 53) and the osteopenia group (n = 47); the hip joint group was divided into the normal bone mass group (n = 83) and the osteopenia group (n = 102). Of these, lumbar bone loss after SCI is correlated with gender and weight (p = 0.032 and < 0.001, respectively), and hip bone loss is correlated with gender, height, weight, and time since injury (p < 0.001, p = 0.015, 0.009, and 0.012, respectively). CONCLUSIONS The incidence of bone loss after SCI was high, especially in the hip. The incidence and influencing factors of bone loss in the lumbar spine and hip were different. Patients with SCI who are male, low height, lightweight, and long time after injury were more likely to have bone loss.
Humans ; Spinal Cord Injuries/complications* ; Male ; Female ; Retrospective Studies ; Incidence ; Adult ; Bone Density ; Middle Aged ; Case-Control Studies ; Osteoporosis/etiology* ; Lumbar Vertebrae ; Bone Diseases, Metabolic/etiology* ; Aged ; Risk Factors

The prevalence of Class III malocclusion varies among different countries and regions. The populations from Southeast Asian countries (Chinese and Malaysian) showed the highest prevalence rate of 15.8%, which can seriously affect oral function, facial appearance, and mental health. As anterior crossbite tends to worsen with growth, early orthodontic treatment can harness growth potential to normalize maxillofacial development or reduce skeletal malformation severity, thereby reducing the difficulty and shortening the treatment cycle of later-stage treatment. This is beneficial for the physical and mental growth of children. Therefore, early orthodontic treatment for Class III malocclusion is particularly important. Determining the optimal timing for early orthodontic treatment requires a comprehensive assessment of clinical manifestations, dental age, and skeletal age, and can lead to better results with less effort. Currently, standardized treatment guidelines for early orthodontic treatment of Class III malocclusion are lacking. This review provides a comprehensive summary of the etiology, clinical manifestations, classification, and early orthodontic techniques for Class III malocclusion, along with systematic discussions on selecting early treatment plans. The purpose of this expert consensus is to standardize clinical practices and improve the treatment outcomes of Class III malocclusion through early orthodontic treatment.
Humans ; Malocclusion, Angle Class III/classification* ; Orthodontics, Corrective/methods* ; Consensus ; Child

Elemene, derived from Curcuma wenyujin, one of the "8 famous genuine medicinal materials of Zhejiang province," exhibits remarkable antitumor activity. It has gained wide recognition in clinical practice for effectiveness on tumors. Dr. XIE Tian, introduced the innovative concept of "molecular compatibility theory" by combining Chinese medicine principles, specifically the "monarch, minister, assistant, and envoy" theory, with modern biomedical technology. This groundbreaking approach, along with a systematic analysis of Chinese medicine and modern biomedical knowledge, led to the development of elemene nanoliposome formulations. These novel formulations offer numerous advantages, including low toxicity, well-defined composition, synergistic effects on multiple targets, and excellent biocompatibility. Following the principles of the "molecular compatibility theory", further exploration of cancer treatment strategies and methods based on elemene was undertaken. This comprehensive review consolidates the current understanding of elemene's potential antitumor mechanisms, recent clinical investigations, advancements in drug delivery systems, and structural modifications. The ultimate goal of this review is to establish a solid theoretical foundation for researchers, empowering them to develop more effective antitumor drugs based on the principles of "molecular compatibility theory".
Humans ; Retrospective Studies ; Antineoplastic Agents/therapeutic use* ; Neoplasms/drug therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Sesquiterpenes/therapeutic use*

Objective: To study the impact of sleep characteristics on myopia, among lower primary school students in Shanghai, so as to provide foundation for the prevention of the onset and development of myopia. Methods: A total of 636 students from the first and second grades of two primary schools in Jiading District, Shanghai, were selected through cluster random sampling for questionnaire surveys and ophthalmological examinations in October 2022. The Childrens Sleep Habits Questionnaire (CSHQ) was used to assess sleep quality at baseline. Ophthalmological examinations were conducted in October 2023(479), during which the students study time, screen time and outdoor activity time were monitored for twoweek, repeated twice. Generalized multivariable Logistic regression models and linear regression models were employed to examine the association between sleeprelated factors and myopia, as well as the strength of this association. Results: The baseline survey indicated a myopia prevalence of 18.58%, with 17.18% at followup. The average CSHQ total score was (51.58±4.44), and the average daily sleep duration was (9.43±4.84)h/d, with only 11.6% of participants meeting the recommended sleep sufficiency. Multivariable regression models indicated that insufficient sleep showed positive association with myopia (OR=1.64, 95%CI=1.05-2.56), while bedtime duration was significantly negative associated with myopia (OR=0.74, 95%CI=0.63-0.91, P＜0.05), adjusting for confounding factors. Inconsistency in bed rest time was a risk factor for myopia (OR=1.07, P<0.05), and the consistency of bed rest time, and wakeup time showed statistically significant correlations with SE (P<0.05). There was also statistically significant correlations between consistency in sleep time, bed rest time, and wakeup time with AL (P<0.05). Conclusions Insufficient sleep and bedtime duration are correlated with the onset and progression of myopia. It is critical to ensure sufficient sleep duration and regular sleep habits for children to reduce the occurrence of myopia in the primary school students.

Pulmonary disease is one of the major threats to human health. However, the current clinical treatment drugs for lung diseases generally have problems such as low lung delivery efficiency, fast clearance rate and obvious toxic side effects. Recently, membrane biomimetic nanocarriers have attracted more and more attention. Due to their advantages of high targeting, long cycle time, good biocompatibility and strong immune escape ability, membrane biomimetic nanocarriers have become a major research hotspot in targeted therapy of lung diseases. In this review, we discuss the main preparation methods of membrane biomimetic nanoparticles, the characteristics of membrane biomimetic nanocarriers from different cell sources and their application in the targeted therapy of lung diseases. At the same time, according to the characteristics of different membranes, the shortcomings, current technical limitations and future prospects are discussed. This review is expected to provide references for the design of membrane biomimetic nanocarriers and their potential applications in the treatment of lung diseases.

Objective To investigate the clinical characteristics and prognosis of pneumococcal meningitis(PM),and drug sensitivity of Streptococcus pneumoniae(SP)isolates in Chinese children.Methods A retrospective analysis was conducted on clinical information,laboratory data,and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.Results Among the 160 children with PM,there were 103 males and 57 females.The age ranged from 15 days to 15 years,with 109 cases(68.1% )aged 3 months to under 3 years.SP strains were isolated from 95 cases(59.4% )in cerebrospinal fluid cultures and from 57 cases(35.6% )in blood cultures.The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87)and 27% (21/78),respectively.Fifty-five cases(34.4% )had one or more risk factors for purulent meningitis,113 cases(70.6% )had one or more extra-cranial infectious foci,and 18 cases(11.3% )had underlying diseases.The most common clinical symptoms were fever(147 cases,91.9% ),followed by lethargy(98 cases,61.3% )and vomiting(61 cases,38.1% ).Sixty-nine cases(43.1% )experienced intracranial complications during hospitalization,with subdural effusion and/or empyema being the most common complication[43 cases(26.9% )],followed by hydrocephalus in 24 cases(15.0% ),brain abscess in 23 cases(14.4% ),and cerebral hemorrhage in 8 cases(5.0% ).Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old,with rates of 91% (39/43)and 83% (20/24),respectively.SP strains exhibited complete sensitivity to vancomycin(100% ,75/75),linezolid(100% ,56/56),and meropenem(100% ,6/6).High sensitivity rates were also observed for levofloxacin(81% ,22/27),moxifloxacin(82% ,14/17),rifampicin(96% ,25/26),and chloramphenicol(91% ,21/23).However,low sensitivity rates were found for penicillin(16% ,11/68)and clindamycin(6% ,1/17),and SP strains were completely resistant to erythromycin(100% ,31/31).The rates of discharge with cure and improvement were 22.5% (36/160)and 66.2% (106/160),respectively,while 18 cases(11.3% )had adverse outcomes.Conclusions Pediatric PM is more common in children aged 3 months to under 3 years.Intracranial complications are more frequently observed in children under 1 year old.Fever is the most common clinical manifestation of PM,and subdural effusion/emphysema and hydrocephalus are the most frequent complications.Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates.Adverse outcomes can be noted in more than 10% of PM cases.SP strains are high sensitivity to vancomycin,linezolid,meropenem,levofloxacin,moxifloxacin,rifampicin,and chloramphenicol.[Chinese Journal of Contemporary Pediatrics,2024,26(2):131-138]

Objective Atrial fibrillation(AF)is a disease of high heterogeneity,and the association between AF phenotypes and the outcome of different catheter ablation strategies remains unclear.Conventional classification of AF(e.g.according to duration,atrial size,and thromboembolism risk)fails to provide reference for the optimal stratification of the prognostic risks or to guide individualized treatment plan.In recent years,research on machine learning has found that cluster analysis,an unsupervised data-driven approach,can uncover the intrinsic structure of data and identify clusters of patients with pathophysiological similarity.It has been demonstrated that cluster analysis helps improve the characterization of AF phenotypes and provide valuable prognostic information.In our cohort of AF inpatients undergoing radiofrequency catheter ablation,we used unsupervised cluster analysis to identify patient subgroups,to compare them with previous studies,and to evaluate their association with different suitable ablation patterns and outcomes.Methods The participants were AF patients undergoing radiofrequency catheter ablation at West China Hospital between October 2015 and December 2017.All participants were aged 18 years or older.They underwent radiofrequency catheter ablation during their hospitalization.They completed the follow-up process under explicit informed consent.Patients with AF of a reversible cause,severe mitral stenosis or prosthetic heart valve,congenital heart disease,new-onset acute coronary syndrome within three months prior to the surgery,or a life expectancy less than 12 months were excluded according to the exclusion criteria.The cohort consisted of 1 102 participants with paroxysmal or persistent/long-standing persistent AF.Data on 59 variables representing demographics,AF type,comorbidities,therapeutic history,vital signs,electrocardiographic and echocardiographic findings,and laboratory findings were collected.Overall,data for the variables were rarely missing(<5% ),and multiple imputation was used for correction of missing data.Follow-up surveys were conducted through outpatient clinic visits or by telephone.Patients were scheduled for follow-up with 12-lead resting electrocardiography and 24-hours Holter monitoring at 3 months and 6 months after the ablation procedure.Early ablation success was defined as the absence of documented AF,atrial flutter,or atrial tachycardia>30 seconds at 6-month follow-up.Hierarchical clustering was performed on the 59 baseline variables.All characteristic variables were standardized to have a mean of zero and a standard deviation of one.Initially,each patient was regarded as a separate cluster,and the distance between these clusters was calculated.Then,the Ward minimum variance method of clustering was used to merge the pair of clusters with the minimum total variance.This process continued until all patients formed one whole cluster.The"NbClust"package in R software,capable of calculating various statistical indices,including pseudo t2 index,cubic clustering criterion,silhouette index etc,was applied to determine the optimal number of clusters.The most frequently chosen number of clusters by these indices was selected.A heatmap was generated to illustrate the clinical features of clusters,while a tree diagram was used to depict the clustering process and the heterogeneity among clusters.Ablation strategies were compared within each cluster regarding ablation efficacy.Results Five statistically driven clusters were identified:1)the younger age cluster(n=404),characterized by the lowest prevalence of cardiovascular and cerebrovascular comorbidities but the highest prevalence of obstructive sleep apnea syndrome(14.4% );2)a cluster of elderly adults with chronic diseases(n=438),the largest cluster,showing relatively higher rates of hypertension,diabetes,stroke,and chronic obstructive pulmonary disease;3)a cluster with high prevalence of sinus node dysfunction(n=160),with patients showing the highest prevalence of sick sinus syndrome and pacemaker implantation;4)the heart failure cluster(n=80),with the highest prevalence of heart failure(58.8% )and persistent/long-standing persistent AF(73.7% );5)prior coronary artery revascularization cluster(n=20),with patients of the most advanced age(median:69.0 years old)and predominantly male patients,all of whom had prior myocardial infarction and coronary artery revascularization.Patients in cluster 2 achieved higher early ablation success with pulmonary veins isolation alone compared to extensive ablation strategies(79.6% vs.66.5%;odds ratio[OR]=1.97,95% confidence interval[CI]:1.28-3.03).Although extensive ablation strategies had a slightly higher success rate in the heart failure group,the difference was not statistically significant.Conclusions This study provided a unique classification of AF patients undergoing catheter ablation by cluster analysis.Age,chronic disease,sinus node dysfunction,heart failure and history of coronary artery revascularization contributed to the formation of the five clinically relevant subtypes.These subtypes showed differences in ablation success rates,highlighting the potential of cluster analysis in guiding individualized risk stratification and treatment decisions for AF patients.

Objective To explore the specific plasma exosomal protein expression in Coronary Heart Disease(CHD)with phlegm-turbidity syndrome(PTS),so as to provide biological reference for the diagnosis of CHD with PTS.Methods A total of 20 CHD patients with PTS and 20 healthy subjects at the same period were included.Plasma exosomes were extracted from all subjects using the qEV size exclusion method.First,10 CHD cases with PTS and 10 healthy subjects were randomly selected,and differentially expressed proteins between the two groups were screened using label free non-targeted protein quantification analysis.Then,MRM targeting protein labeling technique was applied to verify the differentially expressed proteins in the remaining subjects.Results Compared with healthy controls,214 differentially expressed plasma exosomal proteins(61 up-regulated and 153 down-regulated)were found in CHD patients with PTS,mainly related to cholesterol metabolism,complement and coagulation cascade,and immune effects.ANXA6,C4BPB,F8,CFB,APOE,C9,and CLU proteins were further validated by MRM targeting protein.Conclusion CHD patients with PTS had differences in plasma exosomal protein expression from healthy controls,and the differential proteins are mainly related to cholesterol metabolism,complement,and the coagulation cascade.

Objective:To investigate the effects of endocrine drugs on tumor markers and endometrium after breast cancer surgery.Methods:Eighty-eight patients with endocrine therapy for breast cancer admitted to the Heping Hospital Affiliated to Changzhi Medical College from November 2018 to March 2022 were selected, 44 patients taken orally tamoxifen citrate tablets were enrolled in the study group, 44 patients taken orally anastrozole tablets were enrolled in the control group, the patients in the two groups were treated for 12 months. The tumor markers, endometrial thickness were compared between the two groups before treatment and 12 months after treatment. The drug safety was compared too.Results:After treatment, the serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and glycochain antigen 15-3 (CA15-3) in both groups were decreased, and the level of tumor markers in the study group were lower than those in the control group: (3.01 ± 0.23) μg/L vs.(3.89 ± 1.15) μg/L, (4.22 ± 1.21) kU/L vs. (7.38 ± 2.19) kU/L, (16.76 ± 2.19) kU/L vs. (19.87 ± 2.21) kU/L, there were statistical differences ( P<0.05). The endometrial thickness in the study group at 6 months and 12 months after treatment were higher than those in the control group: (7.23 ± 0.22) mm vs. (6.21 ± 0.19)mm, (7.98 ± 0.24) mm vs. (6.47 ± 0.22) mm, there were statistical differences ( P<0.05). At 12 months after treatment, the scores of functional dimension, emotional dimension, social/family dimension and physical dimension in functional assessment of cancer therapy (FACT-G) scale in the study group were significantly higher than those in the control group ( P<0.05). There was no statistically significant difference in adverse reactions between the two groups ( P>0.05). Conclusions:Tamoxifen citrate tablets can effectively inhibit the levels of serum tumor markers and improve the quality of life of patients, and anastrozole tablets can significantly reduce the endometrial thickness of breast cancer patients.