Objective:To investigate the immunohistochemical expression pattern of phosphatase and tensin homolog deleted on chromosome ten(PTEN)protein with chromosome 10 deletion in endometrioid carcinoma(EEC)and its relationship with DNA mismatch repair(MMR)protein.Methods:A total of 121 patients diagnosed with EEC,endometrial atypical hyperplasia/endometrial intraepithelial neoplasia(EAH/EIN),and normal endome-trium due to uterine fibroid resection at Hubei Cancer Hospital Affiliated to Tongji Medical College of Huazhong U-niversity of Science and Technology from May 14,2019 to June 7,2023 were selected as the study subjects,inclu-ding 84 patients in the EEC group,17 patients in the EAH/EIN group,and 20 patients in the control group.Immu-nohistochemical was used to detect the expression patterns and differences of PTEN and MMR in endometrial tis-sues of three groups,and the differences in abnormal expression of PTEN protein in EEC between MMR protein deficient(MMRd)group and non-deficient(MMRp)group were compared.Results:①The expression of PTEN protein in 121 endometrial glandular epithelial cells includes four patterns:normal expression,negativeexpression,reduced expression,and heterogeneous expression.②The abnormal expression rates of PTEN protein in the EEC and EAH/EIN groups(84.5％and 94.1％)were higher than those in the control group(10.0％);The ex-pression rates of MMRd protein in the EEC group and EAH/EIN group(35.7％and 35.3％)were higher than those in the control group(0％),and the above differences were statistically significant(P＜0.05).③The abnor-mal expression rate of PTEN in the MMRd group was 96.7％,which was higher than that in the MMRp group(96.7％vs.77.8％,P=0.048).④In the EEC group,with normal and abnormal expression of PTEN protein,there was no statistically significant difference in the comparison of different pathological grades,muscle infiltration depth,lymph node metastasis,and lymphatic vessel invasion between the MMRd group and the MMRp group(P＞0.05).Conclusions:Identifying the abnormal expression pattern of PTEN protein and combining it with MMR protein detection can help identify endometrial dysplasia,and there may be a correlation between PTEN and MMR protein expression in EEC.The abnormal expression of PTEN may not have a clear impact on the biological behavior of MMRd expressing EEC.

OBJECTIVE To formulate an expert consensus on the prevention and control of respiratory infectious diseases in railway stations and trains in China,and to standardize the prevention and control of respiratory infec-tious diseases in railway stations and trains scientifically.METHODS The government authorities organized multi-ple prevention and control experts from transportation,medical care and prevention fields to conduct in-depth re-search through methods such as meetings and on-site investigations,and combined with their practical experi-ence in this field to formulate this expert consensus.RESULTS In-depth studies were conducted on the prevention and control strategies,measures and emergency response system construction of respiratory infectious diseases in railway stations and trains,and this expert consensus was formed.CONCLUSION This expert consensus supple-ments improves the existing prevention and control system for respiratory infectious diseases in railway stations and trains,and provides an important reference basis for the prevention and control of respiratory infectious disea-ses in railway stations and trains.

Integrative management for pancreatic cancer has stepped into the neoadjuvant era, which brings new issues and challenges for pathological evaluation of surgical specimens. Given the absence of standardized guidelines for the pathological examination and reporting of resected specimens of pancreatic cancer after neoadjuvant therapy, there are variations in pathology sampling, tumor regression grade assessment, and margin assessment between institutions, which substantially impairs the comparability of results between studies. This review provides evidence-based opinions and references for clinical diagnosis and management through sorting out the controversies and difficulties in the assessment of the above pathological parameters after neoadjuvant therapy for pancreatic cancer.

Neoadjuvant therapy for pancreatic cancer is undergoing a paradigm shift from conventional chemotherapy to precision medicine. This expert forum discussed cutting-edge issues in pancreatic cancer neoadjuvant therapy from an evidence-based perspective, incorporating the latest clinical research advances. We focused on innovative directions including immunotherapy combination strategies, liquid biopsy applications, artificial intelligence (AI)-assisted decision making, and individualized precision medicine. We proposed forward-looking concepts such as molecular subtyping-guided individualized treatment strategies, multi-omics integrated efficacy prediction models, and standardized multidisciplinary collaborative care systems. These innovative concepts will drive pancreatic cancer neoadjuvant therapy toward more precise and effective directions.

Objective·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma(MM).Methods·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between October 2021 and September 2023.Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group,and 41 patients admitted from October 2022 to September 2023 comprised the experimental group.The control group received classical chemotherapy for MM[PAD(bortezomib+adriamycin+dexamethasone)or PCD(bortezomib+cyclophosphamide+dexamethasone)],and the experimental group underwent plasma exchange before classic chemotherapy.The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients,with the criterion being a reduction of more than 40%in plasma M-protein levels after exchange,and the total number of exchanges ranged from 1 to 3 sessions.After 2 chemotherapy courses,the free light chain difference(dFLC),serum creatinine(Scr),and other renal function indexes were compared between the two groups.Results·Compared with the control group,the experimental group showed no statistically significant difference in dFLC levels.The Scr level decreased[67.00(54.00,75.00)μmol/L vs 77.50(63.00,94.00)μmol/L,P=0.011],and the estimated glomerular filtration rate(eGFR)increased[97.80(92.80,101.30)mL/(min·1.73 m2)vs 85.80(61.35,95.35)mL/(min·1.73 m2),P<0.001]after treatment.Before treatment,the numbers of patients with MM-related severe renal injury[eGFR<50 mL/(min·1.73 m2)]were 41 in the control group and 28 in the experimental group.After treatment,8 patients(19.51%)in the control group achieved complete renal response[eGFR≥60 mL/(min·1.73 m2)],while 12 patients(42.86%)in the experimental group achieved the same,with the difference being statistically significant(P=0.036).After two courses of treatment,the overall response rates(ORR)of the control group and the experimental group were 76.47%and 92.68%,respectively,and the difference in overall therapeutic efficacy was statistically significant(P=0.031).Conclusion·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period,ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

Objective·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma(MM).Methods·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between October 2021 and September 2023.Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group,and 41 patients admitted from October 2022 to September 2023 comprised the experimental group.The control group received classical chemotherapy for MM[PAD(bortezomib+adriamycin+dexamethasone)or PCD(bortezomib+cyclophosphamide+dexamethasone)],and the experimental group underwent plasma exchange before classic chemotherapy.The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients,with the criterion being a reduction of more than 40%in plasma M-protein levels after exchange,and the total number of exchanges ranged from 1 to 3 sessions.After 2 chemotherapy courses,the free light chain difference(dFLC),serum creatinine(Scr),and other renal function indexes were compared between the two groups.Results·Compared with the control group,the experimental group showed no statistically significant difference in dFLC levels.The Scr level decreased[67.00(54.00,75.00)μmol/L vs 77.50(63.00,94.00)μmol/L,P=0.011],and the estimated glomerular filtration rate(eGFR)increased[97.80(92.80,101.30)mL/(min·1.73 m2)vs 85.80(61.35,95.35)mL/(min·1.73 m2),P<0.001]after treatment.Before treatment,the numbers of patients with MM-related severe renal injury[eGFR<50 mL/(min·1.73 m2)]were 41 in the control group and 28 in the experimental group.After treatment,8 patients(19.51%)in the control group achieved complete renal response[eGFR≥60 mL/(min·1.73 m2)],while 12 patients(42.86%)in the experimental group achieved the same,with the difference being statistically significant(P=0.036).After two courses of treatment,the overall response rates(ORR)of the control group and the experimental group were 76.47%and 92.68%,respectively,and the difference in overall therapeutic efficacy was statistically significant(P=0.031).Conclusion·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period,ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

Objective:To investigate the immunohistochemical expression pattern of phosphatase and tensin homolog deleted on chromosome ten(PTEN)protein with chromosome 10 deletion in endometrioid carcinoma(EEC)and its relationship with DNA mismatch repair(MMR)protein.Methods:A total of 121 patients diagnosed with EEC,endometrial atypical hyperplasia/endometrial intraepithelial neoplasia(EAH/EIN),and normal endome-trium due to uterine fibroid resection at Hubei Cancer Hospital Affiliated to Tongji Medical College of Huazhong U-niversity of Science and Technology from May 14,2019 to June 7,2023 were selected as the study subjects,inclu-ding 84 patients in the EEC group,17 patients in the EAH/EIN group,and 20 patients in the control group.Immu-nohistochemical was used to detect the expression patterns and differences of PTEN and MMR in endometrial tis-sues of three groups,and the differences in abnormal expression of PTEN protein in EEC between MMR protein deficient(MMRd)group and non-deficient(MMRp)group were compared.Results:①The expression of PTEN protein in 121 endometrial glandular epithelial cells includes four patterns:normal expression,negativeexpression,reduced expression,and heterogeneous expression.②The abnormal expression rates of PTEN protein in the EEC and EAH/EIN groups(84.5％and 94.1％)were higher than those in the control group(10.0％);The ex-pression rates of MMRd protein in the EEC group and EAH/EIN group(35.7％and 35.3％)were higher than those in the control group(0％),and the above differences were statistically significant(P＜0.05).③The abnor-mal expression rate of PTEN in the MMRd group was 96.7％,which was higher than that in the MMRp group(96.7％vs.77.8％,P=0.048).④In the EEC group,with normal and abnormal expression of PTEN protein,there was no statistically significant difference in the comparison of different pathological grades,muscle infiltration depth,lymph node metastasis,and lymphatic vessel invasion between the MMRd group and the MMRp group(P＞0.05).Conclusions:Identifying the abnormal expression pattern of PTEN protein and combining it with MMR protein detection can help identify endometrial dysplasia,and there may be a correlation between PTEN and MMR protein expression in EEC.The abnormal expression of PTEN may not have a clear impact on the biological behavior of MMRd expressing EEC.

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

OBJECTIVE To formulate an expert consensus on the prevention and control of respiratory infectious diseases in railway stations and trains in China,and to standardize the prevention and control of respiratory infec-tious diseases in railway stations and trains scientifically.METHODS The government authorities organized multi-ple prevention and control experts from transportation,medical care and prevention fields to conduct in-depth re-search through methods such as meetings and on-site investigations,and combined with their practical experi-ence in this field to formulate this expert consensus.RESULTS In-depth studies were conducted on the prevention and control strategies,measures and emergency response system construction of respiratory infectious diseases in railway stations and trains,and this expert consensus was formed.CONCLUSION This expert consensus supple-ments improves the existing prevention and control system for respiratory infectious diseases in railway stations and trains,and provides an important reference basis for the prevention and control of respiratory infectious disea-ses in railway stations and trains.