OBJECTIVE To evaluate the clinical value of dose-escalated postoperative radiotherapy(PORT)in improving local control and survival outcomes for head and neck adenoid cystic carcinoma(ACC)patients.METHODS This retrospective study analyzed 336 ACC patients treated with surgery plus PORT at Beijing Tongren Hospital from January 2015 to January 2021.Cohort stratification compared high-dose(>60 Gy,n=146)and conventional-dose(≤60 Gy,n=190)regimens.Survival analysis employed Kaplan-Meier estimates with log-rank testing,complemented by multivariate Cox regression for risk adjustment.RESULTS The cohort demonstrated 39.29%(132/336)cumulative local failure rate.The overall survival rates at 1,3,and 5 years after surgery were 98.81%,94.05%,and 90.48%,respectively.Dose-response relationships revealed:1.Significantly reduced local recurrence with high-dose PORT(28.08%vs.47.89%,P<0.001),corresponding to 41.37%lower recurrence risk(a HR=0.59,95%CI=0.38-0.91;P=0.041);2.Superior progression-free survival in the high-dose group(3-year:86.99%vs.76.32%;5-year:82.19%vs.66.32%,all P<0.05);3.Comparable overall survival between groups(median OS:200 vs.160 months,P=0.292).CONCLUSION Dose escalation beyond 60 Gy significantly enhances locoregional control and progression-free survival in head and neck ACC without conferring overall survival advantage,likely reflecting the disease's characteristic indolent metastatic progression.These results establish>60 Gy as an optimal dose threshold for PORT in high-risk ACC management.

Objective To investigate the clinical characteristics,treatment strategies,and prognostic factors of adenoid cystic carcinoma(ACC)of the external auditory canal(EAC),and to provide evidence for optimizing surgical extent and adjuvant therapy.Methods A retrospective cohort study was conducted on 58 patients with pathologically confirmed ACC of the EAC treated in Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,between January 2001 and December 2021.All patients underwent surgical treatment,with some receiving adjuvant radiotherapy.The primary outcome was local recurrence,while secondary outcomes included overall survival(OS)and local recurrence-free survival(LRFS).Survival analysis was performed by the Kaplan-Meier method,and Cox regression models were used to identify risk factors for recurrence.Results The median follow-up time for the entire cohort was 6.27(3.25,11.30)years.The 1-year,3-year,and 5-year OS rates were 96.55％,91.37％,and 89.66％.43.10％of cases were classified as T4 stage at diagnosis,indicating advanced local progression.Local recurrence occurred in 23 patients(39.66％),and distant metastasis was observed in 28 patients(48.28％),with pulmonary metastasis accounting for 92.86％of cases.Multivariate analysis revealed that the solid histological pattern(HR=2.729,95％CI:1.025-7.226,P=0.044)and perineural invasion(PNI)(HR=9.891,95％CI:3.525-27.752,P＜0.01)were independent risk factors for local recurrence.Conclusion ACC of the EAC is characterized by a high propensity for local recurrence and distant metastasis.The solid histological pattern and perineural invasion are critical prognostic determinants.Multimodal therapy(surgery combined with adjuvant radiotherapy)may improve clinical outcomes,and early diagnosis and intervention are pivotal for enhancing survival rates.

Objective To assess the effectiveness of the Gasdermin D C-terminal fragment(GSDMD-CT)as a novel plasma biomarker for the clinical diagnosis of sepsis.Methods Between July 2021 and November 2024,245 patients from Tangshan Gongren Hospital were enrolled in this study.In accordance with the diagnostic criteria for sepsis and the systemic inflammatory response syndrome(SIRS),patient samples were classified into the sepsis group and the SIRS group.Meanwhile,healthy individuals were selected as the healthy control(HC)group.Sepsis patients were further categorized into the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group based on the type of pathogen infection.The levels of GSDMD-CT,C-reactive protein(CRP),and procalcitonin(PCT)were measured in all subjects.Nonparametric tests were employed to compare the differences in various indices among different groups.The diagnostic value of GSDMD-CT in sepsis was evalu-ated by constructing the receiver operating characteristic(ROC)curve.Spearman's correlation analysis was used to examine the relationships among GSDMD-CT,CRP,and PCT.Results The plasma GSDMD-CT levels in the sepsis group 23.02(16.71,33.01)pg/mL and in the SIRS group 16.52(11.26,22.22)pg/mL were significantly higher than those in the healthy control group 7.02(4.42,11.43)pg/mL(U=-10.175,-7.890,P<0.001).Moreover,the plasma GSDMD-CT levels in the sepsis group were significantly higher than those in the SIRS group(U=-2.941,P<0.05).In the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group,the GSDMD-CT levels were 23.01(17.16,27.51)pg/mL,23.41(16.78,35.50)pg/mL,and 16.29(14.53,56.27)pg/mL,respectively.When compared with the healthy control group,the GSDMD-CT levels in these three groups were all significantly higher(P<0.05).However,there were no significant differences in GSDMD-CT levels among these three groups(P>0.05).The area under the curve(AUC)of plasma GSDMD-CT for diagnosing sepsis was 0.881(95%confidence interval:0.833～0.929),with a Youden index(YI)of 0.695,a sensitivity of 85.0%,and a specificity of 84.5%.Spearman correlation analysis indicated a weak correlation between GSDMD-CT and C-reactive protein(CRP)(r=0.32,P<0.001)and a positive correlation between GSDMD-CT and procalci-tonin(PCT)(r=0.65,P<0.001).Conclusion GSDMD-CT exhibits significant clinical value in the diagnosis of sepsis and holds great potential as a biomarker in the diagnostic process of sepsis.

Objective To investigate the clinical characteristics,treatment strategies,and prognostic factors of adenoid cystic carcinoma(ACC)of the external auditory canal(EAC),and to provide evidence for optimizing surgical extent and adjuvant therapy.Methods A retrospective cohort study was conducted on 58 patients with pathologically confirmed ACC of the EAC treated in Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,between January 2001 and December 2021.All patients underwent surgical treatment,with some receiving adjuvant radiotherapy.The primary outcome was local recurrence,while secondary outcomes included overall survival(OS)and local recurrence-free survival(LRFS).Survival analysis was performed by the Kaplan-Meier method,and Cox regression models were used to identify risk factors for recurrence.Results The median follow-up time for the entire cohort was 6.27(3.25,11.30)years.The 1-year,3-year,and 5-year OS rates were 96.55％,91.37％,and 89.66％.43.10％of cases were classified as T4 stage at diagnosis,indicating advanced local progression.Local recurrence occurred in 23 patients(39.66％),and distant metastasis was observed in 28 patients(48.28％),with pulmonary metastasis accounting for 92.86％of cases.Multivariate analysis revealed that the solid histological pattern(HR=2.729,95％CI:1.025-7.226,P=0.044)and perineural invasion(PNI)(HR=9.891,95％CI:3.525-27.752,P＜0.01)were independent risk factors for local recurrence.Conclusion ACC of the EAC is characterized by a high propensity for local recurrence and distant metastasis.The solid histological pattern and perineural invasion are critical prognostic determinants.Multimodal therapy(surgery combined with adjuvant radiotherapy)may improve clinical outcomes,and early diagnosis and intervention are pivotal for enhancing survival rates.

Objective To assess the effectiveness of the Gasdermin D C-terminal fragment(GSDMD-CT)as a novel plasma biomarker for the clinical diagnosis of sepsis.Methods Between July 2021 and November 2024,245 patients from Tangshan Gongren Hospital were enrolled in this study.In accordance with the diagnostic criteria for sepsis and the systemic inflammatory response syndrome(SIRS),patient samples were classified into the sepsis group and the SIRS group.Meanwhile,healthy individuals were selected as the healthy control(HC)group.Sepsis patients were further categorized into the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group based on the type of pathogen infection.The levels of GSDMD-CT,C-reactive protein(CRP),and procalcitonin(PCT)were measured in all subjects.Nonparametric tests were employed to compare the differences in various indices among different groups.The diagnostic value of GSDMD-CT in sepsis was evalu-ated by constructing the receiver operating characteristic(ROC)curve.Spearman's correlation analysis was used to examine the relationships among GSDMD-CT,CRP,and PCT.Results The plasma GSDMD-CT levels in the sepsis group 23.02(16.71,33.01)pg/mL and in the SIRS group 16.52(11.26,22.22)pg/mL were significantly higher than those in the healthy control group 7.02(4.42,11.43)pg/mL(U=-10.175,-7.890,P<0.001).Moreover,the plasma GSDMD-CT levels in the sepsis group were significantly higher than those in the SIRS group(U=-2.941,P<0.05).In the Gram-positive bacterial group,the Gram-negative bacterial group,and the fungal group,the GSDMD-CT levels were 23.01(17.16,27.51)pg/mL,23.41(16.78,35.50)pg/mL,and 16.29(14.53,56.27)pg/mL,respectively.When compared with the healthy control group,the GSDMD-CT levels in these three groups were all significantly higher(P<0.05).However,there were no significant differences in GSDMD-CT levels among these three groups(P>0.05).The area under the curve(AUC)of plasma GSDMD-CT for diagnosing sepsis was 0.881(95%confidence interval:0.833～0.929),with a Youden index(YI)of 0.695,a sensitivity of 85.0%,and a specificity of 84.5%.Spearman correlation analysis indicated a weak correlation between GSDMD-CT and C-reactive protein(CRP)(r=0.32,P<0.001)and a positive correlation between GSDMD-CT and procalci-tonin(PCT)(r=0.65,P<0.001).Conclusion GSDMD-CT exhibits significant clinical value in the diagnosis of sepsis and holds great potential as a biomarker in the diagnostic process of sepsis.

Objective:To investigate the clinical characteristics and prognosis of bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in preterm infants, and to provide basis for early clinical diagnosis and infection control. Methods:The clinical data of infants with CRKP bloodstream infection admitted to the Preterm Infants Ward of Children′s Hospital Affiliated to Zhengzhou University from January 2015 to December 2022 were retrospectively analyzed. The risk factors for death in preterm infants caused by CRKP bloodstream infection were explored through multivariate logistic regression analysis, and the receiver operating characteristic (ROC) curve was used to analyze the clinical value of each factor on evaluating prognosis. The area under curves (AUC) of each factor in different ROC curve were compared by Delong′s test.Results:A total of 96 preterm infants with CRKP bloodstream infection were included, including 70 in the survival group and 26 in the death group. The first onset symptoms of CRKP bloodstream infection in preterm infants were persistent tachycardia (heart rate>180 per minute) (69 cases, 71.9%), fever (61 cases, 63.5%), and apnea (59 cases, 61.5%). There were 88(91.7%) cases of infection combined with septic shock, and 91(94.8%) cases required vasoactive drug support. Multivariate logistic regression analysis showed that the maximum vasoactive-inotropic score (VIS) within 48 hours of onset (odds ratio ( OR)=1.058, 95% confidence interval (95% CI) 1.022 to 1.095, P=0.001), concurrent purulent meningitis ( OR=8.029, 95% CI 1.344 to 47.972, P=0.022), and concurrent necrotizing enterocolitis (NEC) ( OR=10.881, 95% CI 1.566 to 75.580, P=0.016) were independent risk factors for death in preterm infants with CRKP bloodstream infection. The ROC curve showed that the AUCs for evaluating the prognosis of preterm infants with NEC and purulent meningitis were 0.784 and 0.711, respectively. The AUC for evaluating the prognosis of preterm infants with a maximum VIS ≥52.5 points within 48 hours of onset was 0.840, and the AUC for combining the three factors was 0.931. Compared with NEC and purulent meningitis, the AUC for combining factors was higher, the differences were statistically significant ( P=0.002, P<0.001). Conclusions:Preterm infants with CRKP bloodstream infection who have a maximum VIS ≥52.5 points within 48 hours of onset, with NEC and purulent meningitis have a higher risk of death.

Objective To investigate the expression of Toll-like receptor 2(TLR2)and Toll-like receptor 4(TLR4)in peripheral blood mononuclear cells(PBMC)in children with recurrent respiratory tract infection(RRTI)and its relationship with T helper cell 1(Th1)/T helper cell 2(Th2)immune response.Methods A total of 65 children diagnosed with RRTI who admitted to the hospital from December 2020 to December 2022 were enrolled in the study as the RRTI group,and 45 healthy children who underwent physical examination in the hospital during the same period were enrolled as the control group.The relative expression levels of TLR2 and TLR4 mRNA in PBMCs were detected by real-time fluorescence quantitative PCR(qPCR).The expres-sion rates of TLR2 and TLR4 protein in PBMCs were detected by flow cytometry.The levels of Th1 cytokine interferon-γ(IFN-γ),Th2 cytokine interleukin-4(IL-4)and their ratio(IFN-γ/IL-4)in plasma were detected by enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to analyze the corre-lation between TLR2,TLR4 protein expression rates and plasma IFN-γ,IL-4 levels.Results The RRTI group had significantly higher plasma level of Th2 cytokine IL-4 than the control group,significantly lower plasma level of Th1 cytokine IFN-y than the control group,and significantly lower ratio of IFN-γ/IL-4 than the con-trol group,the differences were all statistically significant(P＜0.05).The relative expression levels of TLR2 and TLR4 mRNA and protein expression rates in PBMC of children in the RRTI group were higher than those in the control group,and the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that the protein expression rates of TLR2 and TLR4 in PBMC of children with RRTI were both nega-tively correlated with both plasma IFN-γ levels and IFN-γ/IL-4(P＜0.05)and positively correlated with plasma IL-4 levels(P＜0.05).Conclusion The expression of TLR2 and TLR4 in PBMC and plasma Th1/Th2 cytokines in children with RRTI may be involved in the occurrence and development of the disease.Ex-cessive activation of TLR2 and TLR4 may weaken Th1 function and enhance Th2 function.

Objective:To investigate the clinical characteristics and prognosis of cytomegalovirus-sepsis-like syndrome (CMV-SLS) in premature infants, and to provide the evidence for early clinical identification and treatment.Methods:Premature infants with CMV-SLS admitted to Children′s Hospital Affiliated of Zhengzhou University from January 1, 2019 to December 31, 2022 were selected as the research subjects, and their clinical characteristics, treatment, and prognosis were retrospectively analyzed.Results:A total of seven cases of CMV-SLS were included, with a gestational age of (26.8±1.2) weeks and a birth weight of (890±121) g. The age of disease onset was 55(45, 60) days, and the age of diagnosis was 67(56, 71) days. All the seven cases were exclusively breast feeding after birth, and cytomegalovirus (CMV) DNA was detected positive in their breast milk when diagnosed with CMV-SLS. The common clinical features were fever, abdominal distension, liver function damage, decreased neutrophil and platelet counts. Pneumonia, neonatal necrotizing enterocolitis, hearing loss, and chorioretinitis were common. After the diagnosis was confirmed, all the seven cases were given intravenous treatment of ganciclovir and followed by oral formulations, with a course of treatment ranging from five to seven weeks. Two cases were treated with intravitreal injection of ganciclovir for chorioretinitis. All the seven cases survived. During the follow-up with a corrected gestational age of 12 months, one case had delayed intellectual and motor development, two cases had delayed motor development, and the remaining cases had normal development.Conclusions:CMV-SLS in premature infants mainly occurs in extremely low birth weight infants, with atypical clinical manifestations and may be misdiagnosed easily. If extremely low birth weight infants who receive CMV DNA positive breast feeding show sepsis-like symptoms, the possibility of CMV infection should be considered, and early diagnosis and treatment should be carried out to prevent adverse outcomes.

OBJECTIVE To reveal the pharmacological mechanism of Sofren Injection in the treatment of Qi deficiency and blood stasis syndrome of angina pectoris in coronary heart disease,and to preliminarily verify the reliability of the prediction results by cell experiments.METHODS Firstly,we screened the main chemical components of Sofren injection and their targets from biomedical databases and literature.Then,using the DIAMOnD algorithm,we constructed the angina disease module by screening Qi deficiency and blood stasis syndrome-related genes from the GeneCards and MalaCards databases.Next,we conducted gene functional enrichment analysis of the core targets in the"angina pectoris-Qi deficiency and blood stasis-Sofren Injection"network to identify key pathways.Finally,we performed cell experiments to verify the effect of Sofren Injection on the expression of key pathway proteins in hypoxic H9C2 cardiomyocytes.RESULTS We identified 7 main chemical components of Sofren Injection,targeting a total of 362 genes.We screened 232 known angina pectoris-related genes and added 100 predicted genes by constructing the angina pectoris dis-ease module.A total of 2 960 genes related to Qi deficiency and blood stasis syndrome were obtained.Network topological analysis re-vealed 30 core targets for Sofren Injection in treating coronary heart disease angina pectoris with Qi deficiency and blood stasis syn-drome,including STAT3,EGFR,TNF,and IL-6.Gene functional enrichment analysis identified 82 pathways.Literature analysis combined with the results indicated that STAT3 and the JAK2/STAT3 pathway might be key pathways for Sofren Injection in treating coronary heart disease angina pectoris with Qi deficiency and blood stasis syndrome.Cell experimental results showed significant de-creases in mRNA and protein expression of JAK2 and STAT3 in the SI group and the nicorandil group compared to the model group(P<0.05).CONCLUSION Disease module analysis and cell experiments confirm that STAT3 is a key gene in the pathological mecha-nism of coronary heart disease angina pectoris with Qi deficiency and blood stasis syndrome,and the JAK2/STAT3 pathway is a core pathway for Sofren Injection in treating this condition.This study demonstrates the effectiveness and novelty of combining disease mod-ule for mining the treatment of TCM formulas with specific disease and syndrome.

Objective:To explore the role of cytokines and glucocorticoid receptors (GR) in adolescent depression and childhood trauma.Methods:Using convenient sampling,80 adolescents with depression were recruited from the in-patient department of the Mental Health Center,First Hospital of Hebei Medical University from August 2021 to December 2022. Meanwhile,70 healthy adolescents were recruited to participate in the study. Life and learning stress,childhood trauma,anxiety and depression symptoms were evaluated using adolescent Life Events Scale,Childhood Trauma Questionnaire,Hamilton Depression Scale-17 (HAMD 17) and Hamilton Anxiety Scale(HAMA). Serum glucocorticoid receptor and plasma 12 cytokines were also detected. SPSS 25.0 and AMOS 26.0 was used for statistical analysis. The rank sum test or Chi-square test was used to compare the demographic data and blood indicators between adolescents with and without depression. Spearman method was used to examine the correlation between childhood trauma,GR,cytokines and depression. Maximum likelihood estimation method was performed to test the mediating effect,and the average path coefficient was obtained after testing the indirect path by Bootstrap method. If the 95% confidence interval ( CI) does not contain 0,the intermediary effect is significant. Results:There was significant difference in GR concentration between adolescents with and without depression ( Z=-10.50, P<0.001). IL-1β,IL-2,IL-5,IL-10,IL-12,IL-17 and IFN-α were also significantly different between the two groups. Spearman correlation analysis showed that HAMD 17 and HAMA scores were associated with emotional abuse,emotional neglect,physical abuse,CTQ total score and cytokine level IL-5,IFN-α were positively correlated. Physical neglect and IL-1β were only positively correlated with HAMD 17 score. GR was negatively associated with emotional abuse ( r=-0.523, P<0.001),emotional neglect ( r=-0.245, P=0.002),sexual abuse ( r=-0.172, P=0.035),physical abuse score ( r=-0.180, P=0.027),CTQ total score ( r=-0.562, P<0.001),HAMD 17 score ( r=-0.783--0.271, P<0.001),HAMA score( r=-0.741--0.602, P<0.001),IL-1β ( r=-0.217, P=0.008),IL-5 ( r=-0.334, P<0.001),and IFN-α ( r=-0.276, P=0.001). IL-5 level was positively correlated with emotional abuse score ( r=0.211, P=0.009) and CTQ total score ( r=0.201, P=0.014). IFN-α level was positively correlated with emotional abuse score ( r=0.207, P=0.011) and CTQ total score ( r=0.166, P=0.042). The mediating effect showed that GR played a partial mediating role between childhood trauma and depression (indirect effect: effect size 0.294, S.E. 0.043,95 %CI=0.236-0.398). GR and cytokine IL-5 play a chain mediating role between childhood trauma and depression (indirect effect: effect size 0.067, S.E. 0.040,95 %CI=0.023-0.147). Conclusion:GR,and cytokine IL-5 play a mediating role between adolescent depression and childhood trauma.